Quiz 2 Notes PDF

**[Professionalism]** **[Questions, Advanced Empathy & Mutualization]** **Distinguishing between Content & Feeling** - Content = who, what, when, where, how - Feelings = person's emotional state - Can be experienced at varying intensities - Can introduce temporality here (give the cont...

**[Professionalism]** **[Questions, Advanced Empathy & Mutualization]** **Distinguishing between Content & Feeling** - Content = who, what, when, where, how - Feelings = person's emotional state - Can be experienced at varying intensities - Can introduce temporality here (give the context of time). For example, you could say "At this time..." or "in this moment..." - Sometimes people will say "I feel" but it is not a feeling. Listen for the emotion word! Otherwise, this is considered an example of [empty feelings.] - You may use first person reflecting (talking from the client's perspective) - You may use: - What you are telling me - What I am hearing - I get the sense that **Reflection of Feelings** - With both types, keep the focus on the client (similar to removing judgment from paraphrases) - Straightforward Reflections -- Identify the feeling without adding context to it - Combination Reflections -- Connect the client's feeling with the content that led to the feeling - Metaphors **Reflection of Meaning** - Meaning = how the client understands themselves, their self-concept - How does the client make sense of their current situation? - How does it integrate into their sense of self? Example question: - what do you make of the situation? - what would this mean for you? -- bring in another person to questioning. "What would mom think of the situation?" **Mutualization** - Mutualizing -- when the therapist brings together two or more perspectives so that one shared understanding occurs - Why is this important? - How is this unique to family therapy? - Multipartiality versus neutrality - Multipartiality = the therapist takes all peoples' sides at the same time - Neutrality = the therapist takes no side; clients can feel misunderstood -- model will determine how we handle neutrality - Complexity of Joining with multiple clients -- improvisation and ability to join with mom, dad, and child - Family A, Family Member 1, Family Member 2, Family Member 3 **Goals of Questions** - Help in joining - Gathering information - Challenging a set story - Bringing other family members into participation -- even if they are not in the room - Opening new perspectives - [Ask Yourself:] *What is the purpose of this question I am about to ask?* **Pitfalls** -- self regulate instead of stopping clients from feeling their emotions. We cannot fix people - - - - - - +-----------------------+-----------------------+-----------------------+ | **"Good" Questions** | **Definition** | **Example** | +=======================+=======================+=======================+ | Open Questions | Allow the recipient | What, How, When, Why | | | to answer in a way | -- is the | | | that is meaningful to | intentionality of the | | | them | question -- be it | | | | therapeutic and not | | | | to please your | | | | curiosity. Both-And | +-----------------------+-----------------------+-----------------------+ | Closed Questions | Ask for a specific | Did, Do, Are, Is | | | and limited response | | +-----------------------+-----------------------+-----------------------+ | Swing Questions | Structurally closed | Would, Will, Could, | | | questions, but are | Can | | | intended to function | | | | as open questions | | +-----------------------+-----------------------+-----------------------+ | Relational/ | Focus on what happens | How does \_\_\_ react | | | between two or more | when you \_\_\_? | | Interactional | people | | | Questions | | | +-----------------------+-----------------------+-----------------------+ | Questions as | Circular | Who becomes more | | Interventions | questions-utilize a | anxious when you go | | | circular epistemology | out, your mother or | | | and end to be | your father? | | | exploratory in nature | | +-----------------------+-----------------------+-----------------------+ | Conversational | Help clients tell, | Informed by the | | Questions | clarify, and expand | conversation itself | | | their story | | +-----------------------+-----------------------+-----------------------+ **"Problematic" Questions** **Definition** **Example** ----------------------------- -------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- Double-barreled Questions When two questions are combined How are you feeling about your relationship with your partner, and do you have the relationship with your children that you want? Long Questions Questions that go on for too long Guessing Questions A question with a potential answer in it Is it a sense of rebelliousness as to why you won't listen to your parents? Specific Questions Asking for too precise an answer How many arguments have you had over the past year? Leading Questions An inquiry to the client with a suggestion of what the therapist thinks it should be You want to get along with each other, right? **\ ** **Takeaways & Discussion Points** - Questions should not be used as fillers. They should expand the story and be connected with theory if used as an intervention - Questions are not inherently bad to use, however, some are more effective than others and some may lead to unintended consequences - It's important to mutualize and to join with all clients, but this does not mean that equal time must be provided or that you should follow a prescriptive pattern such as: mutualized response, provide a response to partner A, provide a response to partner B, etc. - Like with everything else, there is nuance to asking questions and building relationships with a family system **[Use of Self & Intensity]** **Vocalics (Paralanguage)** - The "how" to say what you're saying - **Pitch** - - **Pacing** - - **Volume** - - **Therapeutic humor** - **Challenges** - Challenging clients to think about alternatives to their perspectives or resources - Stroke: Joining - *I see something very good in you.* - Kick: What can be changed? - *So how is it that you continue to do something that is problematic for you?* **Self-disclosure** - Intentional self-disclosures - - - - Unwitting self-disclosure - - - **Immediacy** - Therapist immediacy - When the therapist makes a disclosure to the client about how the therapist feels about the client, his reaction to the client, or the therapeutic relationship - A therapist might talk about how the client seems distant, is stonewalling the therapist, or is being too intrusive. - The intent is to help the relationship and to get the clients to be more reflective - Example: *I've been challenging you and I'm not sure if that's okay for you. Could we talk about that for a few minutes?* **Intensity** - Couples and families have the possibility of having high intensity - Because more members of the unit are present; thus, more conflict - **Decrease** - Have clients speak directly to the therapist - Witness talk of other members of the family - Example: *Talking stick* - **Increase** - Helps to move clients out of their prescribed roles - Helping clients have a new experience increases the intensity - Repetition -- signals that communication is extremely important - Example: it is more than just your child suffering... I want to say this again: it is *more than* just your child suffering - Therapeutic Silence -- The therapist intentionally does not say anything, to provide space for the client to speak - Therapeutic Interruption -- The therapist shifts the direction of the conversation - Curse Words -- to match or heighten the client's experience (depending on the client and therapeutic rapport) **Enactments** - Enactment -- when two or more family members talk to each other during the session - Provide information to the therapist because we are seeing an interaction in real-time - The therapist is part of the relational system, and so it goes from a dyadic to a triadic interaction - Shift from content process - Give the family members a chance to try to new ways of interacting! **Being creative and playful** - **Improvisation** - Entering a situation without a formal script and creating what happens on the spot - **Utilization** - when the therapist takes whatever happens in a session and uses that to help move the session forward. A type of improvisation, similar to metaphoric language - One-shot---one response - Example: *Our relationship is sinking; What type of life rafts do you have on board?* - Multiple-round---back and forth metaphorical exchanges - Example: building on the metaphor (page 136) **Goal Setting & Termination** - Summarizing - Provides an overview of the whole issue cycle - No new information - Brief (3-5 sentences) - Three parts: 1. content -- two sentences 2. feelings -- two sentences 3. meaning -- one sentence - Example exercise 12.1 A diagram of a diagram Description automatically generated **Goal Setting** - Determine the purpose of the therapeutic encounter - Should be collaborative - Clients should be invested so that they work toward change - Should be SMART **Well-Formed Goal** - Small - Measurable - Client's Hard Work - Realistic - Start of New Behavior - Salient to the Client - Presence of Behavior - Social Interactional  **Case Scenario** Tom and Susan come to marital therapy. Susan says they are there because she feels they have communication issues; she feels they do not communicate enough. Tom states he does not see a problem but wants to make Susan happy. Both agree things have been tense since Tom lost his job in sales. They are now living on Susan's salary as an elementary school teacher, and both feel uncomfortable with this. **Tom & Susan's** SMART goals assist with treatment planning - - - - - - **Termination** - Goal: To work ourselves out of a job! - - - - - - - - - - - - **[Theories: The Basics *Intergenerational, Experiential, and Strategic*]** **What makes up a theory?** - Underlying assumptions that lead to therapeutic goals - Main ideas and concepts - Role of the therapist - Key Interventions **Intergenerational Theories** +-----------------------+-----------------------+-----------------------+ | | **Bowen Family | **Contextual Family | | | Systems Theory** | Therapy** | | | | | | | ***(Murray Bowen)*** | ***(Ivan | | | | Boszormenyi-Nagy)*** | +=======================+=======================+=======================+ | **Assumptions & | - Problems in | Goals: rebalance | | Therapeutic goals** | relationships | emotional ledgers, | | | stem from | improve relatedness, | | | differentiation | reduce stress | | | of self and | | | | anxiety within a | | | | relationship. | | | | | | | | - Human | | | | relationships are | | | | driven by two | | | | counterbalancing | | | | life forces: | | | | individuality and | | | | togetherness | | +-----------------------+-----------------------+-----------------------+ | **Main ideas** | Differentiation of | Four Essential | | | self, Triangles, | Dimensions: | | | Nuclear Family | | | | Emotional Process, | 1. Facts | | | Family Projection | | | | Process, | 2. Psychological | | | Multigenerational | | | | Transmission Process, | 3. Transactional | | | Sibling Position, | | | | Emotional Cutoff, | 4. Relational Ethics | | | Societal Regression | | | | | 5. Fifth added | | | | later: ontic | +-----------------------+-----------------------+-----------------------+ | **Role of the | \- Act as a coach | Helps clients tap | | therapist** | | into their relational | | | \- To gain an | resources, provide | | | understanding of the | multidirected | | | larger family system | partiality and help | | | | people balance | | | \- To act from a | ledgers and engage | | | detriangulated | ethically in relating | | | position | to others | +-----------------------+-----------------------+-----------------------+ | **Key interventions** | Genogram | Multidirected | | | | partiality | | | | | | | | Acknowledging & | | | | Crediting | | | | | | | | Exoneration | +-----------------------+-----------------------+-----------------------+ **Bowen Family Systems Theory** (*Murray Bowen)* - - - - - **Theory of Problem Formation** A diagram of different stages of interlocking concepts Description automatically generated **Theory of Problem Resolution** - - - - - - - - - - - - **Contextual Family Therapy**\ *Ivan Boszormenyi-Nagy* **Theory of Problem Formation** - - - - - - - - - - - - - - **Theory of Problem Resolution** - - - - - - - - - - - - - - - **Experiential Family Therapies** +-----------------------+-----------------------+-----------------------+ | | **Satir Growth | **Symbolic-Experienti | | | Model** | al** | | | | | | | ***(Virginia | ***(Carl Whitaker)*** | | | Satir)*** | | +=======================+=======================+=======================+ | **Assumptions & | Self-esteem & | Focused on issues of | | Therapeutic goals** | communication are key | life, growth, and | | | elements and there is | process | | | an attention to the | | | | intrapsychic & | - Not about | | | interactive. Goals: | specific behavior | | | to increase | change for a | | | self-esteem, to | family member, | | | foster better choice | but overall | | | making, to increase | enhancement of | | | responsibility, to | living for family | | | develop congruence | members | +-----------------------+-----------------------+-----------------------+ | **Main ideas** | \- The family as a | \- Phases: | | | place of sharing | pretreatment, battle | | | experience | for structure, battle | | | | for initiative, | | | \- humans have honest | midphase/core phase, | | | emotion within | termination | | | themselves but we are | | | | limited or repressed | \- Increase anxiety | | | within societal | in the family and | | | norms. When we are | then decrease stress | | | congruent and our | | | | true selves, we | | | | flourish. | | | | | | | | \- 4 survival stances | | +-----------------------+-----------------------+-----------------------+ | **Role of the | Therapist presents as | *"He does family | | therapist** | genuine self, | therapy by being a | | | promotes emotional | person"* (Whitaker & | | | expression, maintains | Napier, 1982), | | | respect for client | provokes emotion, | | | less about structured | challenges emotional | | | techniques and more | defenses. | | | about experiences in | | | | the therapy room | | +-----------------------+-----------------------+-----------------------+ | **Key interventions** | Sculpting, | Use of a | | | self-mandala, | co-therapist, work | | | resource wheel, use | with 3 generations, | | | of touch, use of | blunt approach, | | | genuine warmth | provocative language | +-----------------------+-----------------------+-----------------------+ **Satir Growth Model** *(Virginia Satir)* **Theory of Problem Formation** - - - - - - - - - - - - - **Theory of Problem Resolution** - Family members are provided an opportunity to gain awareness of self in an attempt to raise their self esteem - Four meta goals - Raising self-awareness - Becoming a choice maker - Becoming responsible - Becoming congruent - Accomplished through six stage process of change - Status Quo +-----------------------+-----------------------+-----------------------+ | | **MRI Brief Therapy** | **Strategic Family | | | | Therapy *(Jay | | | ***(Mental Research | Hayley)*** | | | Institute Group)*** | | +=======================+=======================+=======================+ | **Assumptions & | Problems happen when | \- Symptoms serve a | | Therapeutic goals** | they are repeated in | function within the | | | an interactional | family | | | context | | | | | \- Considers people | | | \- Failed solutions | in context | | | are "more of the | | | | same" | | | | | | | | \- The solution is | | | | the problem | | +-----------------------+-----------------------+-----------------------+ | **Main ideas** | -usually around 10 | \- 5 stage model of a | | | sessions | first session | | | | | | | -First order change & | \- Not an | | | Second order change | insight-oriented | | | | approach, clients | | | -general | need action | | | interventions for all | | | | clients then major | \- directions are | | | interventions are | tailored for the | | | more specific | family and pushed by | | | | the therapist | +-----------------------+-----------------------+-----------------------+ | **Role of the | \- directive | Action oriented and | | therapist** | | focused on the | | | \- expert position | present | | | | | | | \- not responsible | - directive & | | | for creating | prescriptive with | | | conditions for | the family | | | change, the family is | | +-----------------------+-----------------------+-----------------------+ | **Key interventions** | | Directives, | | | | paradoxical | | | | techniques | +-----------------------+-----------------------+-----------------------+ - Introducing a foreign element - Make contact - Chaos - Integration - Implementation - New status quo - Techniques - Sculpting - Family reconstruction - Party Party **[Solution-Focused Brief Therapy]** **History of SFBT** - Developed in 1982 by an American therapist Steve de Shazer (1940-2005) - His wife Korean-American therapist Insoo Kim Berg (1935-2007) - Associates at the Brief Family Center in Milwaukee, USA - They modified exciting brief therapy, keeping only those elements that were linked to a good outcome for the clients **Three Rules of SFBT** 1. 2. 3. **Overview of SFBT** - The focus is on the **client's health** rather than the program, on **strengths** rather than weaknesses or deficits, and **on skills, recourses, and coping abilities** that would help in reaching future goals -- Sharray at all,; Dermer, Wilhite, Hemesath, & Russle, 2000) - SFBT is a future-oriented, goal-directed approach to solving human problems of living - Its roots are linked with Erickson\'s idea that "people have within themselves the **resources and abilities to solve their own problems** even if they don't have a casual understanding of them - Erickson also believed that a **small change in one's behavior** is often all that is necessary to lead to more profound changes in a problem context - SFBT is focused on **finding solutions** not problems and therefore does not look at a person in the sense of being maladjusted. **Solution-Focused Brief Therapy** developed by Steve deShazer & Insoo Kim Berg 1. Focus on the client\'s strengths and abilities. 2. Find out what is working and do more of it. 3. Clients have the resources for change. 4. Clients generate workable solutions. 5. Change starts small and has a ripple effect. 6. Focus on the future when the problem has been solved. 7. Focus on when the problem is not a problem. **Role of the MFT** - Nonjudgement stance - Remain curious - Join with your clients and build a trusting rapport - Determine how active and committed a client is to the process of change - Help clients access the resources and strengths they have but are not aware of or are not utilizing it - Encourage change **Roles of the Client** - **Visitors** -- not involved in the problem and are not part of the solution - **Complaint** -- complains about the situations but can be observant and describe problems - **Customers** -- can describe problems, how they are involved, and are willing to work on finding a solution **Goals of SFBT** - To help the client tap inner resources and to notice expectations at the time when they are distressed. - The goal is then directed towards the solutions to situations that already exist in these expectations. - Focus on sessions and homework is on positive and possibilities either now or future.  **SFBT Techniques** - - Focus on a hypothetical situation where the problem does not exist - - Makes the concept a bit more concrete for the client and is used to rate progress/change - - Praise clients for their strength **\ ** **[Study Guide]** ** SMART goals ** **Well-Formed Goal** - Small - Measurable - Client's Hard Work - Realistic - Start of New Behavior - Salient to the Client - Presence of Behavior - Social Interactional How to write effective SMART goals - Breeze **Pg 150** ***Goal Setting: Prioritizing Goals*** *Most people who come to therapy do not come with just one problem or issue. Usually there are many issues, to varying degrees, that people want changed in their lives. Therapists need to learn how to work with clients to prioritize their issues as this sets the stage for which goal(s) to begin with and which goals can wait for later in the therapy process. There are many ways to prioritize goals with clients. Here is one possibility:* ***therapist**: We've talked about many issues including you two wanting a better marriage, having concerns about your daughter not doing well at school, and having to make a decision of what to do with Stephen's mother now that she is ill. Which of these concerns is most pressing for you?* *While you might prioritize goals with clients and begin to address one first, it is likely that you will touch on two or more goals each session. This is because these issues are significant for clients and it's difficult not* *to talk about them even though another goal is more prominent. Further, issues tend to be connected to one another. So helping a husband and wife enhance their marriage will lead to a change in their interactions, which will likely impact the way they interact with their daughter, which may impact how she is doing in school.* ***Appendix 238*** ***GOAL SETTING*** * Process of therapist and client working together to determine the purpose of the therapeutic encounter* * Provides a direction for where the client wants to go and provides motivation to get there* * Good/ effective goals:* * Two components* * Goal setting:* * Prioritizing* ** Components of a Therapeutic Summary ** - Summarizing - Provides an overview of the whole issue cycle - No new information - Brief (3-5 sentences) - Three parts: 1. content -- two sentences 2. feelings -- two sentences 3. meaning -- one sentence **Pg. 139** *Summaries tend to have one or two sentences of content, one or two sentences of feeling, and then end with one sentence that covers the client's meaning(s). As in the issue cycle, it's usually best to order the summary in this order, descending in depth from the most surface information to the inner depths of the client's experience.* ***Appendix 234*** ***SUMMARIZING*** * Is an overview of the whole of the issue cycle* * Provides assurance that the therapist heard the main points of the client's story* * Bridges between the exploration of the client's story and where they want to go next: their goals* * Consists of three parts:* *"I'd like to take a second and summarize what we've talked about so far. There have been things happening in the family that people are not too keen on. These include a focus on how well Aron is doing academically and the interaction parents and child have. This has led to all of you feeling frustrated and at times angry with one another. This leads to a sense of disappointment because you each have a viewpoint of how a family should be and you don't find yourself being able to live up to that expectation right now."* ** Therapist's ways to increase and decrease intensity in the room with a client ** - **Decrease** - Have clients speak directly to the therapist - Witness talk of other members of the family - Example: *Talking stick* - **Increase** - Helps to move clients out of their prescribed roles - Helping clients have a new experience increases the intensity - Repetition -- signals that communication is extremely important - Example: it is more than just your child suffering... I want to say this again: it is *more than* just your child suffering - Therapeutic Silence -- The therapist intentionally does not say anything, to provide space for the client to speak - Therapeutic Interruption -- The therapist shifts the direction of the conversation - Curse Words -- to match or heighten the client's experience (depending on the client and therapeutic rapport) **Pg. 128** ***Decreasing** intensity* *One of the major ways of **decreasing** intensity in a session is to decrease the amount of time family members speak directly to each other. Therapists can ask members, especially when the session is highly charged, to talk to the therapist rather than each other.* *Another possibility of **decreasing** intensity is to have family members witness the talk of the other member. This may be by bringing the nontalking members behind a one- way mirror or physically moving them to a corner of the room to designate a speaking subsystem (consisting of therapist and one family member) and a non- speaking subsystem (consisting of the other family members). The therapist could then move family members in and out of these two subsystems. If the session is devolving into argumentative chaos, therapists can use a talking stick. The talking stick is any object the therapist gives to clients, who can then only talk when they are holding the object. If you're not holding the object, you're not allowed to talk.* ***Increasing** Intensity* *Helping clients have a new experience **increases** intensity. This comes in the form of tapping into new emotions (Taibbi, 2007). The therapist pays attention to feelings the client hasn't quite articulated but that are just below the surface. Questions can be asked to bring these emotions to the forefront, providing an avenue for individual members or the family as a whole to be surprised by the expression of these new emotions, which have rarely been acknowledged.* *Intensity can also be **raised** through repetition. Therapy is sometimes a chaotic endeavor in which multiple feelings and thoughts occur for each individual as well as the feelings and thoughts being communicated by others. Family members may not process or comprehend what a therapist says. Repetition of a statement is a signal that the communication was extremely important. therapist: It is more than just your child suffering...I want to say this again: It is more than just your child suffering.* *Another way of **increasing** intensity is the use of silence. **Therapeutic silence** is when the therapist intentionally does not say anything, which can provide the therapist or client space to think. Most people are uncomfortable* *in silence. Thus, when the therapist keeps silent, it forces the client to engage in introspection. This may occur after a powerful exchange or experience wherein client and/ or therapist can better process what* *happened.* *Conversely, intensity is **increased** when the therapist interrupts the client. **Interrupting** is usually thought to be rude and problematic--- and it is when it is not purposeful. Therapeutic interruption shifts the conversation from a direction that may not be useful to one that leads toward alternatives. This may be when clients talk about issues not fully pertinent to the therapeutic process or continue to engage in conversations that* *do not help the conversation move forward.* ***client**: I'm just so mad at my spouse. It is not right what they are doing. A friend of mine was saying that in her marriage she was frustrated. For her,* ***therapist**: Let me stop you there for a second. You were experiencing something very powerful, and then you went on to talk about someone else. Can you keep the focus on yourself and stay with that feeling?* *Therapists can also **increase** intensity when they use **curse words**. These would not be to curse out the client, but to match or heighten the client's experience. The therapist's language is used to either acknowledge the client's experience or push the client.* ***Appendix pg. 234*** ***Decreasing**:* * Reasoning* * Prevent escalation into symmetrical relationships where each person tries to deflect ownership of fault and tries to put it on the other* * Decrease the amount of time family members speak directly to each other* * Drawbacks:* ***Increasing**:* * Reasoning* * Repetition of a statement is a signal that the communication was extremely important* * Therapeutic silence* * Therapeutic interruption* * Curse Words:* ** Vocalics ** **Pg. 120** *Vocalics, or paralanguage, is how you use your voice as a means of nonverbal communication.* *We've learned **what** to say, and now we need to learn **how** to say it* ***Appendix pg. 231*** ***USE OF SELF IN THERAPY*** *Vocalics or paralanguage (how you use your voice as a means of nonverbal communication):* *Pitch* *Pacing* *Volume* *Humor* *Challenges (describe what people are doing and its consequences)--- topics that can be challenged:* ** Circular questions ** -------------------------------- -------------------------------------------------------------------------------------------- ----------------------------------------------------------------------- **Questions as Interventions** **Circular questions-**utilize a circular epistemology and end to be exploratory in nature Who becomes more anxious when you go out, your mother or your father? -------------------------------- -------------------------------------------------------------------------------------------- ----------------------------------------------------------------------- **Pg. 113** *Circular questions are a form of questions developed by the Milan team. In this section, we will just focus on the use of circular questions as a possibility and later will connect them to theory (see chapter 16). Circular questions utilize a circular epistemology where influence is mutual. These questions typically tend to be exploratory in nature (Tomm, 1988).* *Circular questions can be placed in several categories: questions about differences in perception of relationships, questions about differences of degree, now/ then differences, and hypothetical and future differences (Boscolo,Cecchin, Hoffman, & Penn, 1987).* *Circular questions were sometimes referred to as triadic questions. Keeney and Ross (1985) explained, "These so- called triadic questions sometimes involve asking a family member to comment on the dyadic* *relationship of two other members" (p. 210).* *Circular questions have the tendency to bring new information into the conversation. This is important, as Bateson (1972) has stated that information is a difference that makes a difference. By focusing on circular patterns, family members* **Pg. 203** *When the Milan team developed circular questions, they realized that questions in themselves were interventive. They did not need to use a prescription or positive connotation to help change the family (Boscolo et al., 1987). This marked the shift from the Milan systemic family therapy as a strategic to a more postmodern approach.* ***Appendix pg. 229*** ***Circular Questions aka Triadic Questions:*** * Utilize a circular epistemology where influence is mutual* * Exploratory in nature* *Types:* ** Open-ended questions ** -------------------- ------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- **Open Questions** Allow the recipient to answer in a way that is meaningful to them What, How, When, Why -- is the intentionality of the question -- be it therapeutic and not to please your curiosity. Both-And -------------------- ------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- --------------------- ----------------------------------------------------------------------------------- ------------------------- **Swing Questions** Structurally closed questions, but are intended to function as **open questions** Would, Will, Could, Can --------------------- ----------------------------------------------------------------------------------- ------------------------- ***Pg. 107*** *Open questions allow the recipient to answer in meaningful ways for them.* ***Pg. 109*** *Examples of open questions:* ***Pg. 115*** *To avoid guessing questions, therapists can keep the questions open ended.* ***Appendix pg. 229*** ***OPEN QUESTIONS*** * Allow the recipient to answer in meaningful ways for them* * They are useful in a therapeutic interview because they add depth to the conversation and allow clients to explain themselves in their own words and manner* * Instead:* ** Unwitting self-disclosure ** ***Pg. 124*** *Self- disclosures can be verbal and nonverbal as well as intentional and unwitting. Your hairstyle, clothes, jewelry, tattoos, use of makeup, accent, etc. are all means in which you communicate to others. People also engage in **unwitting self- disclosures** (Gans, 2011), where they unconsciously reveal parts of their personality. Usually this is not problematic when it comes from the client, but may be problematic coming from the therapist. One reason for this is that the therapist might be sending mixed messages. The verbal communication may express acceptance, but the facial reactions could signal rejection.* ***Appendix pg. 232*** *Self- Disclosure (therapist reveals information about himself to the client):* * Continuum (none...medium...full disclosure)* * Verbal or nonverbal* * Intentional and non- intentional* ** Enactment ** Enactment -- when two or more family members talk to each other during the session - Provide information to the therapist because we are seeing an interaction in real-time - The therapist is part of the relational system, and so it goes from a dyadic to a triadic interaction - Shift from content process - Give the family members a chance to try to new ways of interacting! ***Pg. 131*** *Enactments happen when two or more family members talk to each other during the session. We tend to think of the therapist initiating the enactment, but family members can spontaneously engage with one another. Minuchin and Fishman (1981) described the purpose of enactments, **"The therapist constructs an interpersonal scenario in the session in which dysfunctional transactions among family members are played out"** (p. 79). Besides being one of the most recognizable family therapy techniques (Nichols & Fellenberg, 2000), enactments are a pervasive attitude that therapists adopt in moving from what people say to seeing what they do (Minuchin et al., 2007).* *Minuchin and Fishman (1981) provided several therapeutic advantages of enactments (see figure 11.2). **First**, they provide family therapists with information that may not have been possible otherwise, as enactments are a mechanism for bringing the family's interaction at home into the therapy session. **Second**, enactments help form the therapeutic system as family members' interactions are done in front of and in relation to the therapist. **Third**, enactments help to change the family's reality--- as the family's notion of an IP shifts to a conversation between people regarding a problem. A **fourth** advantage of enactments is that they provide the environment and context for family members to try out new behaviors with one another.*  *Enactments seem quite easy to begin:* *However, engaging in enactments may not be as easy as it first appears. Enactments are actually complex procedures (Nichols & Fellenberg, 2000) where therapists have to determine how to begin the enactment, how and when to intervene, and how to close the enactment. For instance, family members may not engage one another and instead talk to the therapist. Therapists will then have to decide to follow the client's lead or redirect them back to each other. Clients may also start to talk with one another and then try to bring the therapist into the dialogue. At that point, the therapist can redirect nonverbally (pointing to the inquirer's partner) or verbally:* ***therapist**: Minoru, keep talking to your wife. The rest of us are paying attention.* *Once the enactment begins, the therapist then chooses what position to engage the family members. A closer position will lead the therapist to become more of a coach during the enactment, perhaps providing possibilities for people to behave differently.* *Therapists can also sit back and observe from a more distant position. One means of decentering during an enactment is for the therapist to look at her left foot--- or anywhere besides at the people who are talking (Minuchin et al., 2014).* *Traditional enactments can be viewed as having three movements (Minuchin & Fishman, 1981). The **first** **movement** is when the therapist takes a more distant position and observes the family's transactional unscripted process. In the **second** **movement**, the therapist gets the family to engage each other in their problematic process in front of her. The **third** **movement** has the therapist adopting a closer position wherein she suggests alternative ways of relating to one another.* ***Appendix pg. 235*** ***Enactment *** * When two or more family members talk to each other during the session* * Technique:* ** Stroke and Kick ** **Pg. 123** *Minuchin often challenges through a stroke and a kick (Minuchin et al., 2007). The first part of the challenge (stroke) is a joining mechanism. It is the therapist saying, "I see something very good in you." The second part (kick) describes what can be changed. Here, the therapist says, "So how is it that you continue to do something that is problematic for you?"* ***Appendix pg. 232*** ***"Stroke and kick:"*** * Part One--- Stroke: joining mechanism* * "I see something very good in you."* * Part Two--- Kick: describes what can be changed* * "So how is it that you continue to do something that is problematic for you."* ** Tone ** **Pg. 120** ***Pitch** refers to the degree of highness or lowness in the **tone** of your voice. Most people have a natural pitch to their voice. However, there are variations in it so we do not continuously speak in a monotone. We use inflections to heighten or soften certain messages. For instance, in talking with someone experiencing depression, a lower pitch is usually more in tune with the person rather than a higher pitch. When delivering a significant statement, you might raise your pitch as a signal for the client to tune in even more to the message.* ** Termination (different ways in which a client/therapist relationship is terminated) ** - Goal: To work ourselves out of a job! - - - - - - - - - - - - **Pg. 150** *Once the goals have been met, or the client is on the path to reach their goals, termination in therapy can occur. Termination is the ending of the therapeutic relationship. However, this does not mean that therapist and client may not reconvene for a future session. But the word termination can be problematic. Some therapists do not like the word termination and would prefer other terms, such as completion (Boyd- Franklin et al., 2013). **Completion** does not seem as final as termination. Further, termination may have a negative connotation, especially when it is connected to being fired at a job.* ***Appendix pg. 238*** ***TERMINATION** (the ending of the therapeutic relationship).* *Client-Initiated Termination:* *Therapist- Initiated Termination:* *Forced Termination:* *Either therapist or client will no longer be able to continue the therapeutic relationship* *Client Dependency:* *Function of Termination:* ** Dealing with intensity (chapter 11) ** **Pg. 128** *The level of intensity in a session changes depending on who is in the session, what is being talked about, and the intent of the therapist. Modulation in any direction is important to both join and challenge family members. This chapter walks you through ways of decreasing and increasing intensity.* ** Therapeutic Silence ** **Pg. 129** *Therapeutic silence is when the therapist intentionally does not say anything, which can provide the therapist or client space to think. Most people are uncomfortable in silence. Thus, when the therapist keeps silent, it forces the client to engage in introspection. This may occur after a powerful exchange or experience wherein client and/ or therapist can better process what happened.* ** Utilization ** - when the therapist takes whatever happens in a session and uses that to help move the session forward. A type of improvisation, similar to metaphoric language - *When the therapist takes whatever happens in a session--- be it something a client says or does or something the therapist says or does--- and uses that to help move the session forward* - *Focuses on how to explore metaphors* - One-shot---one response - Example: *Our relationship is sinking; What type of life rafts do you have on board?* - Multiple-round---back and forth metaphorical exchanges **Pg. 136** *One type of improvisation is utilization (Keeney & Keeney, 2013). This is when the therapist takes whatever happens in a session--- be it something a client says or does or something the therapist says or does--- and uses that to help move the session forward. In many ways this improvisational utilization focuses on how to explore metaphors. These can be one- shot utilizations or multiple rounds if the metaphor is expanded. **One- shot utilizations** provide just one response to a client's statement. **Multiple-round utilizations** develop the metaphor over several back- and- forth exchanges.* ***One- Shot Utilizations:*** ***Multiple- Round Utilizations:*** ** Interactional (relational) questions ** +-----------------------+-----------------------+-----------------------+ | **Relational/** | Focus on what happens | How does \_\_\_ react | | | between two or more | when you \_\_\_? | | **Interactional | people | | | Questions** | | | +-----------------------+-----------------------+-----------------------+ **\ Pg. 112** ***Relational Questions*** *Family therapists think circularly rather than linearly. This entails viewing problems between people rather than internally. With this epistemology, the questions you ask focus on how one person impacts another* *person. This doesn't discount that every person has distinct thoughts and feelings, but rather that two (or more) unique individuals come together and mutually influence one another. We can look at these questions as being interactional questions. Relational questions focus on what happens between two or more people.* *Relational questions can ask one person how they impact another person or how that other person impacts them.* *Relational questions bring forth information for the therapist but also send an implicit message to the client that the problem is not just one person but several. As such, the question becomes an intervention.* ***Appendix pg. 229*** ***INTERACTIONAL QUESTIONS*** * Focus on what happens between two or more people* * Can ask one person how they impact another person* * Or, can ask how that other person impacts them* ** Postmodern Theories** **Pg. 206** **Solution-Focused Brief Therapy** developed by Steve deShazer & Insoo Kim Berg 1. Focus on the client\'s strengths and abilities. 2. Find out what is working and do more of it. 3. Clients have the resources for change. 4. Clients generate workable solutions. 5. Change starts small and has a ripple effect. 6. Focus on the future when the problem has been solved. 7. Focus on when the problem is not a problem. **Pg. 211** ***Narrative Therapy*** ** Postmodern Perspective (the MFT's role in postmodern theories) **