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Week 12 lecture 371
Sex, Couples, Kids
| Question | Answer |
|---|---|
| Why Couples and Families are important in therapy? | -relationships matter when it comes to mental health. -They may reinforce maladaptive behav, punish effective behav. -"Identified patient" ->family says there is an issue w/ another member, but it may not be that person who is the whole issue |
| Challenges in Family/Couple Tx | -managing alliance w/ multiple ppl, who often have different goals/expectations -Ethical issues: Who is the client? Who do you owe ethical duties to? Issues of confidentiality -there's a lot more going on in therapy room |
| Two Approaches to Family/Couples Therapy | 1)Treat an individual problem, mobilizing relationships to support recovery (ex.Maudsley Model of Anorexia) 2) Treat relationship problems -> target relationship as thing you are treating |
| Couples Therapy (3 types) | 1)Traditional BT (TBCT) 2)Emotion-focused Therapy (EFT) 3)Integrated CBT (IBCT) |
| Traditional BT (TBCT) | direct encouragement of positive behaviour, training in communication & problem solving techniques |
| Emotion-focused Therapy (EFT) | More psychodynamic. Focus on here and now. Deepen emotional experience and expression. Identify and meet unmet attachment needs (acceptance, belonging, and safety). |
| Integrated CBT (IBCT) | Integrates both emotional acceptance and direct change |
| Cognitive Restructuring with Couples | -Automatic thought. -Identify the maladaptive assumption. -Identify the underlying schema. -Identify the cognitive distortion and where they lie in the automatic thought and schemas |
| Behaviour Therapy with Couples (Downward Arrow) | Therapist continuously asks So what, What then, What else when patient is talking about their partner. This is to try and get at what the unmet attached needs are |
| Behaviour Therapy with Couples | Love Days. Behaviour Change Agreements and Contracting. Role Playing or Modeling. Coaching. Communication Training. Timeouts. |
| BT: Love Days | Each spouse identifies various behaviours that their partner finds enjoyable and commits him or herself to increasing these behaviors. Both keep a daily record of their observations. |
| BT: Behaviour Change Agreements and Contracting | Agreement to engage in shared activities or specific behavioural change or modifications |
| Role Play or Modeling | The use of modeling or role playing may help to show couples or family members what the behaviour change may look like |
| Coaching | The therapist structures the interaction between couples or family members as a guide to facilitate change. This is often combined with role play |
| Communication Training | 1) Use "I" statements - focus on how you are feeling in the situation 2)Pause. Get partner to summarize. Check to see if they are on the same page. |
| Timeouts | When things are getting heated, stop and take a break. Make a plan to come back and talk about/try to resolve the issue getting you two so heated |
| EFT Techniques | Cycle where one person takes on the pursuer role (actively trying to fix relationship) & the other is takes on withdrawer role (as the pursuer jumps more into relationship, person backs away). Identify cycle between two partners. De-escalate. Reconnect. |
| Couples Therapy Outcomes (Mainly IBCT vs TBCT) | All do better than wait list control. IBCT vs TBCT: equivalent outcomes. IBCT did better at 2 yr follow-up for relationship satisfaction. 5 yr follow-up outcomes equivalent again. ~25% split up. ~50% sustained gains in relationship satisfaction & conflict |
| General Family Therapy Outcomes | Little evidence. Difficulty of specifying outcomes: who should be changing? how? What if one relationship getting better means another one gets worse for awhile? |
| CBT for Anxious Kids | Coping Cat. Psychoeducation. Relaxation techniques. Cognitive restructuring: FEAR plan. Exposure (including play). Problem solving. |
| FEAR plan | F (Feeling scared). E (Expecting bad things to happen). A (Attitudes and actions that help). R (Results and rewards). |
| How to Modify CBT to be appropriate for children | Modify traditional techniques into play or games. Incorporate more developmentally appropriate vocab & more play/games into therapy. Light saber battle between anxiety thoughts & coping thoughts. Cartoons. Anxiety thermometer. Attention to self-talk. |
| CBT for Anxious Kids outcomes | psychotherapy for kids & teens is efficacious (better than doing nothing). Largest ES for BT or CBT. Larger ES w/ older children vs younger. Parental involvement doesn't increase ES. |
| Sexual Disorders | Desire Disorders. Orgasmic Disorders. Pain Disorders. Excitement/Arousal Disorders. |
| Desire Disorders | Hypoactive Sexual Desire Disorder (not wanting to have sex very much). Sexual Aversion Disorder (being afraid/anxious of sex). |
| Orgasmic Disorders | Premature Ejaculaton. Male Orgasmic Disorder. Female Orgasmic Disorder. |
| Excitement/Arousal Disorder | Male Erectile Disorder. Female Sexual Arousal Disorder: Subjective subtype (feeling like you are not aroused, even though you are biologically), Genital subtype, Combined subtype |
| Pain Disorders | Dyspareunia. Vaginismus. |
| PDE5 Inhibitors: Viagra, Cialis, Levitra | Viagra, Cialis, Levitra. effective in restoring erections in 75% of men. 1/4 of sample unable to sustain initial improvement. |
| PDE5 Inhibitors: Discussion | Study where 58% of men had discussed, >1/2 of these men got a prescription, 16% had continued to use the medication. Why: lack of educ or counselling; fear of side effects; partner concerns; distrust of meds |
| PDE5 Inhibitors: Problems with Medical Model | Men's mental arousal may be just as complex as women's, but it is possibly being ignored. Viagra is about erections, not male sexuality & arousal. Fails to address individual or couple issues. More of a psychological model may give more avenues for change |
| Assessment | 3 sessions just assessing the problem. individual & couple if in relationship. 4 Ps: Predisposing, Precipitating, Perpetuating, Protective. Self-Report Qaire. Medical assessment. Feedback. Interview. |
| The Four Ps | For each each p, examine: Social; Cultural/Religious; Psychological; Biological; Interpersonal |
| Barlow's Model of Sexual Dysfunction | anxiety in sexual situations leads to attentional focus on performance, which compromises sexual arousal. Negative experience enhances anxiety in future sex situations & non-erotic thoughts (NETs) relevant to performance will receive attentional priority. |
| Treatment Goals | People often want to increase performance (ie more sex) BUT most effective goal is to develop a more satisfying sexual relationship (so not necessarily more sex) |
| Sensate Focus Treatment | Stop goal-directed sexual activity (intercourse). Enageg in series of sensual/sexual activities (that is not intercourse). Usually used for treating arousal problems. |
| Benefits of Sensate Focus Treatment | Removes pressure to perform. Returns focus to pleasurable sensations. Reintroduce "basics" of sexual activity. Realize pleasure from a variety of activities. Promotes pleasure & intimacy. Decreases anxiety, expectations, "sexual failures" |
| Format of Sensate Focus Treatment | Homework: 45 min each session. 1-3 sessions/week. 3 stages: non-genital (massaging, kissing), genital (no intercourse), intercourse |
| Treatment: Psychological | Information Processing (pay attention to sexual myths & begin to challenge them) through cognitive restructuring, identify thoughts/beliefs, challenge, examine evidence for/against, de-catastrophize negative outcomes, turn attention to erotic cues |
| Premature Ejaculation Treatments | Education (why it happens). Continue sexual experience after ejaculation. Antidepressant meds. Start-stop technique. The "Squeeze" Technique. |
| Orgasm Disorder Treatments | Education. Directed masturbation. Decrease guilt. Increase arousal. Teach, communicate with partner. Figure out what promotes/hinders. Sex toys. Realize orgasm is not essential for good sex. 90-100% success rate. |
| Sexual Aversion Treatment | Fear hierarchy. Make a list of sex-related activities from easiest/least anxiety-provoking to hardest/most anxiety-provoking |
Created by:
lbord313
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