AMFT APCC CA Clinical Exam Prep 2025 Questions and Answers

Pg. 1 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. AMFT APCC CA Clinical Exam Prep 2025 Questions and Answers Legal issue (no false or misleading information & must display license name and number) / Ethical issue (within scope of competence, no misleading information, and no solicitation of testimonials from clients.) - ANS Advertising Mental Status Exam - ANS MSE Appearance, Attitude, Behavior, Mood/Affect, Speech, Thought Process, Thought Content, Perceptions, Cognition, Insight, Judgment - ANS Elements of MSE Tx model that focuses on resolving ambivalence and using the person's own values and concerns to elicit change. Client-Centered roots. - ANS Motivational Interviewing (MI) 1. Express empathy 2. Develop discrepancy 3. Roll with resistance 4. Support self-efficacy - ANS Principles of MI MI concept 1. Precontemplation 2. Contemplation 3. Preparation Pg. 2 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. 4. Action 5. Maintenance - ANS Stages of Change Open-ended questioning, Affirmations, Reflecting, Summarizing - ANS MI Interventions Client's legal right to not have information revealed during a legal proceeding. - ANS Privilege 1. Client introduces emotional condition in proceeding 2. Client breaks confidentiality 3. Breach of duty (Ct sues therapist or Therapist sues Ct) 4. Therapist is appointed by court to examine client. 5. Client has sought therapy for the purpose of committing a crime 6. Ct is under 16 years old and victim of a crime 7. Sanity determinations 8. Threat to themself or an identifiable other 9. Client is trying to establish competence 10. Coroner requests information due to public health concern. - ANS Exceptions to privilege 1. Client (regardless of age) 2. All members of the Tx unit 3. Guardian ad litem or conservator 4. Personal representative if Ct is deceased. - ANS Who holds privilege Sex therapy approach - ANS Sensate Focus Presence of 1+ Sxs: delusions, hallucinations, disorganized speech, OR disorganized behaviors 1 day to 1 month - ANS Brief Psychotic Disorder Pg. 3 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Presence of 2+ Sxs: delusions, hallucinations, disorganized speech, disorganized behaviors, and negative Sx. 1-6 months - ANS Schizophreniform Presence of 2+ Sxs: delusions, hallucinations, disorganized speech, disorganized behaviors, and negative Sx. 6 months with continuous signs - ANS Schizophrenia Presence of 2+ Sxs: delusions, hallucinations, disorganized speech, disorganized behaviors, and negative Sx WITH major mood episode (major depression or manic) 2+ wks - ANS Schizoaffective Disorder 1. Stupor 2. Catalepsy 3. Waxy flexibility 4. Mutism 5. Negativism 6. Posturing 7. Odd Mannerism 8. Stereotypy 9. Agitation not influenced by external factors 10. Grimacing 11. Echolalia (mocking noise) 12. Echopraxia (mocking movement) - ANS 12 psychomotor features of Catatonia Sxs Lasting @least 1 wk A. Abnormal and persistently elevated, expansive, or irritable mood. Pg. 4 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. B. High energy or activity w 3-4 of the following 1. Grandiosity 2. Decreased need for sleep 3. More talkative than usual 4. Flight of ideas 5. Distractibility 6. Increase in goal-directed activity 7. Risky behaviors - ANS Manic Episode Sxs Lasting @least 4 days A. Abnormal and persistently elevated, expansive, or irritable mood. B. High energy or activity w 3-4 of the following 1. Grandiosity 2. Decreased need for sleep 3. More talkative than usual 4. Flight of ideas 5. Distractibility 6. Increase in goal-directed activity 7. Risky behaviors - ANS Hypomanic Episode 5+ Sxs in a 2 wk period 1. Depressed mood most of the day 2. Decreased interest in pleasurable activities 3. Significant weight loss 4. Insomnia or hypersomnia nearly every day 5. Psychomotor agitation or retardation 6. Loss of energy Pg. 5 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. 7. Feeling worthless 8. Diminished cognitive function 9. Recurrent thoughts of death/suicidal ideation - ANS Major Depressive Episode @least 1 manic episode - ANS Bipolar I Disorder @least 1 hypomanic episode & @least 1 major depressive episode - ANS Bipolar 2 Disorder @least 2 years of Sxs consistent with hypomanic Sx and major depressive Sx but do not meet the criteria for EPISODES. Sx present @least 1/2 the time. - ANS Cyclothymic Disorder Presence of @least 4 mood episodes with a 1 year period - ANS Bipolar Rapid Cycling Temper tantrums manifested verbally and/or behaviorally Not consistent with developmental stage Tantrums occur 3+ times per week Persistently irritable/angry mood in-between tantrums Sxs present for @least 12 mos. in @least 2+ settings Diagnosed between ages 6-18 - ANS Disruptive Mood Dysregulation Disorder 5+ Sxs for @least 2 weeks 1. Depressed mood most of the day 2. Decreased interest in pleasurable activities 3. Significant weight loss 4. Insomnia or hypersomnia nearly every day 5. Psychomotor agitation or retardation Pg. 6 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. 6. Loss of energy 7. Feeling worthless 8. Diminished cognitive function 9. Recurrent thoughts of death/suicidal ideation - ANS Major Depressive Disorder Chronic major depressive disorder over a 2+ year period - ANS Persistent Depressive Disorder (Dysthymia) 5+ Sxs present 1 week prior to the onset of the menstrual cycle 1. Marked affective lability 2. Marked irritability/conflict 3. Marked anxiety 4. Decreased interest in activities 5. Difficulty with concentration 6. Fatigue 7. Marked changed in appetite 8. Insomnia or hypersomnia 9. Sense of overwhelm or out of control 10. Somatic response of pain/tenderness - ANS Premenstrual Dysphoric Disorder @least 3+ Sxs for @least 6 mos (4 wks in children) 1. Excessive distress in separation from home or attachment figure. 2. Excessive worry of separation from home or attachment figure. 3. Fear of events leading to possible separation 4. Refusal to leave safe place or attachment figure 5. Fear of being alone 6. Inability to sleep away from safe place or attachment figure Pg. 7 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. 7. Repeated nightmares involving separation 8. Complaint of somatic reactions when separation occurs - ANS Separation Anxiety Disorder Present Sxs @least 1 month Failure to speak in certain settings Interferes with achievements - ANS Selective Mutism Present Sxs @least 6 mos Marked anxiety towards specific object or situation - ANS Specific Phobia Marked fear about 1+ social setting in which individual is open to scrutiny by others. Present Sxs @ least 6 mos - ANS Social Anxiety Disorder An abrupt surge of intense fear/discomfort that reaches a peak within minutes w/ 4+ Sxs of 1. Palpitations 2. Sweating 3. Trembling 4. Shortness of breath 5. Feeling of choking 6. Chest pain/discomfort 7. Abdominal distress 8. Dizziness 9. Hot/cold flashes 10. Paresthesias 11. Derealization/Depersonalization 12. Fear of losing control 13. Fear of dying - ANS Panic Attack Pg. 8 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Numbness/tingling sensation - ANS Paresthesias Feelings of unreality - ANS Derealization Feelings of detachment from self - ANS Depersonalization Sxs include 1 panic attack + 1 month of Sxs 1. Fear of another panic attack 2. Significant maladaptive change in behaviors to avoid panic attack - ANS Panic Disorder Marked fear of @least 2+ Sxs for @least 6 mos. Public transportation Open Spaces Enclosed Spaces Crowds Outside of the home - ANS Agoraphobia Uncontrollable Excessive worry for @least 6 mos w/ 3+ Sxs 1. On edge 2. Easily fatigued 3. Difficulty concentrating 4. Irritability 5. Muscle tension 6. Sleep disturbance - ANS Generalized Anxiety Disorder (GAD) Pg. 9 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. An anxiety disorder characterized by unwanted repetitive thoughts (obsession) and/ or actions (compulsions). - ANS Obsessive-Compulsive Disorder Involves excessive preoccupation with an imagined defect in physical appearance leading to repetitive behaviors or mental acts - ANS Body Dysmorphic Disorder A disorder characterized by the repeated pulling out of one's own hair with failed attempts to decrease the behavior - ANS Trichotillomania Recurrent skin picking resulting in skin lesions w/ failed attempts to decrease the behavior - ANS Excoriation Disorder Collaborative Teacher, Expert, that uses directive and educational approach with structure. - ANS CBT Role of the Therapist Modify maladaptive thought patterns with adaptive and understand relationship between thoughts, feelings, behaviors. Based in skill building - ANS CBT Theory of Change Learn to recognize and replace negative thought patterns Relief of Sxs and/or problems Develop healthy coping mechanisms - ANS CBT Goals Negative Triads, Automatic Thoughts, Core Beliefs (Schemas), Cognitive Distortions - ANS CBT Concepts Pg. 10 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Homework, Socratic Questioning, Reframes, Assertiveness Training, Opposite Actions, Skill Training, Thought Records, Role Play, Thought Stopping, Restructuring, Validity Testing, Exposure, Finding Alternatives, Systematic Desensitization - ANS CBT Interventions Initial Phase - Build Rapport, Establish Safety, Analysis, Define Problems, Psychoeducation, Goals Middle Phase - Homework, Identify Patterns, Label Distortions, Reframes, Skill Training End Phase - Review new skills, Rehearse, Anticipate future struggles, Termination - ANS CBT Phases of Tx Shifting irrational beliefs to rational - ANS REBT Theory of Change Instructor, Confrontational, Direct - ANS REBT Role of Therapist Alter irrational beliefs & thinking patterns to overcome physiological problems and mental distress - ANS REBT Goals ABC, Irrational Beliefs, Self-Acceptance, Other-Acceptance, Life-Acceptance - ANS REBT Concepts Role-playing, Assertion training, Desensitization, Humor, Operant conditioning, Suggestion, Support, Journaling, Meditation, Guided Imagery - ANS REBT Interventions Pg. 11 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Initial Phase - Psychoeducation, Identify irrational thought patterns Middle Phase - Challenge irrational thoughts with blunt honesty from Therapist, Homework, Building skills End Phase - Review progress, apply learned skills, anticipate future struggles, Termination - ANS REBT Phases of Tx Change happens through mindfulness, developing skills to manage distress tolerance and emotional regulation, and improving interpersonal problem solving skills. Emphasis on accepting uncomfortable thoughts instead of struggling with them. - ANS DBT Theory of Change Ally Validate client and offer alternatives Coach - ANS DBT Role of Therapist The goal is for clients to improve their emotional and cognitive regulation. - ANS DBT Goals Mindfulness, Distress tolerance, Interpersonal effectiveness, Emotion regulation, Homework - ANS DBT Concepts/Interventions Initial Phase - Build Rapport, Work towards behavior control, Begin mindfulness and distress tolerance training, emphasis on addressing self-harm Middle Phase - Enhance emotional experience, Skill building, support client to learn to live, define life goals, Build self-respect, Find peace and happiness End Phase - Find deeper meaning in spirituality, Termination - ANS DBT Pg. 12 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Phases of Tx People are inherently good and growing, No diagnosis, Congruence, Genuine, Positive Regard, Empathy - ANS Client Centered Theory of Change - Therapist is non-directive. - A facilitator (helper) who sets the stage and believes the client is able to do what is necessary for growth and change, self-actualization. Client determines goals of therapy. Does not diagnose - ANS Client Centered Role of Therapist The goals are self acceptance, congruence between idealized and actual selves, increased self functioning, decrease defensiveness, insecurity and guilt, increased comfort with others, increase ability to express feelings in here and now - ANS Client Centered Goals Congruence, Unconditional Positive Regard, Empathy, Self-Actualization in reaching full potential, Locus of Control, Non-Directive Therapy - ANS Client Centered Concepts/Interventions Theory does not adhere to phases of Tx due to emphasis on being client led. - ANS Client Centered Phases of Tx Change occurs through increase awareness of here and now experiences. Both existential & Humanistic - ANS Gestalt Theory of Change Pg. 13 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Non-directive, non-judgmental, Authentic other, Increase awareness, NOT an expert - ANS Gestalt Role of Therapist awareness; self-support; harmony with environment leading to growth - ANS Gestalt Goals Phenomenological Method (description of here and now without interpretation of the therapist), Dialogical Relationship, Experiential, Here and now focus (past experiences addressed in here and now) - ANS Gestalt Concepts Empty Chair, Experiments, Body Awareness Techniques, Focus on the process (Here and Now) - ANS Gestalt Interventions Phases of Tx unfolds through attention to the here-and-now but without set agenda - ANS Gestalt Phases of Tx Change occurs through finding philosophical meaning in the face of anxiety by choosing to think & act authentically. "How do I exist?" - ANS Existential Theory of Change "real" other, Present, Aid - ANS Existential Role of Therapist The goals are for client to discover own life meaning, confronts anxiety in living, Experiences agency & responsibility in contracting own life - ANS Existential Pg. 14 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Goals Self-Awareness, Accepting responsiblity of freedom, Genuine encounters allow unique identities, Life goals do not last and continually recreate self, Always changing, Death is a basic condition that gives significance to life - ANS Existential Concepts Focus on moment to moment, Holding with them in experiencing the pain Mastering emotional pain, Honoring the pain, Empathic availability Our goal is not to take away pain but sit in it with them. - ANS Existential Interventions No phases defined, being present with client - ANS Existential Phases of Tx Change occurs through existential experience - ANS Experiential Theory of Change Authentic "other" Playful and Creative (Absurdity) - ANS Experiential Role of Therapist Increased flexibility Growth - ANS Experiential Goals Battle for Structure (All members of family needs to be involved), Battle for initiative (therapist doesn't work harder than therapist, wait for client to act and sit silently), Trial of Labor Pg. 15 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. (Understand roles), Activating Constructive Anxiety, Tapping into the irrational side, Finding solutions in creative ways - ANS Experiential Concepts/Interventions Initial Phase - Engage family as authentic person, Battle for structure, encourage all members to attend, Family wins battle of initiative, Gather information Middle Phase - Develop sense of cohesion, create alternative interactions, highlight inappropriate boundaries, Role playing, use play and "craziness" End Phase - Highlight accomplishments, family identify blocks to growth, Role play future scenarios, Assess each persons experience of therapy - ANS Experiential Phases of Tx Change occurs by separating person from problem and creating new narrative which emphasizes client's competence and strength (Not concerned with FOO, emphasis on cultural components) - ANS Narrative Theory of Change Collaborator, Investigative reporter, neither direct or passive but ACTIVE ("not-knowing stance), sides with client, focus on client's language and words, think creatively, Co-Author, Therapist does not pathologize - ANS Narrative Role of Therapist Deconstruct problem saturated stories in order to create more helpful stories, Re-authoring the story - having a new story emerge - ANS Narrative Goals Externalizing the problem, social constructivism, deconstructive questions, Identifying dominant discourse, *mapping the influence, Identifying unique outcomes, Enlisting a witness, Writing a letter - ANS Narrative Concepts/Interventions Pg. 16 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Initial Phase - Client tells problem-saturated story Middle Phase - Problem is externalized, mapping influence, identify/explore unique outcomes, re-author story, Enlist a witness End Phase - Document new story, write letter to self or others - ANS Narrative Phases of Tx Change occurs through accessing client's strengths and resources. Emphasizes finding solutions to a problem, not on discovering the cause or origins of the problem. (Not focused on FOO) - ANS Solution Focused Theory of Change Consultant Coach - ANS Solution Focused Role of Therapist The goals are to help client implement small & large changes to achieve preferred outcome, client builds on current strengths & resources - ANS Solution Focused Goals Exception Questioning, Miracle Question, Scaling Question, Presupposing Change, Coping Question, Affirmations/Compliments - ANS Solution Focused Concepts/Interventions Initial Phase - Join with client in "not-knowing" stance, envision preferred future, begin to identify client's strengths, solution oriented language, goals Middle Phase - Identify strengths, identify resources client has already used to deal with problem (coping question), utilize solution talk, Scaling questions, Exceptions to the problems, Feedback to client with compliments and tasks, catch and highlight small changes, cheerleading Pg. 17 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. End Phase - Assist client to identify ways to continue change, Identify hurdles/barriers that get in the way of change, client determines end of therapy - ANS Solution Focused Phases of Tx Change occurs through insight and understanding of early, unresolved issues. - ANS Psychodynamic Theory of Change Non-directive, Establishes holding environment, relationship is ESSENTIAL in client's change - ANS Psychodynamic Role of Therapist Dependent on specific theory with psychodynamic theory - ANS Psychodynamic Goals Past Influences of the present Underlying Conflict Defense Mechanisms - ANS Psychodynamic Concepts Change occurs through reparative experience with therapist and with client's gain of insight - ANS Object Relation Theory of Change Neutral Emphasis on transference/counter transference Therapist is a new and good object Focused on FOO - ANS Object Relations Pg. 18 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Role of Therapist Provide reparative experiences and build new internal structures Gain insight on how past relationships impact client's functioning improving relationships and self and others - ANS Object Relations Goals Object (other people), Internalization, Self and Object Representations, Ego, Splitting, Projection, *Projective Identification (only used in ORT), Introjection - ANS Object Relations Concepts Holding Environment, Building Rapport and therapeutic alliance, empathy, Interpretation, Control resistance, Identify transference/countertransference - ANS Object Relations Interventions Initial Phase - Build rapport, Establish holding environment, Therapeutic alliance with listening, Exploration of client's experience, empathy, and maintaining neutrality Middle Phase - Promote insight and growth through interpretation, Confront resistance and primitive defense mechanisms, Focus on transference/countertransference, identify process projective identification End Phase - Work through termination and potential abandonment issues, consolidate interpretations, review insight gained - ANS Object Relations Phases of Tx Change occurs through empathetic attunement and strengthening the self-structure through optimal responsiveness - ANS Self Psychology Therapy Theory of Change Emphasis on empathic understanding & optimal responsiveness Pg. 19 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Allow emergence of self-object transferences and the repair of disruptions - ANS Self Psychology Therapy Role of Therapy Developing self-cohesion & self-esteem Locating better self objects - ANS Self Psychology Therapy Goals Self-objects (early child caretaker), Self-object needs, Mirroring, Optimal Frustration, Mirroring Transference (accpetance/confirmation), Twinship Transference (someone like them), Idealizing Transference (admiration), Adversarial transference (need for supportive relationship), Experience-Near empathy (experiencing what its like to be client), Enactments, - ANS Self Psychology Therapy Concepts/Interventions Initial Phase - Establish therapeutic holding environment, Demonstrate containment, provide experience-near empathy, Explore client's problem & Hx Middle Phase - Repair disruptions of self object transference, addressing enactments, Empathizing with loss, Mourning loss, Mourning ambitions/fantasies, Identify alternative self- objects End Phase - Reflect on Tx process, Acknowledge & process indues related to termination. - ANS Self Psychology Therapy Phases of Tx Change occurs through exploration of past and current relational attachments and trauma in the environment of a healing, secure and reliable relationship. - ANS Attachment-based Therapy Theory of Change Provide sufficiently secure base Pg. 20 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Create secure, accepting, non-judgemental environment comfort with therapist and environment enables client to share traumatic experiences and explore attachment pattern - ANS Attachment-based Therapy Role of Therapist The goals are raise awareness of client's problematic behaviors and emotional patterns formed in childhood Repair the capacity to regulate affects Resolve any emotional or social disruptions with the patient's life Improve quality of attachment with others - ANS Attachment-based Therapy Goals Attachment behavior system, Secure attachment, preoccupied attachment (anxious), Dismissive attachment (avoidant), Disorganized attachment (anxious/avoidant), Attunement, Interpretations, - ANS Attachment-based Therapy Concepts/Interventions Initial Phase - Attunement with the client to build therapeutic relationship, Provide secure base by displaying empathy and care, Collaboratively identify client's attachment style in problematic behaviors and emotional patterns formed in early childhood Middle Phase - Disrupt are explore in both current relationships and early relationships, including relationship with therapist, Support client's ability to regulate and express emotions in difficult situation, teach client to have reflective stance toward themselves End Phase - Repair by altering client's current reactions to the events that cause them emotional distress by sharing interpretations which will help to create a new realist of the painful event to get rid of unwanted emotions and reactions. - ANS Attachment-based Therapy Phase of Tx Change occurs by helping the system view the family as the problem rather than an individual as the problem. - ANS Systems Theory Pg. 21 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Theory of Change Helps family explore: Belief systems and family values, rules and roles that are present, The family hierarchy, Expectations, and Defense Mechanisms and their purpose - ANS Systems Therapy Role of Therapist Homeostasis, Negative feedback, Positive feedback, Calibration, wholeness, equifinality, Equipotentiality - ANS Systems Therapy Concepts Change occurs by understanding multigenerational dynamics and differentiation. - ANS Bowen Family Therapy Theory of Change • Coach/educator • Supervisor • Investigator • Neutral *Does not analyze or interpret - ANS Bowen Family Therapy Role of Therapist Reduce anxiety & emotional turmoil in family system Self-differentiation within the context of family Decrease emotional fusion Improve communication skills Decrease recurrence of dysfunctional patterns Reduce emotional reactivity Pg. 22 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Facilitate detriangulation - ANS Bowen Family Therapy Goals Triangles (Does not have to be a person), Differentiation of Self, Nuclear Family Emotional system, Family projection process, Multigenerational Transmission process, Emotional Cutoffs, Genograms - ANS Bowen Family Therapy Concepts/ Reduce emotional reactivity, Reframing, Genograms, De-triangulation, Increase differentiation, Teaching "I" statements, Opening cut-off relationships, Process Questions, relational experiments, Models, Bibliotherapy - ANS Bowen Family Therapy Interventions Initial Phase - Create family diagram, assess individual levels of differentiation & triangulation, identify dysfunctional patterns that have been passed through generations Middle Phase - Teach / model differentiation through communication skills , de-triangulation, encourage reunification from cutoff family members, teach the family how tot take responsibility for thoughts and feelings End Phase - Review new skills and knowledge gained - ANS Bowen Family Therapy Phases of Tx Change occurs through action-oriented directives and paradoxical interventions. - ANS Strategic Therapy Theory of Change Directive: Therapist delivers directives that facilitate change, particularly around patterns of communication. Problem solver: Focuses on solving problem/eliminating symptoms Expert: Designs a specific approach for each person's presenting problem - ANS Strategic Therapy Pg. 23 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Role of Therapist Solving presenting problems Change dysfunctional patterns of interactions Symptom-free homeostasis Correcting hierarchies - ANS Strategic Therapy Goals Amplifying a deviation, First-Order change, Second- Order change, Therapeutic stages (social, problem, interaction, goal-setting, task-setting, evaluation) - ANS Strategic Therapy Concepts Paradoxical Directives, Positioning, Homework, Hypothesizing, Prescribing the Problem, Family Life Cycle, Use of Metaphors, Restraining (tell someone not to change), Unbalancing, Encouraging relapse/resistance, Reframing, Ordeals - ANS Strategic Therapy Interventions Initial Phase - Define the problem, Determine how client understand problems, Assess destructive patterns, State goals, what behaviors need to change and what would be the sign of change. Middle Phase - Review attempted solutions, Assign ordeals, prescribe the problem, Relabel behavior, Instruct client to respond to problems in new ways End Phase - Plan for maintenance & future challenges, Emphasize positive changes made - ANS Strategic Therapy Phase of Tx Change occurs through restructuring the family's organization. (bigger picture) - ANS Structural Family Therapy Theory of Change Pg. 24 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. "Friendly Uncle" Active & Involved Helps family understand how family structure can be change Joined - ANS Structural Family Therapy Role of Therapist Restructuring family system to allow for symptom relief ^ constructive problem solving Change dysfunctional transactional patterns Help create flexible boundaries - ANS Structural Family Therapy Goals Alliances, coalitions, power hierarchy, subsystems, family map (never in session or shown to family system), Disengaged Boundaries, Enmeshed Boundaries - ANS Structural Family Therapy Concepts Joining, tracking (paying attention to the dynamics), mimesis (take on family style of language/communication), Unbalancing (one down position), Reframe, Enactments, Boundary Making, Crisis Induction - ANS Structural Family Therapy Interventions Initial Phase - Join with the family, accommodate to and challenge rules family system, assessment/mapping of hierarchy, alignment, and boundaries, reframing to have problem reflect whole system Middle Phase - Highlight & modify interactions, Utilize enactments of problem and unbalance systems End Phase - Review progress made, Reinforce structural change, Provide tools for future - ANS Structural Family Therapy Pg. 25 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Phases of Tx Change occurs through self-awareness & improved communication (humanistic). People are naturally geared towards change and growth - ANS Satir Communication Therapy Theory of Change Active Facilitator Resource Detective Genuine/warm Honest/direct - ANS Satir Communication Therapy Role of Therapist The goals are for clients to increase congruent communication, improved self-esteem & personal growth - ANS Satir Communication Therapy Goals Incongruent Communication, Styles of Communication (Placater, Blamer, Computer (super reasonable), Distracter, Leveler), Modeling Communication ("I" statements), Family Life Chronology (only used in Satir), Family Sculpting, Take Responsibility, Metaphors & Storytelling, Transforming Rules, Iceberg Model, Parts Party, Self-mandala, Craziness, Seven Levels of Experience (yearning, expectation, perceptions, feelings, feelings about feelings, coping, and behavior) - ANS Satir Communication Therapy Concepts/Interventions Initial Phase - Establish rapport, Assess communication patterns, stances, and concerns, Identify Tx focus and goals Middle Phase - Increase the family's congruent communication, Support & strengthen each individual's sense of uniqueness & self-esteem End Phase - Help family practice, implement, and integrate changes and increase awareness of larger familial patterns - ANS Satir Communication Therapy Pg. 26 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Phase of Tx Disclose Fees Signed for Minors Fictitious Name = Name & License of Owner Technology Utilization License Status License Number HIPPA-entity requires NPP Notice where complaints can be filed - ANS Legal Concerns of Informed Consent 7 years from termination or after a minor is 25 years old - ANS Keeping Records Timeline One of the participants is 13 or younger and the other is 14 or older One of the participants is 21+ and the other is under 16 - ANS Mandated Report for child abuse calling CPS immediately written report within 36 hours - ANS Reasonable suspicion timelines for reporting child abuse does not include homelessness but CAN include medical neglect - ANS Reporting Neglect ALWAYS reportable even after client is no longer a minor - ANS Child Pornography Abduction Isolation Pg. 27 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Neglect Physical Financial - ANS Elderly Abuse Categories Emotional Abuse - ANS Elderly Abuse Optional Reporting Report immediately to LE or APS with written report in 2 days - ANS Elderly Abuse Reporting Timeline (NON long term care) Non-physical = report to LE/Ombudsman immediately w/ written report in 2 business days Physical abuse not resulting in bodily injury = report to LE/ombudsman with 24 hrs w/ written report in 24 hrs Physical abuse resulting in bodily injury = report to LE no later than 2 hrs w/ written report in 2 hrs Physical abuse perpetrated by another resident with dementia reported to LE/ombudsman within 24 hrs. - ANS Elderly Abuse Reporting Timelines (Long term care) Crisis Client refuses to sign - ANS Reasons to treat client w/o informed consent Limits of confidentiality Risks and benefits of Tx Alternative Tx Right of Refusal Cancellation Policy Billing procedures Communication and emergency practices Background of therapist Pg. 28 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Defining who client is - ANS Ethical considerations for Informed Consent Must be signed 12+ may consent to own Tx Parents married, either can sign Parents Divorced, custody agreement required to confirm authority to sign Parents never married, either can sign Foster care, lawyer to sign unless Minute Order issued for social worker or foster parent - ANS Informed Consent for Minors "no secrets" policy should be discussed - ANS Informed Consent for Couples Part of the self - not seen as a problem - ANS Egocentonic Part of the self - does not like it - ANS Egodistonic All pervasive of life span, not all of a sudden - ANS Personality Disorders Eccentric/odd: Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder - ANS Personality Disorder Cluster A Dramatic: Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Pg. 29 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Narcissistic Personality Disorder - ANS Personality Disorders Cluster B Anxious, fearful: Avoidant Personality Disorder Dependent Personality Disorder Obsessive compulsive Personality Disorder - ANS Personality Disorder Cluster C Legal - ANS Scope of Practice Ethical - ANS Scope of Competence Minor must sign release whether or not they were the one to sign informed consent. Parents do not have the right to records without release of authorization. - ANS Release of records for 12+ minors Clinician is only responsible for referrals when THEY terminate care - ANS Continuity of Care Grey area - determine best course of Tx for client. Does not always have to be a breach in confidentiality. - ANS Breaking Confidentiality for Suicidal Ideation Clinician must warn the police, not legally obligated to warn the other person (optional). - ANS Clients threat of harming an identifiable other 60+ - ANS Age considered elderly Does not fall under duty to warn; Special circumstances that protect them from having to disclose from "no secrets" policy with couples - ANS HIV+ Pg. 30 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Old enough to drink must be old enough to drive 13 years and younger must also be 13 years or younger - ANS Age for reporting child abuse in sexual relationships Clinicians can initiate but cannot actually hospitalize a client - ANS 5150 Clinicians have: - 5 days to allow clients to inspect - 10 days to provide summary - 15 days to provide a copy - ANS Written request for records timelines Someone that is unable to provide food, clothing, and shelter for themselves due to a mental disorder. - ANS Gravely Disabled Clinicians should refrain from this Must be client initiated Must be within the cultural norm of the population served - ANS Bartering for Services 14 point - ANS Font on legal authorization of release Advertising Authorization to Share Information Confidentiality Fees Informed Consent Insurance Privilege Pg. 31 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Records Referrals Sexual Relations Suicide Telehealth - ANS Legal & Ethical Issues Business Practices Child Abuse Elder/Dependent Abuse Harm to Others HIPAA Scope of Practice Standard of Care Treating Minors - ANS Legal Issues Consultation Countertransference Dual Relationships Diversity Gifts Groups Issues with Other Therapists Personal Problems Scope of Competence Self-Determination Termination Treating Multiple People in Tx Unit - ANS Ethical Issues Pg. 32 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Only theory to use directive approach - ANS Strategic "loner" likes to be alone - ANS Schizoid PD "Lonely" - desires social connection but avoids out of insecurities. - ANS Avoidant PD Only done when goals are not being met, not a reason to continue therapy if previous goals were met - ANS Reformulating Goals Therapeutic Relationship Functional Analysis Define Problem Negative Patterns Educate / Explain Collaborative Goals - ANS CBT Beginning Phase Identify Patterns Assign Homework Monitor Thoughts Label Cognitions Reframe Thoughts Practice Skills - ANS CBT Middle Phase Review Gains Skills Learned Rehearse Situations Pg. 33 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Anticipate Struggles - ANS CBT End Phase Psychoeduation Identify Irrational thoughts - ANS REBT Beginning Phase Challenge Beliefs Direct Confrontation Blunt / Honest / Logical Change Behaviors - ANS REBT Middle Phase Review Progress Apply Skills Anticipate Struggles - ANS REBT End Phase Behavioral Control Mindfulness Distress Tolerance Address Self Harm - ANS DBT Beginning Phase Emotional Regulation Homework Define Life Goals Build Self Respect Find Peace / Happiness - ANS DBT Middle Phase Deeper Meaning - ANS DBT End Phase Pg. 34 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Congruence Empathy Self-Actualization Unconditional Positive Regard Non-Directive - ANS Client-Centered Phases No Interpretations - ANS Gestalt Bowen Establish Rules (Battle for Structure) All Attend (Battle for Structure) Motivate Change (Battle for Initiative) Gather Information - ANS Experiential Therapy Beginning Phase Trial of Labor (Understanding roles) Develop Cohesion Alternate Interactions Highlight Boundaries Role Play "craziness" - ANS Experiential Therapy Middle Phase Highlight Accomplishments / Growth Role Play Future Express Feelings - ANS Experiential Therapy End Phase Tell Story Reasons for Therapy - ANS Narrative Therapy Beginning Phase Pg. 35 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Externalize Problem Mapping Influence Effect of Problem Unique Outcomes Re-Author Story Enlist Witness - ANS Narrative Therapy Middle Phase Document New Story Write Letter to Self - ANS Narrative Therapy End Phase Join Client Preferred Future Client Strengths Solution-Oriented Language Achievable Goals - ANS Solution Focused Therapy Beginning Phase Identify Strengths Resources Present Solution-Talk Exceptions to the Problem Scaling Questions Coping Questions Miracle Questions Presuppose Change Compliment / Affirmations - ANS Solution Focused Therapy Middle Phase Additional Changes Pg. 36 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Identify Hurdles - ANS Solution Focused Therapy End Phase Holding Environment Build Rapport Explore Experience Empathy Interpretations - ANS Psychodynamic Beginning Phase Promote Insight Increase Individuation - ANS Psychodynamic Middle Phase Termination Concerns - ANS Psychodynamic End Phase Holding Environment Build Rapport Client's Experience Empathy - ANS Object Relations Beginning Phase Promote Insight Interpretations Confront Resistance Transference / Countertransference Confront Defense Mechanisms Projective Identification Introjection - ANS Object Relations Middle Phase Termination Concerns Pg. 37 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Consolidate Interpretations Review Insight - ANS Object Relations End Phase Define Problem Family Patterns Communicating Problem State Goals Identify Behaviors - ANS Strategic Beginning Phase Attempted Solutions Assign Ordeals Prescribe Problem Relabel Behaviors Positioning Homework Restraining Paradoxical Directives - ANS Strategic Middle Phase Maintenance of New Behaviors Plan for Future Challenges Emphasize Change - ANS Strategic End Phase Create Family Diagram (Genogram) Assess Differentiation / Triangulation Identify Patterns - ANS Bowen Beginning Phase Teach / Model Differentiation Pg. 38 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED. Communication Skills De-triangulation Reunification of Cut-Offs Teach "I" Statements Reframe Interrupt Arguments Teach Emotion Regulation Take Responsibility - ANS Bowen Middle Phase Review New Skills Review Knowledge - ANS Bowen End Phase