a.     Orient the client toward change, guide therapy

b.     Provide direction by clarifying client’s specific needs and initial expectations

c.      Permit helpers to determine whether they have requisite skills, competencies, and interests to work with the client’s concerns

d.     Serve as basis for selecting and using particular change strategies and interventions

e.     Help monitor progress and measure effectiveness of change interventions

f.      Induce expectation for improvement—clients often make progress as result of the goal-planning process itself

g.     Manage expectations so that the client feels hopeful

: acronym for the qualities therapy goals should have

a.     Specific

                                               i.     Need to have narrow goals from therapy

b.     Measurable

                                               i.     Measure throughout the therapy situation

c.      Attainable

d.     Realistic

e.     Top priority to the client

Define iatrogenic in 10 words or less

    Stages of change model/trans-theoretical model of change—3 main people who started it

a.     Prochaska, DiClemente, and Norcross

b.     Don’t get tricked or fooled, it has two names… it’s the same thing

c.      Know what it was originally developed to help people with

                                               i.     Cigarette smoking

Stages of Change

1) precontemplation

2) contemplation

3) preparation

4) action

5) maintenance

Precontemplation

                                               i.     Unaware of, or in denial of need for change

                                              ii.     People like to protect the stage of change where they are

Externalize goals about other people changing

Contemplation (stages of change)

                                               i.     Acknowledge need but not ready to undertake

                                              ii.      Common stage of change that people like to muddle around in

                                            iii.     Often a lot of  “I wish”

                                            iv.     Prognosis of getting clients who are already in this stage are most likely successful in changing

Preparation (stages of change)

                                               i.     Prior attempts, planning underway for near future

                                              ii.     Usually means you have already tried something and it hasn’t succeeded

                                            iii.     Multiple attempts that have not been successful, but try to improve upon their next attempt

action (stages of change)

                                               i.     Actively working toward goal outcomes

                                              ii.     When you actually make the change

                                            iii.     From the moment the change is made to 6 months after this, you are in this stage

                                            iv.     Likely to slip backwards when in the action stage

                                              v.     This is like relapse

1.     Usually don’t slide all the way back to pre-contemplation, usually fall back to one of the two previous stages

2.     Steps backward are part of the process of change

Maintenance (stages of change)

                                               i.     Focus on consolidation and relapse prevention

                                              ii.     Build in stability so that your changes can stick

a.     Contemplation

b.     A good way to do these is to decide what stages he is NOT in

Think about what the defining qualities of in each stage

      Client descriptions where she will ask us to provide a reasonable SUDS rating and a reasonable GAF

a.     Give each answer as a specific number—a range of numbers is correct… so don’t put a range. It’ll likely fall in the range if you are close

b.     Both 0-100

c.      Think about how the scales are used differently—GAF is usually assigned by the therapist and SUDS assigned by the client

d.     Really lenient on the numbers that would fit

e.     50 is around where the scale breaks for SUDS—and cannot hide that you are upset anymore

Dali Lama on his best day is one of the client descriptions

SUDS rating scale

                                               i.     Subjective units of distress scale

                                              ii.     0-10 or 0-100 scale

                                            iii.     Which way you go with it depends on what client you use

1.     Adolescents to adults 0-100

2.     Children 0-10

                                            iv.     Gives people a way to quantify their own subjective distress

                                              v.     Can be used for a wide range of distress

1.     Physical pain, sadness, grief, temper, etc…

                                            vi.     Give you a way of talking about in a shorthand way what is going on with that person

Because it is numbers, you can plot this on a graph

Global Assessment of Funcitoning (GAF)

a.      Another 0-100 scale.

                                                                                   i.     0=no information is available.

                                                                                  ii.     100=Dr. B has never given it.

                                                                                iii.     REALLY high functioning people up in the 90s.

b.     This scale is often used as a short hand scale of where people are functioning

a.     19=needs to be hospitalized IMMEDIATELY

4 parts or sections of a treatment plan document

a.     List only 4 sections, there are A LOT of them, just pick 4

b.     Know what they are about incase there are future questions for MC—but for this question JUST LIST THEM

1)Multiaxial diagnosis

2)Treatment objectives

3)Helper and client negotiated goals

Criteria for treatment termination or transfer

Systematic problem solving technique

a.     1) Select solutions to try

                                               i.     You don’t have to have just one

                                              ii.     You try them!

b.     2) Implement solutions

                                               i.     Okay so I rented a helicopter. Turns out the route with the helicopter was longer than my route in the car. So that didn’t work, lets try something else!

                                              ii.     You have to accept that there is a trial and error

Various gradual change techniques

a.     Not needing an explosive change in order to change

b.     Catharsis and epiphany—know these words

                                               i.     Catharsis: the purging of the emotions or relieving of emotional tensions, especially through certain kinds of art, as tragedy or music

                                              ii.     Epiphany: a sudden moment of insight or revelation

c.      Think of changes that are slow and gradual

                                               i.     Stages of change model: focuses on change as a process

d.     Successive approximations

                                               i.     Think about how a child learns to write their name

                                              ii.     Small steps that get you towards a larger goal

                                            iii.     Reinforce all throughout the process of achieving the goal

We forget about this in adult behavior sometimes

DBT

a.     Qualities of therapist can help you to be a better helper

b.     Interpersonal effectiveness: helpers need to be able to build and maintain healthy relationships with other people

                                               i.     Set good boundaries, communicate effectively

                                              ii.     What are the times in therapy when you would need to draw on the other skills of DBT—how does being a helper draw these out in you

c.      Mindfulness

                                               i.     Helps you be present in the moment

                                              ii.     Not invented for DBT

                                            iii.     Quality of being present, makes things easier to learn

                                            iv.     Increases the ability to achieve insight

d.     Distress tolerance

                                               i.     Its okay to feel negative emotion and not let that destroy you

                                              ii.     Many people have an exaggeration of their negative emotions

                                            iii.     Afraid emotion is going to take over

e.     Emotional regulation

                                               i.     Being able to regulate emotion, change from sadness to happiness

                                              ii.     Cuts across different diagnoses

f.      Interpersonal effectiveness

                                               i.     Focus on appropriate social responses, how to react to things

Who developed DBT

Marsha Linehan

Who developed ACT?

a.     Steven Hayes

Know that DBT and ACT are both 3^rd wave cognitive behavioral therapies

DBT has been supported for a wide range of clients with lots of clients—kids and adolescence

a.     Dialectical Behavior therapy

                                               i.     Good example of empirically sound treatment

                                              ii.     Good to use with resistant or reactant clients—it says here are skills that are going to make your life easier, but its up to you to learn and practice them

Mindfulness Venn Diagram

a.     Emotion mind and reasonable mind—with wise mind in the middle

Mindfulness Venn Diagram: Reasonable mind

• Facts and common sense are the framework of reasonable mind. You are in reasonable mind when you think logically and rationally.
  

• This intellectual or scientific state of mind defines reality in terms of facts, numbers, equations, or cause and effect.
  
• Whether balancing your checkbook, baking a cake or working a crossword puzzle, you need the knowledge of reasonable mind.

Mindfulness Venn Diagram: Emotion Mind

• If reasonable mind runs "cool" then emotion mind runs "hot."
  
• Passionate, extreme, and intense reactions in emotion mind make reasonable, logical thinking difficult.
  
• When an emotional state controls your thinking and behavior, emotion mind has taken over. Acting the way you feel is how emotion mind behaves. Emotion mind can flood your system with energy in anger or zap your energy in depression.
  
• Impulsively acting the way you feel can lead to out of control behavior creating chaos, hurt feelings, and more problems. Emotion mind tends to be irresponsible, careless, mindless, impulsive, and impatient.
  
• Strong emotions distort facts, magnify excuses, and shrink your perception of consequences.

Mindfulness Venn Diagram: Wise Mind

• Wise Mind is the active integration of Emotional Mind and Reasonable Mind. Wise Mind brings together the logic of reasonable mind and the sensitivity of emotional mind to a serene state of mind.
  
• When you relate what you know (your smarts) to your problems (what hurts) you are being skillful and in Wise Mind.
  
• Wise Mind joins what you know to your problems. Your effort to link your problems causing misery and distress with your reasonable, logical abilities is the basis of skillfulness and Wise Mind.
  
• But Wise Mind is more than this too; the magic of Wise Mind is intuition.

How motivation is related to behavior change

• within the stages of change model: motivation encourages behavior change

how emotions can affect systematic problem solving

a.     Emotions are a hot factor and need to be thought of

b.     Be cautious to not forget about emotion

c.      Ways to increase problem-solving effectiveness by using one’s emotional response as:

                                               i.     Cue for problem recognition

                                              ii.     Motivation to galvanize problem-solving

                                            iii.     Problem-solving goal in its own right

                                            iv.     Possible consequence of some parts of problem- solving

                                              v.     Criterion for evaluating solution outcome

                                            vi.     Reinforcer of effective problem-solving behavior

Reframing

•  Change the client’s perceived ideas about a problematic situations or behavior.
• Goal is to loosen their perceptual change

 Know that it is used very frequently in everyday practice
Almost like an influence response level of basic for clinical practice

Trans-theoretical model of change

a.     What are the goals of the interventions? What are you trying to do when you work the stages of change model

b.     During the stages of change model you are trying to promote health behavior change and in behavior modification

4 types of cognition

1. Cognitive distortions
2. Delusions
3. Automatic thoughts
4. Schemas

Types of Cognition: easiest, hardest, and most effective ways to work with these

                                               i.     Which of these kinds of cognition is easiest to change, which most resistant? And how I would think about my understanding of the way it would be most effective to work with these

1.     Delusions: if you think you are Jesus, you cannot just tell someone they aren’t Jesus and believe you—hard to change

2.     Schemas: can be changed eventually

Cognitive distortion and automatic thoughts NOT the answer

When confronted with an angry client…

a.     Stay calm

b.     Control your own emotion

c.      Stay attentive

d.     Need to pick up on signals of where they are going with their anger

e.     Don’t personalize the clients reaction—don’t take it personally

f.      Its always still about the client

g.     Fall back on listening responses

 En vivo

"in life"

Skills you practice in the real life context in which you need to use it

Power of positive thinking

a.     Positive thinking: Reduce stress by eliminating negative self-talk

b.     Positive thinking helps with stress management and can even improve your health. Practice overcoming negative self-talk with examples provided

Purposes that modeling can be used for

a.     Anxiety and fear reduction

b.     Attitudes toward mental health treatment

c.      Autism and retardation

d.     HIV/AIDS risk and chemical dependence

e.     Interaction skills

f.      Parenting

g.     Presentation formats of modeling

h.     Self-efficacy

i.       Stress

j.       Stuttering

k.     Substance use/substance prevention

l.       Violence and aggression

Building a hierarchy of tasks

a.     Think about the butterflies, reach large goals by breaking them into sub-goal

b.     Realize that you may need to add in steps when you can tell the client is uncomfortable with the next step

How to help clients increase the vividness of their imagined scenes during visualization

a.     Sensory cues are powerful induction aid for enhancing scene’s vividness

b.     When client’s offer input in selecting and developing details of practice scene, they develop more self-efficacy or confidence in using imagery

Why is it dangerous to use guided imagery to “recover” memories?

a.     Have to be so careful when dealing with hypnotized people as to not supplant things into their memories that could change things

                                               i.     Suggestions can change how they remember things

b.     Treatment recovering memory can be very iatrogenic—many times recovering memory is actually just creating new memory

Studies about comparing different types of therapy

a.     General and specific effects in therapy

b.     Piece on a slide when they talk about effects of therapy that are general to any interventions

c.      Any therapy is better than no therapy at all

d.     General effects in therapy are easy to cultivate—EST creates specific effects

Preventing attrition

a.     Attrition is dropping out of therapy

                                               i.     Build a relationship, fall back on listening skills, don’t intervene, collaborative

Hypnosis: good for...

Pain control

a.     But dangerous when it comes to suggestibility—and can encourage people to construct false memories

b.     So be careful

c.      Cannot make you do something that you are morally against doing

d.     Can convince people that they have memories that they don’t actually have—this is scary

Cognitive Triad

a.     Cognitive triad of depression—Beck

                                               i.     Self

                                              ii.     World

                                            iii.     Future

1.     Feeling hopeless or very pessimistic about all of those things is how depressed people think

**do NOT choose "miserable mindset" answer

When positive reframing is inappropriate

a.     Don’t use positive reframing when dealing with a recent death, or in times when cultural differences exist