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