Family Therapy Workshop

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Family Therapy Workshop

• ??.??.????????? ?????????
• ??????????????????? ????????????????????????
• 11 ????????? 2548

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????????????????????????

• I. ????? Primary care
• ????????????????????????
• ??????????????????????????????????????????????????
  ??
• ???????????????? ????? 2-3 ?????
• ??????????????????????????????????????????????????
  ??????????????? (reflexive questions)
• ?????????????????? ??? ?????????????????
• ?????????????????????????? ??? ???????????????????

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Family therapy

• II. ????? Secondary or Tertiary care
• Contact for change
• Specific time-limited contact with whole family
• About 6-10 one hour sessions using family therapy
  techniques
• Focus on family interaction
• Sophisticated hypotheses and formulations about
  family dynamics

4
Family treatment

• Family treatment can be defined as a systematic
  effort to produce beneficial changes in a family
  unit by introducing changes into the patterns of
  family interactions. Its aim is the establishment
  of more satisfying ways of living for the entire
  family and for individual family members.

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Family treatment

• Family therapy might be thought of as any type of
  psychosocial intervention using a conceptual
  framework that gives primary emphasis to the
  family system and aims to affect the entire
  family structure.

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Family Therapy in combination with pharmacotherapy

• Although pharmacotherapy may be the cornerstone
  of treatment of axis I disorders, it should be
  combined with individual and family work for
  almost all patients, and with family therapy at
  some point in the treatment.
• Reasons for this include the following
• Family dynamic issues or other stress may
  precipitate episodes, and therapy can help
  families prevent or cope with further stress.
• Persons with these disorders often have lost
  social skills, or the illness has created
  behavior patterns that make these persons averse
  to their support systems, including the family.

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Family Therapy in combination with pharmacotherapy

• Reasons for this include the following (???)
• The illness has powerful effect on family life,
  and the entire family needs to cope with this
  fact together.
• An ongoing relationship with the family therapist
  not only improves medication compliance but also
  provides continuous support during times when the
  person may not be on medication and provides a
  critical social support for persons dealing with
  what in many cases are chronic and potentially
  lifelong issues.

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Assessing the familys coping mechanism in
PRACTICE

• P Presenting problem (???????????????)
• R Roles and Rules (????? ??? ???????
  ???????????)
• A Affect (??????)
• C Communication (??????????)
• T Time in family life cycle (???????????????????
  ????????????)
• I Illness (????????????)
• C Community resource (???????????????)
• E Environmental factors (???????????????????????
  ?)

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?????????????? ????????? ????????????????

• I. ????????????????? (Family Life Cycle)
• II. ???????????? (Family System)
• III. ???????????????? (Homeostasis)
• IV. ???????????????????? (Family Structure)
• V. ????????????????????????????? (Wider system)
• VI. ???????????????????????????? (Stress on
  family)

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I. ????????????????? (Family Life Cycle)
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????????????????? (Family Life Cycle)
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????????????????? (Family Life Cycle)
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????????????????? (Family Life Cycle)

• ?????????? (Transition) ??????????????????????????
  ????? ?????????????? ?????????????????????????????
  ??????????????????????????????????????????
  ??????????????????????????

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II. ???????????? (Family System)

• ???????????????????????????????????????????
  ????????????????????????????????
  ??????????????????????? ???????????????????????
  (homeostasis)
• ????????????????????? (feedback)
  ????????????????????????????????
• ???????????????????????????????????? (identified
  patient) ?????????????????????????????????????
  ?????????

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III. ???????????????? (Homeostasis)

• ???????????????? (Homeostasis) ???????????????????
  ????????????????????? ????????????????????????????
  ????????????? ????????????????????????????????????
  ??????????????????????? ??????????????????????????
  ???????????????????????????????????

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???????????????? (Homeostasis)

• ????????????????????????? (morphogenesis)
  ?????????????????????????????????????????? ????
  ?????????????????????? ??????????????????????????
  ???????????????????????????????????
  ????????????????????????????????????

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IV. ???????????????????? (Family Structure)

• ????????????????????? (Hierarchy)
• ???????? (Subsystem) ?????? ??????????????
  (Parental subsystem), ??????????????? (Sibling
  subsystem)
• ?????? (Boundary)
• 1. ????????????? ??????? (Rigid boundary)
• 2. ???????????????? (Diffuse boundary)
• 3. ??????????????? ??????? (Clear boundary)

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????????????????????? (Hierarchy)

• ????????????????????? (Hierarchy) ?????????
  ???????????????????????????????????????????????
  ?????????? (power) ??????????????????

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???????? (Subsystem)

• 1. ???????? ??????? (marital subsystem)
• ?????????? ????????????
• ????????? ??????? ???????????????????????????
  (intimacy) ????????????????????????? (commitment)
• 2. ?????????????? (Parental subsystem)
• ?????????? ??????
• ??????????????????????????????????? (child
  rearing), ?????? (guidance), ?????????????????????
  ????????????? (limit setting) ????????????????????
  ? (discipline)

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???????? (Subsystem)

• 3. ??????????????? (Sibling subsystem)
• - ?????????????????
• - ?????????????????????????
• - ?????????????????????????? ?????????
  (negotiation), ?????????????????(cooperation),
  ?????????? (competition), ??????????????????????(m
  utual support) ??????????????????????????????
  (attachment to friends)

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?????? (Boundary)

• ???????????????????????? ?????????????????????????
  ??? ?????????????????????????????????????
• ???????? 3 ????
• 1. ????????????? ??????? (Rigid boundary)
• - ?????????????????? ???????????????????????
  (minimal interaction or communication)
• - ???????????????????????? (maximum privacy)

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?????? (Boundary)

• 2. ???????????????? (Diffuse boundary)
• - ?????????????????????? (minimal privacy)
  ?????????????????????? (maximum interaction)
• - ?????????????????????????????????????????
  (over involved)
• 3. ??????????????? ??????? (Clear boundary)
• - ??????????????????????????????
  ????????????????????????????????? ?????????
  ????????????????????????????????????

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V. ????????????????????????????? (Wider system)

• ??????????
• 1. ???????????????????????
• 2. ??????????????
• 3. ????????????
• 4. ????? ????????????? ??????
• 5. ????? ???????? ???????? ????????????????? (???
  ????? ??????????? ???)

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Wider system
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VI. ???????????????????????????? (Stress on
family)

• 1. ?????????? ????????? (horizontal stressors)
• 2. ?????????? ?????????? (vertical stressors)

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Horizontal and Vertical Stressors

• Vertical Stressors
• Family patterns, myths, secrets,
  legacies
• ?
• Time ?
• Horizontal Stressors ?
• Developmental
• Life Cycle Transitions
• 2. Unpredictable
• Untimely death, chronic illness, accident

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?????????????????? (Family assessment)

• ???????????????????????????????? (family behavior
  pattern)
• ?????????????????????????????????????????
• ?????????????????????????????????? ??????
  ????????????????(circular question),
  ?????????????? (future question)
  ?????????????????????? (???????????? ??????????)

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?????????????????? (Family assessment)

• - ?????????? (Circular questions) ?? 3
  ????????????
• 1. ?????????????????????????? ?????????????????
  ????????????(beliefs), ?????????? (feelings),
  ??????????? (behavior) ???????????????????????????
  ??
• 2. ??????????????????(?????????????????????)
  ??????????????????????? ????????????????
• 3. ?????????????????(empty chair)
  ?????????????????????????????? ?????????????

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?????????????????? (Family assessment) (???)

• 4. ?????????????? (Family genogram)
• ????????????????????????? ???????????????
  ??????????????????? ??????????????????????????????
  ?????????????? ???????????????????????????????????
  ???????
• ???? I.P. ????????????? Identified Patient
  ??????? ???????????????????????????????????????
  ???????????????????????????????

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?????????????? (Family genogram)

• I.P.

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?????????????????? (Family evaluation)

• I. ????????????????????????? ????????
  ??????????????????????????????????????????????????
  (current phase of family life cycle)
• II. ?????????????????????????????
• ?. ???????????????????????????????
• ?. ????????????????????????????????????????
• ????????? ??? ?????????????????????
  ????????????????????????
• ?. ???????????????????????????????

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???????????????????????????????

• ??????????????????????? ??? ????????????
  (Composition and characteristics of the nuclear
  and extended family) ???? ????, ???, ?????,
  ???????? (????????????????????????????????????????
  ????? ?????????????????????????????????),
  ?????????, ????????????? ??? ??????????????????
• ??????????????????????????????????
• ?????????????????????????
• ?????????????????????????????? ???????????
  (??????????????????)

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?????????????????? (Family evaluation) (???)

• ?. ???????????????????????????????????????
  ???????????????? ????????????????????????????????
• ?. ??????????????????????????????????????????????
  ??????? ?????????????????? (strengths) ????????
  (motivations ) ????????????? (resistances)
  ?????????
• III. ?????????????????????????????????????????
  (Formulating the family problem areas)
• IV. ?????????????? ??? ?????????? (treatment
  contract)

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• ??? coffee break ???

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Dysfunctional Familytypes of disturbances

• Problematic family beliefs and myths
• Individual symptomatology
• Life cycle stressors
• Inability of the family to accomplish family
  tasks

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Family system explanations for symptoms

• Symptoms
• - May emerge as a result of problematic
  communication or interactional patterns in family
• - May signal impasse at a particular
  developmental point in the familys life cycle
• - May be part of solution behavior that is
  failing at its task
• - May reflect problems in family structure and
  organization

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Family system explanations for symptoms

• Symptoms
• - May be expressed when aspects of familys life
  are denied or dissociated
• - May represent a lack of validation
• - May be an expression of an underlying medical
  or psychiatric illness
• - May simply relate to misfortune and bad luck

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Family Therapy

• Is any psychotherapeutic endeavor that
  explicitly focuses on altering the interaction
  between or among family members and seeks to
  improve the functioning of the family as a unit,
  or its subsystems and/or the functioning of
  individual members of the family.

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Family Therapy The most common final goals

• Reduction or elimination of symptoms or
  symptomatic behavior in one or more family
  members
• Resolution of the problem as originally presented
  by the family
• Increased family/marital intimacy
• Role flexibility and adaptability within the
  family matrix
• Toleration of differentness and differentiation
  appropriate to age and development level

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Family Therapy The most common final goals

• 6. Balance of power within the marital dyad and
  appropriate sharing of input and autonomy for the
  children
• 7. Increased self-esteem
• 8. Clear, efficient, and satisfying communication
• 9. Resolution of neurotic conflict, inappropriate
  projective identification, and marital
  transference phenomena

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Family Therapy Models

• 2 basic forms
• Insight-oriented family therapy
• Behavioral family therapy

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I. Insight-oriented family therapy approaches
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Insight-oriented family therapy approaches
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II. Behavioral family therapy approaches
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Behavioral family therapy approaches
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Structural Family Therapy

• ????????????? Salvador Minuchin
• ????????????????????????????????????
  ??????????????????????? ????????????????????
  ????????????????????? (boundary)
  ???????????????????????????????? (subsystem)
  ?????? ?????????????? ???????????????
  ????????????????????????????????(hierarchy)
  ????????????

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Structural Family Therapy

• ??????????????????????????????????????????????????
  ???????
• Enactment ????????????????????????????????????????
  ????????????????????????????????????????????????
• Reframing ????????????????????????????????????????
  ?????????? ???????????????????????????????????????
  ????????

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Strategic Family Therapy

• ?????????????????????????????????? Haley ????
  ?.?.1963 ??? Satir ???? ?.?.1967
  ?????????????????????????????? Metal Research
  Institute ?? Palo Alto ?? California
  ?????????????? Minuchin ?????.?.1974
• Strategic Therapy ??? ????????????????????????????
  ??????????????????????????? ??????????????????????
  ?????????

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Strategic Family Therapy

• ??????????????????????????????????????????????????
  ?????????????????? ???????????????????????????????
  ??????? (solution) ??????????????????? (more of
  the same)
• ??????????????????????????????????????????????
  (family rules) ??????????????????????
  (relationship patterns)???????????????
• ??????????????????? ??????????????????????????????
  ?, ???????????????????????????????????????????????
  ? ????????????????????????????????????

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Strategic Family Therapy

• Haley ????????????????? (directives),
  ????????????? (task assignments),
  ??????????????????????????????????????????????????
  ????????? (paradoxical interventions)
  ????????????????????????????????????????
• Madanes ????????????????????????????? paradoxical
  ??????????? pretend ?????? ??????
  ??????????????????????????????????????????????????
  ????????????????

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Brief Family Therapy

• Mental research institute in Palo Alto
• Complete therapy within 10 sessions
• Attended to the way a family solves its problems
  rather than to the reasons for the problem or the
  individual pathology
• A communication-based approach founded in
  cybernetics
• Practical and solution-oriented
• Focus on the regulation of family patterns by the
  family rules

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Brief Family Therapy

• Milan school
• Examines every aspect of the present relationship
• Focus on the way each person tries to help the
  family
• Both the Palo Alto group and the Milan school
  approaches also promote the idea of cotherapy and
  the use of the therapist teams, with in-room
  teams and teams behind one-way screens working
  together

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Systemic Family Therapy

• ????????????????????????????????????????
  ???????????? ?????.?.1978 ????????? 4 ???????
  Selvini-Palazzoli, Boscolo, Cecchin ??? Prata
• ??????????????????????????????????????????????????
  ????????????????????????? (functioning of family
  system) ????????????????????????????????????
  (family ritual) ??????????????????? (hypotheses)

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Systemic Family Therapy

• ??????????????????????????????????????????????????
  ?? (breakdown of boundaries) ?????????????????????
  (parent subsystem) ?????????????? (child
  subsystem) ?.?. ???? ?????????????????????????????
  ?????????? ???????????????????????????????????????
  ?????????????????????????????
• ??????????????????????????????????????????????????
  ?????????????????????????????????????? (family
  cohesion hypotheses)

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Systemic Family Therapy

• ??????????????????????????????????????????????????
  ??????????????????????????????????????
• ??????????????????????????????? (circular
  question) ????????????????????????????????????????
  ??????????????????????????????????????? ?????????
  ?????????? ???????????? ?????????????????????????
• ????????????????? (neutrality) ???????????

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Systemic Family Therapy

• ??????????????
• ?????????????????????????? 5-8 ????? (sessions)
  ?????????? 10 ?????
• ??????????????????????????? 1 ?????
  ?????????????????????????????????????
  (??????????????????) ??????????????????????
• ????????????????????????? 1-3 ?????????????????
  ??????????????????????????????????????????????????
  ????????????????????? ??????????????? 4
  ??????????????????????????????????????????????????
  ??????????

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Systemic Family Therapy ?????????????? (???)

• - ????? 2-3 ??? ?????????????????????????????????
  ?????????????????????????? session ??? 1 ???
• 1. ???????????????????????????????????????????????
  ???? ???? ??????????????? 1 ?????
• 2. ??????????????????????????? ???????????????????
  ???? ?????????????????????????????????????????????
  ??????????????????????????????????????
• 3. ?????????????????????????????????????????
  ?????????????????????????????????

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Systemic Family Therapy ??????????????(???)

• ??????????????????????????????????????????????????
  ???? (pre-session meeting) ?????? 15 ????
  ??????????? therapist ??? co therapist
  ???????????????????????????????????? 30-45 ????
  ????????????? (break) ?????? 15 ????
• ??????????????????????????????????????????????????
  ????????????????????????????????????? (positive
  connotation ??? prescription) ????????????????????
  ?????????????????????????? ???????????????????????
  ??????????????????????????????????????????????????
  ?????????????

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Systemic Family Therapy ??????????????(???)

• ??????????????????????????? ?????? 15 ????
  ??????????????????????????????????????
  ???????????????????????????????????????? positive
  feedback ?????????????????????????????????????????
  ????? ????????????????????????????????????????????
  ????????????????????????????????????
  ?????????????????????
• ??????????????????? (prescription)
  ???????????????????????? ?????? ??????????

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Systemic Family Therapy ????????????????

• ?????????????? ???????????????????????????????????
  
• ??????????????????????????????????????????????????
  ???????????????????
• ??????????????????????????????????????
• ??????????????????????????????????????????????????
  ??????
• ??????????????????????????????????????????????????
  ????????? ?????????????????????????

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Basic strategies of family intervention

• Supporting adaptive mechanisms, supporting and
  encouraging strengths, and imparting new
  information, advice, and suggestions
• Expanding individual and family emotional
  experience
• Explicit development of interpersonal skills,
  such as communication skills, parenting skills,
  and problem-solving skills

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Basic strategies of family intervention

• Reorganizing the family structure
• Increasing insight and fostering intrapsychic
  conflict resolution
• Helping the family find new and more positive
  ways of understanding their situation

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Family treatment techniques

• Reframing Therapist perceives and understands
  the patient's or the familys frame and counters
  this frame with another, competing view.
• Enactment is the technique of eliciting the
  playing out of interpersonal problems the family
  complains of in the therapeutic hour.
• Focusing ???????????? focus ?????????????????
• Boundary making Therapist can make boundaries by
  verbal reconstruction, giving tasks, special
  rearrangements of seating in the sessions,
  nonverbal gestures, and eye contacts.

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Family treatment techniques

• Unbalancing techniques To change the
  hierarchical relationship of members of a family
  system or subsystem. There are 3 basic ways of
  unbalancing the family hierarchy and power
  distribution
• Affiliating with certain family members
• Ignoring family members
• Entering into a coalition with some family
  members against others.
• Creating s systemic reality Therapist helps the
  individual family member perceive themselves as
  acting and reacting to one another in the family.
• Paradoxical techniques Most therapists reserve
  this type of intervention for more resistant
  couples.

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Satirs Systemic Brief Therapy

• ????????????? Virginia Satir
• Iceberg metaphor?????????
• ?????????????
• Make contact ??????????
• Explore listen to iceberg, not to a story
• Set goals ??????????? level ??? iceberg
• ??? intervention (??????????????????? iceberg
  ?????)
• Anchoring ??????????? iceberg

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Personal Iceberg MetaphorBehavior

• Coping (stances)
• Feelings
• Feelings about feelings
• Perceptions
• Expectations
• Yearnings
• Self I am, life energy

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Therapeutic process (Satir Model)

• Make contact
• Hope
• Problems
• Set Goals positive goals
• Commitment
• Explore
• Change ??????? experiential
• Anchoring
• Closure
• Homework

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Psychoeducational Approaches

• 3 main approaches
• Parent Management Training
• Relapse Prevention Training
• Family Group Education

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Expressed Emotion (EE)

• ????????????? high EE ??????? ????????????????????
  ?????????? (high relapse rate)
• ????????????????? high EE ??????????????
• Critical (?????, ??????)
• Hostile (?????????)
• Emotionally overinvolved (??????????,
  ?????????????????????????????????????????????????)
  

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Eclectic Approach

• ????????????????????? ????????????????????????????
  ??????? ??????????????????????????????????????????
  ???????????????????? (simple short-term method)
  ??????????????????????????????????????????????????
  ???????????????????????????
• ?????????????????????????????? ???????????????????
  ?????????????????????????????????????????
  ??????????????????????????????????????????????????
  ?????? ???????????????????????????????????????????
  ???

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Thank you for your attention