Summary MFT national exam: questions 2023.

1. MRI Primary Contributors 2. MRI Therapy Structure 3. MRI Out-of-Ses- sion Directive 4. MRI Prescribing the Symptom 5. MRI Restraining the Progress of Change Bateson, Jackson, Satir, Haley, Weakland, Watzlawick 1. Intro to treatment setup. 2. Inquiry and definition of problem. 3. Estimation of the solution (pos. feedback) maintaining. 4. Setting goals for treatment. 5. Selecting and making behavioral or strategic interventions. 6. Termination Instructing the clients to engage in behavioral change outside of the session as opposed to in session. Paradoxical intervention where one instructs the client to intentionally engage in the behavior they wish to change. Client may rebel and experience desired change or com- ply and realize they have control. Paradoxical intervention where clients come into session and report that they are experiencing change so therapist encourages them to slow down and be cautious about changing too fast. 6. MRI Positioning Paradoxical intervention of pushing a family member fur- ther into the absurdity of their initial position, thereby making them realize their own absurdity. 7. MRI Paradoxical Intervention 8. MRI Treatment Duration 9. MRI Therapy Goals Used to address that families are naturally resistant to change. Involves instructing fam not to change or to change in ways that contradict their desired change. Limited to 10 sessions, less if problem is solved. Resolve current problem, provide symptoms relief and create second-order change. 10. MRI Diagnosing Non-pathologizing and systemic. 11. MRI Assessment 12. MRI Symmetrical Relationship 13. MRI Complemen- tary Relationship 14. MRI Metacom- munication 15. MRI Report and Command Func- tions 16. MRI More of the Same 17. MRI Problem as Attempted Solu- tion 18. MRI First-Order Change 19. MRI Second-Or- der Change 20. Object-Rela- tions Diagnosing 21. Object-Relations Therapy Goals 22. 22. Get description of problem. Understand the problem, then therapist identifies the behavioral patterns that maintain that pattern. Based on equality, behavior of one mirrors that of the other. Based on differences that fit together. Communicating about communicating. Essentially refers to non-verbals going on in the room that have an impact on what is being said verbally. Every communication has 2 components: Report- Content of the message. Command- A message about the relationship. Problem when families fail to appropriately respond to normal life circumstances, families will do more of the failed solution as opposed to trying a different solution. The problem is not the problem, the attempted solutions to fix the problem reinforces the interactional behavioral sequence. Changes in family patterns that occur at the behavioral level. Changes in family patterns of interaction that occurs at the level of beliefs or rules. Non-pathologizing. Develop insight and work through unresolved conflict. Eventually, individuals develop healthy egos and begin to relate to others maturely without projection. Object-Relations Therapy Structure 23. Object-Rela- tions Assessment 24. Object-Rela- tions Introject 25. Object-Rela- tions Countertransfer- ence 26. Object-Relations Transference 27. Object-Rela- tions Interpretation 28. Object-Relations Working Through 29. Object-Rela- tions Insight 1. Assess early childhood experiences and current and past relationships. Explore current relationship style. 2. Foster insight and begin working through. 3. Individual begins to experiment with developing new behaviors and ways to interact. Fosters later experiences that can re-shape internalized objects. Non-Structured. Explores: -Early childhood experiences and the clients' interpreta- tions of them. -Past and present relationship with caregivers. -Current relationship style and where they are struggling with healthy relationships. Internalized objects become introjects, and are split into being either all-good or all-bad. The therapist's tendency to attribute qualities that reflect unresolved grievances from a previous relationship onto a client. Tendency of individuals to attribute qualities to other indi- viduals that reflect unresolved grievances from a previous relationship. Therapist's hypothesis about the influence of the client's past experiences on their current behaviors and strug- gles. After insight is achieved, working through process entails translating insight into more desirable and constructive ways of being. The process of raising unconscious forces to awareness, allowing clients to better understand how underlying dy- namics impact their behavior and relationships. 30. Each parent projects the remnants of their repressed object relationships onto the child. The child then inter- Object-Rela- tions Projective Identification 31. Object-Rela- tions Object 32. Object-Rela- tions Projection 33. Object-Rela- tions Main Contributor 34. Bowen Differen- tiation 35. Bowen Dysfunc- tion 36. Bowen Fami- ly Projection Process nalizes these projections into becoming significant com- ponents of their personality. An individual's collective distortions based upon his or her subjective experiences and perceptions of another person, typically an internalized representation of a par- ent/caregiver based on repeated interactions throughout early childhood. When a child is born, each parent projects fragments of repressed object relationships onto the child. James Framo Differentiated individuals are able to react to the world rationally and enter into relationships while balancing competing needs for belonging and individuality. Opposite is emotionally fused and ruled by emotions. Comes from lack of differentiation. Symptoms come from when stress exceeds a persons ability to handle it or when the level of anxiety exceeds the system's ability to bind it. Undifferentiated parents transmit immaturity to children. When stress overwhelms, one parent may become emo- tionally distant, the other may become overly involved with the child. 37. Bowen Triangles Smallest stable unit in system. Forms out of the anxiety of a 2-person system; to stabilize the relationship a third party is drawn in. 38. Bowen Solid-Self An individual who is more differentiated and is able to function based on personally defined set of values, be- liefs, convictions and life principles. 39. 39. Bowen Pseu- do-Self An individual who is not differentiated and may be fused with another person. Does not reason from own internal values but borrows from others. 40. Bowen Soci- Society influences how families function. Bowen believed etal Emotional that the more differentiated individuals and families resist Process destructive social influences (sexism, racism, etc.) 41. Bowen Therapy 1. Assessment Phase - Patterns of togetherness and Structure individual exploration of family of origin. 2. Genogram Phase 3. Differentiation Phase 42. Bowen Going Technique that encourages clients to go home and ex- Home Again perience family of origin without emotional reactivity. Re- searches emotional cut-offs. identifying triangles, etc. 43. Bowen Primary Murray Bowen Contributor 44. Bowen Diagnos- Non-pathologizing and systemic focus. ing 45. Bowen Goals of 1. Decrease Anxiety Therapy 2. Increase levels of differentiation. Focus on working through underlying process and con- flicts, not symptom reduction. 46. Bowen Person to Person Relation- ships 47. Bowen Emotion- al Cut-Off 48. Bowen Nu- clear Fami- ly Emotional Process (Undif- When one is differentiated and can talk rationally to an- other person without blaming the other or triangulating. Minimizing contact with family. It may decrease anxiety but does not resolve fusion. May be denial of importance of family and an exaggerated sense of independence. People tend to select spouses that are the same level of differentiation. Less differentiation = More fusion = 1. Reactive emotional distance 2. Dysfunction in spouse ferentiated Ego Mass) 3. Overt marital conflict 4. Project unto children 49. Bowen Relation- A technique that helps clients experience what it's like to ship Experiment act counter to their usual emotionally driven responses. Helps people discover their ability to move against the ways emotions are driving them. 50. Bowen Therapist Coach - Helps clients start process of self-discovery and Stance differentiation. 51. Bowen Process Designed to slow people down, diminish anxiety, and start Questions them thinking. Structured to encourage clients to think about the processes within the family and about their roles. 52. Bowen Therapist I position, coaches to make "I statements". Therapist Position may model this behavior while remaining neutral and not emotionally reactive to avoid triangulation. *Non-anxious presence* 53. Bowen Emotional responses are passed down through genera- Multi-genera- tions. Least differentiated child will marry undifferentiated tional person and subsequent generations will be less differen- Transmission tiated. Process 54. Bowen Assess- Genogram - Symbolic chart of family. Tracks multi-gener- ment ational family processes and tracks changes in triangles. 55. Bowen Displace- A technique for helping family members achieve sufficient ment Story distance to see their own roles in family system. Story would be about another family with similar problems. 56. Contextual Merit Earned when parents are responsible and ethical with the equitable asymmetry within the parent-child relationship. If parents are equitable and fair, they earn merit, which leads to loyalty from childhood when the children become adults. 57. Contextual Equi- table Asymmetry The concept that children cannot care for themselves and are entirely dependent upon their parents. 58. Contextual Mul- tidirectional Par- tiality Therapist is accountable for everyone whose well-being is potentially impacted by a therapeutic intervention. Every intervention must serve the best interests of everyone involved. 59. Contextual As- -Focus on family resources sessment -Monitor interactions between facts, psychology, transac- tions and relational ethics. -Track themes of trust, loyalty, reliability and fairness. 60. Contextual Pri- Ivan Nagy mary Contributor 61. Contextual Four 1. Facts- Stable and physical attributes people are born Primary Dimen- with (gender, race) and contextual circumstances (di- sions vorce, trauma). 2. Psychology- One's internal experience of the world, thoughts, emotions, desires. 3. Transactions- Patterns of organization and dynamics within the family system. 4. Relational Ethics- Most important. Refers to the re- sponsibility each individual has for the impact that their behavior has on others. 62. Contextual Loy- An individuals' internalized expectations of and obliga- alty tions to his or her family of origin. Loyalty is assumed to influence individual functioning. 63. Contextual Lega- Qualities that are attributed to an individual as an account cy of being born to his or her parents. 64. Contextual Enti- What individuals are inherently due from others in their tlement family and what is earned from others based up behavior towards them. 65. Contextual The manner in which individuals within a family keep track Ledger of and balance debts and entitlements. 66. Contextual Con- textual The systemic impact of all that are impacted by therapeu- tic effort. 67. Contextual 1. Therapist becomes temporarily parentified to relive Deparentifica- parentified child. tion Process 2. Addresses family dynamics to work toward systemic change. 68. Contextual Phas- 1. Gather history. es of Therapy 2. Address any urgent needs, create balance. 3. Family members learn to act ethically toward others. 69. Contextual Treat- -Work through entitlements~ take responsibility for own ment Goals behavior. -Work through perceived legacies -Differentiate between irrational and justifiable guilt -Achieve exoneration 70. Contextual Diag- Non-pathologizing and maintained a systemic focus on nosis the presenting problem. 71. Contextual Split When a child finds that they have to choose loyalty to- Filial Loyalty wards one parent at the expense of being loyal to the other. 72. Contextual Filial Children are inherently loyal to family of origin. Loyalty 73. Contextual Re- Multi-generational transmission of destructive entitlement volving Slate of in which one generation harms the next generation de- Injustice spite the face that there was no wrong-doing. 74. Contextual De- Results when individuals experience the denial or entitle- structive Entitle- ment from family of origin so the seek what they believe ment is owed to the from another relationship, often family of creation. 75. Fairness and ethical consideration with lead to: Contextual Debts/Filial Responsibility 76. Contextual Par- entification 77. Contextual Exon- eration 78. Strategic Thera- py Structure 79. Strategic Who is Involved 80. Strategic Metaphoric Task 81. Strategic Re- framing 82. Strategic Para- doxical Interven- tions 83. Strategic Goals of Therapy Debts- Destructive entitlement Filial Responsibility- Loyalty Child takes on role of parent. Becomes caretaker in at- tempt to earn love. Process in which an individual restores balance to ledger. First session is important and has 4 stages: 1. Social Stage- Therapist aims to make clients comfort- able (joining). 2. Problem Stage- Asks each person perspective of prob- lem. 3. Interaction Stage- Therapist observes but not inter- prets, looks for sequences, hierarchies, triangles and al- liances. 4. Goal Setting-Learn which solutions have been tried and failed, aims directives at small changes. Goal of shifts in structure and hierarchies. Few family members, usually 1 or 2, more if directly related to the identified problem. Usually both parents. Prescribing a directive to a family that engages them in conversation or activity that is easier than talking about the problem directly. By discussing it through metaphor, it will indirectly contribute to resolving the actual problem. Presenting an alternative perspective on a family mem- bers' view of another's problematic behavior. Interventions used to address the concept that families are naturally resistant to change. Symptom relief and changes in structure of family and parent parental hierarchy. 84. Strategic Pre- senting Problem as Metaphor 85. Strategic Unbal- ancing 86. Strategic Pre- tend to Have Symptom 87. Strategic Incon- gruous Hierar- chies 88. Strategic Align- ing with Parental Generation 89. Strategic Ordeal Therapy 90. Strategic Main Contributors 91. Strategic Direc- tives Symptom is redefined as a metaphor of a larger problem. An intervention where the therapist intentionally sides with one family member over the other. Meant to disrupt homeostasis. Paradoxical Intervention where therapist instructs child to have a symptom and instructs parents to help child through it. Occurs when children create symptoms in attempt to change their parents. Technique directed at strengthening the parental hierar- chy and reinforcing that parents are in charge of the chil- dren. Therapist breaks neutrality and intentionally aligns with parental subsystem. Paradoxical directive that places a client in a situation where it creates more work for them to maintain problem symptoms than it would be to change it. Jay Haley and Cloe Madanes Specific, directed behavioral tasks for the family to en- gage in during session and then carry out at home be- tween sessions. 92. Strategic-Human- 1. Dominate and Control (behavior problems) ism How Individuals Resolve Conflict 2. Desire to be loved (anxiety and depression) 3. Love and protect (abuse and neglect) 4. Repent and forgive (sexual/physical abuse) 93. Strategic-Human- -All problems stem from conflict between love and vio- ism Themes lence. -Clients are continually presented with range of choices as to what to make of themselves and the present circum- stances. 94. Strategic-Human- Cloe Madanes ism Primary Contributor 95. Cybernetics Iso- morphism 96. Cybernetics At- tenuating/ Neg- ative Feedback Loops Phenomenon in which two or more systems or subsys- tems exhibit similar or parallel structures. Maintains stability and homeostasis; Reduces Change. 97. Cybernetics Studying organization, pattern, and process rather than matter, material, and content. 98. Cybernetics Equipotentiality 99. Cybernetics Equifinality 100. Cybernetics Am- plifying/ Positive Feed Back Loops 101. Cybernetics Feedback Loops 102. Cybernetics Same initial conditions can result in different end states. An organism or system can reach the same end state from multiple sources, conditions, and means. Mechanism by which families respond to changes in homeostasis. Attempts to change the system from a steady state to a new steady state or behavior. Self-Correcting mechanisms by which families attempt to adjust deviations and maintain organizational integrity. A state that emerges when a system is balance between Negative Entropy openness and closedness. 103. Cybernetics En- tropy 104. Cybernetics Homeostasis Refer's to a system's tendency to break down over time which threatens the survival of the system. Tendency of a system to resist change and maintain dynamic equilibrium. 105. Cybernetics Mor- phogenesis 106. Cybernetics Mor- phostasis 107. Cybernetics Rip- ple Effect 108. Cybernetics Re- cursiveness 109. Cybernetics Process versus Content 110. Cybernetics Process versus Structure 111. Cybernetics Structures 112. Cybernetics Sys- tem 113. Cybernetics Boundaries 114. Cybernetics Family Models/Maps 115. Cybernetics Cir- cular Causality A system's tendency towards growth, creativity, change, and innovation. A system's tendency towards stability. Change that occurs at one level of a system will result in changes across other levels of the system. Reciprocal or circular causality. Speaks to mutual interac- tion between people, events, and their ecosystems. Process is how it is said and content is what is being said. An infrequent behavior is a process. A frequent behavior is a structure. Aspects of a system that are relatively static and endur- ing. They can be changed. A unit bonded by a set of interrelated elements which exhibits coherent behaviors. Contains the properties of: -Permeability -Selectivity -Variability Open Systems vs. Closed Systems. Individuals and systems will consciously or unconsciously use models or maps to manage boundaries and make sense of individual and shared realities. There is no linear causality. Things mutually affect others. 116. 116. Communication Theory Metacommunica- tion 117. Communication Theory Complementary Relationship 118. Communication Theory Symmetrical Relaionship 119. Communication Theory Streptic Communication 120. Communication Theory Paralinguistic Communication 121. Communication Theory Kinesthetic Communication 122. Communica- tions Theory 123. Communication Theory Haptic/Symbolic Communication Communicating about communication. Modifies, qualifies or disqualifies a communication. Often refers to non-verbals that have a profound impact on what is being said. Based on differences that fit together. Based on equality, behavior of one mirrors that of the other. Sounds (claps, whistles). Includes tone, pace, and inflection. Refers to body motion. Conceptualize symptoms in an individual as a means to keep the system stuck. Model of sequential causality which can be understood through chains of behavior. Includes touch. 124. 124. Communication Theory Analogic Communication 125. Communication Theory Digital Communication 126. Communication Theory Proxemics 127. Characteristics of a Double Bind Communication that has little structure, but is rich in con- tent (i.e. drawing). Communication that is verbal and is interpreted based on meeting. Spatial Relations; Communication that includes body lan- guage, stance, and preferred physical distance. 1. Communication involves 2 or more people in an impor- tant emotional relationship. 2. Pattern of communication and the relationship is a repeated experiences. 3. Involves a command to not do something with a threat of punishment. 4. An abstract injunction that contradicts above is given, also threat of punishment. 5. 3rd negative injunction both demands a response and prevents escape. Binds recipient to environment. 6. After time, messages have been communicated enough times that individual is conditioned to elicit same response. Says symptoms of schizophrenia resulted from individual receiving contradictory commands from which there is no escape. 128. General Systems The parts of the system are interrelated and the whole is Theory 129. Ludwig von Bertalanffy 130. Nathan Acker- man greater than the sum of its parts. -1940's -Developed General Systems Theory ~ All parts of sys- tem are interrelated and whole is greater than the sum of its parts. Considered the "Father of Family Therapy" and was among the first to work with the entire family. - -First to classify family as solitary unit of treatment -"Tickling the Defense"~ provoking families to open up and say what's on their mind. 131. Gregory Bateson Father of Cybernetics. 132. Adler -Early 1900's. -Identified role others and society have on personality development. -Launched Child Guidance Movement. 133. Dreikers -Founded family counseling centers in 1920's. -Symptoms experienced by young children are not the problem, family tension and parental issues are the prob- lem. 134. Kurt Lewin -Field Theory -"The whole of a group is greater than the sum of its individual members" -Process of change: 1. Unfreezing (motivation and readiness) 2. Changing (help client get new point of view) 3. Refreezing (help integrate new point of view). 135. Bertrand Russel -1920's -Theory of Logical Types~ defined systems, within define- able systems, within defineable systems. 136. Emily Mudd -1932 founded Marriage Council of Philadelphia, which became AAMFT in 1979. 137. Lyman Wynne -1940's -Pseudomutuality- systemic pretense of harmony and closeness that hides conflict and interferes with intimacy. -Pseudohostility- volatile and intense way of disguising and distorting both affection and splits. -Rubber-Fence Boundary- families seem yielding, but are nearly impermeable to information from outside systems. 138. John Bowlby -1949 -Attachment Theory: Secure Attachment Insecure Attachment Anxious-Resistant Type Anxious-Avoidant Type Disorganized/Disoriented Attachment 139. Theodore Lidz -1950's -Marital Schism: Parents overly focused on their own problems which harms the marriage, individuals, and the children. -Marital Skew: One parent dominates the family and the other is dependent. 140. John Bell -1951 -He may have been the first to treat families -Approach to therapy had 3 phases: 1. Child-centered phase 2. Parent-centered phase 3. Family-centered phase 141. Don Jackson -1959 -Introduced Conjoint Therapy, where spouses were seen together. 142. Symbolic-Experi- ential Bilateral Pseudo-Therapy 143. Symbolic-Experi- ential Degrees of Craziness 144. Symbolic-Experi- ential Phases of Therapy Occurs when family members attempt to play therapist to one another, this is avoided. -Going Crazy -Being Driven Crazy -Acting Crazy Early- Therapist must win Battle for Structure and family must win Battle for Initiative. Middle- Achieve reorganization around interpersonally expanded symptoms. Later-Family begins to operate as a mobile milieu therapy unit within the the family-co-therapist suprasystem. 145. Symbolic-Experi- ential Flight Towards Health 146. Symbolic-Experi- ential Bilateral Transference 147. Symbolic-Experi- ential Therapeutic Double-Bind 148. Symbolic-Experi- ential Teaming Roles 149. Symbolic-Experi- ential Co-Therapist 150. Symbolic-Experi- ential Redefining Symptoms 151. Symbolic-Experi- ential Affective Confrontation 152. Symbolic-Experi- ential Activating Constructive Anxiety 153. Symbolic-Experi- ential Fantasy Alternative When a family would abruptly stop showing up for treat- ment, it was taken as a positive sign that the family experienced sudden and profound growth and no longer requires therapeutic support. A therapists' intentional maneuver to adapt to the lan- guage, accent, rhythm, or posture of the family. Initiated when clients ask about a possible diagnoses. The therapist gives a relational diagnosis that is unlikely to ever change. Healthy members of a family may intentionally be paired by therapist to encourage further healthy behavior by other family members. Always working with a co-therapist allows the therapist to be more crazy in session because one can rely on the co-therapists to ground them. Symptoms are redefined from pathological to efforts to- wards growth. The therapist's intentional confrontation with the family where they will directly and openly share their subjective emotional experience of working with the family. The therapist's effort to reframe symptoms as efforts to- wards building competence by focusing on the positive attributes of anxiety as a means towards self-growth. Discussing stressful situations in fantasy based "what if" terms or de-emphasizing stressful situations by suggest- ing absurd fantasy alternatives. 154. Symbolic-Experi- ential Expanding Distress 155. Symbolic-Experi- ential Battle for Initiative 156. Symbolic-Experi- ential Battle for Structure 157. Symbolic-Experi- ential Primary Contributor 158. Symbolic-Experi- ential Dysfunction 159. Symbolic-Experi- ential Co-therapist Role 160. Symbolic-Experi- ential Role of the Therapist 161. Symbolic-Experi- ential Person of the Therapist Process of expanding the symptom to the system. Ex- panding the distress to include each member, shifting the nature of anxiety with the family and reducing blame and scapegoating. After the therapist wins the Battle for Structure, the family must win this. This means the family realized and demon- strates that they are ready for change. The therapist must first win this if therapy is to be effective. Entails: who attends session, what time sessions are, how frequent sessions are and how long they are. If family is not willing to meet these expectations set by the therapist, they are not prepared to invest in growth process and change is unlikely. Carl Whitaker Comes from emotional suppression. Therapists can rely on their interpersonal intimacy (with co-therapists) to sustain them rather than expecting the client family to meet their needs. Grandparents role- Therapist accepts parenting functions as temporary and remains free to return them to parents at any moment. They are involved and loving, but not essential. They are NOT an expert, the responsibility to change lies with clients. The psychological health and authenticity of the therapist as a person is the primary factor in effective therapy. The therapist is encouraged to be authentic and real with 162. Symbolic-Experi- ential Existential Encounter 163. Symbolic-Experi- ential Therapy of the Absurd 164. Symbolic-Experi- ential Individuation 165. Symbolic-Experi- ential Family Interaction 166. Symbolic-Experi- ential Assessment 167. Symbolic-Experi- ential Diagnosing 168. Symbolic-Experi- ential Who is Involved? 169. Symbolic-Experi- ential Treatment Duration clients relying on spontaneity of their emotional respons- es as they remain present with the family. The therapist's willingness to both receive the family's reactions to them as well as disclose their own reactions towards the family. Symbolic-Experiential Therapy may be referred to as such given its unrecognizable structure, spontaneous process, and therapist transparency. A primary goal in growth-orientated therapies, encourag- ing each individual family member in becoming more and more of who they are. Healthy family interaction is characterized through flexibil- ity and openness to life experiences. -Beings with first phone call -Assesses all the way out to extended family and com- munity and back to internal worlds of every individual. -Attempts to gain thorough understanding of system as a whole and individual idiosyncracies. Pays particular attention to: subsystems, emotional age versus chrono- logical age, triadic patterns, teaming, dyadic collusions, and individual dynamics. Non-pathologizing. If asked what the diagnosis is, thera- pist will respond with a therapeutic double-bind. All members of the family. At least 2 generations. Meets weekly until later phases, then monthly. Will go on as long as needed, usually between 6 months and 2 years. 170. Symbolic-Experi- ential Goals of Therapy 171. Milan Therapy Structure 172. Milan Team Ap- proach 173. Milan A Learning Process 174. Milan Hypothe- sizing 175. Milan Counter- paradox 176. Milan Neutrality and Irreverence 177. Milan Paradoxi- cal Prescription -Increase each members' sense of belongingness, while also encouraging the freedom to individuals. -Develop and environment where individuals feel safe to be emotionally expressive. -Individuals are encouraged to grow in ways congruent to their authentic selves. 1. The pre-session- Team meets and makes initial hypoth- esis. 2. Session- Team meets with family to check hypothesis. 3. Intersession- Team meets to discuss and form an inter- vention. 4. Intervention- Therapist returns and delivers interven- tion to family; either a positive connotation or prescription of a ritual. 5. Post-session Discussion- Team debriefs and makes plans and hypotheses for next session. A team of therapists that strategically hypothesize and plan interventions regarding the family. Often, the team watches therapy through a one-way mirror as it happens. Interventions are viewed as this by the therapist. The ther- apist can test the hypotheses and interventions through trial and error as they learn about the family. Continual process of conceptualizing the nature of the family's behavior that guides questioning and interven- tions Intervention used to unravel a family's double-bind mes- sage by referring to their dysfunction as legitimate and necessary, and as so, instructing the family not to change. The therapist's stance of being open to multiple hypothe- ses regarding the family's behavior. 178. Milan Rituals Intervention presented by therapy team that is described in great detail, instructing individuals in the family to carry our specific behaviors at specific times of the day for a distinct period of time. Serves to provide consistency and clarity as to the hypothesized problem within the family. 179. Milan Positive Connotation Assigned a positive motive or value to each family mem- ber's behavior, whether it's a desirable behavior or not. 180. Milan Goals Open families up to accommodating and adjusting to new information and beliefs and maintain healthy systemic functioning. 181. Milan Who is In- volved? 182. Milan Diagnos- ing 183. Milan Assess- ment 184. Milan Punctua- tion Family members directly related to the problem. The therapists were male-female dyad observed by ther- apy team. Non-pathologizing and problems are systemic. Assessment is ongoing through the Team Approach. Ini- tial assessment comes with demographic gathering over the phone. The manner in which individuals attribute their behaviors as a result of another's behavior. (I only nag you because you never offer to help). 185. Milan Time This suggests that a family's historic perception of a prob- lem influences their current perspective, affecting their view of past and present behavior. 186. Milan Metacom- munication 187. Milan Digital Message The communication about communication in reference to the relationship. Typically is non-verbal or implied mes- sage. The content of the message (objective). 188. A metaphorical message (process). Milan Analogical Message 189. Milan Games Unacknowledged strategies that result in destructive in- teractions within families, often unspoken and used as attempts to control another's behavior. 190. Milan Epistemo- logical Error 191. Milan Epistemol- ogy 192. Milan Therapy Length 193. Milan Primary Contributors 194. Later Milan Cir- cular Question- ing 195. Later Milan Bos- colo and Cecchin 196. Later Milan The Dirty Game 197. Later Milan Palazzoli and Prata 198. Later Milan The Invariant Pre- scription A set of beliefs that are incongruous with reality and become problematic. The manner in which one makes sense of the world, including their relationships to and with others. Long-Term brief therapy. 10 sessions, 1 month apart Palazzoli, Prata, Boscolo, Cecchin When the therapist asks one family member to comment on the interactions of other family members to create circularity within the system and help therapist build a more elaborate hypothesis. Boscolo and Cecchin Moved away from paradoxical intervention and behavioral change and focused on introducing new information into the family system. Goal was for families to create a new epistemology. When parents struggle for control, they triangulate a symptomatic child who then works to defeat the parents. Palazzoli and Prata Focused on interrupting the destructive family games. Therapists instruct mom and dad to tell the family that they have a secret and then take a trip together for a few days. Palazzoli and Prata 199. EFT Primary Contributors 200. EFT Primary Emotions 201. EFT Interactional Patterns 202. EFT Secondary Emotions Susan Johnson Leslie Greenberg Refers to underlying emotions that drive relational behav- iors, but are hardly acknowledged or talked about directly. They are the most fundamental emotional experiences such as powerlessness, fear, loneliness, etc. Dichotomous patterns of relating such as the pursuer-dis- tancer or attacker-blamer relationship pattern. Refers to the surface level emotions designed to protect the primary emotions and reflect more upon the interac- tion that the individual. Usually reactive in nature and resembles defensiveness, frustration, and anger. 203. EFT Attachment An individual's basic need for trust and security, signifi- cantly influenced and developed throughout infancy and early childhood per child's relation to their primary care- giver. 204. EFT Softening Displayed when a partner withdraws from defensive- ness/aggressiveness and begins to open up to the emo- tional experience of their partner as opposed to remaining exclusively focused on their own experience. 205. EFT Primary Needs Needs that are related to attachment and experienced through primary emotions. 206. EFT Bonding The process in which individuals form a connection in a relationship that satisfies the primary need for attach- ment. 207. EFT Assessment Occurs Through Stage 1 1. Looking Within: Exploring how each partner constructs their emotional experience of relatedness. 2. Looking Between: Exploring how partners engage each other and identifying each individual's role in the reaction and maintenance of negative interactional patterns. 208. EFT Diagnosing Non-Pathologizing, Systemic and expanded to the cou- ple. Partners not sick, just stick in deconstructive, yet habitual, ways of managing emotions and relating to others. 209. EFT Who is in- volved? 210. EFT Treatment Duration 211. EFT 3 Primary Tasks of Thera- pist 212. EFT Therapists are intentional about... 213. EFT Therapy Structure Phase 1: 214. EFT Therapy Structure Phase 2: Both partners of the couple should be present. Usually 10-20 sessions. 1. Monitoring and actively tending to and nurturing a positive therapeutic alliance. 2. Expanding and restructuring primary emotional experi- ences. 3. Structuring enactments meant to either clarify present patterns of interaction or step-by-step shape new more positive patterns. -Validating -Focusing the session -Slowing down the processing -Organizing~ creating coherence between partners by re- flecting the growth and change as it takes place through- out discourse of treatment. Cycle De-escalation and Stabilization 1. Establish therapeutic alliance and clarify core issue as attachment-based. 2. Identify the negative interactional cycle that maintains attachment insecurity. 3. Access underlying emotions driving the interactional positions. 4. Reframe the problem as a cycle based on attachment needs/fears. Restructuring Interactional Positions/Patterns 5. Promote identification with disowned attachment needs. 215. EFT Therapy Structure Phase 3: 216. Structural Punc- tuation 217. Structural Thera- py Structure 218. Structural Unbal- ancing 219. Structural Shap- ing Competence 220. Structural Boundary Making 221. Structural Affec- tive Intensity 222. Structural Re- framing 6. Promote acceptance of a responsiveness to each part- ner's new construction of experience. 7. Create emotional engagement by facilitating the ex- pression of specific needs and wants. Consolidation and Integration 8. Facilitate the emergence of new solutions to old prob- lematic relationship issues. 9. Consolidating new positions and cycles of attachment behavior. Termination once Phase 3 tasks are independently main- tained by couple. Therapist's intentional emphasizing of an individual's re- action (body language) or statement, allowing them to become aware of their responses and reflect upon their meanings. 1. Joining and Accommodating Phase 2. The mapping of the family structure phase 3. The intervening phase Intervention where therapist intentionally sides with one family member over the other. Meant to disrupt home- ostasis and encourage change at the behavioral and structural level. Therapy avoids telling families what they are doing wrong; rather, they point out what they are doing right. An intervention where therapists reinforce appropriate boundaries and diffuse inappropriate boundaries by adapting the interactional patterns of the family's struc- ture. Increasing the emotional intensity of the system to en- courage structural change. Presenting an alternative perspective on a family mem- ber's view of another's problematic behavior. 223. Structural Chal- lenging the Symptom 224. Structural Chal- lenging Family Assumptions 225. Structural Spon- taneous Behav- ioral Sequences 226. Structural Enact- ments 227. Structural Mime- sis 228. Structural Join- ing and Accom- modating 229. Structural Goals of Therapy 230. Structural Treat- ment Duration Offers the family alternative ways of perceiving the role of the symptom in relation to the family's structure. Offers the family alternative perspectives and views on how they interact with one another. Similar to enactments, except these behaviors are spon- taneous as opposed to being directed. Having the family experiment with new ways of behaving and interacting, as instructed by the therapist, in the here and now of the therapeutic encounter. Intentional maneuver by therapist, to join and accommo- date with the family by replicating their body language, use of expressive language, mannerisms and other ob- servable behaviors to create a comfortable, trusting ther- apeutic space. Intentional maneuver by the therapist to establish a ther- apeutic relationship with the family system. Therapist will adopt to the family's communication pattern and other mannerisms to create a comfortable therapeu- tic space. Ultimate goal is to restructure family system in a way that promotes problem solving capacities and encourages growth in each individual while mutually supporting family as a whole. Two Primary Elements of a Health System: -A functional spousal subsystem -Clear boundaries between all individuals and subsys- tems 231. Structural Who is involved? 232. Structural Diag- nosing 233. Structural As- sessment 234. Structural Coali- tions 235. Structural Con- flict Management 236. Structural Inter- vening 237. Structural Hierar- chy 238. Structural Com- plementarity 239. Structural En- Short-term. No limit but aims for 10-20 sessions and therapy is terminated once a higher functioning structure is attained. The entire nuclear family. Non-pathologizing and views family as the client. Diag- noses not prescribed. Takes place over time. Therapist observes in-session and tracks: -Boundaries -Complementarity -Hierarchy -Conflict Management When two family members join to create a coalition against one or several other family members. The family's capacity to resolve conflict and negotiate effective and balanced solutions. Therapist is continually stepping in and out of the family, raising intensity, and unbalancing the system through swift and strategic interventions. The physical structure of the family as determined by the system's rules, boundaries, and interactional patterns. A balanced relationship between two individuals that of- ten results in effective teamwork. The relationship may not be symmetrical, or equal parts, but is still balanced. Receive affection and nurturance within family system but meshed Systems may risk autonomy and outside relationships. 240. Structural Disen- gaged Systems May be independent or isolated. 241. Structural Dif- fuse Boundary 242. Structural Clear Boundary 243. Structural Rigid Boundary 244. Structural Boundaries 245. Structural Sub- systems 246. Structural Prima- ry Contributor 247. Structural Plan- ning 248. Structural Inten- sity Boundaries that are permeable and permit fluid contact with other subsystems. May be prone to enmeshment. A boundary between the parental and children subsys- tems that establishes the parents in a leadership position. Allows parents and children to interact, but supports the couple in a separate relationship. Healthy families have clear generational, hierarchical boundaries that allow par- ents to maintain parental roles and children to maintain child roles. Overly restrictive boundaries that permit little contact with outside subsystems, often resulting in disengagement. Individuals, subsystems, and families are separated from one another by boundaries. They are hypothetical lines of demarcation that serve to protect a family and its subsys- tems. Individuals, dyads, triads, and groups form subsystems or units within the family that perform certain functions. Salvador Minuchin The period of assessment in structural family therapy when the therapist hypothesizes about the structure of the family while remaining curious about its actual structure. Achieved by therapist by increasing the affective com- ponent of an interaction, by increasing the length of a dialogue or by repeating the same message in different interactions through use of tone, volume, and pacing.