Clinical Flashcards
topographical model
our psyche (mind) is made of 3 levels:
1) conscious level: thoughts, feelings, perceptions, etc. that we are currently aware of
2) preconscious level: lies just below the conscious level and contains material that is not currently in conscious awareness but is readily accessible to consciousness
3) unconscious level: lies beneath the preconscious level and is the largest component of the psyche - contains threatening emotions and memories and other material that is normally unavailable to conscious awareness
structural theory
a psychic structure that consists of the id, ego, and superego and proposes that personality is largely the result of interactions between them
id
present at birth and consists of all of the basic biological instincts that drive or direct behavior
ego
part of the id that has been modified by its interactions with the external world
superego
last component to develop
it serves as the conscience, operates at all three levels of consciousness, and evolves primarily from the internalization of parental prohibitions, standards, and values
transference
therapist’s neutrality allows the client to project onto the therapist feelings that he or she originally had for a parent or other significant person in the past
countertransference
the therapist projects unresolved feelings toward another person onto the client
Jung’s structure of the psyche
1) conscious: consists of the ego and contains all thoughts, feelings, etc. of which we are currently aware.
2) personal unconscious: contains our own forgotten or repressed memories and includes complexes, which are collections of thoughts, feelings, and attitudes that are related to a particular concept (e.g., power, inferiority) and that influence behavior.
3) collective unconscious: consists of “general wisdom that is shared by all people, has developed over time, and is passed along from generation to generation across the ages”
archetypes
universal mental structures that predispose people to react to certain circumstances in specific ways
individuation
an integration of all conscious and unconscious aspects of the self into a unified whole
Adler’s Individual Psychology
1) feelings of inferiority: develop during childhood in response to real or imagined disabilities or inadequacies - people motivated to overcome their sense of inferiority by using some type of compensation
2) striving for superiority: innate drive toward competence and effectiveness - term “style of life” to describe how a person strives for superiority
3) mistaken (unhealthy) style of life: overcompensation for feelings of inferiority guided by goals that reflect self-centeredness and a lack of concern about the well-being of others
Karen Horney
focused on the impact of early relationships; proposed that certain parenting behaviors (e.g., indifference, overprotection, rejection) cause a child to experience basic anxiety (feeling of helplessness and isolation in a hostile world);
to defend, child adopts certain interpersonal coping strategies (moving toward others, moving against others, moving away from others)
Harry Stack Sullivan
a) prototaxic mode: occurs before symbols are used, discrete, unconnected momentary states, inability to differentiate between the self and the external world
(b) parataxic mode: use of private or autistic symbols, ability to differentiate certain aspects of experience and seeing causal connections between events that occur at about the same time but are not actually related
(c) syntaxic mode: use of symbols that have shared meaning and permit logical, sequential thought and meaningful interpersonal communication
parataxic distortions
the result of arrest at the parataxic mode due to unsatisfactory early relationship;
involve perceiving and evaluating people in the present based on past interpersonal experiences
Erich Fromm
interested in how society prevents individuals from realizing their essential human nature, which is characterized by the capacity to be creative, loving, and productive
ego-defensive functions
involved in the resolution of internal conflicts
ego-autonomous functions
involved in adaptive, non-conflict laden functions such as learning, memory, comprehension, and perception
Object Relations Theory
behavior is motivated by a desire for human connection;
focuses on the impact of early relationships between a child and significant others (“objects”) in the child’s life
object constancy
ability to maintain a predominantly positive emotional connection to a significant other independent of one’s need state or the object’s immediate ability to gratify one’s needs
object constancy three-stage model
1) initial normal autistic stage: first few weeks of life, infant is aware of only themself
2) normal symbiotic stage: infant becomes aware of the external environment but can’t differentiate between self and others
3) separation-individuation stage: 4 substages during which object constancy gradually develops (5-36 months)
Person-Centered Therapy
based on the assumption that people have an innate self-actualizing tendency (capacity to achieve their full potential) that motivates and guides their behavior
incongruence
discrepancy between self and experience, which can impede the self-actualizing tendency and lead to psychological maladjustment
the self (or self-concept)
how a person currently perceives themself;
person’s beliefs about who they are and what they can do
person-centered therapy 3 conditions
1) Empathy: therapist understands the client’s subjective experience and conveys that understanding to the client
2) Congruence: therapist is genuine, open, and honest and exhibits consistency in words and actions
3) Unconditional Positive Regard: therapist truly cares about the client, affirms the client’s value as a person, and accepts the client without judgment
Gestalt Therapy
all behavior is motivated by a striving for homeostasis (balance);
when imbalance occurs due to an unfilled physical or psychological need, they are motivated to obtain something in the environment that will satisfy the need to restore homeostasis;
when that need is satisfied, they withdraw from the environment, and this process recurs as new needs arise
boundary disturbance
persistent disturbance in the contact boundary between the person and the environment that impedes the person’s ability to satisfy his or her needs
types of boundary disturbances
1) introjection: tendency to internalize the beliefs and values of other people without awareness or critical evaluation, resulting in inconsistencies between one’s thoughts and feelings
2) projection: disowning unacceptable aspects of oneself by attributing them to someone else
3) retroflection: doing to oneself what one would like to do to another person
4) deflection: tendency to avoid direct contact with others
5) confluence: blurring of the separation between oneself and others, resulting in a loss of identity
existential therapy
views personality and behavior as a reflection of a person’s struggle with the “ultimate concerns of existence,” which include death, isolation, meaninglessness, freedom, and responsibility
reality therapy
replace the client’s failure identity with a success identity by helping the client assume responsibility for his or her actions and adopt more appropriate ways to fulfill his or her needs
Beck’s CBT
how we feel and act is largely determined by how we think;
maladaptive behavior often due to combination of biological and environmental factors that predispose a person to faulty cognitive patterns
cognitive distortions
systematic errors in reasoning that create the link between dysfunctional schemas and automatic thoughts;
occur when incoming information is biased to fit a dysfunctional schema and, as a result, elicits a maladaptive automatic thought
types of cognitive distortions
1) Arbitrary inference: drawing a conclusion when there’s no evidence to support it or when the conclusion is contrary to the evidence
2) Selective abstraction: focus on certain (usually negative) details of a situation or event while disregarding other, more salient information
3) Overgeneralization: drawing a conclusion based on a single event and then applying that conclusion to other events
4) Personalization: when a person attributes external events to themself even though the event is not actually in the person’s control
5) Dichotomous (all-or-none) thinking: categorizing experiences in 1 of 2 extremes (complete success or total failure)
maladaptive schemas
distort incoming information and lead to inaccurate interpretations and conclusions
Rational Emotive Behavior Therapy
people’s emotional and behavioral reactions to events as being mediated by their beliefs about those events
A-B-C-D-E model
A: activating (antecedent) event
B: person’s belief about that event
C: emotional or behavioral consequence of that belief
D: disputation of irrational beliefs
E: replacing irrational beliefs with effective rational ones
stress inoculation training (SIT)
combines skills training with modification of maladaptive cognitions that interfere with adaptive behaviors b/c when people learn to cope with mild levels of stress, they are “inoculated” against future stressful situations
self-instructional training
individuals can modify their own behaviors through the use of appropriate self-talk:
1) Cognitive Modeling: model performs a task while saying instructions aloud
2) Overt External Guidance: client performs the same task with guidance and instructions from the model
3) Overt Self-Guidance: client performs the task while saying the instructions aloud
4) Faded Overt Self-Guidance: client repeats the task while whispering the instructions
5) Covert Self-Instruction: client performs the task again while repeating the instructions covertly (via private speech)
problem-solving therapy (PST)
based on the assumption that psychological problems are related to deficits in social problem-solving skills;
primary goals are to help clients develop a positive problem orientation and develop and apply a rational problem-solving style
Biofeedback
allows a person to gain control over a physiological response by monitoring the response and providing the person with immediate and continuous feedback about the status of that response with a visual or auditory signal
EMG (electromyography) biofeedback
provides information about level of muscle tension (chronic pain, incontinence, and motor impairment)
EEG (electroencephalogram) biofeedback
(AKA neurofeedback) - provides information on brain wave activity (depression, anxiety, ADHD, insomnia, seizures)
Thermal (temperature) biofeedback
provides information about skin temperature (Raynaud’s, migraine headaches)
systems theory concept of families
1) Wholeness: elements of a system produce an entity that is greater than the sum of the individual elements
2) Open vs. Closed Systems: open system has permeable boundaries that allow it to interact with the environment; closed system has impermeable boundaries that prevent interactions
3) Homeostasis: systems tend to preserve a state of stability and resist change
4) Positive vs. Negative Feedback: negative feedback consists of information or actions that maintain the system’s status quo; positive feedback consists of information or actions that cause deviation and produce instability and change
5) Equifinality vs. Equipotentiality: equifinality occurs when different processes have the same outcome; equipotentiality occurs when the same process can have different outcomes
communication theory
communication patterns within a family system “shape the operation and function of the system”
two levels of communication
1) report level: verbal and conveys the literal meaning (content) of the message
2) command (metacommunication) level: usually nonverbal and expresses the relationship between the communicators
symmetrical interactions
based on equality and can lead to competition and conflict (“symmetrical escalation”)
e.g., partners repeatedly respond to each other’s angry remarks with remarks that are more intense in terms of anger
complementary interactions
based on inequality (one member assumes the dominant role in conversations while the other member assumes a submissive role, their interactions are complementary)
postmodernism perspective
reality is created through social interaction and, consequently, that therapy is a creative process in which the therapist collaborates with family members to deconstruct old views of reality and co-construct new realities
differentiation of self
a family member’s ability to separate their intellectual and emotional functioning from others in the family
triangles
form when a two-person system becomes unstable due to conflict and recruits a third person into their system to restore stability
multigenerational transmission process
the process by which patterns of differentiation are transferred from one generation to the next
emotional cutoff
occurs when a family member attempts to distance themself from the family physically and/or emotionally as a way to deal with conflict within the family system and usually indicates that the family member has a low level of differentiation
Bowenian Extended Family Systems Therapy
help each family member become more differentiated while remaining connected to other family members
Minuchin’s Structural Family Therapy
restructure the family so that it’s better able to respond adaptively to intra- and extrafamilial sources of stress
family structure, boundaries, rigid family triads
clear boundaries
firm but flexible and allow family members to maintain a balance between separateness from and connection to other family members
rigid boundaries
lead to disengagement between family members and promote isolation
diffuse boundaries
lead to enmeshment (manipulative emotional reactivity) and promote excessive dependence
3 rigid family triads
1) Triangulation: each parent demands that a child side with them during a dispute so that the child is “pulled” in two directions
2) Detouring: parents reinforce deviant behavior in the child because it takes the focus off the problems they’re having with each other
3) Stable coalition: when two family members consistently “gang up” against another family member
Haley’s Strategic Family Therapy
use appropriate strategies to resolve family’s presenting problems;
alter the interactional sequences that maintain problematic behaviors that arose through communication and power
2 types of directives
direct: straightforward instructions or advice that family members are likely to agree to follow;
indirect: attempts to influence family members to act in a certain way without directly instructing them to do so (reframing, paradoxical interventions)
paradoxical interventions
asking family members to do something they are likely to resist and thereby change in the desired way;
idea is to utilize the energy of resistance to help the couple make changes in their communication patterns
5 stages of strategic family therapy
1) social stage: therapist speaks to each family member and observes family interactions
2) problem stage: therapist asks family members questions about the presenting problem
3) interaction stage: therapist asks family members to discuss the presenting problem, which allows the therapist to collect information about their interactions.
4) goal-setting stage: therapist and family members agree on therapy goals
5) task-setting stage: therapist gives the family a directive to complete at home
Milan Systemic Family Therapy
the problematic behaviors of family members involve repetitive behavioral interactions (“games”) that maintain the family’s state of homeostasis;
discover, interrupt, and eventually change the rules of their game;
see their problem in an alternative way and identify new ways to interact
strategies of systemic family therapy
1) Hypothesizing: collecting data to determine what is maintaining the family’s problem and identify appropriate interventions
2) Neutrality: therapists maintain a neutral position by attending to and accepting the perceptions of all family members
3) Circular Questioning: asking each family member about their perceptions of a family relationship or a specific event
4) Positive Connotation: reframing a problematic behavior as beneficial or good
5) Paradoxical Prescriptions: tasks that require family members to engage in the problematic behavior to help them understand that the behavior is under their control
6) Family Rituals: tasks designed to alter family games by requiring family members to change their behaviors in a specific circumstance
behavioral family therapy
all behavior is learned and maintained by antecedents and consequences operating in the family environment;
reduce or eliminate current problematic behaviors and replace them with more adaptive behaviors
Solution-Focused Therapy
focuses on the solutions to problems rather than on the problems themselves;
client describes problems, define realistic therapy goals in positive terms, explore times when the problems were absent or less severe as, feedback, encouragement and suggestions, evaluate progress
miracle question
used to help identify therapy goals and requires the client to imagine the absence of his or her problem and the resulting effects
exception question
used to identify times when the problem did not exist or was diminished in order to help the client develop a solution orientation
formula first session task
given to a client to complete before the second therapy session that requires the client to observe what is happening in their life that they would like to continue to have happen
Lazarus’s Multimodel Therapy
most psychological problems are multifaceted, multidetermined, and multilayered;
careful assessment of 7 parameters or modalities:
behavior, affect, sensation, imagery, cognition, interpersonal relationships, and drugs, diet, and exercise (biology)
BASIC ID
tracking
determining the “firing order” of a client’s modalities (i.e., the modality sequence associated with the client’s problem) to help identify appropriate interventions
bridging
attending first to the client’s preferred modality and then transitioning to their least preferred modalities to foster rapport and decrease resistance
Prochaska and DiClemente’s Transtheoretical Model
(AKA stages of change model)
proposes that people pass through a predictable sequence of stages when modifying their health-related behaviors
6 stages of theoretical model
1) precontemplation stage: unaware that there is a need to change and has no plan to change
2) contemplation stage: recognizes the need to change and, although somewhat ambivalent, plans to change within the next 6 months
3) preparation stage: intends to take action within the next 30 days and may have already started to take small steps towards change
4) action stage: actively engaged in making behavioral changes
5) maintenance stage: been actively changing behavior for at least 6 months and is working to prevent relapse
6) termination stage: not tempted to engage in old behaviors and is 100% confident in their ability to avoid relapse.
motivational interviewing
people are ordinarily ambivalent about making changes in their lives so it provides a “client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence”
motivational interviewing OARS
Open-ended questions that cannot be answered with “yes” or “no”
Affirmations that compliment the client and recognize their strengths
Reflective listening that restates or adds meaning to what the client has said
Summaries that foster insight or reinforce statements made by the client that support change (“change talk”)
Interpersonal Psychotherapy
a) depression is due to a medical illness that is not the client’s fault
(b) it’s related to interpersonal events that trigger or follow the onset of symptoms
interpersonal problem areas
role transitions, role disputes, interpersonal deficits, complicated grief
Yalom’s 3 formative stages of group therapy
1) Orientation, Hesitant Participation, Search for Meaning, and Dependency: concerned with the rules, structure, and purpose of the group; hesitant; look to leader for approval
2) Conflict, Dominance, and Rebellion: establish place, control hierarchy may occur
3) Development of Cohesiveness: trust, good communication
feminist therapy
empowerment of the individual and transformation of society;
challenged traditional male-oriented psychological theory and practice
relational-cultural theory
AKA self-in-relation theory
development (esp female development) proceeds through relationship elaboration rather than through separation or disengagement;
mental health is determined by the ability to deepen connections and relationships throughout the life span;
gender-related differences in self-concept, relationality, and other aspects of personality and behavior can be traced to differences in the early mother-daughter and mother-son relationship
multicultural counseling
counseling services where relevant cultural traits are incorporated in the context of the counseling process including ethnicity, race, gender, sexual identity, socioeconomic status, disabilities, age, and spirituality
etic perspective
(universal) perspective when therapists believe that people from different cultures are essentially the same
emic perspective
(culture-specific) perspective when therapists believe that people from different cultural backgrounds differ in important ways and that psychological theories and strategies that are appropriate for individuals from one cultural group may not be appropriate for individuals from other groups.
cultural encapsulation
1) defines reality according to their own set of cultural assumptions
2) insensitive to cultural variations among individuals
3) disregards evidence that disproves their assumptions
4) relies on quick, simple, and technique-oriented solutions to problems
5) evaluates others based on their own perspective
worldview
how people perceive, evaluate, and react to the situations they encounter
4 types of worldview (Sue & Sue)
1) internal locus of control and internal locus of responsibility (IC-IR): believe they are the masters of their own fate and are responsible for their own successes and failures
2) internal locus of control and external locus of responsibility (IC-ER): believe they could shape their own lives if given a chance but that others are responsible for their outcomes
3) external locus of control and internal locus of responsibility (EC-IR): believe they have little control over their lives but assume responsibility for their own failures
4) external locus of control and external locus of responsibility (EC-ER): believe they have little or no control over their lives and are not responsible for their own outcomes
acculturation
dynamic and multidimensional process of adaptation that occurs when distinct cultures come into sustained contact which involves different degrees and instances of cultural learning and maintenance that are contingent upon individual, group, and environmental factors
4 models of acculturation
1) integration orientation: retain their own culture while also adopting the dominant culture
2) assimilation orientation: reject their own culture and adopt the dominant culture
3) separation orientation: retain their own culture and reject the dominant culture
4) marginalization orientation: reject both their own culture and the dominant culture
healthy cultural paranoia
involves distrust and suspiciousness but refers to the normal (nonpathological) response of African American individuals to oppression and racism
racial microaggression
brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward people of color
microinsults
nonverbal messages or insensitive remarks that demean the person’s racial or ethnic background
microinvalidations
“communications that exclude, negate, or nullify the psychological thoughts, feelings, or experiential reality of a person of color”
microassaults
explicit verbal or nonverbal racial derogations that are meant to hurt or harm the intended victim and involve name-calling, avoidant behavior, or intentional discriminatory acts
high-context communication
relies heavily on culturally defined meanings, nonverbal messages, and the context in which it occurs and is characteristic of several ethnic/cultural minority groups
low-context communication
relies on the verbal message, is independent from the context, and is characteristic of European Americans
Racial/Cultural Identity Development (R/CID) Model
5 stages of development that oppressed people experience as they struggle to understand themselves in terms of their own culture, the dominant culture, and the oppressive relationship between the two cultures
5 stages of R/CID Model
1) Conformity: prefer the lifestyle and values of the dominant culture, have strong negative feelings about their own minority group and other minority groups that are similar to their own
2) Dissonance: confusion and conflict as the result of encountering circumstances that are inconsistent with their cultural beliefs and attitudes
3) Resistance and Immersion: actively reject the dominant culture, strongly identify with and are committed to their own culture, and may feel guilty and angry about their past negative feelings toward their own group
4) Introspection: conflict between personal autonomy and the rigid constraints of the previous stage - begin to question their unequivocal loyalty to their own culture and absolute rejection of the dominant culture
5) Integrative Awareness: resolved the conflicts of the previous stage, appreciate aspects of their own culture and the dominant culture, and have a positive self-image and strong sense of autonomy
Black Racial Identity Development Model (AKA the Nigrescence Model) 5 stages
1) Pre-Encounter: prefer White culture, may have internalized negative stereotypes of Blacks and blame Blacks for their own problems
2) Encounter: important event or series of events challenges the person’s worldview and causes the person to question their positive attitude toward White culture and consider what it means to be a member of a group that is the target of racism
3) Immersion-Emersion: denigrate White culture and glorify Black culture. They actively seek out opportunities to learn about Black history and culture and prefer associating with individuals of their own race
4) Internalization: started to develop a sense of security about their Black identity, their negative feelings about White culture have declined
5) Internalization-Commitment: nternalized a Black identity and are committed to social activism to improve equality for oppressed group
Helms’s White Racial Identity Development Model stages
1) Contact: lack of awareness of racial differences, limited contact with members of minority groups, “colorblind”
2) Disintegration: interactions with members of minority groups lead to greater awareness of inequality
3) Reintegration: resolve their conflicts by adopting the position that Whites are superior and minorities are inferior
4) Pseudo-Independence: dissatisfied with their racist views, often as the result of a disturbing event
5) Immersion-Emersion: explore what it means to be “White” and are interested in determining how they can feel proud of their own race without being racist
6) Autonomy: internalize a nonracist White identity that is based on a realistic understanding of the strengths and weaknesses of White culture
Troiden’s Model of Homosexual Identity Development
1) Sensitization: begins before puberty and is characterized by feeling different from others
2) Identity Confusion: begins in middle or late adolescence when the person realizes that they feel sexually attracted to same-sex individuals and considers the possibility that they are homosexual
3) Identity Assumption: occurs during or after late adolescence and initially involves being tolerant of a gay or lesbian identity
4) Identity Commitment: internalized their gay or lesbian identity and accepted homosexuality as a “way of life.”
multisystems approach
considering the multiple systems that impact individual and family functioning and targets the individual, the immediate and extended family, nonblood relatives and friends, church and community services, social service agencies, and other outside systems
cuento therapy
uses Spanish folktales as the basis for role-playing and discussion and has been found to be effective for reducing emotional and behavioral problems and improving ethnic pride in Hispanic children
therapy interventions likely to be most successful for African American clients
time-limited and adopts a problem-solving approach, multisystems
therapy interventions likely to be most successful for Hispanic American clients
active, goal-oriented, time-limited approach (CBT);
family therapy;
adopt a formal style (formalismo) in initial sessions but a more personal style (personalismo) in subsequent sessions
network therapy
helps empower clients to cope with life stresses by utilizing relatives, friends, and tribal members as a social support system
therapy interventions likely to be most successful for Asian American clients
brief structured and solution-focused approach;
expect the therapist to be an authority (but not authoritarian) and to suggest specific courses of action while also fostering their participation by encouraging them to help identify therapy goals and solutions to problems;
behavioral approach
intersectionality
the unique effects of factors such as race/ethnicity, gender, age, class, religion/spirituality, and disability and the interaction of these effects with the effects of sexual orientation
3 levels of prevention
1) primary: implemented before a disorder develops to reduce its incidence (rate of new cases) and are provided to an entire group or population of individuals
2) secondary: providing early intervention to keep a problem from becoming a full-blown disorder and are aimed at individuals who are exhibiting early signs of a disorder
3) tertiary: prevent the recurrence of a disorder and/or reduce its debilitating effects and are aimed at individuals who already have the disorder
client-centered case consultation
consultant helps the consultee resolve a problem they are having with a particular client;
assesses the situation to determine the cause of the problem, provides consultee recommendations for resolving the problem
consultee-centered case consultation
consultant identifies and addresses deficiencies in the consultee that are interfering with the consultee’s ability to provide effective services to members of a particular group of clients
program-centered administrative consultation
consultant works with program administrators to determine why an existing program is not having the desired outcomes
consultee-centered administrative consultation
consultant works with program administrators to improve their ability to effectively design, implement, and/or evaluate future performance
theme interference
loss of objectivity that occurs when a consultee’s reactions to a particular type of client (e.g., adults with BPD) are affected by the consultee’s previous experience with that type of client
behavioral consultation
behavior is learned and current behavior(s) can be replaced with new, more acceptable behavior(s);
indirect service delivery to a client in which the consultant works with the consultee (e.g., teacher or therapist) who is then responsible for providing services to the client (e.g., student or patient)
stages of behavioral consultation
1) problem identification: consultant and consultee work together to operationally define the problem behavior.
2) problem analysis: consultant and consultee conduct a functional analysis to identify the antecedents and consequences that are maintaining the problem behavior, then formulate a treatment plan
3) treatment implementation stage: consultant helps the consultee carry out the treatment and collect data on its outcomes
4) treatment evaluation: consultant and consultee analyze the outcome data to determine if the treatment achieved its goals and decide if it should be continued, discontinued, or modified
advocacy consultation
set of activities performed by a consultant to further the goals of a disenfranchised group (physical disabilities, poor SES residents);
focuses on bringing about change that will benefit the consultees through use of media or law
telepsychology
technological devices, such as telephones or video chatting software, for provision of mental health services
telepsychology pros
less expensive to administer, may cover a diverse range of services, conducting sessions with clients with limited mobility, various assessments, consultations, and crisis management
telepsychology cons
still relatively new, confidentiality (record keeping, protection of client data, encryption), challenges with providing therapy across state lines, and security against cyber infiltration
ethical guidelines for telepsychology
1) competence with the technologies they use, including being aware of any potential impact made on clients or others they work with
2) maintain professional and ethical standards of care (careful review of the benefits and the risks a client may experience, ensuring informed consent is appropriately communicated and documented, storing data with reasonable security, disposing of data in an appropriate manner)
3) follow all laws and regulations relevant to the use of telepsychology, keeping in mind differences across state or regional borders
healthcare systems
integrate and coordinate the delivery of services from institutions and professionals to the public
Beveridge model approach to healthcare
uses public funds to provide services
private model approach to healthcare
uses private funds to provide services
Bismarck model approach to healthcare
uses a mixture of private and public funds
suicide prevention
evaluating the client’s level of suicide risk and intervening in a manner commensurate with that risk;
the evaluation involves considering the client’s risk and protective factors and integrating information obtained from various sources, including the client, the client’s family, and other healthcare professionals
risk factors for suicide
history, warning signs, age, gender, race/ethnicity, marital status, psychiatric diagnosis, hopelessness, physical health
GRWMHAPHP
mental disorder with the greatest suicide risk (in order);
teenagers
MDD, a substance use disorder (esp. alcohol), and schizophrenia;
depression is comorbid with conduct disorder, a substance use disorder, or ADHD
suicide risk factors that result in hospitalization
previous suicide attempt or frequent and intense suicidal ideation, specific suicide plan that involves access to lethal means, severe mental illness or substance use, hopelessness, poor insight, lack of social support
child maltreatment experiences in order
neglect, physical, emotional, and sexual abuse
child characteristics that have been linked to an increased risk for physical abuse
low birth weight and prematurity; difficult temperament; chronic or serious physical illness; and physical, cognitive, emotional disabilities, female
cycle of violence
Phase 1) Tension Building: escalation of tension with verbal abuse and minor physical abuse and may last for days, weeks, or months. “walks on eggshells” to appease partner and avoid a serious incident of abuse.
Phase 2) Acute Battering Incident: intense violent incident. Women most often seek help during this phase.
Phase 3) Loving Contrition: perpetrator is remorseful and apologetic and promises that violence “will never happen again”
intimate partner violence (IPV)
occurs between two people in a close relationship and includes physical violence, sexual violence, stalking, and psychological aggression (e.g., humiliation, coercive control)
prevention and intervention of IVP
arrest of the offender, mandated treatment for the offender, and support for the victim is more effective than arrest of the offender alone
outcomes of Eysenck (1952)
44% showed improvement with psychodynamic, 66% for ECT, while 72% with no therapy;
concluded that the effectiveness of psychotherapy does not have scientific support;
lots of problems with his methods tho
outcomes of Smith, Glass, and Miller (1977, 1980)
first to use meta-analysis
the average therapy client was “better off” than 80% of patients in the no-treatment control group;
psychotherapy can reduce medical costs
dose effect model
predictable relationship between number of therapy sessions and probability of improvement:
50% of psychotherapy clients show improvement by the 6th to 8th therapy session;
75% by the 26th session;
85% after a little over a year
Howard et al. phase model
1) remoralization: occurs during the first few sessions and involves a decrease in feelings of hopelessness
2) remediation: symptom relief and, depending on the initial severity of symptoms, requires up to 16 additional sessions
3) rehabilitation: occurs in subsequent sessions and involves a gradual improvement in long-standing maladaptive behavior patterns
4 common factors of therapy
1) extratherapeutic: client characteristics that include severity of symptoms, motivation, psychological mindedness, resilience, and sources of support (40%)
2) relationship: therapist’s empathy, warmth, and acceptance (30%)
3) expectancy: “placebo effect”, client’s positive expectations about the effects of treatment (15%)
4) techniques: theories and strategies that are unique to specific treatments (15%)
efficacy research
randomized clinical trials - controls as many aspects of treatment as possible;
maximizes internal but limits external validity
effectiveness research
conducted in the “real world” and does not permit as much experimental control;
good external but lower internal validity
triangular model of supervision
integrates the supervisory relationship and organizational policies while emphasizing service delivery to clients
Sue et al. (1991) outpatient vs. inpatient outcomes
when compared to White individuals, Asian American and Mexican American individuals were underrepresented in outpatient relative to their proportions inpatient, while African American individuals were overrepresented;
African American clients generally had less positive outcomes than White, Asian American, and Mexican American clients and were more likely to terminate treatment prematurely
SAMHSA (2015) outcomes
outpatient mental health services use was highest for White individuals, American Indian/Alaskan Native, African American, Hispanic American, and Asian American individuals;
annual percentage of inpatient mental health services use was highest for American Indian/Alaskan Native individuals, African American, Hispanic American, White, and Asian American individuals
client-therapist matching outcomes
racial/ethnic matching of clients and therapists had a greater impact on the favorability of a client’s perceptions of their therapist than on therapy outcome and reduces the risk of premature termination;
therapist’s cultural competence, compassion, and similarity to clients in terms of worldview have a greater impact than racial/ethnic matching on therapy outcomes
psychasthenia
was a psychological disorder characterized by phobias, obsessions, compulsions, or excessive anxiety
MMPI-2 validity scales
? (Cannot Say): # of unanswered or double-marked items
L (Lie): lack of insight or has attempted to present self in a favorable light
F (Infrequency): malingering, significant pathology, an attempt to “fake bad,” or responding to all items as either T or F
K (Correction): defensiveness or denial, an attempt to “fake good,” or responding “F” to all items
VRIN (Variable Response Inconsistency) and TRIN (True Response Inconsistency): assess response inconsistency, invalid profile
Fp (Infrequency/Psychopathology): “fake bad” even if the examinee is a psychiatric patient
Fb (F Back): responded to items toward the end of the test in a deviant way
S (Superlative Self-Presentation): defensiveness, attempt to “look good”
NEO Personality Inventory-3 (NEO-PI-3)
measures the Big Five personality traits and the 6 facets that define each trait
Myers-Briggs Type Indicator (MBTI)
based on Jung’s personality typology and provides information on 4 bipolar dimensions: introversion-extraversion, sensing-intuitive, thinking-feeling, and judging-perceiving
Thematic Apperception Test (TAT)
identifying each story’s “hero”, includes:
needs (internal determinants of the hero’s behavior),
press (external determinants of the hero’s behavior),
thema (the interaction between needs and press),
outcomes
Strong-Campbell Interest Inventory
examinees respond to items that address preferences for occupations, school subjects, activities, people, and characteristics using a five-point scale that ranges from “strongly dislike” to “strongly like”
Kuder Occupational Interest Survey
100 items that require examinees to choose their most and least preferred activities from 3 activities
Halstead-Reitan Neuropsychological Battery
assess the neurological functioning of individuals ages 15 and older;
separate tests of lateral dominance, psychomotor functions, sensory-perceptual functions, speech and language, visual-spatial skills, abstract reasoning, mental flexibility, and attention and concentration;
0 to 1.0 - score of 0 to 0.2 suggests normal functioning
The Luria-Nebraska Neuropsychological Battery
scores on 11 scales that measure specific functions (motor, rhythm, tactile, visual, receptive speech, expressive speech, writing, reading, arithmetic, memory, and intellectual processes) and on scales that are used to help localize brain dysfunction
poor performance on WCST linked to
autism, schizophrenia, depression, alcoholism, and malingering
poor performance on the Stroop linked to
depression, mania, ADHD, and schizophrenia
Tower of London
a measure of higher-order executive functioning and working memory;
poor performance associated with frontal lobe damage, ADHD, autism, and depression
Rancho Los Amigos Scale of Cognitive Functioning
method for tracking improvements in cognitive functioning following a head injury
Gestalt therapy goals
awareness of the self in the here-and-now is viewed as the “curative factor”;
help the client achieve self-awareness and assume responsibility;
making “I” statements, dream work, the empty chair technique = focus on now
choice theory
the choices people make determine the quality of their lives and are the means for both creating and resolving problems
success identity
person chooses to fulfill needs responsibly (i.e., in effective and realistic ways that do not infringe upon the rights of others)
failure identity
person chooses to meet needs in an irresponsible manner
stages of reality therapy
1) W: clients identify wants, needs, and perceptions
2) D: clients identify what they are currently doing and clarify the future direction of their lives
3) E: clients engage in critical self-evaluation to determine the effectiveness of their current behaviors for fulfilling their current and future needs
4) P: clients develop positive plans for improvement and commit to change
adaptive schemas
facilitate efficient information processing and realistic evaluations of events
schemas
enduring core beliefs that organize categories of information in a meaningful way to determine relationships among them, thereby how they are perceived and conceptualized
automatic thought
spontaneous thoughts that arise in response to events and that the person may not be fully aware of;
may lead to dysfunctional emotional and behavioral responses when they are based on maladaptive schemas
automatic thoughts and depression
thoughts take the form of a negative cognitive triad: negative thoughts about oneself, the world, and the future
CBT therapy goals
help the client identify and replace maladaptive cognitive patterns;
test the client’s thoughts and beliefs
irrational beliefs
beliefs that elicit emotions and behaviors that interfere with a person’s goals
Double-bind communication
contradiction between report and command levels;
when a person receives contradictory messages from another person and cannot comment on the contradiction
ecomap
examine interactions between a family and its environment
according to Beck, suicide risk is heightened by
combination of hopelessness and poor problem-solving skills
techniques of Bowenian therapy
1) Genograms: initial assessment tool and also to help family members gain understanding of family processes
2) Process Questions: Process questions (e.g., “How do you react to your husband when he criticizes you?”) are used to help family members see how they might contribute to problems and how other members perceive specific situations
3) Relationship Experiments: homework assignments that are designed to help family members practice relating to other members from a more differentiated position
3 overlapping stages of structural family therapy
1) joining with the family: building rapport and “blending” with the family by using mimesis (adopting the family’s language, affective range, and behavioral style) and tracking (using the content of family communications to demonstrate interest and understanding)
2) formulation: identifying the family’s dysfunctional repetitive patterns through observation of the family’s interactions and construction of a family map that illustrates the family’s structure
3) restructuring: use of various techniques to alter the family’s repetitive interactions
communication and power in strategic family therapy
communication is used to express power;
power: person’s ability to influence and control relationships with others;
power usually determined in families by hierarchies
characteristics of systemic family therapy distinguish it from other approaches
(a) provided by a team of 4 therapists, with 1 or 2 therapists meeting with family members and the other therapists observing sessions from behind a one-way mirror
(b) sessions are divided into 5 parts: pre-session team discussion, interview session with the family, discussion of the interview by team members, conclusion of the interview with a task given to the family, and a post-session team discussion of the family’s reaction to the task and formulation of a plan for the next session
(c) once a month for about 10 sessions
operant interpersonal therapy
successful and unsuccessful marriages are distinguished by differences in reciprocal positive reinforcement;
uses contingency contracts to increase the number and range of positive reinforcements exchanged by the partners
use reciprocal reinforcement or “quid pro quo”
transtheoretical model’s 3 factors that affect a person’s motivation to change
1) decisional balance: person’s beliefs about the pros and cons of changing - important during contemplation stage
2) self-efficacy: level of confidence about being able to change - lowest during early stages of change
3) temptation: intensity of the urge to engage in the behavior - lowest during the later stages of change
Selection and Preparation of Group Members
1) group composition: homogeneous vs. heterogenous
2) entry to group: open vs. closed
3) group size: ideal is 7-10
4) inclusion & exclusion criteria
5) premature termination: 30-40% in first few sessions so use prescreening
6) concurrent participation in group therapy and individual therapy
best candidate for group therapy
a “highly motivated, active, psychologically minded and self-reflective individual who seizes opportunities for self-disclosure within the group”
characteristics associated with early dropout of group therapy
low psychological mindedness, a high degree of defensiveness and denial
advantages of co-therapists in group therapy
provide members with a model of a healthy adult relationship, broaden opportunities for transference reactions, allow for a greater observational range
disadvantages of co-therapists in group thrapy
co-therapists may be uncomfortable with each other, may differ substantially in terms of style, strategies, or opinions
important factors in group therapy (Yalom)
interpersonal learning, catharsis, and cohesiveness***
feminist theory empowerment
helping women become more self-defining and self-determining
feminist theory transformation
working toward “creating a society in which relationships are interdependent, cooperative and mutually supportive”
culturally sensitive counselor
recognizes that culture may play a role in a client’s presenting problems and response to treatment;
has the knowledge and skills needed to work effectively with members of different cultural groups
functional cultural paranoia
pathological condition that is characterized by pervasive distrust and suspiciousness of all, regardless
prevention
reducing the incidence and/or duration of mental disorders
best predictor of risk for a future suicide attempt
a past suicide attempt;
50% who commit suicide have made at least 1 previous attempt;
greater the number of past attempts, the greater the risk
age and suicide
suicide rates tend to increase with increasing age;
in recent years, rates for individuals in younger age groups have exceeded those for older age groups
race/ethnicity for suicide
whites;
in 2013, American Indians/Alaskan Natives ages 15 through 34 had the highest rates
marital status and suicide
highest to lowest risk: divorced individuals, widowed, single, married;
the more recent the divorce, the greater the risk
child maltreatment perpetrator characteristics
biological parent(s) followed by, in order, nonbiological parents, parents’ partners, other relatives, and other unrelated adults;
more likely to be women than men;
depression, low SES, marital discord, poor parenting skills
evidence-based treatments (EBTs)
integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences
projective hypothesis
person’s responses to ambiguous stimuli provide information about their personality, needs, feelings, etc
interest inventories
self-report measures that assess an examinee’s preferences with regard to activities and occupations
Mini-Mental State Exam (MMSE)
screening tool for cognitive functioning for older adults;
11 questions that assess 6 aspects of functioning: orientation, registration, attention and calculation, recall, language, and visual construction;
most useful for screening for Dementia in older adults
Glasgow Coma Scale
assesses level of consciousness following acute brain injury and entails rating an individual on their best response in 3 categories: eye opening, motor response, and verbal response
psychiatric disorders among immigrants and refugees
most frequent somewhere between the end of the 1st year through the 3rd year after they immigrate to this country
social displacement syndrome
tendency of immigrants to initially experience elation and optimism, followed by a period of frustration, depression, and confusion as the reality of the adjustments required by their new lives sets in
core schemas
basic assumptions about oneself and the world
psychological phenomena involved in schemas
memory, affect, motivation;
other functions related to perception and information processing
psychotherapy research outcomes
therapy is generally effective for children and adults of all backgrounds;
with the exception of certain specific problem areas, all therapies are about equal
strongest bond in Hispanic-American families
parent and child, especially the mother-son and father-son relationships
crisis theory
people in crisis tend to follow a predictable sequence of responses;
help individuals in crisis learn more effective coping so that they can respond more adaptively when having similar experiences in the future;
views symptoms as expected responses to acute trauma and seeks to return the person to the pre-trauma level of functioning;
emphasize the cognitive and behavioral elements of a crisis
6-8 sessions b/c that’s how long many crises last
prevalence of mental disorders in people 65 and older
lower than any other age group;
only cognitive impairment shows a definite age-associated increase in incidence
efficacy of biofeedback for pain reduction
as effective as treatments such as relaxation training
conversion V pattern (MMPI)
scores on Scale 1 (Hypochondriasis) and Scale 3 (Hysteria) are 65 or higher and at least eight points higher than the Scale 2 (Depression) score;
suggests somatization of psychological problems, a lack of insight, or chronic pain that has an organic basis
psychotic V pattern (MMPI)
scores on Scales 6 (Paranoia) and 8 (Schizophrenia) are 65 or higher and at least eight points higher than the Scale 7 (Psychasthenia) score;
suggests the presence of delusions, hallucinations, and disordered thought
secondary gain (psychodynamic approach)
benefit a person obtains from an experience in connection with a mental health or physical problem (e.g., concern from family and friends) that reinforces the problem
Depression and Anxiety (Beck)
1) in depression, cognitions about hopelessness, low self-esteem, and failure are more common; in anxiety, cognitive themes are usually related to anticipated harm or danger
2) depressed patients are more likely to have absolute thoughts about negative themes, while anxious individuals tend to have questioning thoughts about the uncertainty of future events
core principles of feminist therapy
1) belief that “the personal is political”: client’s problems can be traced to societal and political factors
2) commitment to social change: interested in advancing social change as well as change in individual clients
3) need to value and honor the perspective of women and girls: replace “patriarchal ‘objective truth’ with feminist consciousness, which acknowledges a diversity of ways of knowing”
4) view of the therapeutic relationship as egalitarian: feminist therapists recognize the inherent inequality of the therapeutic relationship, strive to provide a collaborative egalitarian relationship (self-disclosing when appropriate, viewing clients as the experts regarding their own circumstances and concerns)
5) reformulation of traditional views of psychological distress: “communication about unjust systems”, reframed as survival mechanisms
6) recognition of all forms of oppression: challenge other forms of oppression (race/ethnicity, physical abilities, sexual orientation, religious beliefs, class)
two major roles of a group therapist
1) help keep the group focused on the here-and-now
2) help illuminate process
self-reflective loop
group stays focused on the here-and-now but also pauses to examine here-and-now events that just occurred
research on the results of sex therapy
vaginismus and erectile dysfunction is highly effective in the short- and long-term (1 to 6 years);
premature ejaculation suggest short-term success but less permanent results;
low sexual desire in men has poor short- and long-term results;
low sexual desire in women has poor long-term results
Hofstede’s 5 cultural dimensions
power distance, uncertainty avoidance, individualism, masculinity, and long-term orientation;
US scores high on individualism, low on power distance, moderate to high on masculinity, and moderate scores on uncertainty avoidance
phenomenological approach
study of subjective experiences;
attempts to explain experiences from the point of view of the subject via the analysis of their written or spoken words;
basis of person-centered psychotherapy by Carl Rogers
Stress-Buffering Hypothesis
a high level of perceived social support can protect a person against the harmful effects of stress on their physical and psychological health
multicultural competence
most often attributed to one’s level of awareness, knowledge, and skills
NIMH’s TDCRP research project
no differences in outcome were observed between cognitive therapy and antidepressant medication among all patients;
cognitive therapy and antidepressant medication are about equally effective in the treatment of depression;
antidepressants are superior to cognitive therapy in severely depressed patients
widely used treatment for MDD
antidepressant medication
Heinz Kohut
when a young child’s natural self-love (narcissism) is undermined by a parent’s inevitable failure to satisfy all of the child’s needs, the child develops a protective grandiose self;
the grandiose self is ordinarily modified during childhood through maturation and normal interactions with parents;
however, if a parent consistently responds to the child in very unempathic ways, normal development is thwarted
sexual orientation disclosure by lesbians
associated with positive outcomes such as a lower level of anxiety, a lower likelihood of engaging in anonymous socializing (i.e., going to bars) and greater family support following disclosure to family members
primary procedures of analysis in psychoanalysis
1) confrontation: making statements that help clients view their own behaviors in a new way
2) clarification: bring the client’s behavior into sharper focus and involves asking questions and making observations
3) interpretation: explicitly linking the client’s conscious behavior to unconscious processes
* repeated interpretations lead to catharsis (emotional release that results from the recall of repressed material) and insight (understanding of the connection between current behavior and unconscious material)
4) working through: slow, gradual process that involves testing, accepting, and assimilating new insights
Beck Depression Inventory
21 items assess the intensity of mood, behavioral, cognitive, and physical signs of depression;
0 to 13: minimal depression;
14 to 19: mild depression;
20 to 28: moderate depression
29 to 63: severe depression
parallel process
phenomenon in clinical supervision where the therapist in training behaves toward the supervising therapist in ways that mirror how the client is behaving toward the therapist in training
elaborative rehearsal
thinking about how new information relates to existing memory
pros of countertransference
a therapist’s analysis of his or her own countertransference reactions can help the therapist recognize subtle aspects of the transference relationship and better understand the patient’s experience
brief psychodynamically-oriented therapy
positive transferences are encouraged and are viewed as essential to treatment progress;
full-scale transference neurosis is discouraged
categories of the Rorschach
1) location: areas of the inkblot the examinee used to derive their response (whole inkblot, common or uncommon detail, white space)
2) determinants: characteristics of the inkblot that determined the examinee’s response (form, color, texture/shading)
3) content: the objects perceived by the examinee (e.g., people, animals, food, nature)
4) popularity: extent to which the examinee’s response is frequently given by examinees or is unusual
5) form quality: degree of similarity between the examinee’s response and the shape of the inkblot
Rorschach interpretation
large number of “whole” responses suggests a high degree of abstract thinking and creativity;
large number of popular responses suggests a tendency to conform to other people while a low number may suggest rebelliousness;
extensive confabulation (focusing on and generalizing a single detail to the entire inkblot) may indicate brain injury
depressogenic schemata
cognitive distortions
Counseling Native American Clients
non-directive, history-oriented, accepting, and cooperative approach;
therapists should be reserved, open, accepting, and willing to listen
Network Therapy
recommended as an appropriate intervention for Native American clients;
therapist acts primarily as a catalyst who initiates the process and brings the client’s family, friends, and relatives (i.e. the client’s network) together to implement the therapeutic process
worldview of minority groups
internal locus of control, external locus of responsibility
diagnostic overshadowing
when a therapist’s ability to recognize or consider other symptoms or conditions is “overshadowed” by one aspect of a client’s symptoms or condition
CBT and DID
need to develop a strong therapeutic alliance in the initial stages of therapy
one potential complication of concurrent individual and group psychotherapy
clients may hold off on responding to what occurs in group therapy because they prefer to wait for the relative safety of individual sessions;
“the client may interact like a sponge in the group, taking in feedback and carrying it away to gnaw on like a bone in the safe respite of the individual therapy hour”
research on client-therapist racial matching
doesn’t have a significant impact on therapy outcome;
for African-American clients, cultural mistrust or suspiciousness of Caucasians is negatively correlated with therapeutic effectiveness;
Caucasian therapists’ own racial identity development is moderately correlated with their multicultural counseling skills
Assimilative Integration
therapist has a commitment to one theoretical approach but also is willing to use techniques from other therapeutic approaches
Theoretical Integration
integrating concepts from different theoretical approaches (e.g. behavioral and psychoanalytic);
most difficult level to achieve integration as the basic philosophy in each theory may differ
Technical Eclecticism
a therapist, rather than adhering to a small number of therapeutic approaches, selects techniques from a wide variety of different therapies depending on what is needed
Vivienne Cass process of homosexual identity development
1) identity awareness: conscious of being different
2) identity comparison: believes may be homosexual, acts heterosexual
3) identity tolerance: realizes is homosexual
4) identity acceptance: begins to explore gay community
5) identity pride: becomes active in gay community
6) synthesis: fully accepts self and others
cognitive disintegration
the tendency to become disorganized under emotional stress or a decreased ability to tolerate stress leading to anxiety-induced decompensation
baseline exaggeration
challenging behavior that exists at a low rate and low intensity may increase dramatically when one has stress or a mental health condition
collateral family system or organization
the extended family (e.g., cousins, aunts, uncles, adult siblings) is emphasized and where extended family members rely on each other for support;
more common in non-dominant subcultures, such as African-American, American Indian, and Asian-American, than it is in the dominant culture
mimesis
adopting a family’s communication and affective style;
one way of joining the family system
autoplastic adaptation
changing or adapting to the environment by altering one’s own behaviors or responses
alloplastic adaptation
changing or adapting to the environment by effecting changes in the environment
Transactional Analysis (TA)
model of people and relationships that is based on two notions:
1) we have functional ‘ego-states’ to our personality
2) these parts converse with one another in ‘transactions’
collaborative empiricism
central technique of Beck’s CBT;
refers to the therapist and client working together to gather evidence and test the logic, or hypotheses, of the client’s thoughts and beliefs
reframing
relabeling a behavior to make it more amenable to therapeutic change
violence against gays and lesbians (Gregory Herek)
attributable to a combination of psychological (individual) and cultural heterosexism
heterosexism
ideological system that denies, denigrates, and stigmatizes among nonheterosexual forms of behavior, identity, relationships, or community
interventions to increase compliance with hand hygiene practices
no single intervention has consistently improved handwashing frequency in healthcare workers;
most effective approach is a multifaceted one that includes education, written material, reminders, and continued feedback of performance
sexual prejudice (Gregory Herek)
all negative attitudes based on sexual orientation, whether the target is homosexual, bisexual, or heterosexual;
more appropriate term than “homophobia” - which refers to heterosexuals’ dread of being in close quarters with homosexuals and homosexuals’ self-loathing
defense mechanisms
conflicts take place in the unconscious and create anxiety, which signals to the ego that a conflict must be resolved;
when the ego is unable to do so using realistic, rational means, it employs one of its defense mechanisms, which operate at an unconscious level and deny or distort reality
targets of analysis in psychoanalysis
1) free associations: asking the client to say whatever comes to mind without censure to help lower a client’s defenses and bring unconscious thoughts and feelings into conscious awareness
2) resistance: when the client is unwilling or unable to address threatening, anxiety-arousing issues
3) dreams: dreams contain symbols that provide important information about unconscious impulses which the therapist interprets the true meaning (latent content) of these symbols
4) transference
3 types of communications, or transactions, between the three ego states
1) complementary transactions: can occur among any combination of ego states and involve the original communication being met with an appropriate response
2) crossed transactions: involve the original communication eliciting a response from an inappropriate ego state
3) ulterior transactions: involve confusion b/c one of the communicators is giving a dual message - the communication can be coming from one of two different ego states
manual-guided treatments
detail the theoretical underpinnings of a treatment, the treatment goals, and specific therapeutic strategies and guidelines;
initially developed to standardize treatments so that their effects could be empirically evaluated and provide guidelines for training therapists
Consumer Report’s 1995 study
failed to find a relationship between therapist level of training and outcome
ethnic minority clients with a strong affiliation with their own culture
tend to prefer ethnically similar counselors;
some research shows that outcomes for such clients is better when the counselor is ethnically similar
empirical criterion keying
items are assessed to determine how well they distinguish between prespecified criterion groups (e.g., between depressed and non-depressed individuals);
items that best distinguish between the groups are maintained for the final version of the scale or the test
humanistic school of psychotherapy
person-centered therapy, Gestalt therapy, and transactional analysis;
emphasizes human capacities and potentialities rather than deficiencies;
we have a natural tendency toward self-actualization or personal growth;
neurosis or pathology occurs due to defensive distortions (e.g., blocks to awareness in Gestalt therapy, conditions of worth in person-centered therapy) that prevent this natural tendency from operating
the fourth force in psychology
multiculturalism;
one which complements the behavioral, psychodynamic and humanistic explanations of human behavior
multiculturalism
Pedersen (1991): “a wide range of multiple groups without grading, comparing, or ranking them as better or worse than one another and without denying the very distinct and complementary or even contradictory perspectives that each group brings with it”;
others advocate attention to the racial/ethnic minority groups within a culture
displacement (psychoanalytic)
person redirects sexual or aggressive impulses away from a dangerous or threatening target to a safer target or outlet
projection (psychoanalytic)
involves attributing one’s own unacceptable impulses or emotion to someone else
reaction formation
person converts an unacceptable wish or impulse to its opposite;
clergyman preaching rabidly against sexual immorality while strongly desiring or engaging in the very behavior he criticizes
sublimation
person rechannels socially unacceptable impulses into socially useful activity, such as art or work;
considered the healthiest and most successful defense mechanism
tracking
identifying with the family’s values and history;
one way of joining the family system
blocking (structural family therapy)
blocking the family from engaging in its normal way of functioning so that it is forced to adopt new interactional patterns
George Kelly
perhaps the first cognitive theorist;
“psychology of personal constructs”;
a construct (synonymous with a schema), is a cognitive template through which the world is interpreted
determinism
in a situation in which a person makes a certain decision or performs a certain action, it is impossible that he or she could have made any other decision or performed any other action
CBT and severe depression
the first goal in therapy is to increase activity level through the use of behavioral tasks;
once active, cognitive procedures are used to identify and modify cognitive distortions
undoing
ego defense mechanism in which a person relieves anxiety over a behavior by attempting to make up for it in other areas
Feminist Object Relations Theory
relationship between mother and child and how gender differences result from the mother being the primary caretaker;
the division of labor which occurs in families (although less so in recent years), is characterized by women being more involved in affective, interpersonal relationships than men;
this is inevitably passed on to both boys and girls who ‘reproduce’ this sexual and familial division of labor
psychodrama
type of group therapy which provides members an opportunity to play roles in a spontaneous performance of their issues and practice new, more effective behaviors and roles
CBT and panic disorder
connected to “catastrophic misinterpretations” of bodily sensations, symptoms, and mentation;
the client’s “overcastrophization” of early signs of the attack such as hyperventilation results in a full-blown attack;
thus, at least initially, therapy focuses on identifying and modifying the client’s misinterpretations of symptoms and thoughts immediately before and during the attack
Social-Role theorists
individuals in positions of lower power and status are better at reading/perceiving members of higher status groups than are those from higher status groups at reading people from lower status groups
somatic therapy
types of treatment involving manipulations of the body;
3 main types:
psychopharmacological or drug therapy (most common);
ECT: administering a muscle relaxant and anesthetizing a patient before passing an electric current through the non-dominant brain hemisphere;
psychosurgery (most extreme form of somatic therapy)
Lazarus cognitive appraisal theory
the emotional reaction to a situation follows a cognitive assessment of the situation;
three types of appraisal:
1) primary: one’s perception of the situation (i.e., positive, negative, or irrelevant)
2) secondary: assessment of resources available to deal with the situation
3) re-appraisal: watching the situation and changing the other types of appraisals as necessary
Logotherapy
form of existential therapy developed by Victor Frankl that postulates a will to meaning
psychoanalytic theory and mania
occurs as a defense against depression, due to an inability of the person to tolerate or admit to being depressed
emotional reasoning
cognitive distortion that refers to a person believing that because he or she feels a negative emotion, there must be a corresponding negative external situation
best practices
approaches to counseling practice that have empirical evidence to support their effectiveness
The Symptom Checklist 90-Revised (SCL-90-R)
90-item self-report inventory that is designed to assess general psychiatric symptoms of anxiety, depression, somatization, obsessive-compulsiveness, and hostility on a Likert scale for individuals 13 and older
projective identification
defense mechanism in which one or more parts of the self are falsely attributed to another, which are then unconsciously accepted by the recipient, and the projector then identifies with the projected part in the other
tacrine hydrochloride (Cognex) and donepezil hydrochloride (Aricept)
have beneficial effects on memory and reasoning for some patients with mild to moderate Alzheimer’s Dementia;
hypothesized that these drugs prevent the breakdown of ACh and thus increase the availability in the brain;
not considered a cure
therapy outcomes with children and adolescents
across treatment approaches, girls respond better than boys, with adolescent girls responding best of all;
this is somewhat contradictory to earlier research, which found that younger children respond better than older children
structured learning therapy (SLT)
incorporates “social skills training,” an early approach to the treatment of depression, along with modeling, role-playing, skill instruction, and performance appraisal
paralanguage
refers to vocal cues, other than words or language, individuals use to communicate meaning
dynamic assessment
variety of procedures involving departure from standardized test administration to obtain additional information about an examinee;
done after the test has been administered using standardized procedures;
used in the assessment of individuals with learning disabilities or mental retardation
“testing the limits”
providing cues to see how many are needed to generate successful performance;
the more cues required, the more severe the learning disability
conditions of worth
Roger’s person-centered;
mother provides affection and approval only when child behaves in certain ways
