Clinical

Question 1

Berry’s bidirectional acculturation model (1993)

Answer 1

Berry (1993) distinguishes between two independent dimensions in his discussion of acculturation: involvement in one’s minority culture and involvement in the majority culture. Integration, assimilation, separation, or marginalization (not in either); According to Berry, a person’s level of acculturation can be described in terms of four categories that reflect the person’s adoption of their own culture and the culture of the dominant group – i.e., integration, assimilation, separation, or marginalization.

Question 2

Adler’s individual psychology theory

Answer 2

Adler believed that all behaviors are goal-directed and purposeful. He further asserted that while misbehavior was intended to meet one of four goals, each goal ultimately was rooted in a desire to belong; Adler’s personality theory and approach to therapy stress the unity of the individual and the belief that behavior is purposeful and goal-directed. Key concepts are inferiority feelings, striving for superiority, and style of life (which unifies the various aspects of an individual’s personality). Maladaptive behavior represents a mistaken style of life that reflects inadequate social interest. Adler’s teleological approach regards behavior as being largely motivated by a person’s future goals rather than determined by past events.

Question 3

The primary goal of Gestalt therapy

Answer 3

is to increase awareness and integration of all aspects of the self. This includes integrating one’s feelings, thoughts, and actions.

Question 4

Helms’s White Racial Identity Development Model

Answer 4

distinguishes between six identity statuses (stages): contact, disintegration, reintegration, pseudo-independence, immersion-emersion, and autonomy. A White therapist is likely to be most effective when working with a client from an ethnic/racial minority group when the therapist is in the final stage of Helm’s identity development—i.e., the autonomy stage. A person in this stage has internalized a positive (non-racist) White identity that includes an appreciation of and respect for racial/cultural similarities and differences.

Question 5

Helm’s White Racial Identity Development Model - Contact

Answer 5

People in this status are oblivious to racism, lack an understanding of racism, have minimal experiences with People of Color, and may profess to be color-blind. Societal influence in perpetuating stereotypes and the superior/inferior dichotomy associated between Blacks and Whites are not noticed, but accepted unconsciously or consciously without critical thought or analysis. Racial and cultural differences are considered unimportant and these individuals seldom perceive themselves as “dominant” group members, or having biases and prejudices.

Question 6

Helm’s White Racial Identity Development Model - Disintegration

Answer 6

In this stage, the person becomes conflicted over racial moral dilemmas that are frequently perceived as polar opposites: believing one is non-racist, yet not wanting one’s son or daughter to marry a minority group member; believing that “all men are created equal,” yet society treating Blacks as second class citizens; and not acknowledging that oppression exists while witnessing it (a la the beating of Rodney King in Los Angeles). The person becomes increasingly conscious of his/her Whiteness and may experience dissonance and conflict between choosing between own-group loyalty and humanism.

Question 7

Helm’s White Racial Identity Development Model - Reintegration

Answer 7

Because of the tremendous influence that societal ideology exerts, initial resolution of dissonance often moves in the direction of the dominant ideology associated with race and one’s own socio-racial group identity. This stage may be characterized as a regression, for the tendency is to idealize one’s socio-racial group and to be intolerant of other minority groups. There is a firmer and more conscious belief in White racial superiority and racial/ethnic minorities are blamed for their own problems.

Question 8

Helm’s White Racial Identity Development Model - Pseudo-independence

Answer 8

A person is likely to move into this phase due to a painful or insightful encounter or event, which jars the person from Reintegration status. The person begins to attempt an understanding of racial, cultural, and sexual orientation differences and may reach out to interact with minority group members. The choice of minority individuals, however, is based on how “similar” they are to him or her, and the primary mechanism used to understand racial issues is intellectual and conceptual. An attempt to understand has not reached the experiential and affective domains. Understanding EuroAmerican White privilege, the sociopolitical aspects of race, and issues of bias, prejudice, and discrimination tend to be more an intellectual exercise.

Question 9

Helm’s White Racial Identity Development Model - Immersion-emersion

Answer 9

If the person is reinforced to continue a personal exploration of him/herself as a racial being, questions become focused on what it means to be White. Helms states that the person searches for an understanding of the personal meaning of racism and the ways by which one benefits from White privilege. There is an increasing willingness to truly confront one’s own biases, to redefine Whiteness, and to become more an activist in directly combating racism and oppression. This stage is marked with increasing experiential and affective understanding that were lacking in the previous status.

Question 10

Helm’s White Racial Identity Development Model - Autonomy

Answer 10

Increasing awareness of one’s own Whiteness, reduced feelings of guilt, acceptance of one’s own role in perpetuating racism, renewed determination to abandon White entitlement leads to an autonomous status. The person is knowledgeable about racial, ethnic and cultural differences, values the diversity, and is no longer fearful, intimidated, or uncomfortable with the experiential reality of race. Development of a non-racist white identity becomes increasingly strong.

Question 11

The primary goal of a newly developed community-based mental health program is to help people recently discharged from a psychiatric hospital adjust to life in the community. This is an example of:

Answer 11

Prevention programs are often described as primary, secondary, or tertiary, depending on their goals. You are likely to encounter a question or two on prevention on the exam. Tertiary preventions are designed to reduce the prevalence of mental disorders by reducing the duration or preventing the recurrence of mental disturbance.

Question 12

Margaret Mahler proposed that the development of a sense of self is related to:

Answer 12

projective identification - Mahler’s theory of early development focuses on the processes that contribute to the development of a sense of identity. Separation-individuation is triggered by the child’s ability to separate from their primary caregiver. It begins at about 4 to 5 months of age when a child who is being held by their caregiver is able to lean away to scan the environment.

Question 13

Smith, Glass, and Miller’s meta-analysis of the psychotherapy outcome research (1980) found that people receiving therapy are “better off” than about _____% of people who need treatment but do not receive it.

Answer 13

80%; Smith, Glass, and Miller report an average effect size of .85 for 475 controlled studies of psychotherapy (1980). This means that the mean outcome score of people who receive treatment is higher than the mean outcome score of about 80% of people who need treatment but do not receive it. For the exam, you want to be familiar with the results of the Smith et al. meta-analysis as well as understand what meta-analysis is used for and be able to interpret an effect size. These are described in the Clinical Psychology chapter of the written study materials.

Question 14

Howard et al.’s (1996) phase model

Answer 14

predicts that the effects of therapy vary depending on the number of sessions. The characteristics of the three phases of the model include remoralization, remediation, and rehabilitation. Remoralization occurs during the first few therapy sessions and is characterized by a decline in feelings of hopelessness

Question 15

Gerald Caplan (1970) distinguishes between four types of mental health consultation:

Answer 15

client-centered case consultation, consultee-centered case consultation, program-centered administrative consultation, and consultee-centered administrative consultation.

Question 16

Client-centered case consultation

Answer 16

Client-centered case consultation focuses on a particular client. In this type of consultation, the consultant collects information about the client and makes recommendations to the consultee about the best course of action.

Question 17

In comparing Asian and Asian-American therapy clients to European American clients, researchers frequently point

Answer 17

Researchers have suggested that people from Asian cultures ordinarily view the mind and body as inseparable and, as a result, often express mental health problems as somatic complaints such as headaches, fatigue, or sleep problems.

Question 18

feminist therapy view on self disclosure

Answer 18

A key characteristic of feminist therapy is its emphasis on an egalitarian relationship, and sharing one’s life experiences with a client is viewed as one way of promoting balance.

Question 19

Cross’s Black Racial Identity Development Model distinguishes between four stages:

Answer 19

pre-encounter, encounter, immersion-emersion, and internalization. Cross’s model is based on the premise that African American identity development is directly linked to racial oppression. During the initial pre-encounter stage, race has low salience.

Question 20

reality therapy theory

Answer 20

Glasser, the founder of reality therapy, viewed identity as a basic psychological need and distinguished between success and failure identities. A person develops a success identity when the person fulfills their needs in a responsible way.

Question 21

Prochaska and DiClemente’s stages of change (transtheoretical) model (1982)

Answer 21

The six stages of Prochaska and DiClemente’s transtheoretical stages of change model include precontemplation, contemplation, preparation, action, maintenance, and termination.

Question 22

The five stages of the Racial/Cultural Identity Development Model

Answer 22

The five stages of the Atkinson, Morten, and Sue’s (1993) Racial/Cultural Identity Development Model include conformity, dissonance, resistance and immersion, introspection, and integrative awareness. During the introspection stage, the individual begins to question the unequivocal position that they adopted during the previous resistance-immersion stage with regard to their own culture and the dominant culture.

Question 23

A family therapist using the structural approach of Salvador Minuchin would most likely:

Answer 23

As its name implies, structural family therapy focuses on altering the family’s structure in order to change the behavior patterns of family members. Even if you are unfamiliar with Minuchin, you may have been able to guess that structural therapy would be concerned with boundaries. Structural family therapists view family dysfunction as being related to boundaries that are too diffuse (enmeshed) or too rigid (disengaged).

Question 24

According to research when working with a Black family, it is important to keep in mind that:

Answer 24

Historically, researchers (Billingsley, 1969; Boyd-Franklin, 1989; Paniagua, 1994; Sue & Sue, 2003) have found that Black families are generally less likely to follow traditional White family sex-role stereotypes in comparison to Whites.

Question 25

Alloplastic vs autoplastic interventions

Answer 25

In the context of psychotherapy, alloplastic and autoplastic refer to the focus of an intervention with regard to the environment. The goal of an alloplastic intervention is to make changes in the environment, so it better accommodates the individual, while the goal of an autoplastic intervention is to change the individual so that they are better able to function effectively in their environment.

Question 26

Acupuncture

Answer 26

Acupuncture is a traditional Asian method for restoring health and involves stimulating specific anatomical points on the body, usually with a thin metallic needle. The traditional explanation for its effects is that illness is due to a blockage of qi (vital life energy) and that acupuncture unblocks the flow of qi along the pathways through which it circulates in the body. Research suggests that its benefits may be due to the release of pain-suppressing substances or to an alteration in blood flow in areas around the needle or in certain regions of the brain.

Question 27

Black racial (Nigrescence) identity development model

Answer 27

Cross’s Black Racial Identity Development Model consists of four stages: During the pre-encounter stage, race and racial identity have low salience. In the encounter stage, the person has greater racial/cultural awareness and is interested in developing a Black identity. In the immersion/emersion stage, race and racial identity have high salience and the person moves from intense Black involvement (immersion) to strong anti-White attitudes (emersion). Finally, during the internalization stage, race continues to have high salience and the person adopts an Afrocentric, biculturist, or multiculturist orientation.

Question 28

COMMUNICATION/INTERACTION FAMILY THERAPY (SYMMETRICAL VS. COMPLEMENTARY COMMUNICATION):

Answer 28

The communication/interaction approach is associated with Jackson, Satir, Haley, and others and focuses on the impact of communication on family and individual functioning. It distinguishes between two communication patterns: Symmetrical communication occurs between equals but may escalate into a competitive one-upsmanship game, and complementary communication occurs between individuals who are unequal and emphasizes their differences.

Question 29

Cultural competence

Answer 29

Sue and Sue (2003) describe cultural competence as involving three competencies: the therapist’s awareness of their cultural assumptions, values, and beliefs; knowledge about the worldviews of culturally diverse clients; and skills that enable them to provide interventions that are appropriate and effective for culturally different clients.

Question 30

Cultural encapsulation (Wrenn)

Answer 30

Culturally encapsulated counselors interpret everyone’s reality through their own cultural assumptions and stereotypes and disregard cultural differences and their own cultural biases.

Question 31

Cultural vs functional paranoia (Ridley)

Answer 31

Ridley described nondisclosure by African American therapy clients as being due to two types of paranoia: A client is exhibiting cultural paranoia (which is a healthy reaction to racism) when they do not disclose to a white therapist due to a fear of being hurt or misunderstood. A client is exhibiting functional paranoia (which is due to pathology) when they are unwilling to disclose to any therapist, regardless of race or ethnicity, as a result of mistrust and suspicion.

Question 32

Cybernetics (feedback loops)

Answer 32

Cybernetics is concerned with communication processes and distinguishes between negative and positive feedback loops. A negative feedback loop reduces deviation and helps a system maintain the status quo, while a positive feedback loop amplifies deviation or change and thereby disrupts the system.

Question 33

Diagnostic overshadowing

Answer 33

Diagnostic overshadowing was originally used to describe the tendency of health professionals to attribute all of a person’s psychiatric symptoms to their intellectual disabilities. Subsequent research found that diagnostic overshadowing also applies to other conditions and diagnoses.

Question 34

Double-bind Communication

Answer 34

As originally defined by Bateson, Jackson, Haley, and Weakland (1956), double-bind communication is an etiological factor for schizophrenia and involves conflicting negative injunctions – e.g., “do that and you’ll be punished” and “don’t do that and you’ll be punished” – with one injunction often being expressed verbally and the other nonverbally. In addition, the recipient of the contradictory injunctions is not allowed to comment on them or seek help from someone else.

Question 35

Efficacy vs effectiveness research

Answer 35

An ongoing debate on psychotherapy outcome research is over the best way to evaluate the effects of psychotherapy. On one side of the argument are experts who support efficacy studies (clinical trials); on the other are those who prefer effectiveness studies, which are correlational or quasi-experimental in nature.

Question 36

Emic vs Etic Orientation

Answer 36

Emit and etic refer to different orientations to understanding and describing cultures. An emic orientation is culture-specific and involves understanding the culture from the perspective of members of that culture. An etic orientation is culture-general and assumes that universal principles can be applied to all cultures.

Question 37

EXTENDED FAMILY SYSTEMS THERAPY (DIFFERENTIATION, EMOTIONAL TRIANGLE, GENOGRAM)

Answer 37

Bowen’s approach to family therapy extends general systems theory beyond the nuclear family. Key terms include differentiation of self and emotional triangles: Differentiation refers to a person’s ability to separate their intellectual and emotional functioning, which helps keep the person from becoming “fused” with the emotions that dominate the family. An emotional triangle develops when a two-person system attempts to reduce instability or stress by recruiting a third person into the system. Therapy often begins with the construction of a genogram, which depicts the relationships between family members, the dates of significant life events, and other important information. The therapist often sees two members of the family (spouses) and forms a therapeutic triangle in which the therapist comes into emotional contact with the family members but avoids becoming emotionally triangled. The goal is to increase the differentiation of all family members.

Question 38

EXISTENTIAL THERAPY:

Answer 38

The existential therapies are derived from existential philosophy and share an emphasis on personal choice and responsibility for developing a meaningful life. They describe maladaptive behavior as the result of an inability to cope authentically with the ultimate concerns of existence – i.e., death, freedom, existential isolation, and meaninglessness.

Question 39

Eysenck

Answer 39

Eysenck was a British psychologist known for his factor analysis of personality traits, contributions to behavior therapy, and 1952 review of psychotherapy outcome studies in which he found that 72% of untreated neurotic individuals improved without therapy, while 66% of patients receiving eclectic psychotherapy and 44% receiving psychoanalytic psychotherapy showed a substantial decrease in symptoms. Based on these findings, Eysenck concluded that any apparent benefit of therapy is due to spontaneous remission.

Question 40

FEMINIST THERAPY (NONSEXIST THERAPY, SELF-IN-RELATION THEORY):

Answer 40

Feminist therapy is based on the premise that “the personal is political.” It focuses on empowerment and social change and acknowledges and minimizes the power differential inherent in the client-therapist relationship. Self-in-relation theory applies feminism to object relations theory and proposes that many gender differences can be traced to differences in the early mother-daughter and mother-son relationship. Feminist therapy must be distinguished from nonsexist therapy, which focuses more on the personal causes of behavior and personal change.

Question 41

FREUDIAN PSYCHOANALYSIS (DEFENSE MECHANISMS, ANALYSIS):

Answer 41

According to Freud, when the ego is unable to ward off danger (anxiety) through rational, realistic means, it may resort to one of its defense mechanisms (e.g., repression, reaction formation) which share two characteristics: They operate on an unconscious level and they serve to deny or distort reality. In psychoanalysis, the analysis of free associations, dreams, resistances, and transferences consists of a combination of confrontation, clarification, interpretation, and working through.

Question 42

GENERAL SYSTEMS THEORY

Answer 42

General systems theory defines a system as an entity that is maintained by the mutual interactions of its components and assumes that the actions of interacting components are best understood by studying them in their context. Consistent with general systems theory, family therapists view the family as primarily an open system that continuously receives input from and discharges output to the environment and is adaptable to change. The influence of general systems theory on family therapy is evident in the concept of homeostasis, which is the tendency for a family to act in ways that maintain the family’s equilibrium or status quo.

Question 43

GESTALT THERAPY (BOUNDARY DISTURBANCE, TRANSFERENCE, AWARENESS):

Answer 43

Gestalt therapy views “awareness” (a full understanding of one’s thoughts, feelings, and actions in the here-and-now) as the primary curative factor and defines neurosis as a “growth disorder” that is often attributable to a boundary disturbance (e.g., introjection) that leads to an abandonment of the self for the self-image. Gestaltians regard a client’s transference to be counterproductive and respond to it by helping the client recognize the difference between their “transference fantasy” and reality.

Question 44

GROUP THERAPY (FORMATIVE STAGES, COHESIVENESS, PREMATURE TERMINATION):

Answer 44

According to Yalom, therapy groups typically pass through three formative stages — (1) orientation, participation, search for meaning, and dependency; (2) conflict, dominance, and rebellion; and (3) development of cohesiveness. Yalom describes cohesiveness as the most important curative factor provided by group therapy and the group therapy analog for the therapist-client relationship in individual therapy. He proposes that prescreening of potential group members and post-selection preparation can reduce premature termination from group therapy and enhance therapy outcomes.

Question 45

Health belief model

Answer 45

The health belief model proposes that health behaviors are influenced by (1) the person’s readiness to take a particular action, which is related to their perceived susceptibility to the illness and perceived severity of its consequences; (2) the person’s evaluation of the benefits and costs of making a particular response; and (3) the internal and external “cues to action” that trigger the response.

Question 46

healthcare systems

Answer 46

Healthcare systems are the collaborative effort between institutions and professionals to provide services to the public.

Question 47

health promotion

Answer 47

Health promotion involves several different methods of encouraging healthy behaviors, such as advertising and increased education.

Question 48

high vs low-context communication

Answer 48

Members of many culturally diverse groups in America exhibit high-context communication, which relies on shared cultural understanding and nonverbal cues. It helps unify a culture and is slow to change. In contrast, White people are more likely to exhibit low-context communication, which relies primarily on the verbal message, is less unifying than high-context communication, and can change rapidly and easily. Differences in communication style can lead to misunderstandings in cross-cultural therapy.

Question 49

AFFECTIONAL ORIENTATION IDENTITY DEVELOPMENT MODEL (updated from HOMOSEXUAL IDENTITY DEVELOPMENT MODEL):

Answer 49

Troiden’s (1988) model of affectional orientation development distinguishes between four stages – sensitization/feeling different, self-recognition/identity confusion, identity assumption, and commitment/identity commitment.

Question 50

HOWARD AND COLLEAGUES (DOSE DEPENDENT EFFECT; PHASE MODEL):

Answer 50

Howard et al. (1996) identified a dose dependent effect of psychotherapy – i.e., about 75% of patients show measurable improvement at 26 sessions and that this number increases to only about 85% at 52 sessions. They also identified a phase model, which predicts that the effects of psychotherapy are related to the number of sessions and distinguishes between three phases: remoralization, remediation, and rehabilitation.

Question 51

HYPNOSIS (REPRESSED MEMORIES):

Answer 51

Orne and Dinges propose that hypnosis involves experiencing alterations of memory, perception, and mood in response to suggestions and characterize its essential feature as a “subjective experiential change” (1989, p. 1503). Although hypnosis has been used to help people recover repressed memories, the research suggests that it does not seem to enhance the accuracy of memories, may produce more pseudomemories (inaccurate or confabulated memories) than accurate memories, and may exaggerate a person’s confidence in the validity of uncertain memories, especially for those that are inaccurate.

Question 52

INTERPERSONAL THERAPY (PRIMARY PROBLEM AREAS):

Answer 52

Interpersonal therapy (IPT) is a brief manual-based therapy that was originally developed as a treatment for depression, but it has since been applied to a number of other conditions. IPT focuses on symptom reduction and resolving one or more primary areas of interpersonal functioning – unresolved grief, interpersonal role disputes, role transitions, and interpersonal deficits.

Question 53

JUNG’S ANALYTICAL PSYCHOTHERAPY (COLLECTIVE UNCONSCIOUS, ARCHETYPES, INDIVIDUATION):

Answer 53

Analytical psychotherapy views behavior as being determined by both conscious and unconscious factors, including the collective unconscious which is the repository of latent memory traces that have been passed down from one generation to the next. Included in the collective unconscious are archetypes (primordial images) that cause people to experience certain phenomena in universal ways. Therapeutic strategies include the interpretation of dreams and transferences (which reflects projections of both the personal and collective unconscious). A key concept in Jung’s personality theory is individuation, which refers to an integration of the conscious and unconscious aspects of the psyche that occurs in the later years and leads to a unique identity and the development of wisdom.

Question 54

MENTAL HEALTH CONSULTATION (CAPLAN):

Answer 54

Caplan distinguished between four types of mental health consultation: (1) Client-centered case consultation focuses on helping the consultee work more effectively with a particular client. (2) Consultee-centered case consultation focuses on enhancing the consultee’s ability to deliver services to a particular group or population of clients. (3) Program-centered administrative consultation involves working with one or more administrators (consultees) to resolve problems related to a particular program. (4) Consultee-centered administrative consultation involves enhancing the ability of administrators to develop, implement, and evaluate programs.

Question 55

Motivational Interviewing (OARS)

Answer 55

Motivational interviewing was developed specifically for clients who are ambivalent about changing their behavior and combines the transtheoretical (stages of change) model with client-centered therapy and the concept of self-efficacy. The specific techniques of motivational interviewing are open-ended questions, affirmations, reflective listening, and summaries (OARS).

Question 56

MULTISYSTEMS MODEL (BOYD-FRANKLIN):

Answer 56

Boyd-Franklin’s multisystems model is an ecostructural approach for African American families that addresses multiple systems, intervenes at multiple levels, and empowers the family by utilizing its strengths. Systems that may be incorporated into treatment include the extended family and nonblood kin, the church and other community resources, and social service agencies.

Question 57

Network therapy

Answer 57

Network therapy has been identified as an effective intervention for Native American clients and is often used as a treatment for alcohol and drug abuse. It is a multimodal treatment that incorporates family and community members into the treatment process and situates an individual’s problems within the context of their family, workplace, community, and other social systems.

Question 58

OBJECT-RELATIONS FAMILY THERAPY (PROJECTIVE IDENTIFICATION, MULTIPLE TRANSFERENCES):

Answer 58

For object relations family therapists, maladaptive behavior is the result of both intrapsychic and interpersonal factors. A primary source of dysfunction is projective identification, which occurs when a family member projects old introjects onto another family member and then reacts to that person as though they actually have the projected characteristics or provokes the person to act in ways consistent with those characteristics. The primary goal of therapy is to resolve each family member’s attachment to family introjects and involves addressing multiple transferences (i.e., transferences of one family member to another, transferences of each member to the therapist, and transferences of the family as a whole to the therapist).

Question 59

Parallel Process

Answer 59

Parallel process occurs in clinical supervision when the therapist (supervisee) behaves toward their supervisor in ways that mirror how the client is behaving toward the therapist.

Question 60

PERSON-CENTERED THERAPY (FACILITATIVE CONDITIONS):

Answer 60

Rogers’ person-centered therapy is based on the assumptions that people possess an inherent ability for growth and self-actualization and that maladaptive behavior occurs when “incongruence between self and experience” disrupts this natural tendency. The therapist’s role is to provide the client with three facilitative conditions (empathy, genuineness, and unconditional positive regard) that enable the client to return to their natural tendency for self-actualization.

Question 61

PERSONAL CONSTRUCT THERAPY:

Answer 61

George Kelly’s personal construct therapy focuses on how the client experiences the world. It assumes that a person’s psychological processes are determined by the way they “construe” (perceives, interprets, and predicts) events, with construing involving the use of personal constructs, which are bipolar dimensions of meaning (e.g., happy/sad, competent/incompetent) that begin to develop in infancy and may operate on an unconscious or conscious level. The goal of therapy is to help the client identify and revise or replace maladaptive personal constructs so that the client is better able to “make sense” of their experiences.

Question 62

PREVENTION (PRIMARY, SECONDARY, TERTIARY):

Answer 62

Methods of prevention are classified as primary, secondary, or tertiary: Primary preventions make an intervention available to all members of a target group or population in order to keep them from developing a disorder. Secondary preventions identify at-risk individuals who are showing early signs of a disorder and offer them appropriate interventions. Tertiary preventions are designed to reduce the duration and consequences of an illness that has already occurred.

Question 63

PSYCHIATRIC INPATIENTS (DEMOGRAPHIC CHARACTERISTICS):

Answer 63

Research on the utilization rates of mental health services has provided the following information about the demographic characteristics of psychiatric inpatients: (1) For both men and women, admission rates into psychiatric hospitals are lowest among the widowed, intermediate for those who are married or divorced/separated, and highest for the never married. (2) Although Whites represent the largest number of psychiatric inpatients, when population proportions are taken into account, patients from other races are overrepresented. (3) For both men and women, the largest proportion of admissions is in the 25 to 44 age range.

Question 64

RACIAL/CULTURAL IDENTITY DEVELOPMENT MODEL:

Answer 64

The Racial/Cultural Identity Development Model (Atkinson, Morten, & Sue, 1998) distinguishes between five stages that people experience as they attempt to understand themselves in terms of their own culture (from a community of color), the dominant culture, and the oppressive relationship between the two cultures. The five stages are: conformity (positive attitudes for the dominant group), dissonance (confusion and conflict over contradictory attitudes), resistance and immersion (active rejection of the dominant group), introspection (uncertainty about the rigidity of Stage 3 beliefs), and integrative awareness (adoption of a multicultural perspective).

Question 65

Reality Therapy

Answer 65

Glasser’s reality therapy is based on choice theory, which assumes that people are responsible for the choices they make and focuses on how people make choices that affect the course of their lives. It proposes that people have five basic innate needs (survival, love and belonging, power, freedom, and fun) that that a person adopts a success (versus failure) identity when they fulfill these needs in a responsible way.

Question 66

Resilience

Answer 66

Resilience is the psychological capacity to cope with socio-environmental challenges.

Question 67

Separation-Individuation (Mahler)

Answer 67

Mahler’s version of object relations theory focuses on the processes by which an infant assumes their own physical and psychological identity, and her model of early development involves several phases. The development of object relations occurs during the separation-individuation phase, which begins at four to five months of age. According to Mahler, adult psychopathology can be traced to problems that occurred during separation-individuation.

Question 68

Sexual Orientation and Gender Diversity (Internalized homophobia coming out)

Answer 68

Issues faced by lesbian, gay, bisexual, transgender, questioning, intersex, and agender or asexual individuals include internalized homophobia and coming out. Internalized homophobia occurs when LGBTQIA+ individuals accept negative stereotypes about sexual orientation and gender diversity and incorporate them into their self-concept. Consequences include low self-esteem, self-doubt, and self-destructive behavior. Coming out (disclosing one’s sexual orientation) to family members, friends, and others is associated with rejection and other negative consequences as well as with higher levels of self-esteem and positive affectivity, lower levels of anxiety, and other positive consequences. Research suggests that the age of coming out is about the same for gay males and lesbians.

Question 69

SEXUAL STIGMA, HETEROSEXISM, AND SEXUAL PREJUDICE (HEREK):

Answer 69

Herek (2004) argues that the term homophobia is ambiguous and imprecise and proposes that it be replaced with sexual stigma, heterosexism, and sexual prejudice. Sexual stigma refers to “the shared knowledge of society’s negative regard for any non-heterosexual behavior, identity, relationship, or community” (p. 15). Heterosexism refers to cultural ideologies, which are “systems that provide the rationale and operating instructions” (p. 15) that promote and perpetrate antipathy, hostility, and violence against LGBTQIA+ individuals. Sexual prejudice refers to negative attitudes that are based on sexual orientation, whether the target is gay, lesbian, bisexual, or heterosexual. Herek found higher levels of sexual prejudice among heterosexual men (versus heterosexual women) and among individuals who are older, have lower levels of education, live in Southern or Midwestern states or in rural areas, or have limited personal contact with LBGTQI+ people.

Question 70

SMITH, GLASS, AND MILLER (META-ANALYSIS/EFFECT SIZE):

Answer 70

Smith et al. used meta-analysis to combine the results of the psychotherapy outcome studies and found, contrary to Eysenck, that psychotherapy does have substantial benefits. In one study, they obtained an average effect size of .85, which indicates that the typical therapy client is better off than 80% of individuals who need therapy but are untreated.

Question 71

SOLUTION-FOCUSED THERAPY (QUESTIONS):

Answer 71

Solution-focused therapists focus on solutions to problems rather than on the problems themselves. In therapy, the client is viewed as the “expert” while the therapist acts as a consultant/collaborator who poses questions designed to assist the client in recognizing and using their strengths and resources to achieve specific goals (e.g., the miracle question, exception questions, scaling questions).

Question 72

STRATEGIC FAMILY THERAPY (PARADOXICAL INTERVENTIONS):

Answer 72

Haley’s strategic family therapy focuses on transactional patterns and views symptoms as interpersonal events that serve to control relationships. Therapy focuses on symptom relief (rather than insight); and involves the use of specific strategies, especially paradoxical interventions (e.g., ordeals, prescribing the symptom, reframing) that are designed to alter the behavior of family members by helping them see a symptom in an alternative way or recognize they have control over their behaviors or by using their resistance in a constructive way.

Question 73

STRUCTURAL FAMILY THERAPY (BOUNDARIES, RIGID TRIADS, JOINING):

Answer 73

Minuchin’s structural family therapy emphasizes altering the family’s structure in order to change the behavior patterns of family members. Boundaries (rules that determine the amount of contact that is allowed between family members) are one element of the family structure: When boundaries are overly rigid, family members are disengaged and when they are too diffuse or permeable, family members are enmeshed. Minuchin distinguished between three chronic boundary problems, or rigid triads: detouring, stable coalition, and triangulation.

Question 74

Therapist-client matching

Answer 74

Research on therapist-client matching in terms of race, ethnicity, or culture has produced inconsistent results. However, matching may reduce premature termination for members of some groups (e.g., Asian and Latinx). Some research suggests that other factors (e.g., similarity in values and worldview) are more important than similarity in terms of race, ethnicity, or culture.

Question 75

TRANSTHEORETICAL MODEL (STAGES OF CHANGE):

Answer 75

Prochaska and DiClemente’s (1992) transtheoretical model of behavior change proposes that the change process involves six stages (precontemplation, contemplation, preparation, action, maintenance, termination) and that interventions are most effective when they match the person’s stage of change – e.g., consciousness raising, dramatic relief, and environmental reevaluation are useful for helping clients transition from the precontemplation to the contemplation stage

Question 76

Treatment Manuals

Answer 76

Treatment manuals were originally developed to standardize psychotherapeutic treatments so their effects could be empirically evaluated and to provide guidelines for training therapists. They specify the theoretical underpinnings of the treatment along with treatment goals and specific therapeutic guidelines and strategies. A potential limitation of treatment manuals is that they may oversimplify the therapeutic process.

Question 77

Triangular Model

Answer 77

A form of supervision that emphasizes providing service to clients that includes organizational policies, professional knowledge, and the supervisory relationship.

Question 78

WHITE RACIAL IDENTITY DEVELOPMENT MODEL:

Answer 78

According to Helms (1990), White racial identity development involves two phases: abandoning racism (statuses 1-3) and developing a nonracist white identity (statuses 4-6). Her White Racial Identity Development Model involves six statuses (stages): contact (little awareness of racism), disintegration (increasing awareness of race and racism which leads to confusion and conflict), reintegration (idealization of White society and denigration of people of color) pseudo-independence (questioning of racist views), immersion-emersion (confrontation of own biases), and autonomy (internalization of a nonracist White identity).

Question 79

Worldview (SUE)

Answer 79

As defined by Sue (1978), a person’s worldview is affected by their cultural background and is determined by two factors – locus of control and locus of responsibility. Differences in worldview can affect the therapeutic process. For example, White middle-class therapists typically have an internal locus of control and internal locus of responsibility (IC-IR) and are likely to have problems working with a Black client with an internal locus of control and external locus of responsibility (IC-ER) who may challenge the therapist’s authority and trustworthiness and be reluctant to self-disclose.

Question 80

According to Herek (2004), which of the following individuals is most likely to discriminate against someone who identifies as gay?

Answer 80

Herek (2004) indicated that individuals who identify as heterosexual and have high levels of sexual prejudice are more likely than those with low levels of sexual prejudice to "respond negatively to gay individuals, support anti-gay political candidates and policies, and discriminate against gay people"; so hetero and sexual prejudice