How do you know?
How do you know when you have balanced alliances? What document will I use to know?
FSR’S. I would know because I will have tried to matched to the family, also being mindful of the families responses and interactions with therapist
You’re working with a family that consists of grandma, youth, and her two siblings. Family was referred because youth engages behaviors like stealing, lying, and getting into physical fights at school. Youth has also put her hands on grandma. Grandma states she doesn’t know how she can keep doing this and often ignores youth, especially when she feels too overwhelmed with her behavior, often causing more conflict as youth feels close to grandma and often wants her attention. What are some things to consider when creating a behavior change plan for this family? What are some skills you would teach?
It's important to consider that youth is seeking connection with grandma while grandma is more autonomous. You could teach emotional validation and regulation, clear expectations/consequences, family bonding, check ins, ect
You’re meeting with a family for the 2nd session and mother begins to talk about all the bad things the youth has been doing. She is cursing and yelling, and the youth does not have an opportunity to speak. You observe the youth becoming restless, agitated and nervous. What do you do? How do you keep it relational?
I would interrupt and then I will point process the youth’s behaviors to mom’s aggressive speaking. I will then, divert the conversation to youth to speak his point.
What is the goal of the engagement phase?
To enhance perception of responsiveness and credibility
What information would you use to create a generalization plan?
You would use risk and protective factors. Plan should include how you would generalize the skills and what skills need to be generalized, how you would teach the family to plan for relapse, and what resources you will be connecting the family to.
How do you know your BC Plan is relational?
I know my BC plan is relational when I use the hierarchy and functions to address the family’s risk and protective factors.
You are working with a family that consists of mom, youth, and stepdad. Youth has a history of abuse from his biological father and demonstrates symptomology of PTSD. Mom also has trauma from being abused as a child, and stepdad from the 10 years that he was in a gang. The family demonstrates a lot of negative thought patterns that lead to conflict and feelings of anxiety and sadness. The family struggles to communicate without triggering one another and practices avoidance or aggressive communication. What skills would you want to teach this family? How would you do that?
CBT skills (teach them to recognize and challenge negative thought patterns, connect thoughts to feelings and behaviors), emotional regulation (coping strategies, have them practice mindfulness), assertive communication (I statements, reflections)
You arrive at session, and you observe that youth is wearing a hoody, something that he has never worn in previous sessions. You asked mother and youth what happened and inquire about the hoody. The youth is not giving you any eye contact and mother is sharing that the week was great. Youth has a history of Baker Acts in the past for self-harming behaviors in the past. What do you do?
I would address the incongruence of what mom is saying and my observations of the hoody and youth’s body language, I would review the safety plan with the family and address my concerns with the family and point process the youth’s behavior.
List and describe at least 3 change focus techniques
Matching, point processing, sequencing, strength based relational statements, attending to the positive, interrupting and diverting
What are the goals of the generalization phase and how do you accomplish them?
To generalize skills by helping the family apply the skills to all systems outside the family, to maintain change by preparing for relapse, and to support change by connecting the family to necessary resources.
How do you know the family has improved or eliminated the referral problem?
I will use the assessments of OQ,YOQ, YOQ-SR, and FSRS to track the progress of the family. I will also receive feedback from the family and assess interactions
You’re working with a family that consists of mom, youth (13), brother (11), and sister (7). Everyone in the family is diagnosed with ADHD, including mom. Mom yells a lot when she gets overstimulated by the kids and often goes back on discipling the kids when she feels guilty. All the children struggle with outbursts when they feel upset and often instigate one another, sometimes leading to physical fighting. What skills would you teach this family? What is important to consider when thinking about how you would teach them?
Hands on/games are important because they are younger and ADHD is present. Emotional identification and regulation, positive communication
You’re working with a family that just entered the generalization phase. You come to the session and the family shares that they are feeling hopeless and had a big relapse over the weekend. Mom and youth both share about conflict regarding house chores that led to a screaming match between the two. Mom admits that she felt triggered when youth did not do what she said she would and started to yell at youth before taking a break like they have talked about before. Youth shares that she felt very angry when mom was yelling and walked away before she started a physical fight like she would have in the past. What do you do next? How would you address the hopelessness while being this deep into the process?
Normalize relapse as a part of the process. Highlight strengths: mom acknowledged she felt triggered and youth recognized her anger and walked away before things got physical. Use relapse plan to highlight this as a risk and solidify a plan for how to address it. Ensure mom and youth are connected to individual supports to help cope with their emotions if needed.
Describe the change meaning skills
Theme hints: words you use in session to start forming a theme, relabels: giving a behavior a softer meaning, reframes: identifying a less intense/more benign reason for the negative behavior, reframes plus: noble but misguided intent around a negative behavior, themes: alternative meaning to relationship patterns (can be behavioral or relationak)
What information should be included in a relapse prevention plan?
Risk factors, protective factors (strengths), progress made, family triggers, warning signs, plan to address this (refer back to skills), next steps
How do you know when your ready to move to BC? List all?
When you’ve reached all the goals of motivation which include: reducing negativity and blame, increasing hope, creating a balanced alliance and relational focus as well as having an understanding of the families risk and protective factors, behavior patterns, hierarchy and relational functions.
You’re working with a family that is about to move to BC. Dad has a drinking problem, is very protective over youth, and checks on her hourly to make sure she is where she’s supposed to be and doing what she’s supposed to do. Youth sometimes sneaks out or lies about where she’s going. Family speaks negatively of one another and often deflects onto another person when discussing their role in the family dysfunction. Everyone in the family screams at one another and has gotten physically aggressive with each other. You have completed motivation and created a relational focus on how they all have learned to respond to their emotions in a tense way and don’t know how to communicate in a positive way with one another. What skills would you teach this family? Give an example of how you would teach them.
Emotional identification and regulation, assertive communication, family bonding
You are meeting with a family for a behavior change session and your plan for the session was to come in and teach the family I statements. Once you arrive, you can tell the family is tense. Mom shares that she is very upset because she just found out the youth has been skipping classes and lying about where she is at when she leaves the house. Mom states that she is done and doesn’t feel like the youth will ever change. The youth keeps her head down and doesn’t say much as mom is explaining the situation. What do you do?
Use some motivation skills to reduce the negativity, increase hope, and get back to a relational focus (point process youths body language, attend to the positive, reiterate reframes), remind family that frustration is normal but they still are learning the skills to do something different. Use your rationale to explain why the skill you’re about to teach can relate to this situation. Use the situation when teaching the skill.
You are meeting with a family for one of your first motivation sessions. Youth will barely engage in session and does not offer up any information. Mom is forthcoming but displays a lot of negativity. You're worried you're losing the youth and want to hear their perspective of what's happening in the family. What skills could you implement here and how would you use them?
Matching, spend more time getting to know family before diving deeper, ask for youths phone number/info to build on that alliance, allow youth to give thumbs up and thumbs down to guesses, point process youths disengagement, sequence what happens when therapist is not in the room
What are some ways you can plan for relapse with a family?
Open discussion around what bumps may come up and how to address that, teach the family a new skill that will reduce the risk for relapse (expectations and consequences, family affirmations, family bonding), have them write out their own relapse plan (provide poster board and have them write out family do’s and don’ts, triggers, warning signs, ect).