A - Clinical Flashcards
What kind of strategy is Self Instructional Training?
Control Strategy
Reality therapy is different than self-instructional training in that it…
Reality therapy is about helping the client focus on the “here-and-now” (so like real life) in order to help the client create a better future through decision-making/control. Self-instructional training is about helping client replace negative thoughts with positive ones; respond better to stimuli.
_________ is to cause to become less sensitive or insensitive while ___________ is to make increasingly aware of, in a concerned or sensitive way.
desensitize / sensitize
An increase in the frequency of a response by removing an aversive event immediately after the response is performed
negative reinforcement
Before heading out for a day at the beach, you slather on sunscreen (the behavior) to avoid getting sunburned (removal of the aversive stimulus).
You decide to clean up your mess in the kitchen (the behavior) to avoid getting into a fight with your roommate (removal of the aversive stimulus).
On Monday morning, you leave the house early (the behavior) to avoid getting stuck in traffic and being late for work (removal of an aversive stimulus).
At dinner time, a child pouts and refuses to each the vegetables on her plate. Her parents quickly take the offending veggies away. Since the behavior (pouting) led to the removal of the aversive stimulus (the veggies), this is an example of negative reinforcement.
negative reinforcement; so, if you do this, then that won’t happen; this makes you do “this” more… the that not happening reinforces the this and the negative means the that gets removed.
A behavioral technique that uses positive imagery to increase desirable behavior
covert modeling
A client is encouraged to imagine another person doing a positive behavior in their environment; then they imagine positive consequences from the behavior… what technique is this?
covert modeling
Covert modeling is best used with client who…
have a good imagination; can use positive imagery and engage mental rehearsal.
What is the therapeutic orientation of coping skills training?
CBT
What is the premise of coping skills training?
you’re trying to TEACH SKILLS to increase cognitive, affective, and behavioral proficiency
What is coping skills training commonly used for?
Managing anxiety-provoking situations; from situational stressors to chronic anxiety disorders.
What are two key components of coping skills training?
- positive self-statements and 2. positive imagery
VandenBos (2007) reported that coping skills training is a very effective technique, especially with ________________
Children!
What kind of stressors does coping skills training help with?
divorce; test taking anxiety.
Can coping skills training help with phobias and nightmares?
YES
Mary is a 5 y/o girl suffering from nightly nightmares. The most effective CBT treatment for her is?
Coping skills training
Covert aggression is most typically displayed in children of which gender?
female
Covert sensitization is a behavior or cognitive technique?
behavior. it’s all about behavior.
I see a bear. My muscles tense. I feel afraid.
This best illustrates William James’ theory of emotion.
An approach to cognitive therapy defined by Beck in which the client and therapist are considered equal partners working together to address problems and effect change.
Collaborative Empiricism
Mutual understanding, communication, and respect… this define’s Beck’s approach to engaging clients. What did he call this?
Collaborative empiricism
client capable of objective analysis/conclusions; Beck; equal partners; carl rogers; client and therapist working together; cognitive therapy
Collaborative empiricism
Key figure associated with collaborative empiricism?
Beck
What is the premise of collaborative empiricism?
client is capable of objectively analyzing his/her own issues and arriving at a conclusion
How does a therapist approach collaborative empiricism? Like what is the strategy the therapist will use?
Guided discovery.
Tell me two things to describe guided discovery:
- You use socratic questioning and 2. help client develop/test hypotheses
A therapeutic technique by Beck where therapist helps client CHALLENGE unpleasant beliefs/assumptions.
Cognitive modification
Cog mod is based on assumption that a person can change their ________ by changing their ________.
undesirable behavior; how they think
Beck R & R of cog mod =
recognize and replace thoughts thoughts thoughts thoughts thoughts!!
cognitive modification gets some push back by behaviorism… behaviorism says that change in behavior can’t just come from changing thoughts, but changing _____________
external stimuli.
_________ conditioning is the learning process through which the relative frequency of a response increases as a result of reward or reinforcement.
operant
_________ conditioning is a type of learning found in animals, caused by the association (or pairing) of two stimuli.
pavlovian (think dog… pavlov’s dog)
what is dichotomous thinking?
absolutes… always, every, never…
When a person uses their emotional state to derive a rationale for that state
emotional reasoning
“I feel this way because something must be wrong” is an example of…
emotional reasoning
Cognitive therapists believe that unpleasant emotional states come from _____________ or ___________ rather than the situation itself.
cognitive distortions; interpretation of the situation
In order for cognitive modification to work, the client has to be ___________
aroused affectively
emotional reasoning is a cognitive distortion that is resistant to change because
it’s a sticky cycle… using your emotions to justify the rationale for the source of your suffering… hard to pull people from this… hard to encourage away from it.
Which type of cognitive distortion actually worsens other cognitive distortions?
emotional reasoning
a DBT component where the therapist validates the client’s emotional experience WHILE encouraging change
emotional validation
Cognitive distortion: exaggerating the negatives
magnification
Cognitive distortion: using isolated cases to make wide generalizations
overgeneralization
Cognitive distortion: thinking in absolute terms (always, never, every)
dichotomous thinking
Freudian psychoanalysis involves analyzing _____ _____ ____ and _______?
free association, transference, dreams, and resistances
Freudian psychoanalysis consists of a combination of _____ _____ _____ and _______
confrontation, interpretation, working through, CLARIFICATION
Freud posited that when the ego is unable to ward off danger (anxiety) through rational, realistic means, it resorts to one of its ________.
defense mechanisms
What two characteristics do all defense mechanisms share, according to Freud?
1) they serve to distort reality and 2) they operate on an unconscious level
DM: Refusing to accept external reality because it’s too threatening
denial
DM: the gross reshaping of external reality to meet internal needs is called?
distortion
DM: this occurs when one attributes to others one’s own unacceptable thoughts/emotions.
projection
DM: refers to indirectly expressing aggression toward others.
passive aggression
DM: the direct expression of an unconscious impulse without conscious awareness.
acting out
DM: subconsciously viewing another person as more positive than they are.
idealization
DM: involves shifting sexual or aggressive impulses to a more acceptable target
displacement
DM: an extreme separation of emotion from ideas in order to distance oneself from anxiety
intellectualization
DM: converting unconscious inappropriate impulses into their opposites
reaction formation
DM: the overt expression of ideas or feelings in such a way to give others pleasure
humor
DM: occurs when one identifies so deeply with some idea that it becomes a part of that person’s character
introjection
DM: transferring/expressing negative emotions or instincts in positive, more acceptable ways
sublimation
DM: the rejection of painful or shameful experiences from consciousness and prevents unacceptable impulses/desires from reaching consciousness
repression
DM: the process of giving a socially acceptable reason to explain unacceptable thoughts or actions
rationalization
DM: when a person becomes stuck in a successfully completed developmental stage and returns to this stage in response to difficult life problems
fixation
DM: a return to a former or less developed state.
regression
The id, a completely unorganized reservoir of energy that includes all instincts and reflexes that are inherited at birth, operates according to what?
pleasure principle
The ________ is that part of the id that has been modified by its interaction with the external world, functions to suspend the pleasure principle, and represents the ___________
ego; reality principle
What part of the ego acts as the conscience and is constructed largely from internalization of parental restrictions, prohibitions, and customs?
superego; morality principle
What unconscious mental process is characterized by limited logic, substitution of one idea with another, and by immediate discharge or energy?
primary process
In Psychoanalysis, __________ __________ works to resolve the tension created by the pleasure principle. … Freud described it as infantile, primitive and dreamlike, driven by a need to maximize pleasure and minimize pain.
primary process
What conscious mental process, per psychoanalysis, is more logical and sequential in nature?
secondary process
This is the term a psychoanalytic psychologist might use to describe a weakening of one’s defenses and the consequent breaking through of an impulse
signal anxiety
in psychoanalytic theory, anxiety experienced as a spontaneous response to any stimulus that causes dissolution of the ego.
primary anxiety
in psychoanalytic theory, anxiety that arises in response to internal conflict or an emerging impulse and functions as a sign to the ego of impending threat, resulting in the preemptive use of a defense mechanism.
signal anxiety
Three types of anxiety according to Freud
- neurotic anxiety (fear of losing control of the id) 2. reality anxiety (fear of real world events) 3. moral anxiety (fear of violating our own moral principles.
During _________ a client is asked to attend to all thoughts and report them without suppressing or censoring.
free association
freud described _______ as a reluctance or inability to recall the traumatic memories that caused ones symptoms
resistance
What is the term used to describe a client’s projections of his own feelings, thoughts, wishes, and attitudes about others in his past onto the therapist?
transference
Freud used the term ________ to describe a transference reaction that became very intense during analysis.
transference neurosis
Of the two transference reactions, a client’s feelings of love that are displaced from original objects (parents) onto the therapist are considered ____________ transference and facilitates treatment
positive
___________ transference involves displacement of aggressive drives from the original objects onto the therapist.
negative
what term is used to describe a relationship that allows the client to identify with the therapist as a person, one who can eventually help replace id with ego?
therapeutic working alliance
in psychoanalytic terms, a client experiences ________ when the recall of unconscious material leads to emotional release, while _________ occurs when connections are made between current behaviors and unconscious material
catharsis; insight
what psychoanalytic technique serves the purpose of gradually increasing a client’s insight into the reasons underlying current feelings and behavior?
interpretation
from a psychoanalytic perspective, a client who reports they have been thinking about problems outside of therapy indicates what?
a good working alliance has been established
This person was a Neo-Freudian who established analytic psychology
Carl Jung
Freud believed a client’s current/future behavior were mainly determined by the past; Jung believed what?
important to understand people’s future hopes and aspirations, not just effects of past
Jung contended that the _________ unconscious arises from repression, whereas ________ unconscious comes from universally inherited neural patterns and is described as the reservoir of the experiences of our species
personal/individual; collective
From Jung’s analytic perspective, _____________ are innate, universal prototypes for ideas that may be used to interpret observations. A group of memories and interpretations associated with one is termed a __________.
archetype; complex
__________ = find pleasure externally; ______ turning inward of libido
extroversion; introversion (Carl Jung)
Jung believed that at approximately 40 years old, people shift from the ______ of their youth to the _________ of adulthood, a time period referred to as _________-
extroversion; introversion; mid-life crisis
sexual/aggressive is to Freud as ______/aggressive is to Jung?
social
The collective unconscious consists of what per Jung?
archetypes - many - but 4 common = shadow, persona, anima/animus, and self
Jung was influential in theoretical foundation of what personality test?
MBTI Myers-briggs type indicator (introverted/extroverted orientations).
Who blended Freud’s psychoanalysis with humanist psych?
JUNG. Mr. Carl Jung.
Jung wrote a lot about two things… what were they?
- universal symbols (remember the YouTube video? all the circles? 2. meaning of life. Remember, individuation is a big deal for him. Self-actualization was a focus.
Freud believed present and future were rooted in past; Jung believed ______________
hopes/aspirations just as important as the past
Freud emphasized libido; Jung instead emphasized
social rather than sexual drives (they both agreed on aggression…)
T/F Freud and Jung both agreed there is an individual unconscious
T
For Jung, neuroses develops out of……………..
conflicting archetypes as folks become more actualized
For Jung, transference represented both the __________ and _________ ___________
individual and collective unconscious
4 main archetypes of the collective unconscious for Jung
shadow, self, anima/animus (also persona)
________________ is common to all people, is drawn from thought and behavior patterns across people groups over time, consists of archetypes, and was developed out of ________ work with psychotic pts who had similar delusions/hallucinations?
collective unconscious; JUNG
___________ psychology is less focused on how problems arise and more focused on interventions (in contrast to ________ _______)
humanistic; jungian psych
For Jung, transference was a projection of:
both individual and collective unconscious
In Feminist Object Relations Therapy, what are the 2 contributors to gendered behaviors?
- sexual division of labor and 2. mother-child relationship (positing that many gender differences can be traced to differences in mother-daughter and mother-son relationships)
Reality therapy (1) rejects the ________ and the concept of _______; (2) focuses on ______ behaviors and beliefs; (3) views transference as ________ to the therapy process; (4) stresses _________ processes; (5) emphasizes ______, especially the client’s ability to judge what is right/wrong in daily life; and (6) teaches specific behaviors that will enable clients to ____________.
medical model; mental illness; current; detrimental; conscious; value judgments; fulfill their needs
In object relations therapy, how is the therapist exploring/examining defenses and transferences?
by looking at unconscious relationships
3 important features of object relations therapy
safety, security, and attachment
_______________________ shapes relationships later in life according to Object Relations Therapy
attachment early in life
According to object relations theory, a child’s behavior and interactions are based on ___________
quality of relationship with mom
Humans want to related to ________ according to object relations theory
objects
According to object relations therapy/theory, ____________ shape perceptions and expectations of important people in life
early attachments
Which type of psychoanalysis is focused on exploring ego adaptive processes (reality testing, judgment, sense of reality, affect/impulse regulation, primary/secondary thought processes, etc.) within the individual’s interpersonal and sociocultural realities?
ego psychology
In ego psychology, ego defenses are seen as:
can be adaptive or maladaptive; protect from anxiety
Adaptive ego defenses…
ward off excessive anxiety; foster effective coping
Maladaptive ego defenses…
protect the individual but thwart coping and wholeness of the individual
Who was one of the earliest Neo-Freudians? (Neo just means they agreed with Freud, but adapted his stuff)
Anna Freud - his daughter
Which Neo-Freudian stressed the importance of protective, supportive, and educational attitudes toward children?
Anna Freud
Anna Freud differentiated _________ symptoms for adults and children
neurotic
Who developed the first known classification for childhood symptoms that was able to reflect developmental issues and formalize assessment procedures? What was it called?
Anna Freud; diagnostic profile
What are the 6 progressions in the developmental line - Anna Freud
DEPENDENCY EMOTIONAL SELF-RELIANCE SUCKING RATIONAL EATING WETTING/SOILING BLADDER/BOWEL CONTROL IRRESPONSIBILITY RESPONSIBILITY PLAY WORK EGOCENTRICITY COMPANIONSHIP
Adler was one of the original founders of ____________
psychoanalysis
Adler is well-known for the development of _________
individual psychology
Ironically, individual psychology is not so much individualistic but _________
social
In individual psychology, the individual is seen in their ______ context
social
Adler believed that people are motivated by a need to _________
belong
According to Adler, problems arise when the need to belong is misdirected into one of FOUR goals
power | revenge | attention seeking | displays of inadequacy/insecurity
Who coined the term inferiority complex?
ADLER - the person is too focused on being perfect… neurosis comes from this per Adler.
Who was the first psychologist to highlight the importance of family birth order in the development of one’s personality?
ADLER
______ was like Jung in that he believed humans are driven by ______ needs; disagreeing with Freud
Adler; social
What is the goal of Adlerian therapy?
increase feeling of community; promote equality; replace ego-centrism with courage and social contribution
What techniques are used in Adlerian therapy?
It’s honestly a lot like those cognitive and behavioral interventions… socratic questioning, assessment, pragmatic problem solving, guided imagery, and role playing.
What is the purpose of teleology?
investigate final causes, expected outcomes, endpoints, and purposes. “teleological lens”
The teleological lens helps the therapist with what?
better understand what motivates individual behavior; the systemic purposes of symptoms; the goal of triangulation (so in family therapy, which is where Adler would use this lens); etc.
Adler is using the teleological lens to help folks make ___________ _________
lifestyle assessments… reflecting on lifestyle
How does Adler define lifestyle?
integrated rules and themes of interaction; people are actors, artists, and creators… they strive for goals… this leads to unique styles of life. And family is important here. Events in the family AND ESPECIALLY INTERPRETATION OF EVENTS impact style of life. Some reframing might be needed to address mistaken interactions to create new perspective of an experience
What is the Object Relations terms used to describe a person’s tendency to separate object-representations into good and bad, usually leading to aggressive feelings, irrational thinking, and poorly regulated behaviors?
Splitting
In object relations theory, this is the mental representation of a person that, when inappropriately developed, leads to pathology
object introject
Margaret Mahler, and object-relations theorist and therapist if most noted for her study of
separation-individuation; a process by which internal representations of the self and others are formed
psychologists who primarily emphasize impact of early relationships on PERSONALITY development and view maladaptive behavior as the result of abnormalities in early relationships use what approach to psychotherapy?
OBJECT RELATIONS
what is the main difference between freudian psychoanalysis and ego analysis?
ego-analysis places greater emphasis on the role of the ego as opposed to the id, specifically in personality development.
Adler believed children developed compensatory behavior patterns to defend against their feelings of inferiority. what did he call this?
style of life
According to Adler, if an inferiority complex develops a connection with a specific part of the body, it is called what?
organ inferiority
what is another term Adler used instead of inferiority complex?
masculine protest
Adler posited that what types of childhood feelings motivated growth, domination, and striving for superiority?
inferiority complex
This personality theory and approach to therapy stresses the unity of the individual and the belief that behavior is purposeful and goal-directed. therapy focuses on exploring lifestyle determinants, including family atmosphere, distorted beliefs and attitudes, and birth order.
Adler’s individual Psychology
Which therapeutic technique involves the use of guided dramatic action to examine problems or issues raised by an individual or group?
psychodrama; sociodrama
Psychodrama claims to increase ____ and _____ well-being, enhance _____, and encourage the development of new _____.
physical; emotional; learning; skills
Five basic elements of psychodrama (or the operational components)
PROTAGONIST; AUXILIARY EGOS; AUDIENCE; STAGE; DIRECTOR
Psychodrama: “Protagonist”
person selected to represent the theme
Psychodrama: “Auxiliary Egos”
group members who assume roles of significant others in the drama
Psychodrama: “Audience”
group members who witness the drama; represent the world at large
Psychodrama: “Stage”
physical space where drama conducted
Psychodrama: “Director”
trained psychodramatist
3 phases of psychodrama
- warm up (ID theme/select protagonist) 2. Action (dramatize/explore ways to solve problem) 3. Sharing (debrief time)
Speaking of drama… there’s some drama between psychodrama and _____ _____
assertiveness training
How is psychodrama different than assertiveness training??
AT = more concerned with facilitating insight; PD = trying to change interpersonal behavior
Key person with psychodrama is…
Moreno! remember moreno… dr. porter… psychodrama was his thing…
Family birth order would be important to a counselor using what theory?
individual psychology
Neo-Freudians placed emphasis on what?
social and cultural influences
self or ego psychology… which one emphasizes empathic stance?
self! Kohut! his work with narcissism
ego psychology began to take shape in the early part of the 20th century when the focus of freudian psychology began to shift from the id to the ego. important contributions marked the transformation from freudian to ego psychology, including?
Heinz Hartmann’s work; ego psychology and the problem of adaptation
Who is the person associated with transactional analysis
Eric berne
In transactional analysis, people are analyzed on four levels:
- structural (made up of 3 ego states - parent, adult, child) 2. transactional (so the interaction of these 3 ego states between two people - can be overt/social [hard line] and covert/psychological [dotted line] - can be complimentary, crossed, or “ulterior”) 3. racket and game analysis (several degrees of games; life positions = I’m OK/you’re OK, I’m OK/you’re not OK, I’m not OK/you’re not OK, I’m not OK/you’re OK – rackets are habitual ways of feeling/games are when people seek confirmation/strokes) 4. script
From a behavioral perspective, catharsis is considered a form of _______________? And this results from ______?
extinction; flooding
_________ is the necessary precondition for effective group therapy?
cohesion
The goal of Gestalt Therapy is to achieve ___________
conscious awareness; discovering parts of self that are blocked
According to Gestalt therapists, increased _______ is enough to cause change
awareness
What is the invisible veil according to Sue and Sue
lack of awareness
The invisible veil operates….
outside of consciousness
according to Beck’s cognitive theory, negative thinking occurs _______________, in depressed people
automatically/without awareness
This type of technique can help build awareness
mindfulness
Terms to associate with hypnosis
Pain w/psych components; IBS, relaxation techniques, suggestion
The use of suggestion and deep breathing to reduce autonomic arousal and induce a sense of relaxation
autogenic training
one of the most controversial subjects in the history of psychology and psychiatry is?
that of repressed memories (often a traumatic memory of an event/environment stored by the unconscious mind outside of awareness)
Narcissism, empathy, developmental deficits, and parent-child interactions
self psychology
Premise of self-psychology
kid didn’t get needs for mirroring (getting approval from parent) and idealizing (having an adult worth idealizing) met; think narcissism
Approach/techniques within self-psychology
EMPATHY; Don’t be a blank slate because narcissistic people can’t respond well to this
Harry Stack Sullivan’s 3 modes of existence
prototypic, parataxic, syntaxic
Sullivan’s view of personality
develops over time… 3 modes of existence… prototaxic, parataxic, syntaxic
prototaxic
first few months of life; sensations
parataxic
person starts to see their bias, truth, error, etc. if this developmental stage isn’t done successfully, then parataxic (so like cognitive) distortions can form
syntaxic
emerges later in life; logical; analytical
Klerman’s IPT is short term or long term? treats what condition?
short; unipolar/nonpsychotic depression
Klerman’s IPT is about improving…
connection and communication skills
APA empirically supported treatment for depression
IPT
Humanism v. Behaviorism
behaviorism too mechanistic; too focused on non-human animals
Humanism v. Psychoanalysis
psychoanalysis is too pessimistic and too focused on sexual motivations and the unconscious
Humanism v. Biological Psych
Biopsych is too deterministic
Self-actualization is associated with
humanism
What is self-actualization?
realization of personality; fundamental human purpose; think values/intentions/meaning
3 notable humanistic therapies
gestalt (fritz Perls); client centered (rogers); existential (Rollo May and yalom)
existential therapy - Rollo May and yalom
purpose of life, death, limitations in life. client responsible for creating meaning and values in life.
gestalt therapy - Fritz Perls
personal accountability; reunification of the whole self; ID/make aware of separated parts of self
client-centered therapy - carl rogers
egalitarian relationship b/t client and therapist; not as focused on assessment/diagnoses; deep empathy and genuineness in therapeutic relationship
ultimate goal for humanistic therapies…
describe what it means to be HUMAN
What kind of therapist might say “human behavior is rooted in subjective reality”
a humanistic therapist
Gestalt therapy
present focused; people lose themselves and parts gotta come back together; theory not well supported but techniques have good support (so like empty chair, two chair, talking to parts of oneself, unfinished business, “stay with the feeling,” etc.); building insight; very experiential - “meta communication;” BOUNDARIES hinder progress - projection, introjection, retroflection, deflection, confluence…….
Therapeutic style that addresses the client’s motivation for change
MI
In MI, who needs to be the one to articulate the costs and benefits of change?
the patient
which intervention is collaborative, directive (but not confrontational), works to explore and resolve ambivalence, and tries to understand the client’s perceptions/goals/values?
MI
what are the 2 stages of MI?
- increase motivation for change 2. strengthen commitment to the decision for change
4 principles of MI
- empathy is huge 2. help increase self-efficacy 3. point out discrepancies between behaviors and values 4. reluctance to change is natural/not always pathological (resistance not pathological….)
Goals of MI
resolve the ambivalence, help elicit self-motivational statements
Pay attention to difference between GOALS and PHASES of MI
okay?
The 1st phase of motivational interviewing consists of increasing motivation to change by building rapport and exploring ambivalence; the second phase works to strengthen the commitment to change by working on behavioral plans and……?
goal-setting
your client is telling you about a dream he had about a dog and a snake. the dog is young and innocent but is slowly getting squeezed to death by the snake. if you were a gestalt therapist, you would:
encourage self-discovery and insight into the metaphor for PRESENT conflicts
The central goal for gestalt therapy is to….?
increase awareness
A central goal for client-centered therapy is…..?
self-actualization
Kohut’s self-psychology proposes that the ideal way to raise children is to
provide them w/mirroring and idealizing through interactions with parents.
what is the main focus of Kohut’s self-psychology?
addressing developmental deficits
according to Kohut, narcissistic people can’t benefit from traditional psychoanalysis because
they are too personally preoccupied and can’t project consistently
changes in sensation, perception, thoughts, and behaviors occur in a state of?
hypnosis
The rate of treatment for mental illness among Asian Americans is significantly lower because?
AA’s have a higher threshold for seeking mental health services; takes more to get them to seek the help.
Which ethnicity is thought to have a lower threshold for medication than typically recommended dosages?
asian americans
recent studies on ethnic differences in psychotropic medication dosage have shown that…
asian Americans have lower rates of metabolism for psych meds; so they require lower doses to achieve same clinical effect as white folks
Empiricism (aka Lockean psychology) assumes every human being is born with?
a blank slate- tabula rasa- blank brain
Remember, for Locke, humans gain knowledge through…
experiences with the physical environment; this is empiricism
Locke and other empiricists might all agree that there are _________ and ________ qualities to the ________ environment
primary; secondary; physical
Asian Americans are underrepresented in both _______ and ________ mental health settings.
inpatient; outpatient
Sue and Sue (2003) found that what percent of of therapy clients from racial/ethnic minority groups dropout after the ______ session? Compared to what percent of white clients.
50; 1st; 30
Research on therapist-client matching (in terms of race, ethnicity, culture) is?
inconclusive; it reduces premature termination for asian, hispanic, and white americans, but not African Americans.
Maramba & Nagayama Hall (2002) concluded that ethnic matching did not have a significant effect on ___________________.
number of therapy sessions attended.
Pope-Davis et al., 2002 found that _______ & __________________ are more important than client-therapist similarities in terms of race, ethnicity, or culture
therapist’s education about culture; similarity in values and worldview
Learning that takes place through the CONSEQUENCES of reinforcement or punishment is…?
operant conditioning
Reinforcement _________ a behavior
increased
Punishment ________ a behavior
decreases
Learning from two events that are associated through repeated temporal pairings is…?
classical conditioning
what are some exposure techniques based on classical conditioning?
systematic desensitization, flooding, implosion
Hobart Mowrer proposed a two-factor theory of avoidance learning to explain the development and maintenance of _________
phobias (he used classical and operant conditioning - classical in that neutral + feared stimuli = phobia and operant in that avoidance reinforces…. well, avoiding, aka not getting over the phobia)
Idea that behavior is reinforced through CONSEQUENCES
Operant conditioning
Punishment suppresses negative behaviors but does not ___________.
eliminate them.
what is the Premack Principle
reinforce a low freq bx with a high freq bx
what is an example of fixed interval reinforcement schedule?
weekly paycheck (you get reinforced after a set amount of time passes)
what is an example of fixed-ratio reinforcement schedule?
pay per unit of work completed (you get reinforced after a fixed number of responses)
what is an example of variable-ratio reinforcement schedule?
slot machines (you get reinforced after an average number of responses)
what is an example of variable-interval reinforcement schedule?
bird watching (you get reinforced after a random amnt of time has passed) *tends to be most effective bcs person just keeps doing the thing hoping to get reinforced/they dunno when it will happen. And, fading may occur… basically even if there isn’t a reinforcer, person might keep doing the thing.
What is aversive conditioning?
person learns to avoid certain behavior bcs a noxious response becomes associated with the bx. (this can be done in vivo or by imagination) example of in vivo is Antabuse… meds that cause vomiting after drinking.
What can you treat with aversive conditioning?
smoking and drinking. High relapse rate with paraphilia.
What is behavior modification used to treat?
- conduct disorder (when family involved) 2. Tourette’s (but you need to pair with awareness training, relaxation, and cog therapy), 3. aggressive bxs in kids and 4. physical health/treatment of unhealthy lifestyles
What is the major focus of behavior modification?
encouragement, 5:1; catch the kiddos being good. Mild, mild punishment of bad behavior but should be overshadowed by praise of good behaviors
when you think BANDURA think
social. learning. theory.
Social Learning Theory Components
“AM I Motivated” (Attention Memory Imitation Motivation)
Who said that learning can occur without reinforcement
Bandura… you can observe the modeling of others
Who said that learning and action are separate?
Bandura. Member the kids who learned the behavior but chose not to engage the behavior?
What is reciprocal determinism?
Cog, behavior, environment… all influence one another.
behavioral social exchange theory of family therapy is focused on:
communication problems; deficient reward exchanges.
Which theory is known for bridging cognitive and behavioral frameworks?
social learning theory. bandura.
the most effective ratio of compliments to criticism when applying encouragement in behavior modification is
5:1
aversive conditioning is a form of…
counterconditioning.
which technique has a high recidivism rate when used with paraphilia but is initially moderately effective?
aversive conditioning
what is reciprocal inhibition?
two incompatible responses cannot be experienced at the same time and the stronger response inhibits the weaker response (think counter conditioning; think systematic desensitization; think classical conditioning)
What is the premise of Beck’s theory of depression?
negative attitudes + maladaptive cognitions lead to susceptibility (DIATHESIS) and then combined with STRESS = depression
BECK cognitive errors that result in depression (there are 5)
overgeneralization; selective abstraction; magnification; personalization; dichotomous thinking
BECK - Overgeneralization
neg events in 1 sit will spill to other sim ones
BECK - Selective abstraction
focusing on 1 aspect - ignoring rest of picture
BECK - Magnification
overestimating the neg
BECK - Personalization
putting neg feelings of other on self
BECK - Dichotomous thinking
all good or all bad
BECK’S Schemata
thoughts construct reality… so depressed thoughts… depressed reality. (i.e., cognitive triad = 1. neg views of self, 2. the world, and 3. thee future)
Beck… depression… cognitive triad
- neg views of self, 2. the world, and 3. thee future
Beck’s cog therapy =
collaborative empiricism
Who came up with the learned helplessness theory of depression?
martin seligman
seligman’s theory of depression
past experiences lead to perception one has no control over their environment/life
REBT (therapy) -ABC (personality) DEF (the process) Ellis (the person)
activating event, beliefs (rational/irrational), consequences - disputing intervention, effective philosophy, feelings - Ellis
REBT views bx probs as result of?
self-indoctrination
Ellis… REBT… RATIONAL emotive therapy… what are the different types of irrational thoughts?
musturbation (rigid thinking), awfulizing (turning inconveniences into great disasters), low frustration tolerance, and overgeneralization.
Which therapy is focused on addressing irrational thinking/damaging self-concepts?
REBT
In REBT you’re _______, _______, ______, & _______ irrational beliefs
identifying, confronting, disputing, and replacing
What is the view of maladaptive behavior for Freudians?
psychopathology stems from unconscious, unresolved conflict that occurred during childhood.
What is the goal of psychoanalytic psychotherapy?
reduce sxs by bringing unconscious into the conscious; integrate repressed material into the personality
What’s main premise of psychic determinism?
all bxs are meaningful and serve psychological function; so like slips of tongue can be expression of unconscious motivation
Adler agreed with Freud that all behavior is purposeful, but he adopted the view that bxs are motivated largely by a person’s future goals RATHER THAN BY past events. This is called what?
Teleological lens
What is a mistaken style of life according to Adler? (this is his view of maladaptive behavior)
maladaptive attempts to compensate for feelings of inferiority, lack of social interest, and preoccupation with achieving personal power.
Adlerian: what is the approach for helping the client?
use a lifestyle investigation - looking at the family, hidden goals of the client, and mistakes/distorted beliefs. The client needs to understand THEIR style of life and its CONSEQUENCES.
For Adler, the misbehavior of children is viewed as having 1 of 4 goals:
revenge, power, attention, display inadequacy
Inferiority feelings, striving for superiority, style of life, and social interest are key concepts in ___________________.
Adler’s Individual Psychology
For Adler, a healthy style of life is marked by:
optimism, confidence, concern re: welfare of others.
For Adler, a mistaken style of life is marked by:
goals that reflect self-centeredness, competitiveness, and striving for personal power.
Style of life is fairly well established by what age? Adler
4/5 y/o
Jung: integration of conscious and unconscious… leads to development of a unique identity. This is called what?
Individuation
Jung’s view of maladaptive behavior
sxs are messages that something is wrong
Goal of Jung’s PA
bridging gap b/t CONSCIOUS and individual and collective UNCONSCIOUS
Object relations theorists consider _____ to be a basic inborn drive?
object-seeking
In terms of development, Mahler’s theory emphasizes the _________ process, which begins at ______ of age.
separation-individuation; 4-5 mos.
According to Kernberg, Borderline Personality Disorder is due to inadequate resolution of ________ of object relations into good and bad components. (OR)
splitting
Humanistic therapies
client/person centered; gestalt; existential; and reality therapy
Roger’s client-centered therapy is based on the assumptions that all people have an inherent tendency to _______ and that incongruence between ________ and _______ interferes with that tendency. To help clients achieve congruence, client-centered therapists provide them with three facilitating conditions: 1) ______ 2) ______ 3) _______
self-actualize; self; experience; unconditional positive regard; accurate empathy (understand world as client does); genuineness (when therapist shares their feelings with the client)
Gestalt therapy is based on the assumption that each person is capable of living fully as an ______ whole.
integrated
Neurotic behavior for Gestaltians comes when the client abandons the self for the
self image
Gestaltians consider _________ to be the primary curative factor in therapy.
Awareness = full understanding of thoughts, feelings, actions in the here and now
for existential therapists, maladaptive bxs stem from an inability to cope with
existential concerns of existence (death, freedom, meaninglessness, isolation, etc.)
Glasser, founder of reality therapy, believes that people have 5 basic needs:
survival, love and belonging, power, freedom, and fun. (success/failure identity comes from either expressing these adaptively or maladaptively)
Brief Therapies
MI, TTM, Solution-Focused, IPT
Source of depression for Rehm
deficits in each self-control process
What are the self-control processes? Rehm
self-monitoring; self-evaluation; self-reinforcement
example of self-control deficit; Rehm
selective monitoring of negative events; little self reinforcement for adaptive behaviors; excessive self-punishment.
Self-Monitoring deficits include (Rehm)
only attending to negative events to exclusion of the positive; immediate rather than long term behavior-related outcomes
Self-Evaluation deficits include (Rehm)
perfectionism; making inaccurate/depressive attributions for one’s own behavior
self-reinforcement deficits (Rehm)
administering insufficient self-reward; excessive self-punishment
5 steps of self instructional therapy
- therapist modeling 2. therapist verbalization 3. patient verbalization 4. patient silently talks through (sub vocalizing) 5. patient completes task and thinks it through without vocalization
goal of self instructional training
helping folks be effective in their process of thinking through things…
self instructional training is helpful for treatment of
adhd both types
the pt is introduced to increasingly stressful situations, in which he/she applies same coping skills… this is called
stress inoculation
stress inoculation is an empirically validated treatment for…
PTSD, anxiety, stress, anger
3 steps to stress inoculation
- conceptualize the problem 2. teach skills 3. practice
insufficient rewards, perfectionistic standards, negative self-evaluations, and high self-punishment are all characteristic of ______’s theory of depression
Rehm
adherents to REBT see emotional disturbance as being maintained by
self-indoctrination of irrational beliefs
Premise of biofeedback
learning control of involuntary responses
mechanism of action for biofeedback
affects parasympathetic nervous system
purpose of biofeedback
reduce actions of sympathetic nervous system
Types of biofeedback
EMG, skin temp, galvanic skin response (GSR), EEG
Controversy w/biofeedback
expensive compared to relaxation training, meditation, and self-hypnosis
ECT uses
treatment resistant depression; depression with psychotic features
ECT session freq
6-12
Original use of ECT
Schizophrenia in 30’s
Some pts report ______ problems following a certain number of ECT sessions
memory; antidepressants could mitigate this
Side effect management for ECT
Muscle relaxants; anasthetics
homework for the client engaging EMDR therapy includes
keeping a log of distressing images and thoughts and practicing relaxation techniques
Transtheoretical Model or TTM
Stages of change
TTM: Precontemplation
denial
TTM: Contemplation
knows there’s a problem; ambivalent about change
TTM: Prep
getting ready for change in coming month
TTM: Action
lasts 3-6 mos. they’re going for it
TTM: Maintenance
after change sustained for 6 mos. gotta work on relapse prevention
TTM: Termination
no more relapse; all done
intervention for folks in precontemplation stage
psychoed
interventions for folks in action/maintenance stages
learning skills
when in therapy with an individual, a multitheoretical psychotherapist would work interactively with
thoughts, actions, feelings. or FAT
________________ is a theoretical orientation that integrates cognitive, behavioral, bio psych, psychodynamic, systemic, and multicultural treatment approaches.
Multitheoretical
MPT Purports
Feelings, actions, thoughts are shaped by biological, systemic, and cultural contexts.
self-monitoring
recording thoughts, recoding feelings, recording behavior, self-regulation, behavior management, log book/journal
Beck’s theory of depression
internal locus of responsibility + external locus of control
folks with internal LOC
more likely to feel autonomous; better sense of self-determination
folks with external LOC
more likely to be victim, depressed, stressed
contingency management
contracting, punishing undesirable behaviors, reinforcement, token economy, reinforce desirable behaviors
2 main components of BFT
BPT; BCT (you gotta have a good baseline functioning assessment for ALL THREE OF THESE)
Behavioral family therapy sees problematic behaviors as
unhealthy learned responses
What is the goal of behavioral couple’s therapy? BCT
1) assess strengths/weaknesses in the parents’ interactions 2) teach communication/problem-solving skills
What are some therapeutic techniques in Behavioral Couple’s Therapy (BCT)?
Behavior exchange- state needs clearly & Contingency contracting-I scratch your back u scratch mine
In behavior parent training (BPT), parents are trained to respond to their kids’ behaviors using ________________ techniques
operant conditioning - social/tangible reinforcers, contingency contracting, shaping, token economy, & time outs.
Goals of Behavioral Family Therapy (BFT)
decrease aversive control; increase reward exchanges; improve communication/problem-solving
A subcategory of marriage therapy is?
sex therapy :)
A main premise of behavioral therapy is that behavior is maintained by
consequences
______________ is a way to regulate behavior by selecting an undesirable behavior and reinforcing an alternative behavior to replace the undesirable behavior
contingency management
self monitoring is a process of recording
thoughts, feelings, and behaviors
in self-monitoring, a person would be asked by a therapist to keep a record of thoughts related to a behavior, feelings related to a behavior, what occurred during a behavior, and ________ behavior.
time spent engaged in
when a crisis occurs in the family, they will attempt to regain _______ - decrease stress, and restore balance
homeostasis
what is general systems theory?
entity = maintained by interactions of its components; so actions of components, must be studied/are best understood in context
Families are considered _______ systems
open
Open systems (fam therapy) are characterized by?
receiving external input and discharging output in environment. Closed system doesn’t do this.
In family therapy- per cybernetics- a negative feedback loop…?
helps system maintain the status quo; reduces deviation
In family therapy- per cybernetics- a positive feedback loop…?
amplifies deviation and causes disruption; this can promote appropriate change and help with addressing dysfunction
double-bind communication
Bateson; schizophrenia; do this and be punished; don’t do this and be punished; punishment given verbally and nonverbally.
Two types of communication styles for communication/interaction family therapists
symmetrical; complementary - psychopathology can result from both
view of maladaptive behavior for communication/interaction family therapists
communication problems; symptoms are both a cause and effect of dysfunctional communication patterns
Who is the theorist associated with extended family systems theory?
BOWEN
_______________________ refers to a person’s ability to separate his or her intellectual and emotional functioning
differentiation of self; Murray Bowen; extended family systems theory
_____________ = family whose members are highly emotionally fused
undifferentiated ego mass
Bowen’s emotional triangle
when there is instability in a two person system, a 3rd person may be recruited in to increase stability.
The _______ the level of differentiation in family members, the greater the probability that an ________ will form
differentiation; emotional triangle
Bowen’s family projection process
parental conflicts and emotional immaturity are passed down to their kids; then the kids end up even less differentiated than the parents
Bowen is all about doing what when helping families?
increase differentiation!
For Bowen’s extended fam systems theory, maladaptive behavior stems from?
multigenerational transmission process - just worse and worse differentiation over generations
which fam therapy theorist is using genograms
bowen
3 important elements of Minuchin’s Structural Family Therapy
boundaries; power hierarchies; subsystems
3 boundary problems per Minuchin’s structural family therapy
child becomes a scapegoat for family’s problems; parent and kid gang up on other parent; each parent trying to get the kid to side with them, pulling kid in two directions
view of maladaptive behavior for Minuchin’s structural fam therapy
inflexible structure
Minuchin’s structural family therapy is about changing _______ instead of _______
behavior; fostering insight
3 overlapping steps in Minuchin’s structural family therapy
joining/blend in w/the fam - figure out the structure (use a structural map) - restructure the fam (destabilize, enactment, the reframe)
Jay Haley described interactional difficulties within systems as
rooted in the struggle for power and control
Jay Hayley’s research was often about
power struggles and dominance
triangulation is usually attributed to
minuchin
enmeshment and differentiation are addressed in
bowenian family systems therapy
the focus of haley’s strategic family therapy is?
its brief; just trying to resolve the presenting problem… it’s “strategic”
Minuchin is concerned with ______ in families
boundaries
triangulation, detouring, and enmeshment are all characteristics of what family therapy?
Minuchin’s structural fam therapy
Minuchin’s – not good things that can happen
triangulation, detouring, coalitions
in family systems, circular questioning helps
fam members to ID similarities and differences in their perceptions of events and relationships
hierarchies and communication are foci of which 2 fam therapies?
haley’s strategic and Minuchin’s structural
symmetrical communication
leadership equal- either can take lead
complementary communication
one leads the other
what type of intervention in family therapy is about encouraging the problem behavior?
paradoxical directive
miracle question and exception question are emphasized in which family therapy?
solution-focused
exception question
you’re trying to emphasize past successes
miracle question
imagine how things would be different if a miracle suddenly caused their problems to disappear
Four terms from Virginia satir’s therapeutic model that addresses family of origin impact on commonly used coping skills… called the survival stances. what are they?
placating, blaming, super-reasonable, irrelevant
virginia satir’s goals for her clients included…?
building self-esteem, personal choice, personal responsibility, developing congruence
solution focused therapy is a systems approach that emphasizes…?
exceptions to problems as solutions
Bowen was highly influenced by
psychoanalytic principles
Extended Family Systems: founder, key theoretical constructs, core problem dynamics, key techniques.
Murray Bowen - differentiation of self + feedback loops - triangles + emotional reactivity - Genogram + process questions
Strategic: founder, key theoretical constructs, core problem dynamics, key techniques.
Jackson + Haley - Homeostasis + Boundaries - more of the same solutions - reframing + directives
Structural: founder, key theoretical constructs, core problem dynamics, key techniques.
Minuchin - subsystems - enmeshment + disengagement - enactments + boundary making
Experiential: founder, key theoretical constructs, core problem dynamics, key techniques.
Satir + Whitaker - authenticity + self-actualization - emotional suppression + mystification - confrontation + structured exercises
Psychodynamic: founder, key theoretical constructs, core problem dynamics, key techniques.
Ackerman + Dicks + Nagy - drives + self objects + internal objects - conflict, projective identification, fixation and regression - silence + interpretation
Cognitive behavioral FT: founder, key theoretical constructs, core problem dynamics, key techniques.
Patterson + Liberman + Stuart - Reinforcement + extinction + schemas - inadvertent reinforcement + aversive control - functional analysis + teaching positive control
Solution-focused FT: founder, key theoretical constructs, core problem dynamics, key techniques.
Steve de Shazer + Insoo Kim Berg - language creates reality - problem talk - focusing on solutions and identifying exceptions
Narrative FT: founder, key theoretical constructs, core problem dynamics, key techniques.
white and epston - Narrative theory + social constructionism - problem-saturated stories - externalizing + identifying unique outcomes + creating audiences of support.
Most important factors of group therapy
cohesiveness, catharsis, growth in self-awareness, and improving ability to relate to others
stages of group therapy
forming, storming, norming, performing, adjourning
resistance is most likely during the ______ phase of group therapy and should be discussed with the group
storming
concurrent individual and group therapy CONS
Cts may save disclosure for individual
concurrent individual and group therapy PROS
BPD and narcissism benefit most from group + individual. they can enrich one another
group therapy not appropriate for folks in ______
crisis
Research shows that _________ tend to utilize suicide prevention services more frequently than any other group does.
young white women
_________________ is a type of crisis intervention in which victims of a traumatic event are encouraged to talk about their situation, feelings, and reactions.
psychological debriefing - these folks don’t have symptoms yet. it’s a preventative strategy.
4 stages of critical incident stress debriefing
normalization; encourage expression of feelings; teach self-help; provide referrals.
Is there criticism about critical incident stress debriefing?
yes! study showed half folks still developed PTSD. debate about effectiveness continues.
psychological first aid - 3 goals
safety, social connections, self-efficacy.
critical incident stress debriefing is meant to prevent what disorder?
PTSD
An advocacy consultant focuses on _____ and ____ reform to improve the well-being of ___________.
social; legal; a particular disenfranchised group
what’s the premise of Caplan’s consultation model?
more clients can benefit from mental health care via this type of indirect service because its addressing programs and systems
4 categories of consultation for Caplan
client-centered; consultee-centered administrative; consultee-centered case consultation; program-centered
Primary prevention definition and example:
progs that prevent mental illness and promote healthy lifestyles; only offered to groups; teaching skills, a good example is head start; cast a wide net
Secondary prevention definition and examples:
targets individuals; post-crisis intervention; prevent problems from getting worse; like a early warning system
Tertiary prevention
intervening when MI is severe; clear diagnosis is made; trying to prevent it from getting worse or to prevent relapse if in remission
Most forensic psychs working in criminal law perform duties related to the assessment of _____ and _____.
competency and insanity
Forensic psychs may serve as ________ or evaluate ______.
expert witnesses; potential jury members
correctional forensic psychs are involved in ______ hearings
parole
forensic psychs in civil law
child custody, sex harassment, immigration, employment discrimination, etc.
frequent ethical violations for forensic psychs
basically not being up to snuff on specialized legal knowledge; crappy record keeping; getting too snuggly with attorneys; screwing up confidentiality
Sue (1981) believed that most non-dominant groups will exhibit a ________ worldview as they become more aware of their own cultural identities and the impacts of racism on their lives.
IC-ER
what is the dominant (White, Western, middle-class) cultural view in the United States per Sue?
IC-IR
Intervention for EC-IR
Help clients understand feelings that they do not belong and delineate between positive acculturation attempts versus rejection of their own cultures
_____________ occurs when unresolved personal problems are unconsciously projected onto work tasks, resulting in ineffectiveness. (consultation)
theme interference
primary goal of advocacy consultation is
social change
Beck considered ________ and ________ a red flag for suicide; he developed Beck Hopelessness Scale
hopelessness and dichotomous thinking
what is the CENTRAL task of COGNITIVE therapy?
becoming aware of automatic thoughts and their impact
Automatic thoughts are _______ accessible than voluntary thoughts, and they are more ______ and _____ to change
less; stable; resistant
Efficacy - EST
Efficacy = intervention found beneficial for patients in well-controlled studies
Effectiveness
Effectiveness = refers to how well an efficacious treatment can be transferred from the research clinic to community
A treatment is considered an EST when it has been found _____ in RCTs (or logical equivalents); ya got causal inference
EFFICACIOUS
Strong support (EST)
several well-designed studies; different investigators
Modest support (EST)
1 really well designed study or a couple decent studies
Controversial (EST)
conflicting results
EST 4 characteristics:
- Goals
- Evaluate progress
- Monitoring progress
- Things to change if progress not seen
Crosses Ethnic Identity Development (EID) Model Stages (revised in ‘91 and ‘01)
Pre-Encounter (devalue blackness/idealize whiteness); Encounter (startling event that leads to frame change); Immersion-Emersion (idealize blackness- reject non black values- anger/anxiety fade); Internalization (security and satisfaction); Internalization-Commitment (black community support)
2001 revisions to EID
4 stages - stage 1 now to include assimilation, miseducation, and self-hatred. no change to stage 2. stage 3 broken in two parts (intense black involvement and anti white). stage 4 added a multicultural component.
The Racial Identity Scale RIAS was based on cross’s model - describe some important things with it briefly.
didn’t support encounter stage; not linear but cyclical; the model isn’t really about psychological functioning and self actualization but positive identification with one’s racial group.
EID stages (4)
Pre-encounter, Encounter, Immersion-Emersion, Internalization-Commitment (prenimin)
EID pre-encounter
world = anti-black
EID encounter
startling event - prefers a same race therapist - things shaking up - movement toward black identity
EID immersion-emersion
idealize blackness; anger and anxiety fade
EID Internalization-Commitment
satisfaction and confidence; confidence morphs to commitment to blackness
MID stages (5)
Cool Dogs Retrieve it Immediately, Always - CDRII - Conformity, Dissonance, Resistance/Immersion, Introspection, Integrative-Awareness
MID Conformity
self-deprecating/dominant group appreciating
MID Dissonance
conflict b/t self and other groups
MID Resistance/Immersion
self and same-group appreciating; some conflict about being empathic to same group.
MID Introspection
Basically the person is starting to really think about things; making sense of them; figuring it out
MID Integrative-Awareness
self and all group appreciating- but careful about what they appreciate in the dominant group
What is the Minority Identity Development (MID) model?
about attitudes toward self, ones culture, other nondominant cultures, and the dominant culture
Cross’s Ethnic Identity Development (EID) model- what is it?
ID devt for AA’s as they move from self-hatred to self-acceptance
White racial identity development (WRID) model 2 phases
- abandonment of racism 2. establishment on a non racist white identity
White racial identity development (WRID) model PHASE 1
lack of awareness; acknowledging whiteness (guilt, shame, etc.); choose racism outright
White racial identity development (WRID) model PHASE 2
questioning justifiability of racism; deep emotional state of working through all that goes with racism; internalize new non-racist identity
Cross-cultural research has shown that all of the following emotions and their accompanying facial expressions are universal except:
shame
Cross-cultural research has found that (regarding emotions and facial expressions)
there are a few basic emotions and related facial expressions that are recognized universally
what is the most common stressor faced by gay and lesbian individuals?
isolation
The coming out process in Troiden’s gay and lesbian identity development model is part of which stage
identity assumption
Bicultural Identification Patterns
blended (integrated), alternating back to roots (more ethnic than american), separated from their culture (more american than ethnic).
_________ (race/gender) have higher rates of alcoholism
hisp; men
perceived discrimination is related to ________
anxiety, depression, and other mental health issues.
etic
universal
emic
culture specific
autoplastic
change self
alloplastic
change environment
African American clients and primary presentations of self-disclosure
nonparanoia (pretty open), functional paranoia (medium self-disclosure), confluent paranoia (suspicious… unhelpful paranoia)
paranoia, low disclosure/guardedness, african americans, psych testing
be careful not to over pathologize
confluent paranoia
high levels of distrust and suspiciousness - african americans
Latino American is not a race but an ________
ethnicity
Traditional Latino roles
working dad, stay at home mom, equality in decision-making
Dysfunctional Latino families
male dominant/oppression; mom puts family over herself (socialized to be this way; she’s not necessarily codependent)
fact about machismo
less rigid and terrible in reality than is typically believed by dominant culture.
Rates of alcohol abuse are higher for _______ than any other ethnic demographic groups; including alaskans.
native americans
Chronicity of SUD for NA is related to
anxiety and recreation
Bicultural competence approach (Native American SUD)
teach social/communication skills; blend NA values with popular american culture
adolescents age range
12 and 18
Most common disorders to begin during adolescence
anxiety disorders; major depression; eating disorders; drug abuse; and alcohol abuse.
________ need to be in treatment longer than ______ to achieve similar outcomes; ________ may have more success than _____
adolescent; adults; adolescents; children
Most widely used approach with adolescents
CBT
Treating anxiety disorders in adolescents
systematic desensitization; modeling; observational learning
3 most common mental health conditions seen in geriatric pop
depression; paranoia; dementia - depression is most common
Rate of ______ among older adults 65 and older is higher than for any other age group and higher for ____ than ______
suicide; men; women
Neuroleptics are
antipsychotics
Treating paranoia in geriatric population
neuroleptics (antipsychotics) and therapy
Treating depression in geriatric population
meds, CBT, and electroconvulsive therapy
what type of dementia is the most common?
alzheimers
what is second most common form of dementia?
vascular - diet and exercise and not smoking can reduce risk
socioemotional selectivity theory
social contact is motivated by lots of goals - such as emotion regulation, self-concept, and info seeking. But, for older folks, it’s mostly to get emotional needs met.
deep muscle relaxation, social interaction, and modifying negative, unrealistic cognitions are all ______ techniques
CBT
systematic desensitization is a _______ technique
classical conditioning
Oppositional Defiant Disorder has a typical onset of age
8
SUD prevention for young NAs would be most successful if they are based on
bicultural competence
traditional native american family structure places the most value on
tribal and clan affiliations
the closest relationship in latino american families is
mother-son
HIV in older adults often causes _______; it is commonly misdiagnosed as ___________
dementia; alzheimers (docs might assume person not sexually active)
HIV progresses to AIDS stage _____ as quickly in older adults as younger adults
twice
40% of children diagnosed with conduct disorder will go on to develop _________
antisocial personality disorder
What is the most promising treatment for conduct disorder?
parental management training PMT by gerald patterson - reward prosocial behavior, use positive reinforcement when kid shows positive behaviors, use time outs/loss of privilege for aggressive/antisocial behavior (PMT can also reduce depression in mothers) - parent training leads to most rapid improvement
Multisystemic Treatment (MST) is used to treat which disorder?
conduct disorder
draw back to PMT and MST?
expensive and time consuming; but effective so just do it. Conduct disorder
Common treatments for major depression
IPT, CBT, Behavior therapy, meds, and ECT
______ and _____ found to be as effective as medication in the treatment of major depression
CBT; IPT
most effective treatment for major depression per research
CBT and meds - and CBT aint supposed to last forever; like 20 sessions.
the occurrence of tourette’s is ________ higher in _____
3-4x; boys than girls
tourette’s often comorbid with
adhd, odd, and sld
psychosocial masking occurs when… (think misdiagnosis)
when poor social skills and life experiences lead to the misrepresentation or misdiagnosis of another disorder due to atypical behavior
baseline exaggeration
prior to onset of a disorder, high levels of weird behaviors present, making it tough to recognize the new disorder
intellectual distortion
poor communication skills due to ID, so then you struggle to get at their experience… might say anxious but really angry…
the SINGLE most important factor in treating conduct disorder is
the use of BEHAVIORAL TECHNIQUES
Mania must last ______ or any length of time if ______ is required
1 week; hospitalization
Acute mania is typically treated with _______ and _______
mood stabilizers and antipsychotics
1st line of treatment for bipolar disorder
meds
anticonvulsants (valproic acid, carbamazepine) are used for mood stabilization in treatment of mania because …
lower risk of toxicity compared to lithium
The most effective treatment for individuals who have a history of drug addiction is…
a combo of meds and therapy
Three common treatments for alcohol dependence (DNA)
DNA - DISULFIRAM (aversive treatment/antabuse); NALTREXONE (reduces cravings); ACAMPROSATE (restores glutaminergic neurons to their normal activity level)
Major issue with deterrent med therapy for alcohol use
just not taking the meds; its an oral pill
Non-pharmaco treatments for alcohol abuse
peer support through AA; rehab; IOP, OP therapy
Conger’s Tension Reduction Hypothesis: alcohol consumption reduces _____, which _____ its use.
stress; reinforces (the stress of treatment can push an individual toward a relapse - stress leads to relapse)
the most significant factor that leads to a relapse (alcohol) is:
strong negative emotion (also relationship conflict and social pressures)
marlatt & Gordon say _________ is primary goal of addictions therapy
relapse prevention - relapse is a natural part of recovery and is viewed as a learning opportunity
relapse prevention is used ________ a treatment of abuse
after
how to do Relapse Prevention
help the client ID antecedents and then how to cope/avoid these stressors
components of addiction
physio - psycho - genetic
network therapy - what is it
similar to R/P but engages ct’s social support
concept of physiological tolerance when it comes to addiction
need to have higher dosage to achieve same effect
Pleasure neurotransmitter
Dopamine
How is reciprocal inhibition different than counterconditioning?
…
