MCC 650

MCC662 – Child’s Communication Needs

A child’s play is an intrinsically motivated, nonliteral and imaginative activity that provides them with a nonverbal mode of communication while facilitating development (Landreth, 2002; VanFleet, et al, 2010).  Children are strongly motivated to engage in activities that capture their attention and reflect their inner world.  As a therapist, play therapy allows us a view of a child’s beliefs, feelings, intentions, and perceptions (VanFleet, et al, 2010). The therapist’s role is to establish a relationship with children through play and create a safe environment that is accepting, respectful, and sensitive to their needs, (Play Therapy, Basics for Beginning Students, 2006).   In doing so, it is important for a therapist to adjust his interventions to suit a child’s unique needs.  Communication must be adapted to a child’s developmental needs, cultural perspective, and life experiences (Landreth, 2002; VanFleet, et al, 2010).  Below, I provide an overview of how every child’s needs might vary and how to adapt accordingly.

Variations in a Child’s Needs

Landreth, (2002) utilizes the metaphors of molasses vs. popcorn, and orchid vs. mushroom, to describe the varied approaches children display to life’s problems (p50).  Understanding a child’s unique developmental, sociocultural, and interpersonal needs essential in order to adapt effectively.   Understanding how a child’s needs can vary is a first step to contextualizing observations during therapy.   What follows are just a two examples.

Variation in Stages of Play

Children can be observed displaying stages of play during therapy.  VanFleet, et al, (2010) discuss stages of play that include: (1) warming up, (2) aggression, (3) regression, and (4) mastery.  These stages are a convenient assessment of a child’s progress while in therapy (VanFleet, et al, 2010).  In contrast, Landreth, (2002) mentions stages with an emotive focus that include observable stages represent the gradual development of greater self-awareness.

Systems Theory & Ecological Perspectives

Other variations in a child’s needs can be understood from a systems theory and ecological perspective (Metcalf, 2011; VanFleet, et al, 2010).  From a systems theory perspective problems are reflective of the home environment.   A complex web of interpersonal relationships in a child’s home often has a circular causality, which influences the child in complex ways (Metcalf, 2011).  Adding to this insight is an ecological model of human development (VanFleet, et al, 2010).  This ecological model describes children as embedded within an immediate family, community, neighborhood, as well as culture (VanFleet, et al, 2010).  These contexts further complicate the nature of each child’s unique and highly varied needs (Gil & Drewes, 2005).

Diagnoses & Presenting Problems

The discussion board posts this week are convenient examples of how children often bring complex issues to therapy.   Diagnoses such as PTSD, ADHD, and autism, each present with unique challenges for a therapist during play therapy.  Complex issues such as severe neglect or sexual abuse often require a multidimensional approach in which one singular intervention is rarely sufficient (VanFleet, et al, 2010).

Adapting to a Child’s Needs

Molasses vs. Popcorn

Adapting to a child’s needs is no simple matter in light of all the ways it can vary from individual to individual.   Since play is a form of communication, adapting a child’s unique needs is essential so this can be possible.   Landreth, (2002) provides an excellent example in his utilization of the popcorn and molasses metaphor to indicate varied energy levels present in play therapy.  VanFleet, et al, (2010) discuss two cases that are excellent example of the molasses and popcorn metaphor found in Landreth (2002).  In one case, VanFleet, et al, (2010) share the story of a nine-year-old boy with ADHD who would around in therapy like popcorn.  Therapists captured his attention and intrinsic motivation by providing physically engaging activities he enjoyed (VanFleet, et al, 2010).  Directive play interventions decreased his impulsivity (VanFleet, et al, 2010).

In contrast, VanFleet, et la, (2010) also discuss another case of a boy about the same age with PTSD who had grown up in a domestic violence situation.  With symptoms of hypervigilance, night terrors, depression, and explosive anger, he was brought to therapy (VanFleet, et al, 2010).  Initially, he refused to talk and played alone in a corner.  The therapist was patient and let him move at his own pace.  Nondirective Child-Centered Therapy was utilized in which the therapy provided a safe, accepting presence (VanFleet, et al, 2010).

Guiding Principles

The above examples are a convenient illustration of how I might respond to varied levels of energy in play therapy.   The underlying goal in any interventions would be to provide an environment in which a child can engage a play-oriented communicative exchange with the therapist.  With a goal of providing a non-judgmental and accepting presence, it would be my goal to respect the child’s own self-actualizing tendencies (Landreth, 2002).  Allowing the child to lead the way, would mean being in tune with their needs and patiently following along with adaptations necessary to maintain a therapeutic environment (Landreth, 2002).

Expected Challenges

I have worked as a C.N.A. and Psych Tech for about 13 years.  In this span of time, I am frequently assigned to a patients on a 1:1 basis for safety purposes.  Based on this background, I have noticed the greatest difficulty with adolescents and children who are defiant and oppositional.  In the context of my position, I am required to set limits, so the patient adheres the rules of the acute care units while maintaining safety.

Setting aside my roles as mother and health care worker, are required in the play therapy context.   This would present the greatest challenge for me personally.  The nature of a play therapist’s interaction with children is based on an attitude of respect and acceptance.  Providing these qualities requires an awareness of how I am present with the child from moment to moment.  The intentionality and self-awareness underlying all this, would be essential in order to be fully present and provide a child unconditional validation.

References

Gil, E., & Drewes, A. A. (2005). Cultural issues in play therapy. New York: Guilford Press.

Landreth, G. (2002) Play therapy: The art of the relationship (3rd Ed.). New York, NY: Oxford University Press.

Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New York: Springer Publishing Company

Play Therapy: Basics for Beginning Students [Video file]. (2006). Microtraining Associates.  Retrieved September 10, 2015, from Academic Video Online: Premium.

VanFleet, R., Sywulak, A. E., & Sniscak, C. C. (2010). Child-centered play therapy. New York: Guilford Press.

 

 

 

 

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MCC 662 – Play Therapy

In therapy, we give to others based on who we are, and not what we know.  Landreth, (2002), asserts this is especially true for when working with children.   Creating a therapeutic atmosphere, displays of personal courage, and self-understanding, are important for therapists when working with children (Landreth, 2002).   Below, I describe each of these qualities and discuss areas in need of improvement.

Personal Assessment

Creating a Therapeutic Atmosphere.

The adult-child relationship that exists in the context of play therapy is unique in every child’s experience (Landreth, 2002).  Rarely experienced with adults, child therapists engage in a playful interaction that is not “verbally bound” (Landreth, 2002, p96).  Child therapists display a genuine sensitivity and interest in a child’s thoughts and feelings.  Landreth’s (2002) description of the respect and sensitivity required in play therapy, reminds of Marsha Linehan’s concept of emotional validation.  When a child’s perspective is met with validation, they allowed experience acceptance, understanding, and a sense of legitimacy (Linehan, 1997).  Rather than managing or correcting a client’s feelings, a child therapist should seek to respect the validity of this experience from the child’s viewpoint (Linehan, 1997).  The intentionality required to provide this therapeutic atmosphere, requires a great amount of awareness (Landreth, 2002).

When I consider all that is required to provide this therapeutic environment, there are several areas of improvement that come to mind.  As a mother, letting go of “mommy-mode” will be a challenge as I adopt the child therapist’s perspective.   The disciplinary and limit setting elements of motherhood would need to take a back seat.  Additionally, as someone who tends to process things verbally, letting go of this mode of interaction for a play-oriented one, would be a new experience for me.  One key strength I bring is an appreciation of validation, as a critical element in all therapy (Linehan, 1997).  I feel my current profession, has provided me many opportunities to develop this basic skill.

Personal Courage.

Landreth (2002), discusses several personality characteristics essential for a child therapist.  When reviewing these characteristics, I thought personal courage presented the biggest challenge for me personally.   Landreth (2002), describes it as a willingness to admit our mistakes and shortcomings (p102).  This concept is similar to Brene Brown’s (2006), notion of vulnerability which she defines as a willingness be truly seen by risking exposure.   This sort of personal courage goes against one’s natural psychological defenses against hurt or shame (Brown, 2006).  Acting as a child therapist out of personal courage requires a non-defensive expressiveness.  On the one hand, I do have much patience, and am fairly secure in acknowledging my shortcomings (Landreth, 2002).  These qualities can help me display personal courage in my interactions with children during therapy.  On the other hand, I do believe a high degree of self-awareness and mindfulness is required.  This requires an amount of self-care that is currently hard to sustain, as a night-shift worker.   Hopefully, with a different work schedule in my future career, this could be remedied somewhat.

Therapeutic Self-Understanding.

An awareness of our “motivations, blind spots, and biases” (Landreth, 2002, p103), is critical for any therapist.  As Landreth, (2002) notes, the values and ideals underlying these issues are integral to who we are, and we should be aware of them for this reason.  Since we give to others on the basis of who we are, it is our responsibility to understand how these issues can impede or promote our efforts.   While I do consider myself to be a highly self-aware individual as a lifelong self-help junkie, this quality still presents a challenge.  The idea that my personal motivations or biases could enter a play therapy setting makes me cringe somewhat. The best solution is to make personal growth and self-care is a priority.  This would allow me to gain a awareness of how I become an integral part of the therapeutic relationship so I can act more proactively.

Plan for Improvement

As I read through the above descriptions of three essential qualities, I realize  improvement is unlikely to occur overnight.   As a student therapist, I believe personal development should be an ongoing concern.  The following goals can help me develop these essential skills for working with children in therapy.

  1. Goal One: Seek Opportunities to Work with Children.   While this class can provide a vital foundation of knowledge to begin working with children, experience is essential.   I need to seek opportunities to work with children, in order to better understand how to be of a therapeutic benefit in this community.  This can include seeking work-related opportunities, volunteering, and choosing my internship placement carefully.
  2. Goal Two: Be Mindful of How You Respond to Others’ Emotions. The therapeutic environment child therapist’s seek to create provides clients with a unique respectful and validating experience.  Being mindful of how I choose to “attend” to the emotions and thoughts of all children in my life is a good start.  How do I take time to listen and acknowledged the grain of truth in my sons’ feelings and thoughts?  Do I rush to correct any misperception without listening?   Considerations such as these, can help me understand how realistically develop this unique way of relating to children and adolescents.
  3. Goal Three: Display Personal Courage in Conversations with Sons.  My oldest son is 15 and lately I’ve found the personal dynamic between us changing.  He is very bright and observant, and can at times bring up issues that touch upon my own mistakes and shortcomings.  While he doesn’t do so in a disrespectful way, I find I may react with occasional twinges of defensiveness.  I’ve currently practiced, the vulnerability that is integral to personal courage in these conversations.  This effort has taught me what Landreth (2002) says about how we give to children on the basis of who we are and not our internal knowledge bank.
  4. Goal Four: Journal Regularly & Seek Therapy As Needed.  Prior to entering this program, I had been in therapy for about five years.  I still remain in contact with my therapist, and as needed, I may still visit her from time to time throughout my career.  I believe self-understanding requires commitment in the form of adequate self-care coupled with time for reflection.  I enjoy journaling and blogging, and these efforts have provided great insight into myself.  I will continue doing these things in order to promote greater self-understanding in my new role as a therapist.

References

Landreth, G. (2002) Play therapy: The art of the relationship (3rd Ed.). New York, NY: Oxford University Press.

Linehan, M. (1997).  Validation and psychotherapy. Washington, D.C.: American Psychological Association.

Brown, B. (2006). Shame resilience theory: A grounded theory study on women and shame. Families in society: The journal of contemporary social services,87(1), 43-52.

 

 

 

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Studying for the NCE – Behavioral Therapies – A Closer Look

For the second part of this paper, an article will be reviewed that is titled: “Behavioral Couple Therapy:  Building a Secure Base for Therapeutic Integration” (Gurman, 2013).   This article begins with a historical overview of how individual and couples-oriented behavioral therapies have developed.  At the conclusion of this paper, are comments on how Integrative Behavioral Couple’s Therapy can help a practitioner provide a secure base for couples.

A Historical Perspective

n an effort to dispel a historically negative caricature of behavioral therapy Gurman (2013) provides a historical review of behavioral therapy’s course of development.  According to Gurman (2013), despite the historical distrust of this method, approximately 80% of all couple and family therapists now utilize it (p115).   Next is a review of Gurman’s (2013) description of behavioral therapy’s development and application.

Individual Behavioral Therapy

Behavioral therapy’s origins begin with Pavlov’s classical condition and Skinners operant conditioning models.  During individual behavioral therapy’s first wave of development in the 50’s and 60’s, efforts were being undertaken to address the deficits of psychoanalysis (Gurman, 2013).  The stimulus-response learning perspectives of early behavioral therapy were nonetheless criticized as emphasizing first-order changes and a mechanistic in orientation (Gurman, 2013).  Bandura’s social learning theory introduced behavioral therapy’s second wave of development (Gurman, 2013).  In an effort to address a wider range of difficulties, cognitive variables were incorporated with behavioral therapy methods.   Finally during behavioral therapy’s third wave of development cognitive behavioral approaches were applied to an ever increasingly range of issues.  The influences of eastern thought and Buddhist practices were then integrated into many third wave therapies, including Acceptance and Commitment Therapy, and DBT (Gurnman, 2013).  In reaction to the early first-wave behavioral therapies, these third wave CBT therapies emphasized a holistic perspective that considers the importance of context.

Behavioral Couple’s Therapy (BCT).

Interestingly, the development of Behavioral Couples Therapy (BCT) followed a similar path as its individualized variant.  During its first wave of development Gurnman, (2013) describes Operant-Interpersonal Treatment for Marital Discord (OMIT, and Traditional Behavioral Couple Therapy (TBCT).  OMIT, closely resembling early forms of individual behavioral therapy and focuses on each partner’s responsibility.  OMIT focuses on changing behavior with techniques that include techniques and marital token economies, and Quid Pro Quo Contracts (Gurnman, 2013).  TBCT, also a first wave couples behavioral therapy, includes a rewards vs. cost perspective.   Skill development became the focus for TBCT, based on the notion that “nastiness begets nastiness” (Gurnman, 2013, 119).   Since Gotmann’s research has confirmed the uselessness of these early interventions, BCT has developed well beyond its historical origins.

Cognitive-Behavioral Couple’s Therapy (CBCT) constitutes the second wave of BCT’s evolution and development (Gurnman, 2013).   With this perspective the emphasis on skills training was now considered too limiting.  Internal psychological process including automatic thoughts and schemas gained attention in BCT’s ongoing development.  Internal belief structures, and each partner’s attachment history, gained new attention through CBCT.

Integrative Behavioral Couple’s Therapy (IBCT)– The Third Wave

Gurnman, (2013) concludes his paper with a description of BCT’s third wave approach: Integrative Behavioral Couple’s Therapy.  IBCT is a unique form of behavioral therapy that appreciates individual differences and facilitates empathy (Gurnman, 2013).  Central to this approach is non-judgmental perspective in which a holistic analysis is given priority.  The context of a given situation, is important in understanding why behaviors and interactions persist.  In IBCT, context refers to “the term used for changeable steams of events that can exert an organizing influence on behavior” (Gurnman, 2013).  Understanding the function and purpose of behavioral patterns means examining context.  This requires a close examining of a early child experiences, attachment histories and recurrent core themes or patterns in a relationship.

Unlike the earlier forms of Behavioral Couple’s Therapy (BCT) in its third wave of development, insights have been incorporated to address effectively Gotmann’s perpetual problems (Gurnman, 2013).   Functional analysis is useful in explaining how the effects of context and the causal historical underpinnings of ongoing interpersonal relationship patterns.  Techniques and skills taught therapy, can provide a secure and safe place to discuss issue openly during a session.  For example, carefully wording one’s words, by using “I” to discuss one’s feelings and “it” to describe problems in a neutral third-part context are convenient examples (Gurnman, 2013).   Other unique interventions include tolerance-building, which involves a process of learning to find new experiential meaning in the midst of ongoing unsolvable conflicts.  This technique is quite intriguing since it reflects an insight of the Gottman’s regarding masters and disasters and how they take in life experiences.

IBCT – Providing a Secure Base

In conclusion, I would like to make a few comments on IBCT and its ability to provide a secure base during therapy (Gurnman, 2013).  While earlier versions of BCT involve interventions that involve directly modifying thoughts and behaviors, IBCT utilizes a new approach (Gurnman, 2013).  The goal in IBCT appears to involve linking individual experiences with relational ones in an order for the couple to understand each other better.  A mutual understanding of context, provides for the development of more adaptive interactions, and greater empathy.  As a result, alongside pragmatic behavioral changes, are deeper insights that allow partners to develop a greater appreciation for one another.

Underlying this transformation, I’m quite intrigued by how Gurnman (2013) describes the therapist’s role in this process.  As Gurnman (2013) states, rather than micromanaging clients’ behavior, the therapist is watching ongoing functional patterns throughout therapy, and allowing this to play-out.  Gurnman, (2013), describes therapists as barometers, who are wholly present, maintaining a non-defensive and mindful stance throughout sessions.   From this perspective, Gurnman (2013) states that the functional analysis is enriched with the underlying meaning and affective functions of behaviors.  By “wondering aloud” (Gurnman, 2013, p133), within a safe environment, the therapist can introduce these insights to couples in session.

Finally, Gurnman (2013) concludes his article with the following comment:  “The therapist’s emotional resonance to such implicit experiences can greatly facilitate the identification of controlling variables in the couple’s problem themes” (p133).   This insight reflects a comment by Dr. Heitler in the assigned “Angry Couple” video (Holland & Schein, 1995).  In this video, we see Dr. Heitler becoming frustrated at one point during therapy with this angry couple.  She uses this emotional reaction, as a way of understanding and facilitating the variables that underlying their ongoing conflicts (Holland & Scheiin, 1995).  I had great appreciation for how Dr. Heitler was able to remain present and non-defensive throughout this process.  She used this emotional reaction as a guidepost for her interventional techniques (Holland & Schein, 1995).

References

Gurman, A. S. (2013). Behavioral couple therapy: Building a secure base for therapeutic integration. Family Process, 52(1), 115-138. doi:10.1111/famp.12014
Holland, J. (Director & Schein, L. (Producer. (1995).  The Angry Couple [Video File].
Psychotherapy.net. Retrieved November 11, 2015, from The Psychotherapy.net Collection.
Lebow, J. (2006, Sep). FROM RESEARCH TO PRACTICE, scoreboard for couples therapies. Psychotherapy Networker, 30 Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://search.proquest.com/docview/233324408   ?accountid=28125

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Studying for the NCE – Personal Lesson about the Binuclear Family

Ahrons, et al, (2006), describe the binuclear family as a concept that helps normalize a broken home situation in a healthy way.  This term refers to situations in which one family member lives in two homes as the result of divorce. (Ahrons, et al, 2006).  Since nobody in my extended family has ever divorced, my experience with binuclear situation is very limited.   For this reason, I find it interesting that unresolved conflict is the norm in a binuclear family situation.   Upon learning this fact, I’ve stopped to examine my personal beliefs about conflict.  In my family of origin, conflict is conceived of in a highly negative manner.  My parents are college professors who tend to “lead” with their intellect.  As a result emotions take a back seat and issues were “discussed” calmly.   This typical manner of handling issues stands in stark contrast to shows such as “Rosanne”, which my mother always hated.  According to here, it was off putting because everybody was rude to one another.   To this day, as a result of those experiences, I tend to have difficulty with conflict.

Ahrons, et al, (2006) describe conflict as a component of the nuclear family, which must be normalized.  Rather than defining it in highly negative terms, Ahrons, et al, (2006) see it as an issue to manage.  Improving communication styles, examining boundaries and establishing roles are just a few ways in which the therapist can help a families manage conflict more effectively

Most Rewarding Challenges

Helping a family getting unstuck from dysfunctional patterns of interaction would be especially rewarding to me.  This starts as the family learns to see the situation differently by taking time to consider all perspectives of a situation in a therapy session together.   With this understanding in place, this video introduces the concept of a limited partnership that involves a redefinition of the co-parenting relationship (Ahrons, et al, 2006).  Small changes such as developing clear boundaries and roles can make big differences for children.

Most Difficult Challenges

The therapist in this video cautions against allowing our beliefs and values to enter the therapeutic situation (Ahrons, et al, 2006).  Self-awareness is critical in order to prevent imposing our beliefs upon others.   As I’ve stated earlier, I have a problem dealing with conflict.  In a previous position, I worked in a law office with several family law attorneys.  As the individual responsible for preparing many of the legal documents, I often found myself in the middle of conflict.  Family therapy situations such as the one in this video wouldn’t be overwhelming to me.   However, in families with greater levels of dysfunction and conflict, I might become overwhelmed.   The therapist in this video makes a point of noting that beginning therapists often become anxious with so many people in the room together who don’t get along (Ahron, et al, 2006).  This may become me, especially if you add addiction and domestic violence to a situation.

Handling Difficult Challenges

As a therapy student, I don’t think avoiding difficult situations would be the best option.  Working on developing the skills necessary to address these issues effectively would be the best route to take.   I need  to educate myself on issues I have little experience with, such as addiction.  Finally, I will need practice on learning how to manage conflicts in the directive manner as described in this video (Ahrons, et al, 2006).

References

Ahrons, C. R., Graumann, P., Lerner, S., & PsychotherapistResources.com. (2006). Making divorce work: A clinical approach to the binuclear family (Instructor’s version. ed.). San Francisco, CA: Psychotherapy.net

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Studying for the NCE – Family Secrets

In a video Dr. Imber-Black (Family Secrets, 2006), defines secrets as information which is withheld from someone that produces distress and shame as well as create symptoms of dysfunction in a family.  Keeping secrets requires a degree of heightened tension and anxiety.  Communication is less open and individuals are less emotionally present.  For the secret-keeper a feeling of shame perpetuates the secrete and an anxious worry that “if you knew you wouldn’t love me anymore” pervades their thinking  (Family Secrets, 2006).  In contrast the person unaware of this secret, exists in the family as an outsider within the system.  At some level they are aware of this fact and that there is a problem, but they feel they are not supposed to notice. (Family Secrets, 2006).  In addition to worry and confusion, individuals left in the dark begin to doubt their own intuitions.  Over time, family secrets develop into a systemic problems that affect many generations.  Imber-Black (Family Secrets, 2006), describes relationships as booby-trapped, waiting to explode symptomatically as a result of the ongoing secrecy.  Triangles, betrayal, and hidden-alliances as just a few symptoms of secrecy in families that can develop over time (Family Secrets, 2006).  In the end, nobody is able to live as a whole individual in full acknowledgment of the truth (Family Secrets, 2006). In time boundaries are laid down in which those who know and don’t know become divided (Family Secrets, 2006).  Symptoms of these secrets are maintained and supported by efforts as by family members to maintain secrecy for the sake of a systemic homeostasis.

Secrets Supporting Symptoms

Imber-Black states that “knowing, but acting like you don’t know and pretending you are what you are not” are key components of secret keeping (Family Secrets, 2006).  With this in mind, what exactly is meant by Imber-Black’s assertion that “secrets support symptoms” (Family Secrets, 2006)?  The maintenance of family secrets requires a concerted and coordinated effort by everyone in the family.   These efforts can involve the closed communication systems, rigid boundaries and emotional distance.   By keeping a secret, the family is able to maintain homeostasis, although change is unable to happen for the better.  For this reason, I am in agreement with Imber-Black’s therapeutic stance regarding the Reiger family secrets.  While Imber-Black is supportive of whatever decision the family makes, and allows them to move at their own pace, she makes her position clear (Family Secrets, 2006).   Secrets restrict the free flow of information, harming everyone involved.  The secret keeper, is left with distress and shame and unable to live life outside this reality (Family Secrets, 2006).  At the same time, this secret violates a person’s right to know, and “affects their ability to freely [process all information] about their lives” (Family Secrets, 2006)

Understanding The Positive Outcome

What factors attributed to a positive outcome in this particular case?  Not all  instances of revealing family secrets, are likely to go as well as they did within the Reiger family.   Fortunately several important factors were working in their favor.  Firstly, I feel it helps that Dr. Imber-Black was the therapist.  As an individual who has studied, written, and researched extensively on this issue, she was able to delineate several symptoms of family secrecy in the video.   Additionally, I do feel it helps that some time has pasted since the tragic circumstances of Jerry’s death.   The emotions surrounding these events are a bit “less raw”.   I also think the strength of Ray and Liz’s marriage helped them work through this issue together.  They appeared willing to listen and support each other throughout this process.  Finally, while Liz’s parents and Jerry’s family had strong opinions about their marriage at the time, fortunately they were able to move past these issues.  It seems they were open-minded enough to see things from Galen’s viewpoint, and how this secrecy was a dis-service to him.

In cases where things do not go very well, I would expect to see a family divided, as a result of this new information.  The mourning of a lost relationship is strangely similar to a death “of sorts” as family members stopped communicating.  The end result is a long process of  “radical acceptance” and “forgiveness” in order to begin moving forward.  The toughest thing in such cases is the realization that you can only have control over your own actions and behavior.

I greatly appreciated the fact that the instructor included this video.  I struggled with the hypothetical ethical scenarios several weeks ago that touched on this very subject.  Having this information in hand, provides a useful perspective with which to better clarify one’s understanding of the systemic effects of secrecy.

References

Family Secrets: Implications for Theory and Therapy [Video file]. (2006).Psychotherapy.net.

Retrieved October 15, 2015, from The Psychotherapy.net Collection.

Imber-Black, E. (1999). The Secret Life of Families: Making Decisions about Secrets:  when Keeping Secrets Can Harm You, when Keeping Secrets Can Heal You–and  how to Know the Difference. Bantam Dell Publishing Group.

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Studying for the NCE – Gottmans

Abstract

This paper provides a review of an assigned video titled, “Building Trust, Love and Loyalty in Relationships”.   It is a videotaped lecture of John & Jill Gottman, who have devoted their work to understanding relationships.

Question One: “What do these therapists identify as the key ingredients to promoting successful marriages?”

The assigned video this week, we hear John and Julie Gottman discuss the results of almost 30 years of research on marriage.  According to their studies, approximately 69% of all conflicts in a relationship are unsolvable and a byproduct of temperamental differences and lifestyle preferences (Building Trust, Love and Loyalty in Relationships, 2013).   Based on their research they could predict with 90% accuracy the status of a relationship in five years time (Building Trust, Love and Loyalty in Relationships, 2013).   The key to their predictive accuracy lies in examining how the couple handles conflict.   He describes these couples that have participated in his studies as falling within two general categories:  masters and disasters.  The disaster couples become more visibly agitated during conflict. In fact, these disaster couples often display signs that the relationship is doomed in what John Gottman describes as “The Four Horseman of The Apocalypse” (Building Trust, Love and Loyalty in Relationships, 2013).   During a conflict, disaster couples engage in finger pointing, defensiveness, contempt, and stonewalling (Building Trust, Love and Loyalty in Relationships, 2013).  In contrast, master couples are able to maintain calm during conflict, and display empathy, interest, and respect.  The key to long-term success in such cases is an attitude of appreciation and respect even through ongoing conflict.   Criticisms handled with an attitude of pointing toward rather than away.  Describing gently what one wants and how one feels then prevents defensiveness, and the other individual is able to respond with listening and acceptance.   Over time, these couples develop an appreciation and respect and learn to look at their lives together in terms of what they have to be grateful for.

Question Two:  “Do you think that it is possible to build healthy marriages in a counseling session?”

At one point in the video Julie Gottman, describes a counseling session with a couple from Alabama.  In a session, she describes how the wife shares something pivotal, about how her father kidnapped her at night as a young child after divorcing her mother.  As a result of the trauma associated with being separated from her mother, she vowed that she would never let anyone control her again.  This insight was pivotal for the couple, and helped her husband understand why she was always so controlling.  After describing this story, Julie Gottman discusses how this pertains to their theory of marriage.  The uppermost levels of their marriage theory pertain to the notions of shared meaning.  Understanding the perspectives at which the other person is able to take in life experiences is critical.  Are you able to honor and appreciate their meaning system, and how their life experiences and actions reflect this?   Examples, such as this, provided by the Gottman’s show how effective their theory of marriage has served their efforts as therapists.  I do believe that it is possible to build healthy marriage in counseling sessions, given that the couple is motivated and willing to work on the relationship.    Insights such as what is provided in the Gottman’s theory of marriage, when coupled with pragmatic changes can transform the quality of a relationship.

Question Three: “For you as a counselor, what do you view as obstacles or difficulties in conducting successful marriage counseling?”

One key obstacle to conducting successful marriage counseling is if each individual entered with divergent long-term views of the relationship.  If one couple was much less motivated than the other to work on the relationship, there would be limitations to the degree of success.    Other obstacles and difficulties to marriage counseling would include severe mental illness and substance abuse.  Finally, histories of abuse and/or trauma during childhood may complicated the degree of success in marriage counseling, unless these past events were worked through first.

Question Four: “Do any of the issues that are presented differ for same sex couples vs. heterosexual couples?”

In the assigned video, Dr. Gottman didn’t find any significant differences between heterosexual and homosexual couples.  For example, regarding the issue of stonewalling, both lesbian and gay couples, appeared to engage in this behavior equally (Building Trust, Love and Loyalty in Relationships, 2013).  It is important to note, that the Gottmans’ research was based on a laboratory study.  The couples spent weekends in a camera-equipped apartment and observations were isolated to this context.  I do firmly, believe differences between same sex and heterosexual couples would have been observed, if real-world behavioral analysis could have occurred.  For example, Patterson, et al, (2009) briefly mentions challenges unique to same-sex couples including: prejudice, same-couple composition, lack of social-support.   Examining the couples, contend with issues such as these may provide unique insights not found in the Gottman’s studies.

Question Five: “Share one (or more) new insights into marriage counseling that you learned from this video.”

From this video series, I learned that my hubby and I are actually doing very well.  We displayed several ongoing habits common in the Master couples, described by Gottman.  The biggest insight that stuck with me, from this personal perspective was their description of the three love stages.  In the final stage of love, commitment appears to reflect a feeling of gratitude, which involves the fourth level of perspective taking from their marriage theory.   The rose-colored glasses notion involving seeing the best in your partner related to this idea.  It also pertained to how one choose to take in the experience of life, were you seeking for things to be grateful for or criticize?  As I understand it, this final stage of commitment is a feeling of gratitude that permeates all things that transpire between a couple.  Underlying this insight is the simple realization that it is how I’m looking at something and not just what I’m looking at, that is critical.  This video gave me a renewed appreciation for my marriage and the life I’ve created with my husband.

 

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Studying for the NCE – CBT Family Therapy Defined

Metcalf (2011) states that CBT family therapy is based on Albert Bandura’s social learning theory.   Behavioral origins include skinner’s operant conditioning and Pavlov’s classical conditioning.  From this perspective, the cognitive processes people utilize are important when trying to understand how they make sense of their reality.  The behavioral influences provide insight on how beliefs and behaviors are observed and replicated in families.  With all this in mind, change occurs in CBT family therapy when new ways of thinking and interaction are allowed to occur.   This therapy is a present-oriented approach requires a direct and active role of therapists.

One Concept:  Invalidating Environment

Metcalf (2011) spends quite a bit of time discussing Dialectical Behavioral Therapy, a model designed originally by Marsha Linehan, for patients with Borderline Personality Disorder.  A key theoretical concept in DBT is the invalidating environment.  This concept is based on the biopsychosocial model, which asserts mental health is a byproduct of individual vulnerabilities and environmental factors.   According to Linehan, invalidating environments are situations in which a person’s private experiences are met with disapproval and rejected.  Metcalf, (2011) states that in an invalidating environment a person is made to feel they should “not feel what [they] feel” (p97) or think what they think.  Understanding how invalidating environments affect a child’s emotional development is an important insight for parents.

Strengths of CBT

Strengths of CBT include its focus on the present alongside the direct and active role therapists take on when utilizing this model.  I also appreciate that CBT provides both insight and pragmatic solutions for families.  These factors allow this theory to be used in many contexts and even brief therapy.

References

Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New York: Springer Publishing Company

 

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Studying for the NCE – Dealing with Family Conflict

While I haven’t had any professional experience dealing with family conflict, there are many useful insights from the assigned materials this week.   Nay, (2010 describes angry couples in a way that is similar to how Dr. Gottman had described the disaster couples from his research.  In angry/disaster couples, there is a tendency for arguments or ongoing conflicts to quickly escalate and physiological symptoms of fight-or-flight to set in (Nay, 2010). As the therapist in “The Angry Couple” video (Holland & Stein, 1995), explained, oftentimes underlying the conflicts are interpersonal patterns that reflect early childhood experiences.  While the video shows a useful therapy structure that involves both individual and joint couples therapy, the Nay (2010) article provides conflicting perspectives on this technique.  On the one hand, while this technique is useful in addressing early childhood experiences, others might feel that this method isn’t truly a systemic approach.  I’m personally uncertain about how I feel.

Diffusing Conflict.

In the assigned video, the therapist suggests that conflict-focused therapy should focus on: (1) symptom reduction, (2) conflict resolution, and (3) the development of conflict resolution skills, (Holland & Stein, 1995).   Techniques utilized by therapist throughout this video, to prevent and manage conflict involve the establishment of structure.  This structure involved guidelines or rules that could allow both clients to experience a feeling of safety while in therapy so feelings could be explored honestly. For example, structural guidelines can include: (1) avoiding inflammatory crosstalk, (2) using “I” or “and” statements, (3) and allowing equal time for each individual to share their thoughts.  Finally,  the therapist in this video did a good job of managing the emotional conflict level, with an agreed-upon “stop” intervention, when the discussion became too heated.  When utilizing structural guidelines like this, the couple in the video was able to begin practicing conflict resolution skills.  This allowed the dynamic between them to shift from conflict to collaboration.

Anger Prevention Strategies.

The useful anger prevention strategies I saw in these resources pertained to two key insights.  In the assigned video,  therapist discusses early childhood experiences with this couple individually, in order to understand how this is impacting their relationship.  Over the course of several sessions, we learn how experiences in their families of origin impacted them emotionally, and left them with unresolved interpersonal relationship patterns.  When coupling this insight with homework and joint sessions, I believe a transformation of their relationship is possible.   In contrast, the Nay, (2010) article discusses techniques such as the “STOP” acronym, which stands for “stop, think, objectify and plan”.  Skills such as these can provide individuals with anger management skills that are also likely to impact relationships positively over the long term.

References

Holland, J. (Director), & Schein, L. (Producer). (1995). The Angry Couple [Video file].Psychotherapy.net. Retrieved November 11, 2015, from The Psychotherapy.net Collection.
Nay, R. (2010). Case study, stop the merry-go-round: Strategies for angry couples. Washington: Psychotherapy Networker, Inc.
Patterson, J., Williams, L, Edwards, T., Chamow, L. & Grauf-Grounds, C. (2009). Essential Skills in Family Therapy: From the First Interview to Termination. New York: Guilford Press.

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Studying for the NCE – The Initial Session

Abstract

This paper address issues surrounding the initial family therapy session.   It will begin by discussing common anxieties and expectations of family members in therapy.  There will then be an overview of my own anxieties as a beginning therapist.  The paper concludes with a plan that can help me prepare for my first session with a therapist to address these issues.

As a student therapist, imagining my first one-on-one session with a client is a daunting notion.  Family therapy is significantly more overwhelming, in light of the relationship issues and inherent circular causality.  These anxieties are often coupled with a family members who have divergent expectations, anxieties and concerns.  What follows is an overview of common issues concerning clients when beginning therapy for the first time. 

Client Anxieties & Expectations

Desire For Resolution

Prior to the first session, while family members are waiting to be seen, an array of anxieties are likely to loom in everyone’s mind.  Oftentimes, when families enter therapy it is because problems have become unmanageable and they cannot handle things independently.   The initial anxieties clients’ experiences prior to a session are often related to ongoing turmoil at home.  A desire for resolution is a key expectation that fuels efforts to seek outside help.  Clients’ enter the first session with a lot of hope that a remedy to the turmoil can be uncovered (Patterson, et al, 2010).  Each family member probably has a different take on the underlying issues, which further complicates matters.  Ironing these divergent perspectives in the first session can start as everyone takes time to discuss their take on key issues bring the family to therapy.   During this first session the therapist will need to discuss these issues in order to define therapeutic goals (Patterson, et al, 2010).

Motivation and Resistance

Another observation related to clients’ anxieties pertains to the varied levels of motivation present.  This divergence in motivation amongst family member can be observed at the onset of start therapy regarding a noticeable desire to work through issues.  Some family members will be more resistant to the entire therapy process, which is likely to complicate matters further.   It will be important for the therapist to assess motivation and what stages of change each family member is at (Patterson, et al, 2010, p36).  Motivational interviewing techniques can help with resistance and ambivalence as key barriers to therapy.

Perceptions of Therapy

Past experiences in therapy are likely to further color clients’ expectations prior to the first session.  In fact, as a student therapist, when I share with others my career goals, I have occasionally come across people who claim “they don’t believe in therapy”.  While this can at times be related to negative experiences in therapy, it can also be simply an individual’s desire not to “rehash old issues”.   In reality there are many paths to the same point of resolution that are reflective in temperament-based differences.   Some individuals may be more responsive to therapy than others.  Addressing a client’s believes about therapy will require establishing a connection and attending with administrative issues while discussing any past experiences.

Professional Anxieties & Expectations

Performance anxiety is a huge issue for me as a student therapist.  Family counseling is more anxiety inducing than traditional therapy for me, since I’m now in front of a group of people.   Part of this anxiety is related to the fact that I will bring all my life experiences, biases, perceptions, feelings, and temperament to the table while with clients.  Self-awareness will be key to understand how these factors influence my work as a therapist in individual and family counseling.  My tendency has been address such anxieties by being over-prepared with thorough research.  This can involve taking time to review thorough clients’ medical and psychosocial histories as well as cultural backgrounds can be helpful.  Telephone interviews will be helpful in gaining clarity on the nature of the problem and its underlying complexities.

Finally, I feel its also important to mention that anxiety is part of the learning process with beginning therapists.   The stages of development for beginning therapists are all a part of this process (Patterson, et al, 2010).  This development process includes leaning essential skills, developing a theoretical framework, and self-examination.  As I have experienced them, thus far, they have occurred concurrently.

Putting Clients at Ease

Before Initial Contact

Addressing my own performance anxiety will be an essential preparatory step before I can attend to the client’s expectations and concerns.  This will entail self-awareness, adequate self-care, and an acceptance of anxiety as part of the learning process.   Pre-session telephone interviews, discussed in Patterson, et al, (2010), are also an essential step to addressing client’s expectations and anxieties.   Talking with family members in these pre-session phone calls, can allow the therapist an opportunity to assess these expectations and concerns.  In addition to developing a better understanding of the presenting problems, client expectations can also be discussed.  Based on this information, the therapist engages in some preliminary hypothesizing (Patterson, et al, 2010, p22), on the possible nature of the presenting problems.  This process can help the therapist in developing questions for the first interview that can further clarify matters.

Developing Connections

Patterson, et al, (2010) describe joining as a means to make “clients feel a sense of connectedness, which usually arises when they feel you understand, respect, and care about them” (p25).   Joining begins when you shake a clients’ hands and greet them in the waiting room.  It continues when you engage in some preliminary small talk before “getting down to business”.  The main goal of this social talk is to create a safe and secure environment that makes the clients feel at ease (Patterson, et al, 2010).  As the first session progresses, attentive listening skills and direct eye contact will also facilitate the joining process (Patterson, et al, 2010).

Administrative Issues

Confidentiality Issues, Fee Structures, and Release of Information Forms are just a few administrative tasks that should also be addressed during the first session (Patterson, et al, 2010).  These administrative issues, can address several of the client’s concerns about entering into therapy.  Common concerns for most clients entering therapy involve cost and how confidential information will be handled.  Discussing your fee structure and the client’s insurance policy can address cost-related issues (Patterson, et al, 2010).   Limits of confidentiality and how you handle confidential information amongst family members can also ease clients’ anxieties.  The main goal of this discussion is to dispel any anxieties, by making the client aware of what they can expect in therapy.

Defining Goals

Clarifying everyone’s expectations and goals for therapy will involve continuing the discussion that began in earlier phone interviews.   The preliminary hypothesizing that occurs after the initial phone interviews can provide guidance on the questions the therapist must ask.  Taking time to allow each family member to discuss his or her concerns is critical.   There are liable to be multiple problem areas with divergent perspectives on each issue.  Expectations may be unrealistic, the issues unclear, and occasionally some family members may have unstated agendas (Patterson, et al, 2010).  Several key concerns guide this discussion.  Firstly, are the client’s presenting problems within the scope of our care and ability (Patterson, et al, 2010)?  Secondly, do you have a clear understanding of the client’s expectations and can everyone come to a consensus about the goals for therapy (Patterson, et al, 2010)?

Building Motivation

In the pre-session phone interview, it will be possible to assess levels of resistance in family members and determine how willing they will be to participate.  These initial insights can be further explored during therapy through motivational interviewing techniques.  Clients’ should be assessed in terms of their level of resistance against the stages of change (Patterson, et al, 2010).  Motivational interviewing techniques can be helpful in addressing any ambivalence to the possibility of change (Patterson, et al, 2010).

References

Patterson, J., Williams, L, Edwards, T., Chamow, L. & Grauf-Grounds, C. (2009). Essential Skills in Family Therapy: From the First Interview to Termination. New York: Guilford Press.

 

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