Dialectical behavioural therapy uses all of the following techniques except:
D. Marsha Linehan developed dialectical therapy for patients with borderline personality disorder who repeatedly harm themselves. The treatment uses both behavioural and cognitive methods. It is highly structured and is manual based. Therapy is intense with individual sessions, skills training in a group and access by telephone to the therapist between sessions. It is delivered by a small team of therapists and lasts for up to a year. Individual sessions have four elements: cognitive behavioural techniques including self monitoring; dialectical ways of thinking about problems – seeing causality in terms of both/and rather than either/or and the possibility of reconciling opposites; mindfulness, that is the practice of detachment from the experience; use of aphorisms, that is phrases that encapsulate the approach –e.g. people may not have caused the problems, but have to solve them anyway. Skills training sessions are provided in a group basis and telephone contacts are designed to help patients get out of crises, by using the skills learnt in the sessions.
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Which of the following is considered to be the most important therapeutic factor in group psychotherapy?
C. Cohesion is the sense that the group is working together towards a common goal. This is believed to be the most important factor related to positive therapeutic effects. Group cohesion has been likened to the therapeutic alliance in dyadic treatment. In dynamic therapies, specific and non-specific elements contribute to therapeutic change. In groups, the presence of other people adds to factors present in all dyadic healing relationships. Non-specific factors are embedded in the relationships established through a consistent, accepting, non-judgemental, and supportive environment. These are all elements of a cohesive group. Groups provide a corrective emotional experience in which patients experience others (including the therapist) responding to them differently from those in their past. Members share their stories (catharsis) and feel less isolated when others have shared similar stories (universalization); they have opportunities to be helpful to others through both cognitive understanding and emotional linking (imparting information, providing feedback, and altruism). They also see others improve, which conveys hope. These elements contribute to the sense of collaboration and a willingness to adopt norms (i.e. discuss feelings about the interactions in the meeting) that further members’ sense of efficacy and belonging. They contribute to an experience of support and acceptance, which may be sufficient therapeutic gain for a number of patients. Fight/flight, pairing, and dependency are Bion’s basic group assumptions that lead to a negative therapeutic effect.
In a therapeutic community, the members tolerate behaviour that may not be accepted anywhere else.
This process is called:
A. Permissiveness is the principle where members tolerate behaviour that they may not accept elsewhere. This is also helped by the members having the opportunity to be helpful to others through both cognitive understanding and emotional linking (imparting information, providing feedback, and altruism). Mutual help is the process by which members support each other and help each other to change. Imitation is the conscious emulation of one’s behaviour following that of another – also called role modelling. Altruism is the process of putting another person’s need ahead of one’s own and in the process learning there is value in giving to others.
In a family therapy session, the mother is asked to comment on the relationship between her husband and their eldest son. After this, the family members are asked to comment on the mother’s response.
This method is called:
B. Circular questioning is often used in family therapy as part of assessment. The purpose is to discover and clarify confused or conflicting views among the members of the family. Following this, a hypothesis is constructed about family functioning, which is then presented to the family, who should consider it between sessions. The family may be asked to try to behave in new ways. Paradoxical injunctions are used in couples therapy and family therapy. They are provocative statements designed to elicit a beneficial counter-response that the couple have previously resisted. Very often, this will include a prescription of the ‘unwanted symptom’, which the couple realize and try to give reasons why this is acceptable to the couple. Socratic questioning is a technique used in cognitive therapy. Role reversal is a technique in couples therapy which helps one partner to understand the point of view and experience of the other.
Which of the following is NOT a goal of family therapy?
C. Family therapy is mostly employed in child psychiatry settings, when problems have usually been identified in a child’s behaviour, which has led the family to seek help. The aim of family therapy is to improve family functioning and so help the identified patient. The goals of family therapy include:
Family therapy developed from Ackerman’s work on psychodynamics of family and Bateson’s work on communication. Ackerman’s work led to the development of psychodynamic methods of treatment, while Bateson’s work led to the system’s approach. Minuchin developed further the system’s approach in the USA to form the structural family therapy method.
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