Short-Term Goals/Treatments
Focus is not increased function, but restoration of function. Should have potential to reduce sx and develop coping skills (if stressor lies outside the control of the client).
Intermediate Goals/Treatments
Focus on transferring progress already made to a different setting/relationship. Anything that builds up a short-term goal.
Long-Term Goals
Implications of change in deeply ingrained patterns and responses. Deep intrapsychic conflicts may be resolved.
Relationship Between Level of Function and Goals
The lower the client's level of function, the more specific the goals must be. High functioning, the goals may be general. Reality testing differentiates low functioning from moderate functioning. Meeting role obligations differentiates moderate functioning from high functioning.
Selecting Appropriate Interventions
Efficient and effective help for the client is the objective. Techniques should be selected that provide the greatest reductions in symptoms, largest increase in function, and most reduction in stressors.
Person-Centered Techniques
For use with high functioning.
For use with situational disorders or involving self-esteem/confidence and help in goal setting.
Techniques: acceptance, unconditional positive regard, empathy, reflection, support, clarification, open-ended, modeling, rapport building.
Behavioral Therapy
Targets Dysfunctional Behaviors
Works by altering actions. If the simulation describes sx in terms of behaviors, use behavioral. For use with low to moderate functioning. (Eating, CD, Substance, Impulse, Conflict, Phobias, Sexual, Suicidal, Relapse, some Sleep. When used WITH Cognitive, helpful for Depression, Anxiety, early Personality)
Techniques: Baseline, Contracts, diaries, aversion, consequences, reinforcement schedules, incompatible alternatives, flooding, in vivo, biofeedback, relaxation, role-play, modeling, assertiveness, token, activity schedule.)
Tracking Improvement/monitoring
Self-report/review of data.
Compliance with tx, appointments, referrals.
Lessening of symptoms.
Improvement of functioning (affective and cognitive)
Accessing information from other treatment providers; medications, social interactions, energy level, mood graph
Cognitive Dysfunction
When symptoms are described in terms of cognitive dysfunction, the need for a cognitive technique is indicated.
Rational Emotive Therapy
Useful for the treatment of Depression, Anxiety mild situational Disorders and Bulimia
Cognitive Techniques are Contraindicated When...
Family has a history of bipolar, scizophrenia, cognitive disorder, or mental retardation.
Cognitive Techniques
Analysis of dysfunctional thinking patterns, cognitive restructuring, hypothesis testing, mental/emotional imagery, modeling, thought stopping, meditation, self-talk, record of dysfunctional thoughts, diaries, letter writing, rating systems, hourly mood graph, affirmations, systematic assessment of alternatives, grid evaluations.
Existential Psychotherapy
Goal of changing meaning. Indicated for high functioning individuals. Particularly those with a V code.
Those with mild to moderate depression or anxiety, help coping with life threatening illnesses, situational concerns, seeking meaning in life. NOT for substance abuse
Gestalt Counseling
Used in combination with cognitive & behavioral approaches. Indicated for moderate to higher functioning individuals.
Good for those with somatic complaints, provides access to feelings with the goal of unblocking.
Gestalt often targets anger, grief, anxiety, and depression. Not SA
Adlerian Psychotherapy
Lifestyle results from private logic. Indicated for those with issues of goals and directions, parent-child problems, acting-out behaviors, career crises, marital concerns, or low self-confidence. Focuses on healthy or unhealthy coping skills.
Prolonged Psychoanalysis
Indicated for those with hysteric or phobic disorders.
Contraindicated for those with paranoia, borderline personality disorder, obesity problems.
Psychodynamic Psychotherapy
For high functioning individuals with V Code disorders, personality disorder, Multiple Personality Disorder.
Short term can be beneficial for depression, anxiety, and situational disorders with repeated patterns.
Adjustment Disorders and V Codes
Objectives: symptom relief, improvement of coping skills, and restoration to a least prior functioning.
Anxiety Disorders
Objectives: reduction of anxiety, improved management of stress. Development of socialization skills, sense of matery.
Generalized Anxiety Disorder
Anxiety management program.
Computer Based Training.
Relaxation.
Antidepressants or azapirones may be indicated, but do not recommend pharmacological interventions.
Panic Disorder
Panic Control Treatment.
Computer Based Training.
Relaxation.
Bibliotherapy.
Panic education.
Antidepressants may help. Do not recommend medications.
Obsessive-Compulsive Disorder
Exposure therapy.
Anxiety Management Training.
Cognitive Processing.
Antidepressants may be indicated.
Mood Disorders
Objective: overall adjustment, mood stabilization, alleviation of depression and mania, enhancement of coping skills, improvement of relationships and prevention of relapse.
Disorders of Behavior and Impulse Control. Including Eating Disorders, Sexual Disorders, Sleep Disorders, Psychoactive Substance Use, and Other Impulse-Control Disorders.
IObjective: Reduction of dysfunctional behavior and acquisition of positive behaviors, behavior change.
Emphasis on Behavior Therapy with a multifaceted approach.
Behavior and Impulse Control Techniques::: Education, measurement of changes, improved communication.
Group work can be helpful for those who are resistant to therapy. Medical examination is imporant in the evaluation.
Anorexia and Bulimia
Medical assistance and nutritional counseling must be combined with family therapy for significant change to occur. Hospitilization may be required.
Anorexia and Bulimia Techniques::: Behavioral approaches to stabilize eating patterns, Insight oriented psychotherapy follows stabilization.
Anorexia: more serious because psychotic features may be present.
Bulimia: Insight-oriented, focus on body-image, self-esteem, and behavioral therapy. Hospitilization can be handled on an out-patient basis. Interpersonal therapy, therapy groups, and computer based training, and behavioral weight loss are appropriate.
Sleep Disorders
Insomnia stimulus control therapy.
Sleep restriction therapy.
Relaxation trianing.
CBT.
Benzodiazepines, Zolpidem, and antidperessants may be effective. Do not recommend medication.
Disorders Combining Physical and Psychological Factors
Objectives: Reduced somatization, constructive expression of feelings, stress management, improved socialization, relaxation, positive use of leisure time.
Personality Disorders
Objectives: Improvement in social and occupational functioning, increased communication skills, raised self-esteem, enhancement of coping skills, developing a sense of responsibility. Long-term modification of underlying dysfunctional personality patterns.
Disorder Involving Loss of Contact with Reality
Objective: restoration of contact with reality, enhancement of coping mechanisms, maximizing adjustment to the disorder. Relapse prevention. Providing assistance to family members. Working through appropriate care-related decisions.
Schizophrenia
Behavioral therapy.
Social Learning Programs.
Family Education.
Social Skills Training.
Vocational Rehabilitation.
Antipsycotics may be helpful. Do not recommend medication.
Sexual Disorders
Must rule out underlying mental health conditions such as Anxiety Disorder or Depression. Bichochemical or medication-induced explinations should be explored.
Orgasmic Disorders in Women
Cognitive Behavioral Approaches focus on anxiety reduction and attitude change. Increasing positive feelings and frequency of orgasm. When non-orgasmic symptoms are rooted in traumatic experiences, insight-oriented are indicated.
Dyspareunia
Behavior Therapy may employ systematic desensitization.
Sensate Focus.
Imagery Techniques.
Cognitive Restructuring.
Relationship Interventions.
Supportive Psychotherapy.
Lubrication Assistance.
Surgery may be necessary. Do not recommend treatments.
Vaginismus
Relaxation.
Desensitization.
Guided fantasy.
Self-Control activities.
Supportive Psychotherapy.
Kegel.
Premature Ejaculation
Challenging self-defeating cognitions.
Establishing cooperative partner relationships.
Behavioral interventions: start & stop therapies.
Antidepressants may be prescribed. do not recommend medication.
Erectile Dysfunction
Behavioral therapy targeting performance anxiety.
Cognitive therapy focused on covering scripts.
Individual therapy.
Systematic Desnsititization.
Learning non-intercourse sexual techniques.
Sensate Focus.
Hypoactive Sexual Desire
Masturbatory training
Male Orgasmic Disorder
Genital stimulation
Paraphilias
CBT
Aversive Conditioning
Treatment of Children
Two methods are considered effective:
Insight-oriented approaches and Behavior-based approaches.
Insight for Children: Focus on feelings within experiences, play therapy, Adlerian therapy.
Behavior for Children: rewards, consequences, reinforcement, behavior modification.
Treatment of Adolescents
Three techniques are considered the most useful:
1. Reality Therapy.
2. Peer Culture Groups.
3. Social Skill Training.
In reality therapy, use of contracts and success/failure identity concepts may provide helpful therapeutic considerations.
Attention Deficit Hyper Activity Disorder
Objective: Increasing child's ability to learn and manage impulses.
Oppositional Defiant Disorder and Conduct Disorder
Primary treatment setting will most likely be a residentail treatment program, day program, or combined school and community facility.
Elimination Disorders
Focus on symptom through behavioral approaches.
Dry bed techniques.
Modalities
For the purposes of the exam only 3 modalities exist:
Individual, Family, and Group
Determine what a client's most important need is and use the technique and modality that best fits that need.
Individual Therapy
Recommended for clients who have little connection with others, withdrawn, highly anxious, or introverted.
If the client is suspicious, antisocial, hostile or destructive, individual therapy is better than group work.
Those who do not deal with ambiguity well, those looking for independence, and individualization, difficulties with intimacy are indicated for individual.
Group Therapy
Clients who need reality testing and group feedback.
Recommended for those who may feel stigmatized, scapgoated by individual therapy. For interpersonal behavioral concerns. Anxious clients who experience authority concerns benefit, as well as those who give the therapist excessive power.
Family Therapy
For families with severe pathology but experiencing communication difficulties within the family structure.
When intergenerational conflict arises.
When more than one family member needs help.
Existential Techniques:::
encouraging responsibility. Clarification of options. Life review to discover meaning. Development of belief system. Paradoxical interventions.
ODD and CD Techniques:::
Focus on consequences, reinforcements, or rewards. Methods that delay impulses by using cognitive strategy such as "stop, listen, think." Anger Management.
ADHD Techniques:::
Focus primarily on behavior techniques. Enhancing learning environement through reduction of distractions. Training teachers. Instruction on time management. Stress management and relaxation techniques.
Loss of Contact Techniques:::
Targets symptom eliminiation or reduction. Individual therapy is the usual mode. Hypno therapy for amnesia. Psychodynamic for Multiple Personality. Behavioral therapy for developing coping mechanisms and stress management. Group therapy is not generally indicated.
Personality Techniques:::
Individual therapy is primary with family therapy accompanied. With improvement, group therapy may be useful. Psychodynamic approaches are generally used. To promote changes in relationships cognitive interventions may be used. Medication is rare.
Gestalt Techniques:::
Unfinished business, giving voice to physical sensation, dream exploration, empty chair, top dog & under dog, exaggeration of feelings and actions, confrontation, and encouragement of awareness of responsibility.
Somataform Techniques:::
Physical examination should be part of the assessment process. Individual therapy is the primary mode. Family therapy may help. Holistic approach with cognitive, behavioral, and affective therapies combine the most effective modality.
Depression Techniques:::
Cognitive-Behavioral Techniques are the most effective. Target overgeneralization, perfectionistic thinking, and tendency to catastrophize. Training in communication skills, help in decision making, assertiveness training, increasing pleasurable activities.
Anxiety Techniques:
physical exam generally indicated. Cognitive-Behavioral and behavior therapy. In-vivo work well as well, except in the case of Generalized Anxiety Disorder. Anxiety management, relaxation, guided imagery, stress inoculation, problem solving, progressive muscle relaxation, meditation, biofeedback and exposure.
Most effective therapy is behavioral in approach with a secondary focus on cognition. Group therapy may also be helpful, but individual is most indicated. Ancilary family therapy may be needed as well.
Unless the condition is disabiling, medication is not generally needed, save in the case of Panic Disorder and Obsessive Compulsive Disorder.
Adjustment Techniques:
crisis intervention, brief psychodynamic, stress management. Short-term interventions are most appropriate.
Psychodynamic Techniques:::
transference, exploration of dysfunctional patterns, relationship history, discussion of dreams, childhood memories, hypnotherapy, interpersonal psychotherapy, unconscious conscious, interpretation.
Adlerian Techniques:::
Life script, guided imagery, empowerment and encouragement, birth order, early recollections, role-playing, natural consequences, Phenomenological approach, and development of social interest
individual grief therapy
unresolved grief issues
illness insight counseling
to understand what is occurring in life and ensure tx compliance
stress management counseling
coping with stressors
medication compliance monitoring and counseling
when psych meds are needed and there are issues of compliance
psychiatrist referral to evaluate med needs
when client needs med support
when developing a collaborative tx plan with client, what should be included
identify goals of tx appropriate to the issues being addressed, develop specific objectives to meet goals, address confidentiality requirements and limits
Freudian Therapy
best suited for short term interventions around depression and anxiety; long term with dissociative and personality disorders
role play
technique in therapy and training in which participants act out new behaviors or skills, good for conflict resolution and communication
guided imagery
a technique of relaxation and pain control, use when client is avoiding or overwhelmed by a difficult or fearful situation or memory
Abreaction
Psychoanalytic term for reliving an experience in order to purge it's emotional distress, associated with repressed ideas
engage prior effective coping skills
always a useful approach
confrontation
bring ct back to pre disordered level of coping and function. most effective when higher than preexisting levels of functioning are necessary
positive self talk
enhancing issues of self esteem
relaxation training
A behavioral technique used in the treatment of anxiety disorders that involves progressive and systematic patterns of muscle tensing and relaxing. also for eating disorders -sense of control and self esteem
how to respond to a court order
respond to court personally, indicating possible harm to the client from this disclosure
you work in a large counseling center with a person who specializes in tx that client needs, what do you do?
refer the specialist for the most effective intervention, if ct denies the referral, the counselor doesn't need to continue providing services
has your marriage been mostly difficult or mostly good?
not as open ended as other questions, but still useful
relevant questions to ask to make a dx for marriage counseling
bx (irrational or bizarre) cause problems in marriage? are there specific issues in trust? verbal threats? violence? how long have major problems existed Not medical problems-if no medical problems are mentioned in the case
DSM diagnosis for marriage counseling
...
narrative therapy
method of therapy that separates the person from the problem and encourages people to rely on their own skill sets to minimize the problems that exist in their everyday lives; This type of intervention would be beneficial for client to express feelings or emotions she has been unable to do in any other format. e.g, trauma
Rogerian Therapy
person-centered therapy that focuses on the here and now with the belief that people are trustworthy, resourceful and capable of resolving their own problems.
Animus analysis
This is a Jungian concept involving an exploration in the masculine psyche aspects of the female.