Clinical Flashcards
Interpersonal psychotherapy
- originally developed to prevent relapse from acute episode of major depressive disorder
- has been applied to chronic depression, bipolar disorder, binge eating disorder, bulimia, and other disorders
- goals are symptom reduction and improvement in interpersonal functioning
Based on the medical model and views, depression and other disorders as treatable medical conditions
- primary goals of therapy are to relieve current symptoms and to improve aspects of current interpersonal functioning that are maintaining symptoms
- clients are assigned the sick role in order to allow them to be ill without blaming themselves for their symptoms and viewing their illnesses as temporary and treatable
- interpersonal role disputes, role transitions, interpersonal deficits, and or unresolved grief
Strategies of interpersonal therapy
- tailored to problem area being targeted
Encouragement of effect, communication analysis, decision analysis, and role play
Solution focused therapy
- goal is to help clients find solutions to their problems
-structured session which involve asking questions and receiving feedback And assigning tasks to complete before the next session
- therapist adopt a goal-directed collaborative approach, focus on future, and use several types of questions to help clients identify concrete, realistic therapy goals and personal strengths and resources to achieve goals/ and to monitor progress in therapy
Miracle question
Solution focused
- help clarify therapy goals
” If a miracle happened during the night and your problem was suddenly solved, how would you know that the miracle had occurred??
Exception questions
- used to identify treatment goals by identifying possible solutions to problems
Identify times and the problem did not exist or was less intense
” Can you think of a time in the past 2 weeks where you did not argue with your son?”
Scaling questions
- help evaluate current status or progress towards achieving goals
” The scale from 1 to 10, how stressed are you now?
Transtheoretical model
- goal is to help client move to the next stage of change
- 10 processes of change and optimal process depends on stages of change
Pre-contemplation
- no intention to change
- unaware or not concerned about behavior
Contemplation
- aware of problems and are planning to make changes in the next 6 months
Preparation
- planning to take action in the next month And developed concrete plan of action
Action
- actively engaged in changing behavior
- devoting considerable time and energy in change
Maintenance
- have engaged in new behavior for at least 6 months and working to prevent relapse
Termination
- Have maintained change for at least 5 years
confident inability to maintain change
Conscious raising
- help client transition from pre-contemplation to contemplation And contemplation to preparation stage
Counter conditioning and reinforcement management
Transition from action to maintenance stage and maintenance to termination stage
Motivational interviewing
- goal is to increase client’s motivation to change by helping overcome ambivalence and resistance
- interventions are most effective when match stage of change, most effective for pre-contemplation or contemplation stage
- integrates trans theoretical model, Rogers person-centered therapy, with self-efficacy and cognitive dissonance
- expressing empathy, supporting self-efficacy, developing discrepancy, enrolling with resistance
Developing a discrepancy
Mi
- help clients see a discrepancy between current behaviors and their goals And values
Rolling with resistance
Mi
- decrease resistance by avoiding arguments and power struggles and responding to resistance with acceptance rather than opposition
General systems theory
- traditional approaches influenced by this
- A family is a system of interacting components, and change in one family member changes others
- family systems have homeostatic mechanisms in a state of equilibrium
- are open to some degree: interact with the environment
Cybernetic theory
- family systems receive information through negative and positive feedback loops
Negative feedback loop
- resist change and help maintain status quo
Positive feedback loops
- amplify change and disrupt the status quo
- can lead to a breakdown in the system
Recent approaches to family therapy
- influenced by postmodernism
& Adopt a constructivist or social constructivist perspective
- assume there are multiple viewpoints in realitie
Postmodernism
- challenges the basic premises of general systems: there are universal laws that govern all systems and that can be discovered by scientific research
Extended family systems. (Intergenerational family therapy)-Bowen
+ family problems are due a lack of differentiation That is maintained by emotional triangles, a family projection process, and a multi-generational process
- primary goal is to increase each family members level of differentiation
& Therapist rely on rational process to help clients understand and alter levels of differentiation
- work only with the most differentiated family member or the parents
- the regeneration genogram, process questions, and going home again
Differentiation
- AKA differentiation of self
- ability to distinguish between own failings and thoughts which determines how well the person can separate his or her own emotional functioning from the emotional functioning of others
- low differentiation leads to emotional fusion
Emotional triangles
- when a diad experiences tension it may recruit a third family member
- alleviate tension and increased stability
- likelihood increases as levels of differentiation decrease
Family projection process
- families projection of emotional and maturity onto children which causes children to have lower levels of differentiation
Multi-Generational transmission process
- transmission of emotional immaturity from one generation to the other
- child most involved in family’s emotional system becomes least differentiated and as an adult chooses a partner with a similar level of differentiation, then transmits an even lower level of differentiation to their child most involved in their emotional system and then continues on until the development of symptoms in subsequent generations
Process questions
Bowen
- designed to help family members think logically and less emotionally
Going home again
Bowen
- family member visits family of origin after learning techniques to increase differentiation from family members
Structural family therapy- minuchin
- family dysfunction is due to problems related to family structure
-boundaries,
- development goal is to restructure family so that it’s better able to adapt to stress
- techniques: joining, enactment, boundary making, and unbalancing
Structural family therapy- minuchin
- family dysfunction is due to problems related to family structure
-boundaries,
- development goal is to restructure family so that it’s better able to adapt to stress
- techniques: joining, enactment, boundary making, and unbalancing
Boundaries
Minuchin
- implicit and explicit rules that determine how family members interact with each other
- Continuum: extremely rigid and inflexible boundaries that lead to disengagement and extremely diffuse blurred boundaries that lead to enmeshment clear boundaries relationships
- both lead to an inability to adapt to environmental or developmental stress
In the middle are clear boundaries which allow for close relationships while maintaining A sense of personal identity
Boundaries
Minuchin
- implicit and explicit rules that determine how family members interact with each other
- Continuum: extremely rigid and inflexible boundaries that lead to disengagement and extremely diffuse blurred boundaries that lead to enmeshment clear boundaries relationships
- both lead to an inability to adapt to environmental or developmental stress
In the middle are clear boundaries which allow for close relationships while maintaining A sense of personal identity
Ridgid triad
- chronic boundary problems
Stable Coalition: one parent and kid against the other parent
Unstable coalition; triangulation, each parent demands that the kid sides with them
Detouring attack coalition: parents avoid conflict by blaming child for their problems
Detour- support coalition: parents overprotect child to avoid conflicts
Joining
Minuchin -sf
- used to establish a therapeutic alliance
- Memisis: adopting the families affective behavioral and communication styles
Tracking: adopting content of the family’s communications
Enactment
– family members role play a problematic interaction so the therapist can obtain information about that interaction and encourage family members to interact in an alternative way
Boundary making
Minuchin-SF
Used to soften rigid boundaries or strengthen diffused boundaries
- family member sit closer or further from another member or asking if one family member to be silent or speak up speak up during family interactions
Boundary making
Minuchin-SF
Used to soften rigid boundaries or strengthen diffused boundaries
- family member sit closer or further from another member or asking if one family member to be silent or speak up speak up during family interactions
Unbalancing
- used to alter hierarchical relationships
- therapists temporarily sides with the family member that needs to develop stronger boundaries
- may involve helping family member describe their perspective to other family members
Unbalancing
- used to alter hierarchical relationships
- therapists temporarily sides with the family member that needs to develop stronger boundaries
- may involve helping family member describe their perspective to other family members
Strategic family therapy Haley
- family dysfunction serves an important interpersonal function - symptom is a strategy adapted to a current social situation
For controlling a relationship at all other attempts have failed - maladaptive family functioning is maintained by unclear or inappropriate hierarchical power structures and inflexible patterns of interaction
Goal- altar, hierarchies and interactions maintaining symptoms
Strategies for strategic family therapy
- aimed at specific behaviors
Straightforward directives and paradoxical directives
Strategies for strategic family therapy
- aimed at specific behaviors
Straightforward directives and paradoxical directives
Straightforward directives
Haley-strat f
- instructions to engage in specific behaviors that will change how family members interact
Ex. Set up system of consequences for each misbehavior and consistently apply those consequences
Straightforward directives
Haley-strat f
- instructions to engage in specific behaviors that will change how family members interact
Ex. Set up system of consequences for each misbehavior and consistently apply those consequences
Paradoxical directives
- help family members realize they have control over behaviors or use resistance from other members to help change and desired way
- prescribing the symptom, restraining, and ordeals
Paradoxical directives
- help family members realize they have control over behaviors or use resistance from other members to help change and desired way
- prescribing the symptom, restraining, and ordeals
Prescribing the symptom
- engage in problematic behavior and an exaggerated way
Restraining
- discourage change or warn not to change too quickly
Ordeal
- unpleasant task asked to perform whenever engage in undesirable behavior
Cbt
It was designed as treatment for depression, but has been applied to bipolar disorder, social anxiety disorder, OCD, bulimia and several other disorders.
- Psychological disturbances due to maladaptive cognitive schemas, negative automatic thoughts, and cognitive distortions.
The goal is to identify and correct and replace cognitions that are maintaining maladaptive behaviors and emotions.
Cognitive schemas
- core beliefs that develop during childhood as a result of experience and certain biological factors
- are enduring, can be maladaptive or adaptive, and revealed in automatic thoughts
Cognitive profiles
- different disorders are associated with different maladaptive schemas
Automatic thoughts
- automatically come to mind when triggered by an event and intercede between the event and your emotional and behavioral reaction
- can be positive or negative -
negative automatic thoughts contribute to psychological disturbances
Cognitive distortions
Systematic errors in reasoning that affect your thinking when a stressful event triggers a dysfunctional cognitive schema That in turn affects content of automatic thoughts
- arbitrary inference, the lack of abstraction, personalization, and emotional reasoning
Arbitrary inference
Draw a negative conclusion about unabsorbed characteristic or event from an absorbed one without supporting evidence and or with contradicting evidence
.
Selective abstraction
- paying attention to or exaggerating minor negative detail of the situation while ignoring other aspects of the situation
Personalization
- blaming self for external events that you don’t have control over
Emotional reasoning
- rely on emotional state to draw conclusions about oneself, others in situations
Cbt therapist
Active and structured approach
- reattribution guided discovery, activities scheduling and exposure
Use a variety of cognitive and behavioral techniques to achieve therapy goals
Socratic dialogue
- ask questions to clarify client problems and to define clients problems, identify thoughts and assumptions that underlie the problems and evaluate the consequences of maintaining maladaptive thoughts and assumptions
Collaborative empiricism
- The process of CBT
- due to emphasis on establishing a collaborative therapist client relationship & reality testing maladaptive beliefs
Rational emotive behavior therapy
Primary cause of maladaptive behavior is the continual repetition of irrational beliefs.
- abcde model to explain psychological disturbances and the process of change in therapy
A= activating event
B= client’s irrational belief about the event
C= emotional or behavioral consequence of the belief
D= therapist’s use of techniques that dispute that irrational belief
E= effects of the techniques, replacement of irrational belief with the more rational one
Techniques of Rebt
- variety of cognitive, behavioral, and emotive techniques
- active disputation of irrational beliefs, rational emotive imagery, systematic desensitization, and skills training
Techniques of Rebt
- variety of cognitive, behavioral, and emotive techniques
- active disputation of irrational beliefs, rational emotive imagery, systematic desensitization, and skills training
Stress inoculation training
- focuses on improving ability. Better handle stressful situations by teaching effective coping skills
- Three phases: conceptualization & education, skills acquisition & consolidation and application & follow through
Conceptualization and education
Stress inoculation
- provided with information about stress and its effects and how your cognitions affect your responses to stress
Skill acquisition and consolidation
Stress inoculation training
- learn variety of coping skills which may include Self-Restruction, relaxation and problem solving
Application and follow through
- practice using newly acquired coping skills first in imagined and role-play situations and then in real life situations
Application and follow through
- practice using newly acquired coping skills first in imagined and role-play situations and then in real life situations
Act
- psychological pain is universal and normal
- psychological problems are due to psychological inflexibility which interviews with your ability to be fully present in the current moment and adapt behavior to the present context and own values
- goal is to increase psychological flexibility by addressing six core processes that Foster acceptance, mindfulness, commitment, and behavioral change
Act
- psychological pain is universal and normal
- psychological problems are due to psychological inflexibility which interviews with your ability to be fully present in the current moment and adapt behavior to the present context and own values
- goal is to increase psychological flexibility by addressing six core processes that Foster acceptance, mindfulness, commitment, and behavioral change
Clean pain
Act
- natural levels of physical and psychological discomfort that are inevitable And cannot be controlled
Dirty pain
Act
- act emotional suffering as a result of attempting to control or resist clean pain
Six core processes of act
- experiential acceptance, cognitive diffusion, being present, awareness of self is a context, values-based action, and committed action
Experiential acceptance
Act
- active and aware acceptance of private experiences without unnecessary attempts to alter them
Cognitive defusion
Act
- ability to distance yourself from your thoughts and feelings
view them as experiences rather than reality
Being present
Act
- being in contact with whatever is happening in the present moment
Awareness of self as a context
Act
- ability to view oneself as a context in which one’s thoughts and feelings occur rather than as the thoughts and feelings themselves
Values-Based actions
-act
- depend on the ability to use your values to guide your behavior
Committed action
Act
- commitment to continue to act in ways that align with your values in the future, even when there’s obstacles
Eysneck
– review of 24 empirical studies
- concluded that psychotherapy is ineffective and can have detrimental effects since rates of improvement were lower than spontaneous remission
- 64% of clients that participated in eclectic therapy
44% of patients who participated in psychoanalytic therapy
- showed an improvement in symptoms
Smith, glass, and Miller
- first to use meta-analysis to combine psychotherapy outcome studies
- 475 studies, No treatment control group or alternative non-therapy treatment
effect size of 85
- average therapy client was better off than about 80% of clients who needed but did not receive therapy
Howard, kopta, Krause, and orlinsky
- investigative relationship between duration and outcomes of therapy
Two models: dosage, model and phase model
Dosage model
50% of therapy clients exhibit marked improvement by 6 to 8 sessions
75% by 26 sessions
And 85% by 52 sessions
Phase model
Psychotherapy outcomes can be described in three phases:
remoralization- first few sessions, increase in hopefulness
Remediation- next 16 sessions, reduction in symptoms
Rehabilitation- unlearning long-standing maladaptive behaviors and replacing them with new ways of dealing with various aspects of Life
Emic
- cultural specific , behavior is affected by culture
- general principles don’t necessarily apply to individuals from all cultures
Etic
_ universalistic , behaviors are similar across culture
- general principles apply to individuals from all cultures
Acculturation
- for acculturation strategies, when members of them, minority group are in contact with the majority group
- represent the members acceptance and rejection of their own culture and the dominant culture
- integration, assimilation, separation, and marginalization?
Integration
Retain own minority culture and adopt the majority culture
Assimilation
- reject own culture and adopt the majority culture
Separation
- retain on minority culture and reject majority culture
Marginalization
- reject own minority culture and the majority culture
World view!
- is how we perceive and evaluate situations and determine what is appropriate behavior in those situations
- affected by culture
Can be described in two dimensions: locus of control and locus of responsibility
each dimension can be described as external or internal
Ic/IR
- Believe are in control of own outcomes And are responsible for own successes and failures
- mainstream American culture
IR/EC
- can determine own outcomes of given the chance but other people are keeping them from doing so
EC/ER
- Little or no control over outcomes and are not responsible for them
EC/IR
- Have little control over their outcomes but take responsibility for their own failures
Difference in a therapist and clients worldviews
- can affect the therapeutic relationship
- minorities within ic/er are likely to cause most problems for white therapists with an ic/ir
view therapist and therapy as sources of oppression and be reluctant to disclose personal information in therapy
Microaggression
- brief and commonplace daily verbal, behavioral, or environmental indignities whether intentional or unintentional that communicate hostile, derogatory, or negative racial slightest and insults towards people of color
- micro assault, micro insult, and micro invalidation
Microassault
- explicit racial derogations that are usually intentional and meant to hurt the intended victim
- name calling, and explicit discriminatory acts, most similar to old fashioned racism
Microinsults
- verbal or nonverbal messages that are insensitive to or demean a person’s racial or ethnic identity
Ex. Store manager following black people around the store because doesn’t trust them but never follows white shoppers
Microinvalidations
- communication’s exclude or negate or nullify the psychological thoughts, feelings or experiential reality of people of color
Ex I’m colorblind and treat everyone equally
Racial/cultural identity development model
Atkinson Morton & Sue
- It distinguishes five stages that are determined by minority group members, attitudes towards own group and majority group
Conformity, dissonance, resistance & immersion, introspection and integrative awareness
Conformity
R/CID
- prefer majority group over minority group
- negative attitudes towards your own group and positive attitudes towards majority group
- prefer a therapist from the majority group and view attempts to explore cultural identity as threatening
Dissonance
Stage 2 R/cID
- as a result of exposure to race related information or events, have conflicting attitudes towards majority and own minority groups
- aware of the effects of racism and interested in learning about their own culture
& Prefer a therapist from the majority group but want them to be familiar with their culture and are interesting in exploring their cultural identity
Resistance and immersion
Stage 3 of R/CID
- prefer minority group and reject majority
- positive attitudes towards minorities group and negative of the majority group
- unlikely to seek therapy because suspicious of mental health services but when due will attribute their psychological problems to racism and prefer a therapist from all minority group
Introspection
Stage 4 RC/Id
- question loyalty to own group and are concerned about the biases that affect their judgment of members of the majority group
- comfortable with cultural identity but concerned about autonomy and individuality
Prefer a therapist from own minority group, but willing to consider a therapist from another group who understands their culture and are interested in exploring their new sense of identity
Integrative awareness
Stage 5 of r/ cid
- aware of positive and negative aspects of all cultures
- secure in their cultural identity and committed to eliminating all forms of oppression and becoming more multicultural
Preference of therapist is based on similarity of attitudes and most interested in strategies aimed at community and societal change
Black racial (nigrescience) development model-cross
-orignal model (nigrescience model): 5 phases
Pre-Encounter, encounter, Immersion-Emmersion, internalization, and internalization commitment
Revision: prencounter, encounter, Immersion-Emmersion, And combined internalization and internalization/commitment phase
Changed name to Black racial development model reduced to three stages and added multiple identity Subtypes:
Pre-Encounter: assimilation, miseducation, and self-hatred subtypes
Immersion-Emersion: intense black involvement in anti-white subtypes
Internalization: black nationalist, biculturalist and multiculturalist sometimes
Pre-Encounter
Black racial identity development model
- negative attitudes towards black culture and view it as an obstacle and source of stigma
- prefer a white culture
Encounter
Black racial identity development model
Stage 2
- encounter racism
- have a increased awareness of race and racism
- question views of white and black cultures
- interested in learning about and becoming connected with own culture
Immersion-Emersion
Black racial identity development model stage 3
- reject white culture and are immersed in own culture
Internalization
Black racial identity development model stage 4
- defensiveness emotional intensity related to race decrease
- positive black identity and tolerate and respect racial and cultural differences
Internalization commitment
Black racial identity development model stage 5
- internalize the black identity and are committed to social activism to reduce all forms of oppression
Internalization commitment
Black racial identity development model stage 5
- internalize the black identity and are committed to social activism to reduce all forms of oppression
Helms white racial identity model
- two phases with Three statuses abandonment of racism: contact, disintegration, and reintegration and defining a non-racist white identity: pseudo-independence, immersion-emmersion, and autonomy-
Contact
- white racial identity model stage 1
- limited contact with people from racial or cultural minority groups
Describe self as colorblind
- lack of awareness of racism in satisfaction with the racial status quo
Disintegration
White racial identity model stage 2
-incteased awareness of race and racism leads to moral conflicts
- aware of contradictions that create race related moral conflicts That caused confusion and anxiety
Ex conflict between the belief that all people are created equal and their willingness to live in an integrated neighborhood
Reintegration
- white racial identity models stage 3
- attempts to resolve conflicts by believing that whites are superior to minorities and blaming minority group members for their own problems
Pseudo-Independence
White racial identity model stage 4
- transition when faced with an event that makes them question their beliefs about whites and minority groups
- superficial tolerance of minority group members may be accompanied with paternalistic attitudes and behaviors that perpetuate racism
Immersion -Emersion
- White racial identity model stage 4
- search for personal meaning of racism and understand what it means to be white and benefit from White privilege
aware of racial biases and interest in combating racism
Autonomy
White Racial identity model stage 5
- develop a non-racist white identity, value and diversity And can explore issues related to race and racism without defensiveness
