Couples and Family Therapy

Archived Posts from this Category

March 31, 2010

Comps

Posted by Nathen under CFT cohort, Couples and Family Therapy, graduate school, learning curves, marriage and family therapy, relationships, school, secrets, tests, typing
[2] Comments 

At 8 o’clock tomorrow morning, I am taking my first round of comprehensive exams for my couples and family therapy program. The purpose is to make sure we understand all of the theory we’ve been learning before we start seeing clients. If I don’t pass, I will be given another chance at it in the summer–I won’t be able to see clients this summer, but I could start in the fall.  I feel good about it. I am ready.

We will be graded Pass, Fail, or Pass With Distinction. I expect to get a Pass. I know the material quite well, but we’re supposed to write 3-4 single spaced pages on each of three questions, all in five hours. With citations. That’s a lot of typing. I’ve done three dry runs through the test, and the most I’ve been able to type, even with my outlines in front of me, is 7 1/2 pages, total. I’m not a fast typist, and I still have to think some about what I’m going to write. I’m fine with a “Pass.” Part of my learning curve is learning how to stop at “good enough.”

We’re allowed to bring food, drinks, ipods, and our reference lists with the references in any order. (I’ll paste in my list below). I’m also bringing my own keyboard (Microsoft Natural Keyboard Elite) and mouse (Logitech TrackMan Wheel). Five hours of fast typing–I need to be comfortable! I’d like to bring my chair, too (Herman Miller Aeron), but it’s difficult to bike with.

Tonight I’m treating myself to some food someone else made and getting into bed early.

Here are the questions. I’ve had them since December. Below them is my reference list. Wish me luck!

Question 1

Describe in detail systems theory, contrasting it with modernism (aka positivism). Be sure to include central concepts of both epistemologies and explain them fully. Also detail the main concepts of communication theory, and the connections between communication theory and system theory. Describe a family problem in detail using a specific model of family therapy (Structural, Strategic, Solution Focused, Experiential, EFT, Bowen) to describe the relevant associated concepts to understand the situation. What are the model specific concepts you will use to understand the family? How will it direct your treatment? What interventions might you utilize to help this family? Why are these interventions systemic? How will you evaluate outcomes based on this model of therapy? How will the common factors research influence your view of intervention with this family?

Question 2

Research ethics includes principles of social justice and dictates competence at each of the following levels: a) conducting research, b) consuming research, and c) utilizing the research literature.

Describe the key social justice considerations when conducting research, when evaluating the merits of a research study, and when utilizing research data as a clinician. In your response include notions of consent, validity, and the characteristics of a well-constructed qualitative and quantitative research designs. Finally, specifically describe how you will incorporate your knowledge of research and its relationship to social justice while a clinician at the CFT.

Question 3

Please describe a process for how you will develop a systemic diagnosis and treatment plan for the client system depicted in the vignette below. Carefully describe how your diagnostic impression and treatment plan are informed by your knowledge of (1) diversity, (2) empirically validated treatments, (3) relational ethics, (4) the diagnostic and statistical manual and (5) CFT theoretical frameworks (systems and communications theories). Finally, based on the vignette below, talk about your treatment approach and how it is informed by the five areas mentioned above. Clearly articulate your systemic diagnosis and treatment plan for this client system.

Kelly (39) and Kris (26) presented for couples therapy. The couple reports they have been together for about two years and are very serious about their future together. Kris reports they have “problems understanding each other. We just can’t communicate.” Kelly agrees and reports it’s been that way for several months. Every time they try to talk with each other about their problems they don’t get along and often engage in escalating verbal arguments. The arguments often lead to Kelly leaving the house very upset and not coming home until the next day. Each partner is hoping for it to get better and want to engage in ongoing couples therapy. Kris reports feeling down and “out of sorts” most of the time and has had difficulty in getting out of bed and making it to work on time the past few months; however, is able to have some good days feeling happy and energetic. After the third session, Kelly discloses to you over the phone that he is thinking of engaging in a sexual relationship with another partner but doesn’t want to bring it up in therapy yet, and doesn’t want you to, either. He states that he feels having another partner will help the relationship because he will “be able to get my needs met.” He further reports to you that they both occasionally seek out partners outside the relationship and feel an open relationship works for them, though made the decision years ago to just not talk about it when it is happening.

Comps References

Becvar, D. S. & Becvar, R. J. (2006). Family therapy: Systemic integration. Boston, MA: Pearson.

Burbatti, G. L. & Formenti, L. (1988). The Milan approach to family therapy. Northvale, NJ: Jason Aronson.

Fisch, R., Weakland, J. H., & Segal, L. (1982). The tactics of change: Doing therapy briefly. San Francisco, CA: Jossey-Bass.

Gehart, D. (2010). Mastering competencies in family therapy: A practical approach to theories and clinical case documentation. Belmont, CA: Brooks/Cole.

Haley, J. (1993). Jay Haley on Milton H. Erickson. New York, NY: Brunner Mazel.

Madanes, C. (1991). Strategic family therapy. In A. S. Gurman & D. P. Kniskern (Eds.) Handbook of family therapy (pp. 396-416). Madison, WI: Routledge.

Nichols, M. P. & Schwartz, R. C. (2008). Family therapy: Concepts and methods. Boston, MA: Pearson.

Sandberg, J. G., Johnson, L. N., Dermer, S. B., Gfeller-Strouts, L. L., Seibold, J. M., Stringer-Seibold, T. A., Hutchings, Andrews, J. B., & Miller, R. B (1997). Demonstrated efficacy of models of marriage and family therapy: An update of Gurman, Kniskern, and Pinsof’s chart. The American Journal of Family Therapy, 25(2). 121-137.

Sprenkle, D. H. & Blow, A. J. (2004). Common factors and our sacred models. Journal of Marital and Family Therapy, 30(2), 113-126.

Watzlavick, P., Bavelas, J. B., & Jackson, D. D. (1967). Pragmatics of human communication: A study of interactional patterns, pathologies, and paradoxes. New York, NY: Norton.

Sells, S. P., Smith, T. E., & Newfield, S. N. (1996). A clinical science for the humanities: Ethnographies in family therapy. In S. Moon & D. Sprenkle (Eds.), Research Methods in Family Therapy (pp. 25-63). New York: Guilford.

National Institutes of Health (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. URL http://ohsr.od.nih.gov/guidelines/belmont.html

National Institutes of Health (2010). The Nuremberg code: Directives for human experimentation. URL http://ohsr.od.nih.gov/guidelines/nuremberg.html

Sue, S. (1999). Science, ethnicity and bias: Where have we gone wrong? American Psychologist 54(12), 1070-1077.

Freire, P. (1970). Pedagogy of the oppressed. New York, NY: Continuum.

Aronson, E., Ellsworth, P. C., Carlsmith, J. M., & Gonzales, M. H. (1989). Methods of Research in Social Psychology. Columbus, OH: McGraw-Hill.

Creswell, J. W. (2009). Research design: Qualitative, quantitative, and mixed methods approaches. Los Angeles, CA: Sage.

Corey, G., Corey, M.S., & Callanan, P. (2011). Issues and ethics in the helping professions (8th Ed.) Belmont, CA: Brooks/Cole Cengage Learning.

Fisch, R., Weakland, H., & Segal, L. (1982). The tactics of change. San Fransisco: Jossey-Bass.

American Psychological Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.-TR). Washington, DC: American Psychchological Association.

Bettinger, M. (2006). Polyamory and gay men: A family systems approach. In J. J. Bigner (Ed) An introduction to GLBT family studies (pp. 161-181). New York, NY: Haworth.

LaSala, M. C. (2001). Monogamous or not: Understanding and counseling gay male couples.

Families in Society, 82(6), 605-611.

 

February 17, 2010

The No-Secrets Policy

Posted by Nathen under CFT cohort, countertransference, Couples and Family Therapy, graduate school, infidelity, marriage, marriage and family therapy, no-secrets policy, relationships, secrets, statistics
[5] Comments 

Yesterday, I participated in my master’s program’s OSCEs–Objective Structured Clinical Exercises–for the students in the year ahead of me, who are about to graduate. My cohort played clients in specific, challenging scenarios for the second-year-cohort therapists. The activity was adapted from a medical school test of clinical ability.

My scenario was the most challenging of the day. The therapists came in expecting to be doing a goal setting exercise with a couple but found that only one of us (me) had showed up. I was to immediately disclose an affair and request that the therapist not tell my wife about it. I had ended the affair, felt very guilty about it, and was certain that revealing it would destroy our relationship. I was to try and get the therapist to help me with the “things that pushed me to do this.”

I am not a good actor, so it took all my attention just to get my part across in a semi-believable way. When I watched my cohort-mates play the same part, though, it was heart wrenching. They did such a good job showing remorse, almost crying, showing the fear of losing their husbands, and over “a stupid mistake.” (Well, three stupid mistakes with one person.) I really felt for them–and they were just pretending! I can see how much preparation I will need to do to handle this kind of situation effectively. I am certain to have clients who have affairs. I just looked up the statistics, and the lowest numbers I found are that about 15% of married women and 25% of married men have sexual affairs. That means that at least one out of four couples I see will have had or are heading towards an affair.

Our clinic has a “no secrets” policy for couples counseling. It’s something we bring up on the first day of therapy. If one member of a family has an individual session, what is said in that session is not going to be confidential to the rest of the family. The idea is that for this work, it is the relationship that is our primary client, not the individuals, and that secrets (differentiated from privacy) are toxic to relationships. Also, if the we are brought into one person’s secret and keep it, we can no longer serve the relationship without bias.

I think that the no-secrets policy is a good idea and I have been planning to use it in my work, but now, seeing it in practice, I see that it’s not just a matter of having a policy. I will need to thoroughly wrap my head around how it will apply in different scenarios. I will need to talk it through with a lot of people so I feel comfortable and confident in my thinking. I will also need to remember to remind clients about the no-secrets policy the moment I see that a couples client has come in alone. We introduce the policy during the first session, but that may not be what a client is thinking about when they disclose an affair. They may think that I have trapped or betrayed them if their disclosure is followed by, “Remember that no-secrets policy we talked about during our first session?”

Ideally, in this case, we would work together with the client on a palatable way to reveal their actions to their partner and then work with the couple to heal the rifts. We don’t automatically tell the partner about affairs, either. There are some things that we are required by law and ethics to report, like death threats or the abuse or neglect of a child, but affairs are not one of them. If the cheating partner refuses to allow revealing the secret, I would have to refer the couple, for suitably non-specific reasons, to another therapist who could be unbiased, if in the dark.

I think that I need to rid myself of some countertransference when it comes to affairs. That is, as it stands, I think I might favor cheat-ee over cheating clients, because it’s harder for me to relate to cheating. I walked out of our role plays thinking, “Wow, it’s so much simpler and less painful to avoid an affair than it is to deal with the aftermath!” Can anyone recommend a good book or movie that could help me empathize with someone having an affair–especially someone who feels like they are not in control of their actions, or just not thoughtful, in sexual infidelity?

This is interesting and sometimes painful work I am getting myself into!

 

January 24, 2010

Headlines From Psychology, Part 2

Posted by Nathen under advice, anger, contempt, Couples and Family Therapy, decisions, defensiveness, disease, divorce, headlines, healthcare, helping, lists, marriage, marriage and family therapy, probability, psychology, relationships, science, statistics, video
[5] Comments 

Here’s part 2. (And if you missed it, here’s part 1.) Again, if you are either interested or skeptical, leave me a comment and I’ll point you to the evidence.

Statistically, Divorce is Not a Good Strategy for Getting a Better Marriage: 50 to 67% of first marriages end in divorce. 60 to 77% of second marriages end in divorce.

Your Brain Has Trouble Giving Information About Probabilities Due Weight, So Pay Attention to Base Rates: We have trouble taking the actual prevalence of events into account when making decisions. For example, people tend to be more afraid of dying in a plane crash (lifetime chance: 1 in 20,000) than dying in a car wreck (lifetime chance: 1 in 100) or even of a heart attack (lifetime chance: 1 in 5). One reason for this is that we confuse the ease with which we can think of an example to be an indication of how likely something is. Try this: What do you think is more common, words beginning with “r” or words with “r” as the third letter?

If You Test Positive For a Very Rare Disease, You Still Probably Do Not Have That Disease: This is a headline that should come from medicine, not psychology, but psychologists are better at probability than doctors, who are no better than laypeople, at least when it comes to thinking about this: Even with a very accurate test, if a disease is very rare, a positive result is still much more likely to be a false positive than an accurate positive. I’m going to explain this, but if you don’t get it, don’t worry. Just remember the headline. It’s true.

The table below shows a hypothetical situation with super-round numbers to make it easier to get. You have gotten positive results on a test that is 99% accurate for a disease that occurs only once in 10,000 people. Most people figure they are 99% likely to have the disease. They are wrong:

Test Results
Disease Present? Test Results Positive Test Results Negative Row Totals
Disease Present 99 1 100
Disease Not Present 9,999 989,901 999,900
Column Totals 10,098 989,902 1,000,000

Since your test results are positive, you are somewhere in the left-hand column. You are either one of the 99 who both have the disease and whose test results are positive, called “hits,” or one of the 9,999 who do not have the disease but whose test results are positive, called “false positives.” As you may see, even though your test results are positive, you still are 99% likely to be a false positive and not a hit, simply because the disease is so rare.

Yes, this is counter-intuitive. That’s why it’s important. And that’s why statistics are important. Again, if you don’t understand, don’t worry. If you don’t believe it, though, come up with a specific question, leave it as a comment, and I’ll answer it.

If You Need Help, Ask Someone Specific for Something Specific: Bystanders generally do not help people who are in trouble. The bigger the crowd, the less likely someone will help. It’s not because they are bad or lazy. It’s a specific kind of well-documented confusion. Kind of like in the clip below. What you need to know is, if you need help, even if it seems like it should be completely obvious to anyone around, like you’re having a heart attack, falling to the ground, gasping, whatever, point to a specific person and give them specific instructions: “You, in the red shirt. I’m having a heart attack. Call an ambulance.” Do not assume anything will happen that you did not specifically ask for. A corollary of this headline is, if you think someone might be in trouble, don’t assume they would ask you for help, and don’t assume someone else is helping them. Help them yourself. It could mean the difference between them living or dying.

Get Help For Your Marriage When the Trouble Starts (Or Before): On average, couples wait 6 years after their marriage is in trouble to get help. The average marriages last 7 years. That means that most people who come to couples counseling are deeply entrenched in problems that would have been relatively easy to resolve earlier. It is not uncommon for a couple to come in to counseling with a covert agenda to use the counselor to make their inevitable divorce easier. We can do this, but believe me we’d much rather meet you earlier and help you stay together! Also, I’m not joking about “or before.” Couples counselors are well-trained to give “tune-ups” to couples who are doing well. It’s a good idea.

Anger Is Not Destructive of Relationships, Contempt and Defensiveness Are: Everybody argues. Everybody screws up their communications. It’s the ability to repair things that is the key, and contempt and defensiveness get in the way of that.

 

December 8, 2009

Meta-Worry Man

Posted by Nathen under Couples and Family Therapy, going meta, ideas
[2] Comments 

Doing therapy is all about “going meta,” which basically means taking a one-level-up perspective. In my  couples and family therapy program that usually means talking or thinking about the process couples or families are involved in (are they, for example, acting out a pursuer-distancer pattern?) versus the content of their conversations (the specific complaints, “He never takes out the trash,” “She’s always on my back,” etc). Talking about talking is “meta-talking.” Thinking about thinking is “meta-thinking.” This is an idea I had during a lecture:

 

October 1, 2009

One Half of My Fall Term Workload

Posted by Nathen under Couples and Family Therapy, graduate school, GTD, lists, reading, school
Leave a Comment 

I just entered the assignments listed on the syllabi from my first two (of four) classes–Family Theory and Gender & Ethnicity in Family Therapy. It’s all reading and writing. There are about 20 assignments that I have on repeat in my PDA, so they only show up once here. Still, I anticipate that this is about half of my workload for the next 10 weeks.

Virtual dialog entry for Family Theory    10/6/2009
Two questions from readings–Family Theory    10/7/2009
Personal Epistemology essay 1    10/7/2009
616 e-reserve Glasserfeld    10/7/2009
619 Genogram    10/7/2009
McGoldrick ch 1    10/7/2009
Read Genogram Materials folder    10/7/2009
619 Read AAMFT Code of Ethics URL    10/7/2009
619 Read Chronister, McWhirter, & Kerewsky [In Ecological Model folder]    10/7/2009
Personal Epistemology essay 2    10/14/2009
616 Pragmatics ch 2-3    10/14/2009
616 e-reserve Bateson Theory of schizophrenia    10/14/2009
616 Sullivan lecture 1    10/14/2009
619 Ecological risk and resilience worksheet    10/14/2009
Read a chapter of McGoldrick et al. that relates to your family of origin, and one that seems very different. Write in your journal about these chapters, particularly in relation to yourself.    10/14/2009
Read McGoldrick et al., Appendix: Cultural Assessment    10/14/2009
Skim McGoldrick et al., Chapters 36, 37, 38    10/14/2009
619 Genogram and ecological worksheet due    10/14/2009
619 Read Shachtman    10/14/2009
619 Skim Paniagua    10/14/2009
619 Read McIntosh URL    10/14/2009
619 Read Kincaid    10/14/2009
Personal Epistemology essay 3    10/21/2009
Family theory quiz 1    10/21/2009
Pragmatics ch 4-5    10/21/2009
616 e-reserve Jackson on Homeostasis    10/21/2009
616 Sullivan lecture 2    10/21/2009
619 Read Gone    10/21/2009
619 Read Phinney et al.    10/21/2009
619Read Sullivan et al.    10/21/2009
Personal Epistemology essay 4    10/28/2009
Pragmatics ch 6-7 and epilogue    10/28/2009
616 e-reserve Jackson on Study of the Family    10/28/2009
Sullivan lecture 3    10/28/2009
619 1000-1500 wd reflection paper (weird format–look in syll)    10/28/2009
Read McGoldrick et al,. Chapter 20, 21, 27    10/28/2009
619 Read Serdarevic & Chronister     10/28/2009
619 Read Boyd-Ball & Dishion    10/28/2009
619 Read Nguyen    10/28/2009
619 Read Ung    10/28/2009
619 Read Littleford    10/28/2009
Personal Epistemology essay 5    11/4/2009
Tactics, beginning to end of ch 2    11/4/2009
616 e-reserve Jackson: sick sad savage sane    11/4/2009
Sullivan lecture IV    11/4/2009
619 Begin reading Him    11/4/2009
619 Read Hertlein    11/4/2009
619 Read Grealy    11/4/2009
619 Read Grealy    11/4/2009
619 Read Decker    11/4/2009
619 Read Kerewsky    11/4/2009
619 Read Steele    11/4/2009
619 Read Mahalik et al.    11/4/2009
Personal Epistemology essay 6    11/11/2009
Tactics ch 3-4    11/11/2009
616 e-reserve Jackson, Myth of normality    11/11/2009
Sullivan lecture V    11/11/2009
619 Responses to clinical vignettes due    11/11/2009
619 Read Davies et al.    11/11/2009
619 Read Loschiavo et al.    11/11/2009
619 Read Swofford    11/11/2009
619 Read APA Guidelines for Psycholological Work with Girls and Women    11/11/2009
619 Read Ali    11/11/2009
Read McGoldrick et al., Chapters 10, 22, 23     11/11/2009
619 Read Beatie    11/11/2009
619 Read Carroll, Gilroy, & Ryan    11/11/2009
Personal Epistemology essay 7    11/18/2009
Family theory quiz 2    11/18/2009
Tactics ch 5-6    11/18/2009
616 e-reserve Dramatization of Evil    11/18/2009
619 Clinical paper    11/18/2009
619 Read hooks    11/18/2009
619 Read Lott    11/18/2009
619 Read Miller & Thoreson    11/18/2009
619 Read Beah    11/18/2009
619 Read Williams & Williams-Morris    11/18/2009
619 Read Reeve    11/18/2009
619 Read Root    11/18/2009
Read McGoldrick et al., Chapter 5    11/18/2009
Skim McGoldrick et al., Chapters 6, 7, 8, 9    11/18/2009
Personal Epistemology essay 8    11/25/2009
Family theory paper presentation    11/25/2009
Tactics ch 7-9    11/25/2009
616 e-reserve Tomm on Milan FT    11/25/2009
619 Read Yardley    11/25/2009
Tactics ch 10-12    12/2/2009
616 e-reserve Madanes on Stratigic FT    12/2/2009
619 Read doctoral students’ summary of Sue et al.    12/2/2009
619 Read Georgas et al. (2 parts)    12/2/2009

 

September 28, 2009

I’m Back From NBTSC and About to Start Grad School

Posted by Nathen under Couples and Family Therapy, Not Back to School Camp, school
[2] Comments 

I got back from Vermont and Not Back to School Camp last night and spent today scurrying to get ready for the start of my term. I’m doing a masters in Couples and Family Therapy, starting tomorrow. I’ll do a year of theory (lots of lectures, reading, and writing) and then a year of practice. I’ll be taking clients next summer. Here’s the list of classes for the first term, with the descriptions provided by the program:

Research Methods Research strategies, statistics, and techniques relevant to the field of family therapy provide evaluative skills for interpretation of statistical data, qualitative and quantitative research methods and the bi-directional continuum for research design.

Introduction to Family Therapy Overview of the major models and methods of systemic counseling as they have evolved in the field of family therapy. Application of systemic therapy models to assessment and treatment protocol for common presenting problems.

Family Theory A study of the major theoretical orientation and general theories relevant to the study of the family including exchange theory, symbolic interaction, general systems approach, conflict and phenomenology.

Gender and Ethnicity Introduction to thinking critically about clients’ and therapist’s group memberships and identifications, and the effects of these on the therapeutic relationship and interventions. Particular emphasis is placed on understanding both enduring and changing human diversity contexts through the use of Bronfenbrenner’s Ecological Model and genograms as both assessment and intervention techniques.

 

« Previous Page