Clinical Flashcards
Diagnostic Overshadowing
Diagnostic overshadowing was originally used to describe the tendency of health professionals to attribute all of a person’s psychiatric symptoms to his or her intellectual disabilities. Subsequent research found that diagnostic overshadowing applies to other conditions and diagnoses.
efficacy research vs effectiveness research
An ongoing debate on psychotherapy outcome research is over the best way to evaluate the effects of psychotherapy. On one side of the argument are experts who support efficacy studies (clinical trials); on the other are those who prefer effectiveness studies, which are correlational or quasi-experimental in nature.
effectiveness studies
correlational or quasi-experimental in nature
efficacy research
clinical trials
separation-individuation
(Mahler)
Mahler’s version of object relations theory focuses on the processes by which an infant assumes his/her own physical and psychological identity, and her model of early development involves several phases. The development of object relations occurs during the separation-individuation phase, which begins at four to five months of age. According to Mahler, adult psychopathology can be traced to problems that occurred during separation-individuation
Acculturation (4 terms) “IASM”
(Berry) According to Berry, a person’s level of acculturation can be described in terms of four categories that reflect the person’s adoption of his/her own culture and the culture of the dominant group - i.e.,
- integration
- assimilation
- separation
- marginalization
Solution-Focused Therapy
Solution-focused therapists focus on solutions to problems rather than on the problems themselves. In therapy, the client is viewed as the “expert” while the therapist acts as a consultant/collaborator who poses questions designed to assist the client in recognizing and using his/her strengths and resources to achieve specific goals (e.g., the miracle question, exception questions, scaling questions).
Person-Centered Therapy
Rogers’ person-centered therapy is based on the assumptions that people possess an inherent ability for growth and self-actualization and that maladaptive behavior occurs when “incongruence between self and experience” disrupts this natural tendency. The therapist’s role is to provide the client with three facilitative conditions (empathy, genuineness, and unconditional positive regard) that enable the client to return to his/her natural tendency for self-actualization.
High- Vs. Low-Context Communication
Members of many culturally diverse groups in America exhibit high-context communication, which relies on shared cultural understanding and nonverbal cues. It helps unify a culture and is slow to change. In contrast, Anglos are more likely to exhibit low-context communication, which relies primarily on the verbal message, is less unifying than high-context communication, and can change rapidly and easily. Differences in communication style can lead to misunderstandings in cross-cultural therapy.
Group Therapy (Formative Stages, Cohesiveness, Premature Termination)
According to Yalom, therapy groups typically pass through three formative stages - (1) orientation, participation, search for meaning, and dependency; (2) conflict, dominance, and rebellion; and (3) development of cohesiveness. Yalom describes cohesiveness as the most important curative factor provided by group therapy and the group therapy analog for the therapist-client relationship in individual therapy. He proposes that prescreening of potential group members and post-selection preparation can reduce premature termination from group therapy and enhance therapy outcomes.
Structural Family Therapy
Minuchin’s structural family therapy emphasizes altering the family’s structure in order to change the behavior patterns of family members.
Minuchin’s Boundaries
Boundaries (rules that determine the amount of contact that is allowed between family members) are one element of the family structure: When boundaries are overly rigid, family members are disengaged and when they are too diffuse or permeable, family members are enmeshed.
Minuchin Boundary Problems
(Three specific ones)
Minuchin distinguished between three chronic boundary problems, or rigid triads:
- detouring
- stable coalition
- triangulation
Therapist-Client Matching
Research on therapist-client matching in terms of race, ethnicity, or culture has produced inconsistent results. However, matching may reduce premature termination for members of some groups (e.g., Asian and Hispanic/Latino).
Matching vs Values
Some research suggests that factors other than race and age (e.g., similarity in values and worldview) are more important than similarity in terms of race, ethnicity, or culture.
Cybernetics (Positive And Negative Feedback Loops)
Cybernetics is concerned with communication processes and distinguishes between negative and positive feedback loops.
A negative feedback loop reduces deviation and helps a system maintain the status quo, while
a positive feedback loop amplifies deviation or change and thereby disrupts the system
Worldview (Sue)
As defined by Sue (1978), a person’s worldview is affected by his/her cultural background and is determined by two factors - locus of control and locus of responsibility. Differences in worldview can affect the therapeutic process.
Sue’s Racial View of LoC, LoR
White middle-class therapists typically have an internal locus of control and internal locus of responsibility (IC-IR) and are likely to have problems working with an African American client with an internal locus of control and external locus of responsibility (IC-ER) who may challenge the therapist’s authority and trustworthiness and be reluctant to self-disclose.
Sexual Minorities (Internalized homophobia, Coming Out)
Issues faced by lesbian, gay, bisexual, and transsexual (LGBT) individuals include internalized homophobia and coming out: Internalized homophobia occurs when LGBT individuals accept negative stereotypes about sexual minorities and incorporate them into their self-concept. Consequences include low self-esteem, self-doubt, and self-destructive behavior. Coming out (disclosing one’s sexual orientation) to family members, friends, and others is associated with rejection and other negative consequences as well as with higher levels of self-esteem and positive affectivity, lower levels of anxiety, and other positive consequences. Research suggests that the age of coming out is about the same for gay males and lesbians.
Eysenck
Eysenck was a British psychologist known for his factor analysis of personality traits, contributions to behavior therapy, and 1952 review of psychotherapy outcome studies in which he found that 72% of untreated neurotic individuals improved without therapy, while 66% of patients receiving eclectic psychotherapy and 44% receiving psychoanalytic psychotherapy showed a substantial decrease in symptoms. Based on these findings, Eysenck concluded that any apparent benefit of therapy is due to spontaneous remission.
General Systems Theory
interacting components are best understood by studying them in their context.
homeostasis, which is the tendency for a family to act in ways that maintain the family’s equilibrium or status quo.
Health Belief Model
The health belief model proposes that health behaviors are influenced by
1) the person’s readiness to take a particular action, which is related to his/her perceived susceptibility to the illness and perceived severity of its consequences;
2) the person’s evaluation of the benefits and costs of making a particular response
3) the internal and external “cues to action” that trigger the response.
Double-Bind Communication
As originally defined by Bateson, Jackson, Haley, and Weakland (1956), double-bind communication is an etiological factor for schizophrenia and involves conflicting negative injunctions - e.g., “do that and you’ll be punished” and “don’t do that and you’ll be punished” - with one injunction often being expressed verbally and the other nonverbally. In addition, the recipient of the contradictory injunctions is not allowed to comment on them or seek help from someone else.
Existential Therapy
The existential therapies are derived from existential philosophy and share an emphasis on personal choice and responsibility for developing a meaningful life. They describe maladaptive behavior as the result of an inability to cope authentically with the ultimate concerns of existence - i.e., death, freedom, existential isolation, and meaninglessness.
Object-Relations Family Therapy
For object relations family therapists, maladaptive behavior is the result of both intrapsychic and interpersonal factors.
Object Relations Family Therapy
Source of the Problem
A primary source of dysfunction is projective identification, which occurs when a family member projects old introjects onto another family member and then reacts to that person as though he/she actually has the projected characteristics or provokes the person to act in ways consistent with those characteristics.
Object Relations Family Therapy
Goal of Therapy
The primary goal of therapy is to resolve each family member’s attachment to family introjects and involves addressing multiple transferences (i.e., transferences of one family member to another, transferences of each member to the therapist, and transferences of the family as a whole to the therapist).
Psychiatric Inpatients (Demographic Characteristics)
1) For both men and women, admission rates into psychiatric hospitals are lowest among the widowed, intermediate for those who are married or divorced/separated, and highest for the never married. (2) Although Whites represent the largest number of psychiatric inpatients, when population proportions are taken into account, patients from other races are overrepresented. (3) For both men and women, the largest proportion of admissions is in the 25 to 44 age range.
Gestalt Therapy (Boundary Disturbance, Transference, Awareness)
Gestalt therapy views “awareness” (a full understanding of one’s thoughts, feelings, and actions in the here-and-now) as the primary curative factor.
Gestalt Neurosis
Gestaltions define neurosis as a “growth disorder” that is often attributable to a boundary disturbance (e.g., introjection) that leads to an abandonment of the self for the self image.
Gestalt Transference
Gestaltians regard a client’s transference to be counterproductive and respond to it by helping the client recognize the difference between his/her “transference fantasy” and reality.
Treatment Manuals
Treatment manuals were originally developed to standardize psychotherapeutic treatments so their effects could be empirically evaluated and to provide guidelines for training therapists. They specify the theoretical underpinnings of the treatment along with treatment goals and specific therapeutic guidelines and strategies. A potential limitation of treatment manuals is that they may oversimplify the therapeutic process.
Parallel Process
Parallel process occurs in clinical supervision when the therapist (supervisee) behaves toward his/her supervisor in ways that mirror how the client is behaving toward the therapist.
