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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

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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

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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

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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

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5
Q

Jung

A

Young-disney movies (warrior, fighter) Analytic Psychology -INDIVIDUATION-Archotypes-Generational

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6
Q

Jung Personality

A
  • Psyche Personal Unconscience- forgotten, repressed memory
  • Collective Unconscience-shared, passed down, generation to generation
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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
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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
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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

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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)

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11
Q

Adler Therapy

A

STEP Systemtic Training In Effective Parenting-democratic style of parenting

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12
Q

Adler Lifestyle

A

Healthy,Mistaken(unhealth)- neurosis, psychosis, addiction, birth order is important

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13
Q

Mahler-Object Relations Theory

A

Desire for human relationships journey of separation and individuation (stages)

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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
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15
Q

Problems in Separation/Individuation stage

A

Narcissm and other borderline problems

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16
Q

Humanistic-Existential Similarities

A

Both focus on here and now Also prioritizes clients experience over object reality Concentrate on clients internal qualities

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17
Q

Humanistic-Existential Differences

A
  • Humanistic-acceptance, growth and self-actualization
  • Existential-freedom and responsibility
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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
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19
Q

Person Centered Therapy (Rogers)

A

Self-actualization Fully functional CUE

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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
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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”
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22
Q

Existential Therapy (Yalom)

A

Personal Responsibility and Choice

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23
Q

Existential Therapist Psychological Disturbance

A

Ultimate Concerns of existence death, freedom, isolation and meaningless

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24
Q

Existential Therapy 2 types of anxiety

A

Normal (existential) anxiety-proportional, objective threat, no repression Neurotic Anxiety disproportional objective threat, involves repression

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25
Q

Glasser Reality Therapy

A

Responsibility Success/Failure Realistic Goal Setting Juvenile Deliquents and Adolesence

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26
Q

Reality Therapy Technique

A
  • Ask about Wants and needs
  • Determine what client is Doing to get them met
  • Encourage client to Evaluate his behavior to obtain goals
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27
Q

Reality Therapy Basic Needs (6)

A

Love, Power, Fun, Survival, Freedom, Belong

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28
Q

Positive Psychology Seligman

A
  • Valued Experiences
    • Past-well being, commitment and satisfaction
    • Present-flow and happiness
    • Future-hope and optimism
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29
Q

Postive Psychology PERMA Model

A

Positive/Emotions Engagement Relationships Meaning Accomplishment/Achievement

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30
Q

Interpersonal therapy IPT- Sullivan

A

Medical model Decrease symptoms, Increase interpersonal functioning Timed 12-16 weeks Here and now therapy

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31
Q

IPT Model Therapy

A

Initial Stage-diagnosis “sick role” Middle Phase-assess problem identified, decision analysis Final Stage-termination relapse prevention

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32
Q

Solution Focused Therapy -Shazer

A
  • Solution to problems
  • Client Focused
  • Miracle Question-future
  • Exception Question-past
  • Sealing Question-current toward goals
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33
Q

Transtheoretical Model Prochask and DiClimente

A

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

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34
Q

Transtheoretical Model Motivation affects

A
  • 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)
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35
Q

Motivational Interviewing Miller and Rollnick

A
  • 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
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36
Q

Becks Cognitive Behavioral Therapy (CBT)

A
  • 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
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37
Q

Beck cognitive schemes

A

flexible schemas—core beliefs different disorders have different maladaptive sheas AKA cognitive profiles

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38
Q

Beck cognitive profile depression

A

oneself the world the future

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39
Q

Becks automatic thoughts

A

automatic thoughts - or + triggered by circumstance Dysfuntional Thought Record (DTR)

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40
Q

Beck’s cognitive distortions

A
  • 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
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41
Q

Ellis Rational Emotive Behavior (REBT)

A
  • 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)
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42
Q

Ellis Techniques

A

relaxation, training, learing new skills, systematic desensitization

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43
Q

Self-Instructional training (Meichenbaum)

A

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

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44
Q

Stress Inoculation Training

A

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)

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45
Q

Acceptance and commitment (ACT)

A

Psychological flexibilty (pain) Clean pain-universal everyone mental/physical Dirty Pain-aka dirty discomfort treats chronic pain, psychosis, depression, anxiety, OCD

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46
Q

ACT- Psychological flexibility

A

acceptance, mindfulness, commitment, behavior change, and counter psychological inflexibility

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47
Q

Mindfulness-Based Intervention Mindfulness Based Cognitive Therapy (MBCT) Mindfulness Stress Reduction (MBSR)

A

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)

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48
Q

Cybernetic Theory

A

Regulates functioning positive and negative feedback loops

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49
Q

Negative feedback loops

A

Resist change, keeps status quo (homeostasis)

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50
Q

Positive Feedback loops

A

Increase change disrupts status quo (homeostasis)

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51
Q

Communication theory (family and group)

A

Contributes to family therapy, repetitive patterns of communication and interactions that cause problem behavior (how we interact with schizophrenics)

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52
Q

General Systems Theory (family and group)

A

inteactions come from rules and have homeostic mechanisms that maintain stability and equailbrium

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53
Q

Double-bind communication (family and group)

A
  • 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
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54
Q

Socratic Dialogue

A
  • Beck client asks questions to
    • define problem
    • identify thoughts
    • evaluate consequences of bad behavior
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55
Q

Collaborative Empieism

A

Beck therapist and client co investigate accept support reevaluate or reject assumption, intention or belief

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56
Q

Symmetrical Interactions (communications theory)

A

one upmanship equality elicits similar behavior in someone else

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57
Q

Complementary interactions (f & g) (communications theory)

A

dominant and subordinate role inequality (polar opposites attract) behavior of one complements behavior of other (messy and neat person attract)

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58
Q

Extended Family Systems (EFS)

A

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

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59
Q

Extended Family Systems (EFS) -Differentiation -Intrapersonal -Interpersonal

A
  • Differentiation- both intra and interpersonal
    • Intra-personal distinguish between own feelings/thoughts
    • Inter-personal differentiation decrease can be emotionally fused with other family members
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60
Q

EFS Emotional Triangle

A

dyed 3rd family member (mom-dad, kid or mom-kid, dad)

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61
Q

EFS-Family Projection

A

Process-project emotional immaturity on to family

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62
Q

EFS- Multigenerational Transmission Process

A

extension from one generation to the next

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63
Q

EFS therapy

A
  • 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
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64
Q

Structural Family therapy-Minuchin

A

goal is to unbalance family structure (alter hierarchal relationships) create boundaries/restructure the family

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65
Q

Structural Family therapy Subsystems Boundaries

  • subsystem
  • boundaries
  • diffuised
  • close relationship
A
  • 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
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66
Q

Structural Family Therapy Ridged family Triads

A
  • 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
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67
Q

Structural Family therapy Joining aka therapeutic alliance

  • joining
  • mimesis
  • maintenance
A
  • Joining-adopting communication
  • Mimesis- adopt style and language
  • Maintenance-provide family with support
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68
Q

Structural Family Therapy Family Structure

5 definitions of types of structures

A
  • 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
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69
Q

Strategic Family-Haley

A
  • family control &
  • power/hierarchies therapist straightforward tells them what to do
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70
Q

Strategic Family

Family interactions

List 4 stages

A
  • 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
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71
Q

SF Therapy

A
  • 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
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72
Q

Milan Systematic Family Therapy main idea

A
  • family games aka dirty games
  • alter family rules (MULAN became warrior) short term
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73
Q

Milan Systemic Family Therapy difference from others

A

therapeutic team 5 part therapy-pre session, session, intersession, intervention, and post-session w/ 4-6 week gaps to alter behavior (dirty games)

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74
Q

Milan Systemic Family Therapy treatment

A
  • 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)
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75
Q

Milan Systemic Fam Therapy (key to remember)

A

kid with Milano cookies family games-patterns of communication vs dirty games-communication problematic (need alter)

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76
Q

Narrative Family therapy

A

-restory -replace problem stories with better ones -person is not the problem, problem is outside of the person

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77
Q

Narrative family therapy story replacement

A

get to know family separate listen to client “sparkling moment” separate family from problem bring in preferred better narratives

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78
Q

Narrative family therapy techniques

A

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

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79
Q

Emotionally Focused Therapy (EFT) Geenburg&Johnson

A
  • attachment theory &
  • humanistic experimental -
    • emotions/attachment influence relationship -
    • partner needs usually a health problem -
    • distress-partner interaction and emotion from others
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80
Q

Emotionally Focused Therapy (EFT) Technique

A
  • partner needs to EXPRESS &
  • deal w/emotion *expand &
  • restructure emotional experience 1)assessment & de-escation 2) change position& creating bonding events 3) consolidation & intergration
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81
Q

Group therapy model effective & contraindicated

A
  • 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
Q

Group therapy antisocial behavior

A

better—>homogenous group worse—>hetergenous group

83
Q

Group Therapy Characteristics # of people cohesiveness closed open

A
  • 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
Q

Group Therapy Formative Phases Yalom

A

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
Q

Group Therapy Factors Yalom

A

effects of group therapy, group cohesiveness instillation of hope

86
Q

Group therapy Tuckman and Jenson think Pinata

A

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
Q

Prevention -Consultation Therapy and Psychotherapy Research Caplan (& Gordon) Model

A

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
Q

Prevention-Consult Gordon-Model

A

*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
Q

Mental Health Consultation

4 types of consultation

A
  • 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
Q

Consultation vs Collaboration

A

Consultation-no direct contact w/client, not responsible for client outcomes Collaboration-direct contact, shares responsibility for outcomes

91
Q

Psych Therapy Outcomes PTO

Eysneck

A

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
Q

PTO Outcomes

Smith Glass Miller

Effect size

what it is known for

A

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
Q

Howard and Colleagues

Dosage Model

A

Dosage model

8 sessions = 50% improvement

25 sessions = 75%

50 sessions = 85%

94
Q

Howard and Colleagues

A

Phase Model

1) Remoralization = ↑ hope *initial phase
2) Remediation = ↓ symptoms 16 sessions
3) Rehabilitation = replace bad behavior with good behavior (unlearn bad behavior)

95
Q

Greenson-Working Alliance

A
  1. Working alliance (therapeutic alliance)- relationship between therapist and client
  2. Client Therapist Matching- racial therapist matching w/cultural point of view
    3.
96
Q

Utilization of Mental healthcare services

A

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
Q

Psychological Intervention Savings in Medical Cost

A

20% savings of people with medical cost also seek therapy

98
Q

Cost benifits analysis

A

compare cost and benefits of multiple interventions

99
Q

Individual Placement Support (IPS)

A

Most effective-Vocational Rehabiitation

100
Q

Cost-Effective Analysis

A

compare cost of two interventions when it cannot be expressed by many

101
Q

Cost Utility Anaylsis

A

Compare cost of 2 interventions and Quality adjustment of life

Combines quality and quantity of life duration

102
Q

Early termination

A

more due to transportation than cost

103
Q

Transdiagnositic treatments

A

examine what is common of disorders

biologically

psychologically

environmentally

Treatments-combine treatments

104
Q

UP-Unified Protocol for Transdioagnotic treatment of emotional disorders

A

will treat neuroticism

105
Q

Telepsychology and Evidence-Based Psychotherapy (EBP)

A

↓patient and provider cost

↓stigma and embarassment=evident outcomes

↑therapy w/limited access

106
Q

Teletherapy-anxiety disorder

A

good for comorbid & mood disorders

↑significant improvement w/anxiety using CBT w/video

107
Q

Teletherapy-PTSD

A

telepsych CBT w/PTSD

↓symptoms slightly less than inperson

108
Q

Telepsych-MDD (Major Depressive Disorder)

A

↓depressive symptoms after video conference

video conference helps with insomnia and chronic pain with depression

109
Q

Teletherapy-Bulima Nervosa

A

↓abstinence in bing eating however 12 month follow up is slower

110
Q

Stepped Care 2 fundamental features

A
  1. stepped modeled-least restrictive
  2. self-correcting..results of treatment & decision

↑access to efficient treatment health care through mental health

111
Q

Stepped Care Steps 4 steps

A
  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
Q

Efficacy Research Clinical Trials

A

effiCaCy – CliniCal research trials – College kids – highly Controlled conditions -

MAX internal validity

MAX experimenter control

113
Q

Effectiveness Research

A

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
Q

Cross Cultural Issues & Concepts

World Wide View-Sue

A

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
Q

Acculturation (4 parts)

A

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
Q

CC Issue & Concepts

Health Cultural Paranoia

1) Functional Paranoia
2) Healthy Cultural Paranoia

A

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
Q

CC and Issues

Racial Microaggression

A

(-) 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
Q

CC Issues and Concepts

1) Internalized Racism
2) Colorism

A
  • Internalized racism-person accepts society beliefs about his race or culture
  • Colorism aka consciousness-discrimination based on skin, hair or eye color
119
Q

CC Culture and Issues

Emic Vs Etic

A

Emic -one culture therapist applies to that culture only

Etic-everyone regardless of ethinicity

120
Q

CC Culture and Issues

Autoplatic vs Alloplastic interventions

A
  • Autoplastic-adapt environment & ▲ AUTOmatic thoughts (internal), helps gain insight
  • Alloplastic-▲environment to fit client, remove self from situation (ALLLLL around them, external)
121
Q

CC Culture and Issues

Cultural Encapsulation

A

(Wrenn)-no cultural sensitivity, thier culture applies to all cultures

122
Q

CC Culture and Issues

High vs Low Context Communication

A

High context group understanding & nonverbal-minority

Low context group verbal is independent-whites culture

123
Q

Cross Cultural Issueses

Minority stress theory

Proximal Process

Distal Process

A
  • ↑ risk mental issues in sex minority individual (homosexual)
  • Proximal-concealment, fear of rejection, internalized
  • Distal-external verbal, physical harassment, prejudice, discrimination
124
Q

Cross Cultural Issues

Diagnostic Overshadowing

A

not considering other explanations and for mental health

ex ID individuals cannot experience other mental health conditions

125
Q

Cross Cultural Issues

Credibility and Gift Giving

A

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
Q

Cross Cultural Issues

Evidence-Based Practice and Culturally adapted Interventions (EBPP)

A

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
Q

Cross Cultural Issues

Fidelity

Scientific top down

A
  • 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
Q

Cross Cultural Issues

Culturally Competent Therapist

A
  • awareness
  • knowledge
  • skills

necessary to provide service

129
Q

Cross-Cultural Issues

African American

American Indian

Hispanic

Asian

Homosexual

Older Adults

A
  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
Q

CC Issues-Identity Development Models

Atkinson, SUE

Racial/Cultural Identity Development (R/CID) Model

A

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
Q

CC Issues-Identity Models

Cross Black Racial Identity Model (Nigress)

A

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
Q

CC-Identity Model

Cross Black 2001 reduction to 3

A
  • Preencounter-assimilation, miseducation self-hatred
  • Immersion-emersion-black involvement, & antiwhite
  • Internalization stage-black nationalism, biculturist & multiculturalist
133
Q

CC Issues Identity

Sellers, Smith Rowley

Multidimensional Model of Racial Identity MMRI

A

*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
Q

CC Issues Identity Models

Racial Ideologies

A
  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
Q

CC issues and Identity

Helms White Identity

IPS Information Processing Strategy

A

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
Q

CC issues Identity

Troidens Model of Homosexual Identity

A

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
Q

Migraine headache treatment

A
  • non steriods anti inflamatory drugs
  • alkaloids
  • SSRI’s
  • SSRI agonist
  • beta blocker
  • thermal biofeedback
  • autogenic training
138
Q

Hypertension 2 types

A
  • 10 hypertension-essential hypertension
    • cause unknown
    • *silent killer-asymptomatic
    • 90% of all cases
  • 20 hypertension-blood pressure due to a disease
139
Q

Migrane Headaches

A
  • sx- throbbing usually one side of head
  • may have nausea, vomiting, sensitivity to light
  • emotional stress, missing a meal
  • abrupt weather changes, alcohol
140
Q

Migrane Headaches

2 types of Migranes

and cause

A
  • Migrane headaches w/Aura (classic)
  • Migrane headaches w/o aura most common
  • cause unknown but linked to low serotonin
141
Q

Hypertension Treatment

A
  • lifestyle changes
  • diurectic
  • beta blocker
  • ACE inhibitor & blood pressure medication
  • biofeedback and relaxation training
142
Q

Endocrine Disorder

Hyperthyroidism

A
  • hypersecretion ↑ metabolism
  • ↑ body temperature
  • ↑ heat tolerance
  • ↓ appetite
  • ↑ weight loss
  • ↑ insomnia
  • ↑ emotional lability
  • ↓ attention span
143
Q

Endocrine Disorder

Hypothyroidism

A
  • hyposecreaction ↓ metabolism
  • ↓ appetite w/weight gain
  • ↓ heart rate
  • ↓ body temperature
  • ↓ cold tolerance
  • ↓ libido
  • impaired attention
144
Q

Pituitary Gland

antidiuretic hormone (ADH)

A
  • aka Vasopressin
  • water in urine
145
Q

Pituitary Gland

Central Diabetes insipudus

Nephrogenic diabetic insipidus

A
  • 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
146
Q

Idiopathic

A

disease of unknown origin → think about idiots don’t know the path to disease

147
Q

NOcebo

A
  • (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)
148
Q

Iatragenic

A

infections/complications caused by receiving medical treatment

149
Q

RNA & DNA

A

are linked to memory

150
Q

Temporal lobe personality

A

paranoid, aggressive, argumentative

151
Q

ElectroEncephaoGraphy (EEG)

A
  • measures brain activity (small electrodes on scalp)
  • detect sEizureErs, tumors, sleep disorders, depression, Angelman Syndrome
  • pros-its quick
152
Q

Neuropsychiatric EFG Assessment Aid (NEBA)

A
  • approved for medical and psychological use to diagnose ADHD 6 to 17 years of age
  • looks at ↑beta & ↑theta waves in children w/ADHD
153
Q

Microelectrode

A

single unit technique used primarily for research but also used for moment disorders

154
Q

Neuro Image Technique

Structural Technique

A
  • identify structural changes
    • strokes, tumors, infections
  • MRI and CT are both structural
155
Q

Neuro Imaging Technique

Magnetic Resonance Imaging (MRI)

A
  • 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
156
Q

Computerized Axial Tomography (CAT aka CT)

A
  • 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
157
Q

Positron Commission Tomography (PET)

A
  • functional
  • blood flow, glucose metabolism, oxygen, cancer, dementia, depression, schizophrenia, can see plaques/enlarged
  • ONLY ONE detects Plaques and Tangles
158
Q

Single Photon Emission Computed tomography

SPECT

A
  • blood flow, metabolism, cancer
  • similar to PET scan but easier
  • Cheaper, BUT also less detail b.c of lower resolution
159
Q

Functional MRI (FMRI)

A
  • 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
160
Q

Florideoxglucose PET (FDG-PET)

A
  • access glucose metabolized
  • maybe best for distinguishing Alzheimer’s disease and other neurocognitive disorders
161
Q

First Generation Antipsychotics (FGA)

Traditional Antipsychotics - aka – Neuroleptics – aka – Typical – aka - First Generation – aka - Conventional/ Traditional Antipsychotics

A
  • chlorpromazine (thioridazine) ,
  • haloperidol (Haldol),
  • thioridazine (Mellari),
  • fluphenazine (Prolixin),
  • perphanazine
162
Q

First Gen Antipsychotics

What it does and how it treats

A
  • 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)
163
Q

First Gen Antipsychotics

Side effects

A
  • 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)
164
Q

Second Generation Antipsychotics (SGA-s)

Atypical Antipsychotics – aka - Novel Antipsychotics – aka - 2nd Generation

A
  • clozapine (Clozaril)
  • risperidone (Risperidal)
  • olanzapine (Zypressa)
  • paliperidone
  • quetiapine (Seroquel)
  • ziprasidone
  • aripiprazole (Abilify)
  • as effective for (+) symptoms & more effective for (-) symptoms
165
Q

Second Generation Antipsychotics

what does it treat and how it works

A
  • 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
166
Q

SGA less likely to ____ than FGA

A
  • Less likely to cause extraprymidal side effects
  • he does not cause other problems metabolically
    *
167
Q

Second Gen Antipsych side effects

A
  • 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
168
Q

Antidepressant

SSRI’s Serotonin Reuptake Inhibitor

A
  • 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
169
Q

Antidepressant SSRI’s treatment

A
  • may also be used for premenstral dyshoric disorder
  • OCD, Paranioa, PTSD, Bulima, Nervosa, Premature ejaculation
  • less side effects
  • safer for elderly
  • safer for overdose
    *
170
Q

Antidepressants SSRI

How they work

A
  • 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
171
Q

Antidepressants

What happens when you discontinue

  • discontinuation syndrome
  • serotonin syndrome
A
  • 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
172
Q

NE Reuptake Inhibitor

NDRI’s

A
  • inhibitors reuptake of NE at dopamine site
  • Buproprion
    • wellbutrin & Zyban
173
Q

NDRI’s

Used to treat

A
  • Bipolar D/o
  • Depression
  • MDD
  • Smoking cessation
174
Q

NDRi’s

how does it work

A
  • Blocks (aka inhibits) reuptake of norepinephrine & dopamine, which ↑ norepinephrine & dopamine in the brain
175
Q

NDRI’s

side effects

A
  • Skin rash
  • ↓ appetite & weight loss
  • Dizziness
  • Seizures
  • Insomnia
  • Less anticholinergic
  • Does not cause sexual dysfunction
  • Not cardiotoxic
176
Q

Tricyclic antidepressants TCA’s

drug names

A
  • amitroptyline→Elavil
  • Imipramine*→Tofranil
  • clominpramine**→Anafranil
  • nortriptyline→Pamelor
  • doxipin→sinequan
177
Q

TCA’s

treatment usages

A
  • MDD
  • *imipramine is good for OCD/GAD
  • Panic D/o
  • Neuropathic pain
  • clomipramine** is used to treat premature ejaculation
178
Q

TCA’s

WHAT DOES IT DO

A
  • inhibits reuptake of NE, SE and Dopamine at Synapse which intern
  • ↑SE, NE, and dopamine in the brain
179
Q

TCA

Side affect

A
  • 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
180
Q

Antidepressants

Monoamine Oxidase inhibitors

MAOI’s

A
  • oldest antidepressants
  • phenelzine-Nardil
  • isocarboxaid-Morplan
  • tranylcypomine-parnate
    *
181
Q

MAOI’s

what is it used for

A
  • Atypical or treatment resistant
  • depression (increased appetite, hypersomnia)
  • Panic D/o
182
Q

MAOI’s

what does it do

A
  • Blocks (aka Inhibits) MAO in the brain, which ↑ norepinephrine, serotonin and dopamine
183
Q

MAOI

side effects

A
  • 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
184
Q

Standard 3

Human relations

A
  • related to discrimination, harassment, multiple relationships, informed consent and interruption of services
184
Q

Discrimination

A
  • cannot discriminate
  • don’t have to accept& can refer out if believe it is
    • individual bias will impact diagnosis, values
    • or (-) affect competence
185
Q

Prader-Willi Syndrome

A
  • chromosome abnormality
  • deletion paternal chromosome 15
  • Pathological overeating (hyperphagin)
  • narrow forehead, abnormal eyes, short stature
187
Q

Social-Emotional Moral Development

Piaget Theory

Premoral

Heteronomous

Autonomous

A
  • 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
188
Q

Social-emotional moral development

Kohlberg Moral Development Theory

aka

Heinz Delimma

A
  • 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
189
Q

Kohlberg/Heinz Delimma

3 stages and it s 2 substages

A
  • 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
190
Q

EFS

Bowen-genogram

A
  • known for genogram (family tree) as an assessment tool to obtain information about family
  • goes back at least 3 generations
191
Q

EFS Bowen

Role as therapist

A
  • active role more like trainer or coach
  • help each family member see role by awareness through questioning and elaboration
192
Q

Brief Therapy

Transtheoretical Model

stages and benefits

A

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)

EPPP (10 decks)

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