Ch.16

Question 1

Paraprofessionals

Answer 1

person with no professional training who provides mental health services.

• Services in such settings as crisis intervention centres and other social service agencies.

• obtain agency-specific training and attend workshops that enhance their educational backgrounds.

• trained to recognize situations that require consultation with professionals with greater expertise.

• help to compensate for the sizable gap between the high demand for and meagre supply of licensed practitioners

Question 2

therapist

Answer 2

the term therapist isn’t legally protected, so virtually anyone can hang up a shingle and offer treatment.

• The effectiveness of therapy depends on a host of individual differences.

• Effective therapists are likely to be warm and direct and to establish a positive working relationship with clients, they tend not to contradict clients. Also select important topics to focus on in sessions and match their treatments to the needs and characteristics of clients

The composite view of the “good” therapist is that of an expert who is warm, respectful, caring, and engaged

Question 3

What to look for and avoid in a therapist

Answer 3

Checklist to help select a good therapist - and to steer clear of a bad one.

1. I can talk freely and openly with my therapist.
2. My therapist listens carefully to what I say and understands my feelings.
3. My therapist is warm, direct, and provides useful feedback.
4. My therapist explains up front what they will be doing and why and is willing to answer questions about their qualifications and training, my diagnosis, and our treatment plan.
5. My therapist encourages me to confront challenges and solve problems.
6. My therapist uses scientifically based approaches and discusses the pros and cons of other approaches.
7. My therapist regularly monitors how I’m doing and is willing to change course when treatment isn’t going well.

If your answer is yes to one or more of the following statements, the therapist may not be in a good position to help you and may even be harmful.

1. My therapist gets defensive and angry when challenged.
2. My therapist has a one-size-fits-all approach to all problems.
3. My therapist spends considerable time each session making “small talk,” telling me exactly what to do, and sharing personal anecdotes.
4. My therapist isn’t clear about what is expected of me in the treatment plan, and our discussions lack any focus and direction.
5. My therapist doesn’t seem willing to discuss the scientific support for what they are doing.
6. There are no clear professional boundaries in my relationship with my therapist; for example, my therapist talks a lot about their personal life or asks me for personal favours.

Question 4

eclectic therapies

Answer 4

word that means ‘from a wide range of sources’; are blends
of other therapeutic approaches. They tend to be very personalized to the situation or to the needs of the client.

An eclectic therapist will generally just try to figure out what works best, rather than focusing on a particular theoretical perspective.

Question 5

insight therapies

Answer 5

psychotherapies, including psychodynamic, humanistic, and group approaches, with the goal of expanding awareness or insight. ‘talk therapy’

Question 6

Insight therapies:

Psychodynamic:

what is done?
what are the approaches?

Answer 6

Three approaches and beliefs, which form the core of their approach.

1. They believe that the causes of abnormal behaviours, including unconscious conflicts, wishes, and impulses, stem from traumatic or other adverse childhood experiences.
2. They strive to analyze (a) distressing thoughts and feelings that clients avoid, (b) wishes and fantasies, (c) recurring themes and life patterns, (d) significant past events, and (e) the therapeutic relationship.
3. They believe that when clients achieve insight into previously unconscious material, the causes and the significance of symptoms will become evident, often causing symptoms to disappear.

Psychodynamic therapy is typically less costly, is briefer -weeks or months or open-ended and involves meeting only once or twice per week.

Question 7

Insight therapies:

Psychodynamic:
interpersonal therapy (IPT)

what is done?
what are the approaches?

Answer 7

A short-term (12 to 16 sessions) intervention designed to strengthen people’s social skills and assist them in coping with interpersonal problems, conflicts (such as disputes with family members), and life transitions (such as childbirth and retirement).

In addition to effectively treating depression, IPT has demonstrated success in treating substance abuse and eating disorders.

Question 8

Insight therapies:

Humanistic:

Answer 8

Therapies that emphasize the development of human potential and the belief that human nature is basically positive.

Share a desire to help people overcome the sense of alienation so prevalent in our culture; to develop their sensory and emotional awareness; and to express their creativity and help them become loving, responsible, and authentic.

Humanistic therapists stress the importance of assuming responsibility for decisions, not attributing our problems to the past, and living fully and finding meaning in the present.

Core concepts of humanistic therapies, such as meaning and self-actualization, are difficult to measure and falsify.

Rogers specified three conditions for effective psychotherapy that could be falsified.
— largely on the mark when it comes to the therapeutic relationship. therapeutic relationship is typically a stronger predictor of success in therapy than the use of specific techniques
— but three core conditions he specified aren’t “necessary and sufficient” for improvement.

Question 9

Insight therapies:

Humanistic:
Gestalt therapy

what is done?
what are the approaches?

Answer 9

Therapy that aims to integrate different and sometimes opposing aspects of personality into a unified sense of self.

word gestalt (configuration) means an organized whole.

Believe that people with psychological difficulties are “incomplete gestalts” because they’ve excluded from their awareness experiences and aspects of their personalities that trigger anxiety.

key to personal growth is accepting responsibility for one’s feelings and maintaining contact with the here and now.

Gestalt therapy one of many therapies that first recognize the importance of awareness, acceptance, and expression of feelings.

In the two-chair technique, clients to move from chair to chair, creating a dialogue with two conflicting aspects of their personalities.

Believe that this procedure allows a synthesis of the opposing sides to emerge.

“Good boy” and “spoiled brat” = “good brat”

Question 10

Insight therapies:

Humanistic:
motivational interviewing

what is done?
what are the approaches?

Answer 10

Person-centred interviewing techniques, including warmth and empathy, reflective listening, unconditional acceptance, and avoiding confrontation, lie at the heart of motivational interviewing.

This 1-2 session procedure recognizes that many clients are ambivalent about changing long-standing behaviours and is geared toward clarifying and bringing forth their reasons for changing and not changing their lives.

shown to be helpful in treating alcohol-related problems and has been successful in modifying a variety of health-related behaviours, including exercise and diet.

Question 11

Insight therapies:

Humanistic:
person centered therapy

what is done?
what are the approaches?

Answer 11

(Carl rogers)
therapy centring on the client’s goals and ways of solving problems.

Nondirective because therapists don’t define or diagnose clients’ problems or try to get at the root cause of their difficulties.

With increased awareness and heightened self-acceptance, people hopefully come to think more realistically, become more tolerant of others, and engage in more adaptive behaviours.

To ensure a positive outcome, the therapist must satisfy three conditions:

1. The therapist must be an authentic, genuine person who reveals their own reactions to what the client is communicating.
2. The therapist must express unconditional positive regard that is, a nonjudgmental acceptance of all feelings the client expresses.
3. The therapist must relate to clients with empathic understanding. One way to communicate empathy is by way of reflection that is, mirroring back the client’s feelings-

Question 12

Free association

Answer 12

(Part of psychodynamic)
technique in which clients express themselves without censorship of any sort.

— clients lie on a couch in a comfortable position, say whatever thoughts come to mind, no matter how meaningless or nonsensical they might seem.

Question 13

working through

Answer 13

In the final stage of psychoanalysis, therapists help clients work through, or process, their problems.

The insight gained in treatment is a helpful starting point, but it’s not sufficient.

Consequently, therapists must repeatedly address conflicts and resistance to achieving healthy behavioural patterns and help clients confront old and ineffective coping responses as they re-emerge in everyday life.

Question 14

Resistances

Answer 14

attempts to avoid confrontation and anxiety associated with uncovering previously repressed thoughts, emotions, and impulses.

— To minimize resistance, psychoanalysts attempt to make clients aware that they’re unconsciously blocking therapeutic efforts and make clear how and what they’re resisting.

Question 15

interpretation

Answer 15

From the client’s string of free associations, analysts form hypotheses regarding the origin of the client’s difficulties and share them with the client as the therapeutic relationship evolves.

Therapists also formulate interpretations explanations of the unconscious bases of a client’s dreams, emotions, and behaviours.

timing is everything. If the therapist offers the interpretation before the client is ready to accept it, psychoanalysts maintain, anxiety may derail the flow of new associations.

Question 16

Transmittance

Answer 16

Clients project intense, unrealistic feelings and expectations from their past onto the therapist.

Research suggests that we indeed often react to people in our present lives in ways similar to people in our past.

These findings may suggest that Freud was right about the transference; alternatively, they may mean that our stable personality traits lead us to react to people in similar ways over time.

Question 17

unconditional positive regard

Answer 17

The therapist must express unconditional positive regard that is, a nonjudgmental acceptance of all feelings the client expresses.
— Rogers convinced this elicits a more positive self-concept, that it allows clients to reclaim aspects of their “true selves” that they disowned earlier in life due to others placing conditions of worth on them.

Question 18

reflection

Answer 18

A way to communicate empathy reflection is that, the therapist mirrors back the client’s feelings—a technique made by Carl Rogers.

Ex:
CLIENT: I was small and I envied people who were large. I was well, I took beatings by boys and I couldn’t strike back.
THERAPIST: You’ve had plenty of experience in being the underdog.

Question 19

group therapy

Answer 19

therapy that treats more than one person at a time.

• range 3-20 ppl
• efficient, time saving, and less costly than individual treatments and span all major schools of psychotherapy.
• provide and receive support, exchange information and feedback, model effective behaviours and practise new skills, and recognize that they’re not alone in struggling with adjustment problems.

Question 20

Strategic family intervention

Answer 20

family therapy approach designed to remove barriers to effective communication.

• families often scapegoat one family member as the identified patient with the problem.
• real source of difficulties lies in the dysfunctional ways in which family members communicate, solve problems, and relate to one another.
• members to carry out planned tasks known as directives. Directives shift how family members solve problems and interact.
• paradoxical requests = “reverse psychology.”

Question 21

structural family therapy

Answer 21

treatment in which therapists deeply involve themselves in family activities to change how family members arrange and organize interactions.

• family therapy is more effective than no treatment and at least as effective as individual therapy.

Question 22

Behavioural therapists

Answer 22

therapists who focus on specific problem behaviours and on current variables that maintain problematic thoughts, feelings, and behaviours.

• assume that behavioural change results from the operation of basic principles of learning, especially classical conditioning, operant conditioning, and observational learning.
• use ecological momentary assessment to establish specific and measurable treatment goals, and devise therapeutic procedures.

Question 23

ecological momentary assessment

Answer 23

assessment of thoughts, emotions, and behaviours that arise in the moment in situations in which they occur in everyday life.

• increase clients’ awareness of the frequency and circumstances associated with a behaviour they hope to change.
• to assist therapists with assessment and treatment planning.

Question 24

Behavioural therapies:

Systematic desensitization:

what is done?
what are the approaches?

Answer 24

systematic desensitization:
- patients are taught to relax as they are gradually exposed to what they fear in a stepwise manner.

Approaches:

• exposure therapy:
  — therapy that confronts patients with what they fear with the goal of reducing the fear.
• SD is based on the principle of reciprocal inhibition.
• counterconditioning
• anxiety hierarchy
• in vivo (in real life)
• dismantling:
  — research procedure for examining the effectiveness of isolated components of a larger treatment.
  — isolating the effects of each component and comparing these effects with that of the full treatment package.
  — show that no single component of desensitization (relaxation, imagery, an anxiety hierarchy) is essential: We can eliminate each without affecting treatment outcome.

Question 25

Behavioural therapies:

flooding:

what is done?
what are the approaches?

Answer 25

Flooding therapists jump right to the top of the anxiety hierarchy and expose clients to images of the stimuli they fear the most for prolonged periods, often for an hour or even several hours.

• provide a vivid contrast to SD. Exposed to actual fear.
• based on the idea that fears are maintained by avoidance.
• crucial component of flooding is response prevention.

Question 26

Reciprocal inhibition

Answer 26

Says that clients can’t experience two conflicting responses simultaneously.

Ex: can’t be anxious and relaxed at the same time because relaxation inhibits anxiety.

• counterconditioning, pairing an incompatible relaxation response with anxiety, we condition a more adaptive response to anxiety-arousing stimuli.

Question 27

anxiety hierarchy

Answer 27

anxiety hierarchy a “ladder” of situations that climbs from least to most anxiety provoking.

• therapist asks the client to relax and imagine the first scene and moves to the next, more anxiety-producing scene only after the client reports feeling relaxed while imagining the first scene.
• client reports anxiety at any point, therapist interrupts the process and helps them relax again. Then, reintroduces the scene that preceded the one that caused anxiety.
• process continues until the client can confront the most frightening scenes without anxiety.

Question 28

in vivo

Answer 28

Desensitization can also occur in vivo- that is, in “real life.”

• In vivo SD involves gradual exposure to what the client actually fears, rather than imagining the anxiety-provoking situation.
• effective for a wide range of phobias, insomnia, speech disorders, asthma attacks, nightmares, and some cases of problem drinking.

Question 29

response prevention

Answer 29

technique in which therapists prevent clients from performing their typical avoidance behaviours.

Question 30

Participant modelling:

Assertive training

Answer 30

participant modelling
technique in which the therapist first models a problematic situation and then guides the client through steps to cope with it unassisted. (Social learning)

• primary goals of assertion training are to facilitate the expression of thoughts and feelings in a forthright and socially appropriate manner and to ensure that clients aren’t taken advantage of, ignored, or denied their legitimate rights.
• therapists teach clients to avoid extreme reactions to others’ unreasonable demands, such as submissiveness on the one hand and aggressiveness on the other hand.

Question 31

Participant modelling:

behavioural rehersal

Answer 31

• client engages in role-playing with a therapist to learn and practise new skills.
• therapist plays the role of a relevant person —> client reacts to the character enacted by the therapist —> in turn the therapist offers coaching and feedback.
• To give the client an opportunity to model assertive behaviours, therapist and client reverse roles, with the therapist playing the client’s role.
• By doing so, the therapist models not only what the client might say, but also how the client might say it

Question 32

Cognitive-behavioural therapy (CBT):

Answer 32

treatments that attempt to replace maladaptive or irrational cognitions with more adaptive, rational cognitions.

• advocates hold that beliefs play the central role in our feelings and behaviours.

These therapies share three core assumptions:
(a) Cognitions are identifiable and measurable;

(b) cognitions are the key players in both healthy and unhealthy psychological functioning; and

(c) irrational beliefs or catastrophic thinking,

Question 33

Cognitive-behavioural therapy (CBT):

describe what would be done in this type of therapy

Answer 33

rational emotive behavioural therapy (REBT).
— emphasis on changing how we think, but it also focuses on changing how we act (the behavioural part).

The ABCs Ellis identified lie at the heart of most, if not all, cognitive-behavioural therapies.

We respond to an unpleasant activating (internal or external) event (A) with a range of emotional and behavioural consequences (C).

The differences in how we respond to the same event stem largely from differences in (B) our belief systems.

• Added (B) and (E) campements to describe how therapists treat clients.

REBT therapists snesurage alients to actively dispute (B) their irrational beliefs and adopt more effective (E) and rational beliefs to increase adaptive responses.

To modify clients’ irrational beliefs, therapist forcefully encourages them to rethink their assumptions and personal philosophy.

rational beliefs: They’re flexible, logical, and promote self-acceptance.

irrational beliefs: They’re associated with unrealistic demands about the self (“I must be perfect”), others (“I must become worried about other people’s problems”), and life conditions (“I must be worried about things I can’t control”).

psychologically unhealthy people frequently “awfulize” that is, engage in catastrophic thinking about their problems (“If I don’t get this job, it would be the worst thing that ever happened to me”).

According to Ellis, our vulnerability to psychological disturbance is a product of the frequency and strength of our irrational beliefs

12 irrational ideas (“The Dirty Dozen”)

Question 34

Cognitive-behavioural therapy (CBT):

identify issues/symptoms where behavioural (CBT) approaches that are more effective than insight approach

Question 35

Know which types of therapy are more effective for different disorders

Answer 35

• For specific phobias and obsessive compulsive disorder (OCD), the most successful psychotherapies are behavioural treatments, including systematic desensitization and similar treatments like exposure and response-prevention, or flooding. These treatments are based on the premise that you can’t necessarily identify or treat the cause of the anxiety but you can deal with the symptoms.
• For bipolar disorder, there is some evidence that psychotherapy is useful for the depressive episodes but less helpful during manic or hypomanic episodes.

Question 36

Meta-analysis

Answer 36

statistical method that helps researchers interpret large bodies of psychological literature.

• “analysis of analysis”
• By pooling the results of many studies as though they were one big study, meta-analysis allows researchers to seek patterns across large numbers of studies and draw general conclusions that hold up across independent laboratories

Question 37

empirically-supported treatments

Answer 37

intervention for specific disorders supported by high-quality scientific evidence.

Question 38

Biomedical treatments:

ECT:
describe what would be done in this treatment

Answer 38

patients receive brief electrical pulses to the brain that produce a seizure to treat serious psychological problems.

• typically recommend ECT for individuals with serious depression, bipolar disorder, schizophrenia, and severe catatonia.

Misconceptions:
- is painful or dangerous and that it invariably produces long-term memory loss, personality changes, and even brain damage.

• About 50 percent of people with an initially positive response relapse within six months or so. so ECT isn’t a cure-all.
• ECT may be helpful because it increases the levels of serotonin in the brain.

Question 39

Biomedical treatments:

psychopharmacotherapy:
describe what would be done in this treatment

Answer 39

use of medications to treat psychological problems.

Question 40

Biomedical treatments:

psychosurgery:
describe what would be done in this treatment

Answer 40

brain surgery to treat psychological problems.

• To most critics, the benefits of psychosurgery rarely, if ever, outweighed the costs of impairing memory and diminishing emotion and creativity and the risks of brain surgery.
• procedures involved creating small lesions in the amygdala or in other parts of the limbic system, such as the cingulate cortex, which plays a key role in controlling emotions. Surgeons replaced primitive procedures with ultrasound, electricity and deep brain stimulation (rather than removal or ablation), freezing of tissues, and implants of radioactive materials. Automated surgical devices added precision to delicate brain surgery.

Question 41

Drugs:

SSRIs:
what kind of condition can be treated with this type of medication.
side effects

Answer 41

selective serotonin reuptake inhibitor (SSRI) antidepressants, including Prozac, Zoloft, and Paxil, which boost levels of the neurotransmitter serotonin.

• depression (antidepressants)

• Monoamine oxidase (MAO) inhibitors: Inhibit action of enzymes that metabolize norepinephrine and serotonin; inhibit dopamine
• Cyclic antidepressants: Inhibit reuptake
of norepinephrine and serotonin

Question 42

Drugs:

anxiolytics:
what kind of condition can be treated with this type of medication.
side effects

Answer 42

• anxiety disorders (anxiolytics or antianxiety drugs)

• Benzodiazepines: Increase efficiency of GABA binding to receptor sites.
• Buspirone (Buspar): Stabilizes
serotonin levels.
• Beta blockers: Compete with
norepinephrine at receptor sites that control heart and muscle function: reduce rapid heartbeat muscle tension

Question 43

Drugs:

antipsychotics/neuroleptics:
what kind of condition can be treated with this type of medication.
side effects

Answer 43

psychotic conditions (neuroleptics/antipsychotics or major tranquilizers)

• Conventional antipsychotics: Block
postsynaptic dopamine receptors
• Serotonin- dopamine antagonists (atypical antipsychotics): Block activity of
both serotonin and/or dopamine; also affect norepinephrine, acetylcholine.

Question 44

Drugs:

mood stabilizers:
what kind of condition can be treated with this type of medication.
side effects

Answer 44

• bipolar disorders (mood stabilizers),

• Mineral salts: Decrease noradrenaline increase serotonin
• Anticonvulsant medications: Increase levels of neurotransmitter GABA, inhibit norepinephrine reuptake(Tegretol).
•

Question 45

Drugs:

psychostimulants:
what kind of condition can be treated with this type of medication.
side effects

Answer 45

attention problems (psychostimulants, which stimulate the nervous system yet paradoxically treat symptoms of ADHD).

• Methylphenidate (Ritalin, Concerta),
amphetamine (Adderall), dexmethyl-phenidate (Focalin): Release
norepinephrine, dopamine, serotonin in frontal regions of the brain, where attention and behaviour are regulated.

• Atomoxetine (Strattera): Selectively
inhibit reuptake of norepinephrine

Question 46

including Tardive dyskinesia (antipsychotic drugs)

Answer 46

tardive dyskinesia (TD), a serious side effect of some older antipsychotic medications used to treat schizophrenia and other psychoses.

• symptoms of TD include grotesque involuntary movements of the facial muscles and mouth and twitching of the neck, arms, and legs.
• Most often, the disorder begins after several years of high-dosage treatment (tardive, like tardy, means late-appearing), but it occasionally begins after only a few months of therapy at low dosages

Newer antipsychotic medicines such as Risperdal, which treat the negative as well as positive symptoms of schizophrenia, generally produce fewer serious adverse effects. But they too occasionally produce serious side effects, including sudden cardiac deaths, and the verdict is out regarding whether they’re more effective than earlier, less costly medications.

Question 47

memory loss (ECT and psychosurgery)

Answer 47

• ECT can create short-term confusion and clouded memory.
  — in most cases memory loss is restricted to events that occur immediately before the treatment and generally subsides within a few weeks.
  — first long -term study of patients in the community who received ECT, memory and attention problems persisted in some patients for six months after treatment.