Unit 9: Comparative Psychotherapies - Seminar

Unit 9: Comparative Psychotherapies - Seminar • This week we read chapters 16 and Read the following article on Strategic Family Therapy: National Institute on Drug Addiction (NIDA) (n.d.) Brief strategic family therapy for adolescent drug abuse. Read Chapter 1 � Brief Strategic Family Therapy: An overview Retrieved 08/12/2008 from http://www.drugabuse.gov/txmanuals/bsft/BSFTIndex.html

Unit 9: Comparative Psychotherapies - Seminar • Read article on principles of drug addiction treatment: National Institute on Drug Addiction (NIDA) (n.d.) Principles of drug addiction treatment: A research based guide Read the first article, �Principles of effective treatment.� Retrieved 08/12/2008 from http://www.nida.nih.gov/podat/PODATIndex.html

Unit 9: Comparative Psychotherapies - Seminar • Read Article on Dual Diagnosis: Leshner, A. I. (1999) Drug abuse and mental disorders: Co-morbidity is reality NIDA Notes, Vol. 14, �Directors' Column�. Retrieved 08/12/2008 from http://www.drugabuse.gov/NIDA_Notes/NNVol14N4/DirRepVol14N4.html

Discussion Question 1 1. Treatment for addictions is most often done in a group setting. Why do you think this is so? What in the nature of addictive personality or addition problems makes group therapy a more effective treatment venue??

Discussion Question 2 2. Strategic Family Therapy (SFT): According to the theory of SFT, what is the cause of the dysfunctional behavior? What are the other fundamental assumptions of SFT treatment?

Discussion Question 3 3. Dual Diagnosis: If your client has both an addiction and a psychiatric problem such as depression or bipolar disorder, which do you treat first? Or should you treat them both at the same time? Why? What if the client is just trying to treat their psychiatric problem with the drug/alcohol?

Group and Family Therapy • Group therapy and family therapy both feature multiple clients being treated together • However, they are quite distinct from each other, with separate histories and methods • We will consider them separately in this chapter

Group Therapy: An Interpersonal Emphasis • Most forms of group therapy strongly emphasize interpersonal interaction • take advantage of the fact that the group therapy experience itself is based on interacting with other people • Irvin Yalom is a leader in this interpersonal approach to group therapy • Clients’ problems stem from flawed interpersonal relationship skills • If they can practice and improve on this with fellow group members, they can generalize lessons learned

Therapeutic Factors in Group Therapy • Universality • Clients realize that others share the same struggles (“we’re all in the same boat”) • Especially powerful in homogeneous groups • Group Cohesiveness • Feelings of interconnectedness among group members • Trust, acceptance, belongingness • Analogous to therapeutic alliance in individual therapy

Therapeutic Factors in Group Therapy (cont.) • Interpersonal Learning • The same interpersonal tendencies that contributed to the client’s problems will appear in the group context • Group members form relationships with each other and work to improve them, and those improvements will help with outside relationships eventually

Therapeutic Factors in Group Therapy (cont.) • Interpersonal Learning (cont.) • The group becomes a social microcosm for each client • Clients enact their own relationship pathology (without knowing it) in the group itself • Focus on the here-and-now • Discourage discussion of lives outside of therapy • Encourage discussion of relationships between group members in the current moment • Clients talk directly with each other about they way they behave toward each other

Discussion Question • What are some potential ethical dilemmas of group therapy? For instance, what steps, if any, should be taken by a clinical psychologist if two group therapy clients begin dating? Additionally, how can a psychologist ensure confidentiality in a group setting? • Is confidentiality in a group setting possible?

Practical Issues in Group Therapy • Group membership • Typically 5-10 clients • Open-enrollment groups—individuals leave or join at any time • Closed-enrollment groups—members start and finish together • Most individuals can be included, unless they can’t interact meaningfully with others and reflect upon that interaction • Psychosis, acute crisis, frequent absences are problematic

Practical Issues in Group Therapy (cont.) • Preparing clients for group therapy • Correct misconceptions • Provide realistic and encouraging data about outcome • Encourage helpful ways of participating

Practical Issues in Group Therapy (cont.) • Developmental Stages of Therapy Groups • Initially, cautious and concerned about acceptance • Next, some jockeying for position in the social “pecking order” • Finally, cohesiveness emerges

Practical Issues in Group Therapy (cont.) • Cotherapists • Often, group therapy is conducted by a team of two therapists (rather than one) • Second set of eyes and ears can attend to client behaviors • Also, therapists can model healthy interaction • Cotherapy can be problematic when therapists are competitive, distrustful, or have incompatible therapy orientations

Practical Issues in Group Therapy (cont.) • Socializing between clients • Extra-group socializing between clients (romantic or platonic) is a significant problems • Even when prohibited at the outset, it happens at times • Loyalty to friendship may exceed loyalty to group • Other group members can feel excluded

Discussion Question • Are closed- and open-enrollment groups better suited for certain types of psychological disorders? Are heterogeneous and homogeneous groups better suited for certain types of psychological disorders? • Do you think that the composition of a group contributes to therapy effectiveness? Explain your responses.

Ethical Issues in Group Therapy • Confidentiality • Clients should maintain confidentiality of fellow members, but difficult to enforce • Consequences of broken confidentiality can effect professional or personal life, as well as group climate of trust • Important to get group members to appreciate importance of this and commit to maintaining confidentiality at outset

Outcome Issues in Group Therapy • Not studied as extensively as individual therapy • Existing studies strongly suggest that group therapy is beneficial • About equal to individual therapy in most studies; slightly inferior in a few studies • Can be less expensive than individual therapy also

Family Therapy: The System as the Problem • When the family therapy movement initially arose in the mid-1900s, it was considered revolutionary • Psychological symptoms were a byproduct of dysfunctional families • One individual may exhibit the symptoms, but the problem actually belonged to the entire system

Family Therapy: The System as the Problem (cont.) • Circular causality—events influence each other reciprocally • As opposed to linear causality, which is endorsed by individual therapists • Focus on communication patterns in families • Focus on functionalism of symptoms • Within family, symptoms may be adaptive

Family Therapy: The System as the Problem (cont.) • Homeostasis • Families regulate themselves by returning themselves to an emotional set point • Like a thermostat • A family member may sense that the family is reaching an uncomfortable state, and take action (feedback) to return it to comfort zone

Assessment of Families • Interviews and other methods as used in individual therapy are common • Genograms • A pencil-and-paper method of creating a family tree that incorporates detailed information about the relationships between family members for at least three generations • Process and result can both be beneficial

Assessment of Families (cont.) • Family Life Cycle • A developmental theory for families, including six stages • Leaving Home • Joining Through Marriage • Families with Young Children • Families with Adolescents • Launching Children and Moving On • Families in Later Life • Can be adapted for diversity in culture, experience, and other variables

Assessment of Families (cont.) • Identified patient • It can be critical for the family therapist to persuade the family that the problem is systemic rather than individual • This can be difficult when the family has attributed the problem entirely to one member (identified patient)

Discussion Question • What is your opinion of the systems approach employed by family therapists? • Can family systems be pathological, or is pathology only found in individuals?

Family Therapy: Essential Classic Concepts • Family Structure • Unwritten rules by which a family operates • When flawed, problems in relationships and individuals may result • Family structure can be improved by focusing on subsystems within families and the boundaries between them • Should be neither enmeshed nor disengaged

Family Therapy: Essential Classic Concepts (cont.) • Differentiation of Self • An appropriate degree of self-determination, or becoming your own person, is essential • Families that don’t allow this to happen can create problems for their members • Families remain emotionally fused, or an undifferentiated ego mass

Family Therapy: Essential Classic Concepts (cont.) • Triangles • When two people are in conflict, either one may try to bring in a third person to take their side • In families, this can be problematic, especially when the triangulated person is a child • Therapeutic goal is to encourage detriangulation and direct communication between two people at odds with each other

Family Therapy: Contemporary Approaches • Solution-Focused Therapy • Evolved from strategic family therapy • Emphasis on solving problems • Emphasis on the use of solution-talk rather than problem-talk • Make clients think about positive outcomes rather than unpleasant present situations • Emphasis on exceptions to current problems (times when better) and how they created these exceptions (to encourage them to create more exceptions)

Family Therapy: Contemporary Approaches (cont.) • Narrative Therapy • Highlights clients’ tendencies to create meanings about themselves and the events in their lives in particular ways • Stories we construct about our own lives are powerful influences on the way we experience new events • We “edit” our experiences to fit the story line • Revise stories and recast selves in more positive, heroic way; new events can be interpreted more positively

Ethical Issues in Family Therapy • Cultural competence • Family therapists should appreciate the cultural background of the families • Ethnicity • Religion • Other variables • Often, one family includes a blend of cultural influences • Members from different cultures • Varying levels of acculturation

Ethical Issues in Family Therapy (cont.) • Confidentiality • Can be difficult when one family member tells therapist something in private • Diagnostic Accuracy • DSM disorders apply to individuals, not families • If diagnosis is required, therapist who thinks system is flawed has a dilemma • Labeling identified patient with disorder can perpetuate the family’s tendency to blame one member

Outcome Issues in Family Therapy • Methodological difficulties in measuring outcome of family therapy include the issue of which family members’ opinions should be solicited • Not as much outcome research as individual therapy, but existing research is very positive • Family therapy appears to work about as well as other modes of therapy

Discussion Question • As a family therapist, would you allow members of a family which you are treating to schedule individual appointments in addition to family sessions? If so, would information disclosed during individual sessions remain undisclosed to other family members, or would all information shared by each family member be communicated to all others? • What other difficult interpersonal dynamics might arise in family therapy? What are some ways in which a family therapist can address these issues?

Questions?

Unit 9: Comparative Psychotherapies - Seminar