Clinical Flashcards
1
Q
Freud Personality Therapy
A
Id-Birth Life(sexual) death(aggression) Ego-6 months Reality principle Superego-4/5 years internalize society values
2
Q
Freud Maladaptive Behavior
A
Repression -base keeps thoughts and urges away Reaction Formation- an expression of opposite (defense) Projection- put impulse onto someone else Sublimination- channel unacceptable impulse to social behavior
3
Q
Freud Therapy Technique
A
Psychoanalysis 1) Confrontation-make unconscience to conscience 2) Clarification-bring main things into focus separate 3)Catharsis- repressed sometimes, work through, interpret, insight
4
Q
Other thoughts about Personality ID, EGO, SUPER
A
Id-pleasure vs immediate gratification Ego-seeks partially (deter) gratify id Superego-conscience -block rather than satisfy id
5
Q
Jung
A
Young-disney movies (warrior, fighter) Analytic Psychology -INDIVIDUATION-Archotypes-Generational
6
Q
Jung Personality
A
- Psyche Personal Unconscience- forgotten, repressed memory
- Collective Unconscience-shared, passed down, generation to generation
7
Q
Jung-Archetypes
A
- part of collective unconscious
- universal thoughts and images
- expressed in
- myths dreams, symbols and can include
- Self, Persona, Shadow, Anima/Animus
- myths dreams, symbols and can include
8
Q
Jung Techniques
A
- Dream-interpretation Personal and Collective Unconscience **Transference**-
- projection and countertransference
- Individuation-second half of life becomes separate from whole. In-di-viduation…
- main goal bring unconscious to conscious
9
Q
Adler
A
Future goals and current behavior-mistake style of life Act “as if” you are who want to be Inferiority vs Superiority
10
Q
Adler Personality how it is different from Freud and describe approach
A
change Freud sex instinct to social interest Telelogical approach-motivation by future ( in common w/Jung)
11
Q
Adler Therapy
A
STEP Systemtic Training In Effective Parenting-democratic style of parenting
12
Q
Adler Lifestyle
A
Healthy,Mistaken(unhealth)- neurosis, psychosis, addiction, birth order is important
13
Q
Mahler-Object Relations Theory
A
Desire for human relationships journey of separation and individuation (stages)
14
Q
Mahler Stages
A
- ASD-PRO
- autistic birth - 5 weeks unaware of anything
- Symbiotic 4 weeks to 5 months enmeshed w/mother
- Seperation/Individuation 5 months to 3 years old 1st
- Differentiation 5-10 months 2nd
- Practicing 10-16 months 3rd
- Rapprachment 16-24 months 4th
- Object Constancy 24-36
15
Q
Problems in Separation/Individuation stage
A
Narcissm and other borderline problems
16
Q
Humanistic-Existential Similarities
A
Both focus on here and now Also prioritizes clients experience over object reality Concentrate on clients internal qualities
17
Q
Humanistic-Existential Differences
A
- Humanistic-acceptance, growth and self-actualization
- Existential-freedom and responsibility
18
Q
Rogers- Client Person Centered Therapy
A
- Congruence-in-congruence Help become fully functional self
- phenomenal self Build that client up make them feel better about themselves (client creates goals and therapist empowers) very widely used puts client over goals
- Facilitative Core Cue-Congruent Unconditional positive Regard Empathy
19
Q
Person Centered Therapy (Rogers)
A
Self-actualization Fully functional CUE
20
Q
Gestalt
- definition
- maladaptive behaviors
A
- Boundary disturbance
- Introjection-ingest information
- Projection-put out, can lead to paranoia
- Retroflection-turn onto self
- Deflection-distance self
- Confluence-avoid conflict
21
Q
Gestalt Therapy
A
- Help decipher transference fantasy verses reality
- transference is consistent with here and now
- ↑awareness of environment
- integrate thoughts, feelings and actions
- empty chair-help client stay present
- dream work-royal road to integration, acting out dream in the present
- “I statements” , help clients see projects of others actions
- say “i am selfish” not “my husband or boss is selfish”
22
Q
Existential Therapy (Yalom)
A
Personal Responsibility and Choice
23
Q
Existential Therapist Psychological Disturbance
A
Ultimate Concerns of existence death, freedom, isolation and meaningless
24
Q
Existential Therapy 2 types of anxiety
A
Normal (existential) anxiety-proportional, objective threat, no repression Neurotic Anxiety disproportional objective threat, involves repression
25
Glasser Reality Therapy
Responsibility Success/Failure Realistic Goal Setting Juvenile Deliquents and Adolesence
26
Reality Therapy Technique
* Ask about Wants and needs
* Determine what client is Doing to get them met
* Encourage client to Evaluate his behavior to obtain goals
27
Reality Therapy Basic Needs (6)
Love, Power, Fun, Survival, Freedom, Belong
28
Positive Psychology Seligman
* Valued Experiences
* Past-well being, commitment and satisfaction
* Present-flow and happiness
* Future-hope and optimism
29
Postive Psychology PERMA Model
Positive/Emotions Engagement Relationships Meaning Accomplishment/Achievement
30
Interpersonal therapy IPT- Sullivan
Medical model Decrease symptoms, Increase interpersonal functioning Timed 12-16 weeks Here and now therapy
31
IPT Model Therapy
Initial Stage-diagnosis "sick role" Middle Phase-assess problem identified, decision analysis Final Stage-termination relapse prevention
32
Solution Focused Therapy -Shazer
* Solution to problems
* Client Focused
* Miracle Question-future
* Exception Question-past
* Sealing Question-current toward goals
33
Transtheoretical Model Prochask and DiClimente
Good for addition and smokers Politically correct people are troublemakers PC-PAM-T Precontemplation, -no intention to change w/n 6 month Contemplation-plan to change in 6 months Preparation-prepare to change w/n next month Action-take action for change Maintenance-maintained behavior 6 months Termination-risk for relapse is low
34
Transtheoretical Model Motivation affects
* Decisional Balance-pros and cons of changing
* Self-efficacy-confidence ability to change or relapse
* Temptation-urge to engage in negative behavior (strongest in the beginning of change)
35
Motivational Interviewing Miller and Rollnick
* Combines Rogers Person Centered and Prochaska Transtheorectical and Bandura Self Efficacy and Fistengers Cognitive Dissonance
* Most useful with people in precontemplation or contemplation stage
* IT INVOLVES QUESTIONS, REFLECTIONS AFFIRMATIONS FOR "CHANGE TALK to move towards positive behavior
36
Becks Cognitive Behavioral Therapy (CBT)
* Socratic questions/dialogue
* Correct faulty information & modify assumptions
* Collaborative imperialism alliance between therapist and client to work together against any negative behavior or thoughts
* Socratic questions- asking questions to clarify clients problems and identify maladaptive thoughts
37
Beck cognitive schemes
flexible schemas---core beliefs different disorders have different maladaptive sheas AKA cognitive profiles
38
Beck cognitive profile depression
oneself the world the future
39
Becks automatic thoughts
automatic thoughts - or + triggered by circumstance Dysfuntional Thought Record (DTR)
40
Beck's cognitive distortions
* errors in reasoning when thinking of stressful situation
* Arbitrary interference- (-) conclusion no evidence
* Selective abstraction-drama w/minor details ignore rest
* Dichotomous thinking- 2 extremes i.e. success/failure
* Personalization-think actions due to externally w/o evidence
* Emotional Reasoning-draw conclusions about self, others and situations
41
Ellis Rational Emotive Behavior (REBT)
* irrational beliefs-emotions directive and confrontational
* self indoctorine -internalized-comes from childhood
* ABCDE
* A activating
* B belief (intention of behavior)
* C consequence (emotion of behavior)
* D dispute (techniques to dispute belief)
* E effect (effect of technique)
42
Ellis Techniques
relaxation, training, learing new skills, systematic desensitization
43
Self-Instructional training (Meichenbaum)
Modeling and preventitive w/RET Valid for ADHD and people with task issues 5 steps 1) therapist models overt external 2) client performs/therapist describes overt self guide 3) client performs and describes faded overt 4) client performs and lipsynchs covert self instruction 5) client performs and thinks about steps
44
Stress Inoculation Training
Valid for PTSD Talk to kids about procedure (CAS) 1) Conceptualize aka cognitive/ed phase (problem solve 2) Skill acquisition/rehearsal aka application training (coping) 3) Application aka follow through (use coping skills)
45
Acceptance and commitment (ACT)
Psychological flexibilty (pain) Clean pain-universal everyone mental/physical Dirty Pain-aka dirty discomfort treats chronic pain, psychosis, depression, anxiety, OCD
46
ACT- Psychological flexibility
acceptance, mindfulness, commitment, behavior change, and counter psychological inflexibility
47
Mindfulness-Based Intervention Mindfulness Based Cognitive Therapy (MBCT) Mindfulness Stress Reduction (MBSR)
awareness w/o judgment Mindfulness-Based Stress Reduction (MBSR)-mindful meditation Mindfulness-based cognitive therapy (MBCT)-combines MBSR and CBT- goal for client to become aware of self and decenter (separate oneself from thoughts and emotions)
48
Cybernetic Theory
Regulates functioning positive and negative feedback loops
49
Negative feedback loops
Resist change, keeps status quo (homeostasis)
50
Positive Feedback loops
Increase change disrupts status quo (homeostasis)
51
Communication theory (family and group)
Contributes to family therapy, repetitive patterns of communication and interactions that cause problem behavior (how we interact with schizophrenics)
52
General Systems Theory (family and group)
inteactions come from rules and have homeostic mechanisms that maintain stability and equailbrium
53
Double-bind communication (family and group)
* Schizophrenia -person gets 2 messages from family that contradicts and cannot comment
* Symmetrical interactions-equality, similar as the other, 1-upmanship
* Complementary interaction-inequality and behavior one person complements the behavior of the other. dominate and subordinate role
54
Socratic Dialogue
* Beck client asks questions to
* define problem
* identify thoughts
* evaluate consequences of bad behavior
55
Collaborative Empieism
Beck therapist and client co investigate accept support reevaluate or reject assumption, intention or belief
56
Symmetrical Interactions (communications theory)
one upmanship equality elicits similar behavior in someone else
57
Complementary interactions (f & g) (communications theory)
dominant and subordinate role inequality (polar opposites attract) behavior of one complements behavior of other (messy and neat person attract)
58
Extended Family Systems (EFS)
Bowen -aka Intergenerational and transgenerational family therapy -goal is differentiation (think of a bow and the D in the bow for differentiation) 2 people try to rope in a 3rd -origination of therapy with schizophrenic families and children -therapist is the coach -family will speak to therapist not each other
59
Extended Family Systems (EFS) -Differentiation -Intrapersonal -Interpersonal
* Differentiation- both intra and interpersonal
* Intra-personal distinguish between own feelings/thoughts
* Inter-personal differentiation decrease can be emotionally fused with other family members
60
EFS Emotional Triangle
dyed 3rd family member (mom-dad, kid or mom-kid, dad)
61
EFS-Family Projection
Process-project emotional immaturity on to family
62
EFS- Multigenerational Transmission Process
extension from one generation to the next
63
EFS therapy
* therapist sees client and family at the same time increase family differentiation
* ask questions to diffuse emotion teach family how to engage and interact support family while being neutral and
* avoid family emotional process \*talk directly to therapist vs each other
64
Structural Family therapy-Minuchin
goal is to unbalance family structure (alter hierarchal relationships) create boundaries/restructure the family
65
Structural Family therapy Subsystems Boundaries
* subsystem
* boundaries
* diffuised
* close relationship
* Subsystem-similar units for specific tasks (nursing mom)
* Boundaries-implicit and explicit rules of contact oververly
* diffiused-enmeshed relationship clear boundaries-
* close relationship overly ridged-disengaged relationship
66
Structural Family Therapy Ridged family Triads
* Stable coalition-one parent/child alliance against other parent
* Unstable coalition-aka-triangulation-each parent demands child side w/them
* Detouring-attack coalition-parent blames child
* Detouring-support-avoid conflict by being overprotective
67
Structural Family therapy Joining aka therapeutic alliance
* joining
* mimesis
* maintenance
* Joining-adopting communication
* Mimesis- adopt style and language
* Maintenance-provide family with support
68
Structural Family Therapy Family Structure
5 definitions of types of structures
* family map- subsystems and boundaries
* reframing-name problem behavior
* unbalancing-hierarchical relationships with family members
* boundary making-change degree of proximity to members
* enactment-roleplay problem behavior for a therapist to see
69
Strategic Family-Haley
* family control &
* power/hierarchies therapist straightforward tells them what to do
70
Strategic Family
Family interactions
List 4 stages
* 1) brief stage-observe family
* 2) problem stage- family tells view
* 3) interaction stage- discuss view of problem (family)
* 4)goal setting stage-together family define develop goal
71
SF Therapy
* straightforward -
* paradoxical techniques-help family see they have control (prescribing, ordeals, restraining)
* prescribing to problem- exaggerated behaviors
* restraining-do does not change too quick (small steps)
* ordeal- unpleasant task family has to do/engaged
72
Milan Systematic Family Therapy main idea
* family games aka dirty games
* alter family rules (MULAN became warrior) short term
73
Milan Systemic Family Therapy difference from others
therapeutic team 5 part therapy-pre session, session, intersession, intervention, and post-session w/ 4-6 week gaps to alter behavior (dirty games)
74
Milan Systemic Family Therapy treatment
* hypothesis-initial interview/phone
* neutrality-therapist interact/accept each fam mem prob
* circular questioning-ask each fam mem same question position
* connotation- symptom maintain fam cohesion family rituals-between session alter problems (games)
75
Milan Systemic Fam Therapy (key to remember)
kid with Milano cookies family games-patterns of communication vs dirty games-communication problematic (need alter)
76
Narrative Family therapy
-restory -replace problem stories with better ones -person is not the problem, problem is outside of the person
77
Narrative family therapy story replacement
get to know family separate listen to client "sparkling moment" separate family from problem bring in preferred better narratives
78
Narrative family therapy techniques
QUESTIONS -externalizing questions, view problems outside self -opening space questions, family identify unique outcome -therapeutic letters-reinforce emerging alternative story -therapeutic certificate end therapy acknowledgment -definitional ceremonies tell others of their change/celebrate
79
Emotionally Focused Therapy (EFT) Geenburg&Johnson
* attachment theory &
* humanistic experimental -
* emotions/attachment influence relationship -
* partner needs usually a health problem -
* distress-partner interaction and emotion from others
80
Emotionally Focused Therapy (EFT) Technique
* partner needs to EXPRESS &
* deal w/emotion \*expand &
* restructure emotional experience 1)assessment & de-escation 2) change position& creating bonding events 3) consolidation & intergration
81
Group therapy model effective & contraindicated
* inclusion and exclusion
* effective-increase motivation,
* self-reflective,
* disclosure vs contraindicated-people w/suicidal ideation, delusion, pose threat to the group, unable to control aggression
82
Group therapy antisocial behavior
better---\>homogenous group worse---\>hetergenous group
83
Group Therapy Characteristics # of people cohesiveness closed open
* 7 to 10 people \>7 limited interaction \<10 too hard to involve everyone
* #↑ people↓ cohesiveness, ↑ dropout closed-specific # people, sessions, no replace dropout
* open-replace people, unlimited session, ↓ cohesiveness, may benefit from the energy of new people
84
Group Therapy Formative Phases Yalom
Overlapping phases 1) Initial Orientation-hesitant, giving/seeking advice, clarify purpose 2) Conflict-dominance &rebellion, group must "share" therapist 3) Cohesiveness- decrease conflict, open communication, trust, self disclosure
85
Group Therapy Factors Yalom
effects of group therapy, group cohesiveness instillation of hope
86
Group therapy Tuckman and Jenson think Pinata
Forming-group ground rules Storming-members confrontational w/each other/leader Norming- growth stage, commitment and trust Performing-group functions effectively Adjourning-get closure and say goodbye 2 members
87
Prevention -Consultation Therapy and Psychotherapy Research Caplan (& Gordon) Model
Primary-prevention-aimed at everyone-vaccinations Secondary-screening/treatment-specific people-crisis intervention/substance detox/mammograms Tertiary-relapse prevention-aimed2target group/individual w/disorder, reduce long term impact, AA, daytreatment, half-way house
88
Prevention-Consult Gordon-Model
\*Universal-aimed at everyone (drug prevention in high schools) \*Selective-Individuals identified with increase risk (drug prevention 4 kids w/increased risk \*Indicated Preventions-know high risk w/early signs (kids who have experimented with drugs)
89
Mental Health Consultation
4 types of consultation
* Client centered-consultee(therapist) needs a consult 2 help w/client (1 person, most common in schools) \*get help to gain the trust
* Program Centered Administration-consultant work w/program resolve w/n existing program\*\*administration focus help with trust
* Consultee Centered Case consultation- therapist increase their skills/knowledge to help client \*\*help you help them Consultee (therapist) Centered
* Adminstrative Consultation-increase focus program administration develoment/future/evaluate \*\*\*help program help others
90
Consultation vs Collaboration
Consultation-no direct contact w/client, not responsible for client outcomes Collaboration-direct contact, shares responsibility for outcomes
91
Psych Therapy Outcomes PTO
Eysneck
Therapy may do more harm than good
72% of patients improved without therapy (aka “spontaneous remission” (i.e., Eysenck said therapy wasn’t effective → EWWWWW)
92
PTO Outcomes
Smith Glass Miller
Effect size
what it is known for
Effect size .85
FIRST META-ANALYSIS regarding therapy outcomes (meta-analysis almost has the word metal and BlackSMITHs work with METAl) on average, 80% of patients were better with therapy vs. without [effect size is .85 → this is important to know]
93
**How**ard and Colleagues
Dosage Model
Dosage model
8 sessions = 50% improvement
25 sessions = 75%
50 sessions = 85%
94
**How**ard and Colleagues
Phase Model
1) Remoralization = ↑ hope \*initial phase
2) Remediation = ↓ symptoms 16 sessions
3) Rehabilitation = replace bad behavior with good behavior (unlearn bad behavior)
95
Greenson-Working Alliance
1. Working alliance (therapeutic alliance)- relationship between therapist and client
2. Client Therapist Matching- racial therapist matching w/cultural point of view
3.
96
Utilization of Mental healthcare services
depends on gender, age, sex orientation & race
↑ females 35-49
↑ homesexual vs heterosexual
outpatient ↑biracial, then white, American indian/alaska, black, Hispanic, Asian
Inpatient ↑ American Indian &Alaska Indian, black, biracial, Hispanic, white, Asian
97
Psychological Intervention Savings in Medical Cost
20% savings of people with medical cost also seek therapy
98
Cost benifits analysis
compare cost and benefits of multiple interventions
99
Individual Placement Support (IPS)
Most effective-Vocational Rehabiitation
100
Cost-Effective Analysis
compare cost of two interventions when it cannot be expressed by many
101
Cost Utility Anaylsis
Compare cost of 2 interventions and Quality adjustment of life
Combines quality and quantity of life duration
102
Early termination
more due to transportation than cost
103
Transdiagnositic treatments
examine what is common of disorders
biologically
psychologically
environmentally
Treatments-combine treatments
104
UP-Unified Protocol for Transdioagnotic treatment of emotional disorders
will treat neuroticism
105
Telepsychology and Evidence-Based Psychotherapy (EBP)
↓patient and provider cost
↓stigma and embarassment=evident outcomes
↑therapy w/limited access
106
Teletherapy-anxiety disorder
good for comorbid & mood disorders
↑significant improvement w/anxiety using CBT w/video
107
Teletherapy-PTSD
telepsych CBT w/PTSD
↓symptoms slightly less than inperson
108
Telepsych-MDD (Major Depressive Disorder)
↓depressive symptoms after video conference
video conference helps with insomnia and chronic pain with depression
109
Teletherapy-Bulima Nervosa
↓abstinence in bing eating however 12 month follow up is slower
110
Stepped Care 2 fundamental features
1. stepped modeled-least restrictive
2. self-correcting..results of treatment & decision
↑access to efficient treatment health care through mental health
111
Stepped Care Steps 4 steps
1. Assessment and monitoring evaluate systems & watchfully event
2. Interventions requiring minimal Practiciner Involvement *bibliotherapy*-↑risk depressive patients get techniques *computer-based* track patients symptoms and use multimedia to help cope w/deppression
3. Interventions require more intense training alternatives when they do not respond to group intervention
4. Most restrictive intervention and intensive forms of care-voluntary or mandatory
112
Efficacy Research Clinical Trials
effiCaCy – CliniCal research trials – College kids – highly Controlled conditions -
MAX internal validity
MAX experimenter control
113
Effectiveness Research
Max External Validity
conclusion study and other people
Most similar to real life – so it makes sense it wouldn’t be in controlled conditions; clinical setting
\*Tx is considered effective if it helps 70% of people
114
Cross Cultural Issues & Concepts
World Wide View-Sue
Sue worldview -how we percieve evaluate situations and how we behave
* Internal LC & Internal Responsibility (IC-IR)
* control outcomes including success & failure
* Internal LC & External LR (IC-IR)
* others keeping them from controlling change
* External LC & External LR ( EC-ER) (learned helplessness)
* little to no control, no responsibility
* External Locus of control & internal LR
* little control but will take responsibility
* IC-IR --american culture
* Other 3 minority culture
115
Acculturation (4 parts)
minority group in contact with majority
(retention/rejection)
* Integration – Identify with BOTH majority and minority culture
* Assimilation – Identify with majority culture and REJECT minority culture
* Separation – REJECT (i.e. separate from) majority culture and identify with minority culture
* Marginalization – REJECT BOTH majority and minority
116
CC Issue & Concepts
Health Cultural Paranoia
1) Functional Paranoia
2) Healthy Cultural Paranoia
paranoia reason minority doe not want to develop to a white therapist
1. suspicion & distrust of therapist
2. involves suspicion & distrust that is normal and willing to disclose
117
CC and Issues
Racial Microaggression
(-) things to people of color
* microassult-old fashion racism, meant to hurt
* microinsult-insensitive, overlooked verbal/nonverbal
* microinvalidation-assumptions about who they are based on color (oh your English is good to an Asian American)
118
CC Issues and Concepts
1) Internalized Racism
2) Colorism
* Internalized racism-person accepts society beliefs about his race or culture
* Colorism aka consciousness-discrimination based on skin, hair or eye color
119
CC Culture and Issues
Emic Vs Etic
Emic -one culture therapist applies to that culture only
Etic-everyone regardless of ethinicity
120
CC Culture and Issues
Autoplatic vs Alloplastic interventions
* Autoplastic-adapt environment & ▲ AUTOmatic thoughts (internal), helps gain insight
* Alloplastic-▲environment to fit client, remove self from situation (ALLLLL around them, external)
121
CC Culture and Issues
Cultural Encapsulation
(Wrenn)-no cultural sensitivity, thier culture applies to all cultures
122
CC Culture and Issues
High vs Low Context Communication
High context group understanding & nonverbal-minority
Low context group verbal is independent-whites culture
123
Cross Cultural Issueses
Minority stress theory
Proximal Process
Distal Process
* ↑ risk mental issues in sex minority individual (homosexual)
* Proximal-concealment, fear of rejection, internalized
* Distal-external verbal, physical harassment, prejudice, discrimination
124
Cross Cultural Issues
Diagnostic Overshadowing
not considering other explanations and for mental health
ex ID individuals cannot experience other mental health conditions
125
Cross Cultural Issues
Credibility and Gift Giving
Credibility-therapist trustworthiness and desire for the client to achieve success
Gift Giving-direct benefit the client believes he gains from therapy, ↓ anxiety, sense of hope, normalizing feelings
126
Cross Cultural Issues
Evidence-Based Practice and Culturally adapted Interventions (EBPP)
integrating clinical expertise w/research,
aka evidence-based interventions and evidence-based practice
aka empirically supported treatments
\*culturally adapted interventions I.E. consider language, culture, content, religion, indigenous healers,
127
Cross Cultural Issues
Fidelity
Scientific top down
* adaptation dilemma
what degree will therapist adopt and implement
* most effective involves adding features, most beneficial for those that have the most need for them
128
Cross Cultural Issues
Culturally Competent Therapist
* awareness
* knowledge
* skills
necessary to provide service
129
Cross-Cultural Issues
African American
American Indian
Hispanic
Asian
Homosexual
Older Adults
1. AA-fear of shame, silence eye avoidance expression of respect,egalitiarian therapist should empower, involve family and church
2. American Indian,-family tribe before individual, wellness mind, body and spirit, direct eye contact sign of respect, therapist empower & include family
3. Hispanic-environmental contributors, psych symptoms somatic, religion/spiritual a part of a diagnosis, family over the individual,
1. Cuento therapy-folk talks adaptive behavior
2. Dichos-proverbs idiomatic expression of feelings
4. Asian American-psych problems somatic, fear of shame, formal therapy, eye contact avoidance,therapist considered expert
5. LGBTQ-2x ↑than hetro to have ME
1. coming out-13-15 usually
2. Internalized heterosexism internalized homophobia-negative messages of own sex orientation
3. therapy affirmative therapy-integrating a unique understanding
6. ↓ mental health issues vs younger or middle age
1. ↑ depression more physical and cognitive
2. ↑ anxiety irritability, insomnia & weight loss
3. treatment psychotherapy w/cognitive, sensory, and physical needs
130
CC Issues-Identity Development Models
Atkinson, SUE
Racial/Cultural Identity Development (R/CID) Model
5 stages of how minorities see themselves
* Conformity-neutral or (-) about own, +about others
* sees majority group as superior
* Dissonance-questions all groups, prefer opposite race therapist to help explain own culture
* Resistance & immersion (+) toward own group
* (-) towards majority group
* \*least likely to seek therapy, if sought blames racism for problems
* introspection-questions alliegance to own group, concern of bias of people from other groups
* any race therapist as long as they can help explore new sense of identity
* integrated awareness- aware of + or - of all groups
* strong cultural identity, looking for community and social change
131
CC Issues-Identity Models
Cross Black Racial Identity Model (Nigress)
Pink Elephants Immersed In INtegration
or starts with C and ends with C
* PreenCounter-idealize & prefer white culture
* EnCounter-incidence happens, wants to connect and learn about own culture
* Immersion-Emersion-"blackness" reject white, immerse in own
* Internalization/Commitment Stage-Pro black, secure in identity, both black and white have strengths
132
CC-Identity Model
Cross Black 2001 reduction to 3
* Preencounter-assimilation, miseducation self-hatred
* Immersion-emersion-black involvement, & antiwhite
* Internalization stage-black nationalism, biculturist & multiculturalist
133
CC Issues Identity
Sellers, Smith Rowley
Multidimensional Model of Racial Identity MMRI
\*racial identity varies around time & situation
1. Racial salience-race is important time/place (only black in a restaurant
2. racial centrality -defines self by race & race is important
3. Racial Regard Private-how person feels about being black---\>Public how they think other c them + or -
4. Racial ideology ways & opinions about how others should live in society
134
CC Issues Identity Models
Racial Ideologies
1. Nationalist-unique black control own destiny f%$% everything else
2. oppressed-similarity of oppression experienced by blacks & other groups, form coalitions
3. assimilation similarities w/blacks & other groups work Δ system
4. humanist similarities in all races, concerned w/all human issues
135
CC issues and Identity
Helms White Identity
IPS Information Processing Strategy
Cross De Road People I Expect Access
* IPS Oblivious
* Contact-lack of awareness of racism, happy 2Bwhite
* IPS Suppression & ambivalence
* Disintegration-transition into awareness of the race-related moral dilemma
* IPS Selective Perception & (-) Group distortion
* reintegration-try to resolve whites are superior and minorities are problem
* IPS reshape reality and selective perception
* Pseudo-independence-event makes one question believes about whites & minorities
* \*\*\*\*\*\*superficial tolerance of minority group w/attitudes and behaviors that perpetuate racism
* IPS Hypervigilance & reshaping
* Immersion-Emmsion-meaning or racism, what it means to be white and have privilege
* IPS Flexibility & complexity
* Autonomy -value diversity & explore race w/o defense
136
CC issues Identity
Troidens Model of Homosexual Identity
Self-identity----thinks there
Perceived Identity---claim to be there
Presented Identity coincide-others view them
1. Sensitization-feeling different from same sex peers
2. Identity confusion-mid2late adolesence same sex attraction
3. Identity Assumption-transition accepts being gay around 19-21 males & 21-23 girls, may seek same sex social interactions
4. Identity commitment-internalized being gay and comfortable disclosing to others
137
Migraine headache treatment
* non steriods anti inflamatory drugs
* alkaloids
* SSRI's
* SSRI agonist
* beta blocker
* thermal biofeedback
* autogenic training
138
Hypertension 2 types
* 10 hypertension-essential hypertension
* cause unknown
* \*silent killer-asymptomatic
* 90% of all cases
* 20 hypertension-blood pressure due to a disease
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Migrane Headaches
* sx- throbbing usually one side of head
* may have nausea, vomiting, sensitivity to light
* emotional stress, missing a meal
* abrupt weather changes, alcohol
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Migrane Headaches
2 types of Migranes
and cause
* Migrane headaches w/*Aura (classic)*
* *Migrane headaches w/o aura most common*
* cause unknown but linked to low serotonin
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Hypertension Treatment
* lifestyle changes
* diurectic
* beta blocker
* ACE inhibitor & blood pressure medication
* biofeedback and relaxation training
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Endocrine Disorder
Hyperthyroidism
* hypersecretion ↑ metabolism
* ↑ body temperature
* ↑ heat tolerance
* ↓ appetite
* ↑ weight loss
* ↑ insomnia
* ↑ emotional lability
* ↓ attention span
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Endocrine Disorder
Hypothyroidism
* hyposecreaction ↓ metabolism
* ↓ appetite w/weight gain
* ↓ heart rate
* ↓ body temperature
* ↓ cold tolerance
* ↓ libido
* impaired attention
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Pituitary Gland
antidiuretic hormone (ADH)
* aka Vasopressin
* water in urine
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Pituitary Gland
Central Diabetes insipudus
Nephrogenic diabetic insipidus
* results of ↓ ADH due to tumor, pituitary gland or other issue
* ↑ urination
* ↑ thirst
* dehydration
* weight loss
* low blood sugar
* Nephrogenic insipidus-failure of kidneys to respond to ADK
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Idiopathic
disease of unknown origin → think about idiots don’t know the path to disease
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NOcebo
* (opposite of placebo) – placebo means you take a sugar pill (but think it’s something else) and believe it will have a positive effect;
* Nocebo – is when you take a sugar pill (but think it’s something else) and believe it will make you feel worse (i.e., no good will come from taking the pill)
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Iatragenic
infections/complications caused by receiving medical treatment
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RNA & DNA
are linked to memory
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Temporal lobe personality
paranoid, aggressive, argumentative
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ElectroEncephaoGraphy (EEG)
* measures brain activity (small electrodes on scalp)
* detect sEizureErs, tumors, sleep disorders, depression, Angelman Syndrome
* pros-its quick
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Neuropsychiatric EFG Assessment Aid (NEBA)
* approved for medical and psychological use to diagnose ADHD 6 to 17 years of age
* looks at ↑beta & ↑theta waves in children w/ADHD
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Microelectrode
single unit technique used primarily for research but also used for moment disorders
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Neuro Image Technique
Structural Technique
* identify structural changes
* strokes, tumors, infections
* MRI and CT are both structural
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Neuro Imaging Technique
Magnetic Resonance Imaging (MRI)
* structural
* 3-dimensional images
* detailed
* can detect hemorrhages, bruising, MS, Alzheimers, Huntingtons disease
* Radiowaves NOT Radiation
* \*cross-sectional images
* CANNOT use w/people who have metel in body ex shraphnel, pins, rods, a pacemaker, magnetic fields would rip out of thier body
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Computerized Axial Tomography (CAT aka CT)
* structural
* rapid images (needed 4 quick trauma (car wreck
* cheaper
* detect
* tumors, blood clots, MS, cancer, lesions, Alzheimers
* detailed X-Ray of bone structure
* Exposed to Radiation
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Positron Commission Tomography (PET)
* functional
* blood flow, glucose metabolism, oxygen, cancer, dementia, depression, schizophrenia, can see plaques/enlarged
* ONLY ONE detects Plaques and Tangles
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Single Photon Emission Computed tomography
SPECT
* blood flow, metabolism, cancer
* similar to PET scan but easier
* Cheaper, BUT also less detail b.c of lower resolution
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Functional MRI (FMRI)
* Blood flow, oxygen, used for Alzheimers disease, epilepsy, brain tumors, strokes, TBI’s and multiple sclerosis
* Similar to MRI but gives more information on metabolic activity
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Florideoxglucose PET (FDG-PET)
* access glucose metabolized
* maybe best for distinguishing Alzheimer's disease and other neurocognitive disorders
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First Generation Antipsychotics (FGA)
Traditional Antipsychotics - aka – Neuroleptics – aka – Typical – aka - First Generation – aka - Conventional/ Traditional Antipsychotics
* chlorproma*zine (*thiorida*zine)* ,
* haloperidol (Haldol),
* thiorida*zine* (Mellari),
* fluphena*zine* (Prolixin),
* perphana*zine*
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First Gen Antipsychotics
What it does and how it treats
* Schizophrenia (positive symptoms: hallucinations, delusions, disorganized thinking, trouble w/movement, concentration)
* Delusional D/o
* Brief psychotic D/o,
* Schizoaffective D/o
* \*primarily block dopamine receptors (D2)
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First Gen Antipsychotics
Side effects
* *Anticholinergic effects* (dry mouth/eyes, blurred vision, tachycardia, constipation, urinary retention)
* *Extrapyramidal* effects akathisia – restlessness especially in the legs → very common and associated with premature termination of treatment, _parkinsonism_ – mask like face, shuffling gait, drooling, resting tremor, _bradykinesia, Tardive Dyskinesia_ – involuntary movements of face/trunk or arms → usually occurs after about a year of being on antipsychotics; 50% of people will experience full remission of these symptoms after medication is stopped → to gradually withdraw Rx [more common in women & older adults], _dystonia_ – painful muscle spasms)
* *Neuroleptic Malignant Syndrome (NMS)* → rare (muscle rigidity, tachycardia, hyperthermia, mutism, joint pain, altered consciousness (mental state), fever; MAY BE LETHAL so need to withdraw the Rx IMMEDIATELY)
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Second Generation Antipsychotics (SGA-s)
Atypical Antipsychotics – aka - Novel Antipsychotics – aka - 2nd Generation
* ***clozapine (***Clozaril)
* risperidone (Risperidal)
* olanzapine (Zypressa)
* paliperidone
* quetiapine (Seroquel)
* ziprasidone
* aripiprazole (Abilify)
* as effective for (+) symptoms & more effective for (-) symptoms
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Second Generation Antipsychotics
what does it treat and how it works
* Schizophrenia (positive & negative symptoms)
* Bipolar D/o MDD (some of them)
* Clozapine and other SGA may be effective when FGA have failed
* Blocks (aka inhibits) dopamine (D3 & D4 receptors) & serotonin
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SGA less likely to ____ than FGA
* Less likely to cause extraprymidal side effects
* he does not cause other problems metabolically
*
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Second Gen Antipsych side effects
* Anticholinergic effects (dry mouth/eyes, blurred vision, tachycardia, constipation, urinary retention)
* Sedation
* Agranulocytosis (clozapine) ↓ in white blood cells = risk for infection (tends to manifest as a sore throat and fever)
* Neuroleptic Malignant3 Syndrome → rare (muscle rigidity, tachycardia, hyperthermia, altered consciousness, fever; MAY BE LETHAL so need to withdraw the Rx IMMEDIATELY)
* Metabolic Syndrome (weight ↑, ↑ blood pressure, ↑ risk for heart disease and diabetes) Less likely to cause Tardive Dyskinesia/ Extrapyramidal effects
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Antidepressant
SSRI's Serotonin Reuptake Inhibitor
* fluoxetine→ prozac, saratem FDA ok age 6+
* bulima, bipolar and depression
* fluoxamine→ luvox
* paraxetine→ paxil, bipolor & depression, premature ejaculation
* sertraline→Zoloft-bipolor & depression
* Citalopm→-celexa
* SSRI- overall improve premature ejaculation
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Antidepressant SSRI's treatment
* may also be used for premenstral dyshoric disorder
* OCD, Paranioa, PTSD, Bulima, Nervosa, Premature ejaculation
* less side effects
* safer for elderly
* safer for overdose
*
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Antidepressants SSRI
How they work
* anticholinergic-BLOCKS ACH
* Blocks (aka inhibits) the reuptake of serotonin & norepinephrine which ↑ serotonin and norepinephrine in the brain
* \*take about 2-4 weeks to kick in for depressive symptoms
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Antidepressants
What happens when you discontinue
* discontinuation syndrome
* serotonin syndrome
* discontinuation syndrome-
* headaches, dizzyness, mood impaired concentration, sleep disorder and flu-like symptoms
* Serotonin syndrome- potentially fatal
* extreme agitation, confidence autonomic instability, hyperemia, tremor, seizures, delirium
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NE Reuptake Inhibitor
NDRI's
* inhibitors reuptake of NE at dopamine site
* Buproprion
* wellbutrin & Zyban
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NDRI's
Used to treat
* Bipolar D/o
* Depression
* MDD
* Smoking cessation
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NDRi's
how does it work
* Blocks (aka inhibits) reuptake of norepinephrine & dopamine, which ↑ norepinephrine & dopamine in the brain
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NDRI's
side effects
* Skin rash
* ↓ appetite & weight loss
* Dizziness
* Seizures
* Insomnia
* Less anticholinergic
* Does not cause sexual dysfunction
* Not cardiotoxic
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Tricyclic antidepressants TCA's
drug names
* amitroptyline→Elavil
* Imipramine\*→Tofranil
* clominpramine\*\*→Anafranil
* nortriptyline→Pamelor
* doxipin→sinequan
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TCA's
treatment usages
* MDD
* \*imipramine is good for OCD/GAD
* Panic D/o
* Neuropathic pain
* clomipramine\*\* is used to treat premature ejaculation
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TCA's
WHAT DOES IT DO
* inhibits reuptake of NE, SE and Dopamine at Synapse which intern
* ↑SE, NE, and dopamine in the brain
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TCA
Side affect
* T-toxic C-cardia A anticholinergic
* Anticholinergic effects (dry mouth/eyes, blurred vision, tachycardia, constipation, urinary retention)
* Hypertension or hypotension
* GI problems
* Memory problems
* Sexual Dysfunction
* Weight gain
* Sedation
* Cardiotoxic
* CAN BE LETHAL IF OVERDOSE
* Contraindicated if have heart condition, seizures, high blood pressure, suicidal thoughts
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Antidepressants
Monoamine Oxidase inhibitors
MAOI's
* oldest antidepressants
* phenelzine-Nardil
* isocarboxaid-Morplan
* tranylcypomine-parnate
*
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MAOI's
what is it used for
* Atypical or treatment resistant
* depression (increased appetite, hypersomnia)
* Panic D/o
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MAOI's
what does it do
* Blocks (aka Inhibits) MAO in the brain, which ↑ norepinephrine, serotonin and dopamine
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MAOI
side effects
* Anticholinergic effects (dry mouth/eyes, blurred vision, tachycardia, constipation, urinary retention)
* Insomnia Headaches Sedation Sexual dysfunction Hypotension
* CAN BE LETHAL IF OVERDOSE
* Avoid taking MAOIs + SSRIs b/c can cause serotonin syndrome which could lead to death CAN CAUSE HYPERTENSIVE CRISIS – if eat foods with tyramine aged meat, fava beans, orange pulp, kimchi, tomatoes, cheese, wine/beer, pickled/smoked fish, packaged soups, etc.
* OR combine taking this medication with taking amphetamines or antihistamines
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Standard 3
Human relations
* related to discrimination, harassment, multiple relationships, informed consent and interruption of services
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Discrimination
* cannot discriminate
* don't have to accept& can refer out if believe it is
* individual bias will impact diagnosis, values
* or (-) affect competence
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Prader-Willi Syndrome
* chromosome abnormality
* deletion paternal chromosome 15
* Pathological overeating (hyperphagin)
* narrow forehead, abnormal eyes, short stature
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Social-Emotional Moral Development
Piaget Theory
Premoral
Heteronomous
Autonomous
* *Premoral*
* birth to 5
* limited understanding of rules
* *Heteronomous Stage*
* *5-6 years of age*
* *rules do not change, consequences should be based on behavior*
* *Autonomous Stage*
* *10-11 years of age*
* *people can be changed by agreement*
* *rules can be changed*
* *judgment is based on intention of guilty party*
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Social-emotional moral development
Kohlberg Moral Development Theory
aka
Heinz Delimma
* moral reasoning w/moral delimmas
* 3 levels each with 2 stages
* a person is asked if husband must decide to steal a drug to save wifes life or obey the law and risk wifes life
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Kohlberg/Heinz Delimma
3 stages and it s 2 substages
* *Level 1 Preconventional Morality*
* Punishment/obedience→avoid punishment, get rewards
* its against the law and I will go to jail
* Instrumental hedonism→obey to seek rewards
* satisfy personal need
* if I am quiet I will get a cookie
* *Level 2 Conventional Morality*
* **Good Boy/Good Girl→gain approval by obeying/***conforming to rules***
* golden rule treat others how you want to be treated
* socially okay with others, to please/help
* Law & Order→if its legal it must be okay
* does this violate a law set up by others
* fulfilling your duty to society, respect authority
* Level III *Post-conventional Morality*
* **Democratically Accepted Laws-aka Social/Morality Contract→society matters most
* we follow rules to make society better
* Morality of Individual Principles of Conscience→act based on values
* respect, equality, justice
* definition of right and wrong based on self gereral principles
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EFS
Bowen-genogram
* known for genogram (family tree) as an assessment tool to obtain information about family
* goes back at least 3 generations
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EFS Bowen
Role as therapist
* active role more like trainer or coach
* help each family member see role by awareness through questioning and elaboration
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Brief Therapy
Transtheoretical Model
stages and benefits
PC-PAMT
* Precontemplation
* denial and believe change is impossible
* benefit from conscious raising, dramatic relief, environmental reevaluation
* Contemplation
* within 6 months
* ambivelent about change
* benefit from self-reevaluation
* Preparation
* within 1 month
* benefits from support to change, self reevaluation, and self-liberation
* Action
* now
* benefits from contingency management, stimulus control & counter conditioning
* Maintenence
* maintained 6 months
* main goal relapse prevention
* Termination
* patient is confident
* risk for relapse is low
* 3 factors
* decision balance-strength of belief & change
* self-efficacy-self confidence about the ability
* temptation-urge to engage in behavior (usually the strongest in beginning stages)
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