Clinical Psych Flashcards
Who was the father of American psychology?
William James
Where was the first American Psychology Lab?
At Harvard; William James
James-Lange Theory of Emotion
We feel our emotions after our physiological reactions; we feel sad because we cry
William James authored
Principles of Psychology describing his emotion theory in 1890
Cannon-Bard Theory of Emotion
States that when confronted with an arousing event, people first feel and emotion then experience physiological reactions such as sweating, muscle tension, or trembling
Two-Factor Theory of Emotion
Developed by Schaechter and Singer; states that emotions are the result of physiological arousal and bodily responses to an event.
Covert sensitization
Pairing of imaginative negative consequences with an undesirable behavior. Purpose is to reduce likelihood of the behavior; use of negative mental imagery and rehearsal
Shaping
Using selective reinforcement (approximations) to modify a general response. Building a better bx by dividing it into small increments or steps and then teaching one step at a time until the desired bx is achieved; steps become a series of intermediate goals
Inoculation
Four-phase training program for stress management often used in CBT
Covert modeling
Increase desirable behavior by imagining others performing similar behaviors with positive outcomes; ct imagines specific positive consequences of new behavior; based on simple modeling
Participant modeling
A type of role modeling in which the therapist first engages in a desired behavior, and then through the use of aids the ct gradually moves toward the ability to perform the desired task
Coping Skills Training
Teach cts skills increasing cognitive, behavioral and affective proficiencies; commonly used for managing anxiety-provoking situations; uses positive self-statements and positive imagery
Avoidance conditioning
A form of Operant Conditioning in which an organism is trained to avoid certain responses or situations associated with negative consequences
Collaborative Empiricism
Aaron Beck’s cognitive therapy; Ct and therapist are equal partners working together with mutual understanding, communication and respect. Premise is that ct is capable of objectively analyzing his/her own issues and arriving at own conclusions. Uses guided discovery.
Dichotomous thinking
Thinking in absolute terms, like “always,” “every,” or “never”
Emotional reasoning
Cognitive distortion in which individuals use their emotional state as evidence for rationale defending the source stimulus as the “cause” of their emotional state
Magnification
exaggerating negatives
Age of Freud’s oral stage
0-1
Age of Freud’s anal stage
1-3
Age of Freud’s phallic stage
3-6
Age of Freud’s latency stage
6-12
Age of Freud’s genital stage
12+
Suppression
avoidance of thoughts/emotions
Reaction formation
acting or staging feelins in direct opposition to one’s true feelings because those true feelings are unacceptable to the self
Introjection
Deeply identifying with an idea or object
Displacement
expression of thoughts or feelings to a safe target rather than the true target
Sublimation
transforming negative emotions into positive action or behaviors
Frued believed projection was:
root of paranoia
Frued and phobias
displacement of emotions from original object to new of symbolic object
Frued mania/hypomania
polar opposite expression of underlying depression
Frued and anxiety
bolstered defensed in response to id impulses spilling into the ego
Object-cathexis
the id’s investment of the energy into an object that will satisfy an instinctual need
Symbolization
A way of handling inner conflicts by turning them into distinct symbols
La Belle Indifference
A description of the unconcerned attitude toward symptoms that has been seen in Conversion Disorder
Jung focused on (unlike Freud)
Social and aggressive origins over sexual drives; and adult and mid-life experiences over childhood; introduced concept of the collective unconscious
Jung’s self
regulation center of psyche, archetype for the ego
Jung’s shadow
AKA mask, part of oneself that opposes the ego
Jung’s anima
feminine aspect of a person
Jung’s animus
masculine aspect of the person
How did Jung believe neurosis developed?
From conflicting archetypes as people strive to be more fully functioning
Jung’s transference includes:
both personal unconscious and the collective unconscious
What are two areas of interest for Jung?
Universal symbols and the meaning of life are two areas of interest for Jung
Categorical personality traits
Identified extroversion, introversion, orientations toward external or subjective inner worlds. Later these traits became part of the Myers-Briggs Type Indicator (MBTI) test.
Heinz Kohut
Established self-psychology. Believed that narcissistic personality disorder is really a mask for fragile self-esteem, that people are born with a bipolar structure consisting of immature grandiosity and dependent over-idealization.
Melanie Klein
Known for her work with young children; she is also one of the earliest developers of object-relations theory, taking into account social relationships specifically
Who created the field of child psychoanalysis?
Anna Freud; she discovered that children’s symptoms were different from adults and that their sx were related to developmental stages
Karen Horney
Was most well-known for her work with the neurotic personality that she developed from a childhood filled with anxiety; she id’d 3 ways of dealing with the world: moving toward, again, and away from people
Humanistic psychology
Arose after Freud’s theories. Placed a greater emphasis on a person’s freedom of choice, regarding free will as the person’s most important characteristic. Seldom focused on how psychological probs developed, instead, humanistic psychology was (and is) interested in therapeutic interventions.
William Fairbain
Object-seeking shaped mind and personality, a basic motivation to make and keep connections with other people. Pleasure-seeking is the manner to relate to objects - opposing Freud’s belief that object-related is manner to seek pleasure.
How did Melanie Klein believe child psychoanalysis should be conducted?
Much like adult psychoanalysis, in opposition to Anna Freud
Margaret Mahler
Focus on emergence of individual self thru separation and individuation process. First 3 yrs form lifelong mature object-relations. First mth of life, biological needs dominate. 2nd mth recognition of mother-object, but not different from self (symbiosis), 6-36 mths separation-individuation phase. Successful resolution results in permanence of emotional-object, thus parent exists even when out of sight
Personal Construct Therapy
A psychotherapeutic technique by which a person is assumed to control his or her world via personal constructs and cognitive categories. Therapists guide cts in daily practice at viewing the world in a way and interacting w/people using this novel point of view.
Milan Systematic Family Therapy
An approach to therapy that contends pathology is not contained within an individual, but in the context of the family system. According to this approach, if interactional patterns within the systemic framework (family) changed, so would individual problem behaviors
Ego Psychology
Evolved from Freudian Theory and psychoanalysis; took shape thru Siggy and Anna’s contributions; finalized as distinct theory by Heinz Hartman, “Eg Psychology & the Prob of Adaptation” (1939); focuses on ego functions and person’s interpersonal and socio-cultural context; individuals are innately adaptive
Ego Psychology’s views of the ego
Ego is autonomous and adapts and shapes to the environment; operates thru defenses; personality organized thru interactions w/the world (also shaped by internal needs)
Ego psychology - what causes psychological problems?
Ego deficits and person-environment fit contribute to psychosocial problems
According to ego psychology, what are the ego functions?
Reality testing, judgment, sense of reality, affect and impulse regulation, primary and secondary thought processes and regression in the service of the ego
In Ego Psychology, what is mastery-competence and adaptation?
The ability of the person to develop a “sense of competence” by mastering conflicts, internal needs, and environmental demands.
Ego Psychology and Object Relations
One should from a sense of self and others, and develop relationship to self and others
Self-Psychology
One of the four main schools of psychology, founded by Heinz Kohut; evolved from classic Freudian approach and ego psychology, and highlighted the importance of empathy in therapy. The subjective “I” is the focus of study.
Anna Freud
Focus on social and cultural factors’ influence and shaping of personality; didn’t focus on unconscious conflicts as much as her dad; focused on children (supportive, protective, educational); developed first-known classification system of childhood sx; formalized assmt procedures; looked at developmental level
Anna Freud and the Developmental Line
Series of id-ego interactions that decrease a child’s dependence on external controls and increase ego mastery of themselves and their world. Dependency to emotional self-reliance; sucking to rational eating; wetting and soiling to bowel control; irresponsibility to responsibility in body mgmt; play to work; egocentricity to companionship
Alfred Adler
Viewed neurosis as a result of a faulty lifestyle involving a struggle for power
Alfred Adler was one of the original founders of _______, and developed ___________
Psychoanalysis; Individual Psychology
Individual psychology
Not individualistic, but social. People are viewed within social context. People are motivated to belong. Problems in belonging misdirected to power, revenge, attention, or displays of inadequacy.
Adler believed children’s misbehavior stemmed from these misdirections:
Power struggle, revenge, attention, displays of inadequacy
Adler’s Power Struggle
Belonging gained thru control; compliance diminishes personal value
Adler’s revenge
If a child cannot be in charge, seek revenge; feeling significant only when others hurt in the same way they have been hurt
Adler’s attention
Feeling significant only through attention seeking/engaging in inappropriate behavio
Adler’s displays of inadequacy
Belonging only through complete inadequacy, becoming helpless and incompetent; do not attempt tasks as failure is expected
Adler’s Inferiority Complex
Inferiority motivates ultimate goal fro perfection or develops into neurosis. Neurosis develops from maladaptive efforts to compensate for inferiority. Influenced by family, friends, and birth-order.
Adler’s Goals of Therapy
Increase feelings of community, promote feelings of equality, replace egocentric self-protection, self-enhancement and self-indulgence w/self-transcending, courageous and social contributions. Methods: socratic questioning, assessment, guided imagery, role-playing, problem-focused problem-solving
Premise of psychodrama
Guided dramatic action to examine problems and develop insight, personal growth, and integrate cognitive, affective, and behavioral components for an individual.
Key figure in psychodrama
Jacob L. Moreno, M.D.
In psychodrama, who is the protagonist?
The person representing the “theme” of the drama
In psychodrama, who are the auxiliary egos?
Represent significant others in the drama
In psychodrama who is the audience?
They witness the drama and represent the world at large
In psychodrama, what is the stage?
The physical space to conduct the drama
In psychodrama, who is the director?
The trained psychodramatist
What are the three phases of psychodrama?
Warm-up (theme is id’d and protagonist selected), action (dramatization occurs and protagonist explores new methods for resolution of the problem), sharing (group expresses connection w/the protagonist’s work)
Eric Berne
Examined interactions through communication and scrutiny of habitual patterns of bx/associations. Awareness of intent behind communication (eliminate deceit) resulting in ct’s improved interpretation of personal bx. It was to be broadly applied, even outside of therapy. Believed people are capable of making their own decision and are responsible for their own fate.
Berne’s Therapeutic Levels of Analysis
Structural analysis, transactional analysis, racket and game analysis, and script analysis
Berne’s Structural Analysis
Individual personality analyzed; three separate ego states: Parent (traditions and values that are copied from parental and authoritarian figures), child (creativity, humor, excitement, impulsive parts of personality), and adult (computer processor between ego states and outside world; logical, reasonable, and unemotional)
Berne’s Transactional Analysis
Interpersonal personality analyzed; interaction between ego states of two people; two levels: social (overt) and psychological (covert). Types of interactions: complementary (same ego state), crossed (mixed ego state), ulterior (dual levels of communication)
Berne’s Racket and Game Analysis
Life positions of OKness of self and others. Four positions: I’m okay, you’re okay; I’m okay, you’re not okay; I’m not okay, you’re okay; and I’m not okay, you’re not okay. Rackets and games used to find support for one’s life position. Rackets are habitual way of feeling and games are seeking confirmation (strokes) regarding perspectives of self.
Berne’s Script Analysis
Life patterns at thematic levels analyzed. These are the patterns that virtually dictate life; arise from parents giving their children messages/injunctions.
William Glasser
A developer of reality therapy and choice theory; an advocate for mental health as a public health issue
Reality Therapy
An approach to psychotherapy that focuses on the client’s here-and-now and the means to creating a better future through decision-making and control.
Systemic Therapy
A school of therapy that focuses on the interactional patterns and dynamics among group members in relationships (family and marital therapy).
Thoughts on catharsis (behaviorists, Freud, Yalom)
Behaviorists believe that catharsis is a reduction in an emotional response resulting from extinction. Freud used to emphasize catharsis but this is no longer used in psychoanalysis. Yalom identifies catharsis as necessary for interpersonal learning in group therapy.
According to Yalom, what is the necessary precondition for all other therapeutic factors to occur?
Cohesion
Identification
A defense mechanism in which one unconsciously takes on the characteristics of another person.
Introjection
A defense mechanism whereby someone takes aspects of someone else (in the form of bx, ideas, or feelings) and unconsciously incorporates them into their personality or self-view. The source of the introjection or the introject, is usually someone important in the person’s life.
Reintigration
A person’s attempt to resolve confusion regarding increased awareness of his or her ethnicity due to increased contact with other racial groups by accepting the views of both sides.
Autogenic Training
The use of suggestion and deep breathing to reduce autonomic arousal and induce a sense of relaxation.
Contingency Management
The use of positive or negative reinforcement to increase the frequency of desired behaviors or decrease the frequency of undesirable behaviors.
Identification
A defense mechanism in which a person feels anxious about perceived failings and therefore mirrors the behavior of a person they consider successful in order to symbolically borrow that person’s success
Projective Identification
A concept introduced by Melanie Klein in which the individual deals with emotional conflict or internal or external stressors by falsely attributing to another his own unacceptable feelings, impulses, or thoughts. The other person, then, conforms to the individual’s fantasy that underlies the projective identification.
Premise of Kohut’s Self-Psychology
Deficits in meeting a child’s needs of mirroring (infant rcvg approval and admiration from parent) and idealizing (presence of an adult worth idealizing) result in unhealthy narcissism. The therapist should provide opportunity for these needs to be met, does not work for narcissism (they are too preoccupied, can’t project)
Premise of Sullivan’s Interpersonal Theory
Identified the development of personality from emotional exchanges in a social context.
Sullivan’s three modes of existence
Protaxic: serial sensations, single, unconnected experiences. Parataxic: sequential sensations, temporal causations (hindered parataxic dvpmt is root of neurosis. Transference is a parataxic distortion). Syntaxic: Emerges around age 1. Logic and analytical thinking, language acquisition.
Klerman’s application of Interpersonal Theory to unipolar, non-psychotic depression
Aims to improve current interpersonal relationships to improve depression. Four areas addressed: grief, role disputes, role transitions, interpersonal deficits. Effective for relapse prevention
Motivational Interviewing
A client-centered, directive therapy that aims to enhance intrinsic motivation; this therapy technique is goal oriented and the primary focus is on examining and resolving ambivalence.
Erich Fromm
A neo-Freudian who believed that personality development is largely influenced by societal and economic factors and problems are the result of society preventing people from achieving their true natures.
Three notable humanistic therapies
Client-Centered, Gestalt, and Existential
Gestalt Therapy
Fritz Perls: Focus in discover/reunification of the whole self, identification and awareness of split off parts of the self, emphasizes personal accountability
Existential Therapy
Rollo May and Irvin Yalom: Client’s responsibility for finding/creating meaning and values in one’s life; addressed purpose of death, life, and limitations
Existentialism
A philosophical orientation that posits that humans are born with no inherent tendency toward good or evil, but only with the freedom to make choices that will define their essence.
Wolfgang Kohler
Key figure in Gestalt Therapy. Research surrounding insight learning with apes. Buried food too far to reach, spontaneous use of tools - sticks.
Polster and Polster’s “boundaries that hinder progress.” (Gestalt)
Projection: (Undesirable aspects of oneself results in suspiciousness). Introjection (Taking in what others say without analyzing it for oneself). Retroflection (Directing impulses, such as anger onto self). Deflection (Distancing gained thru distraction, humor, asking questions). Confluence (Seeing oneself as in-line with another, results in lack of awareness of conflicts).
Two phases of Motivational Interviewing
Increasing motivation for change (build rapport, recognize probs, explore ambivalence; useful for precontemplation) and strengthen commitment to the decision for change (goal setting, making bx plans, avoiding roadblocks to success; useful in contemplative stage).
Four principles of Motivational Interviewing
Empathy, pointing out discrepancies between values/beliefs and behaviors, accepting reluctance to change as natural (not resistance as pathology), encouraging self-efficacay.
Self-Control Training
Program developed by William Miller that was first successfully implemented with less-dependent problem drinkers; it is now used in a variety of settings, including classrooms, where the focus is placed on establishing effective self - rather than externally - controlled behavior; some techniques used to accomplish this are self-recording, self-evaluation, self-determination of contingencies, and self-instruction.
Aversive conditioning
A counterconditioning process involving the pairing of a stronger noxious stimulus with the original stimulus resulting in the stronger noxious response
Reciprocal Inhibition
Another counterconditioning technique whereby incompatible responses cannot be experienced at the same time, thus causing the stronger of the two to inhibit the weaker.
Higher-Order Conditioning
A classical conditioning concept in which an established CS is paired with a neutral stimulus, thereby acting as a US, until it elicits a UR
Shaping
Teaching a desired behavior by reinforcing behaviors that gradually approximate the targeted behavior (“successive approximation”)
Bandura’s Social Learning Theory
Learning thru observation of others; Four components: attention, retention, motoric performance, motivation. Sources of reinforcement: external, vicarious, and self-generated. Learning is separate from action and can occur without reinforcement.
Bandura’s reciprocal determinism
Cognitions, behavior and environment all influence each other
Four Assumptions of Social Learning Theory (Based on needs)
Need to establish concrete and observational goals, need to realign w/the contingencies of social reinforcement, need to model appropriate behaviors, need to establish family contracts that seek to develop normal family functioning.
Structural Family Therapy
Focuses on the reorganization of strengthening of family relational structures as the major goal of treatment.
Bowen’s Family Systems Therapy
A direct but non-confrontational approach that zeroes in on the role of the individual in the extended family system.
Interpersonal Therapy
A patient’s presenting problem is related to interpersonal difficulty and therapy is aimed at addressing four primary problems: grief, role disputes, role transitions, or interpersonal deficits
Beck’s Theory of Depression
Maladaptive cognitions and dysfunctional attitudes create a vulnerability (diathesis) that when combined with continued stress results in depression
Beck’s five common errors that can cause depressive symptoms:
Overgeneralization (neg events from one situation will happen in another), selective abstraction (focus on one aspect of situation, ignoring others), magnification (overestimating negative aspects), personalization (attribution of negative feelings of others onto oneself), and dichotomous thinking (all good or all bad judgments)
Beck’s specificity hypothesis
Different types of cognitive content develops different degrees of depressive symptoms.
Beck’s cognitive triad
Negative view of self, negative view of the world, negative view of the future
P. M. Lewinsohn
Associated with the findings that a depressed individual’s self-evaluations reflect an unbiased perception of reality and more accurately correspond with observer evaluations.
Ellis REBT: ABCs and DEFs
Activating events, Beliefs (rational or irrational attitudes about event), consequences (emotional and/or behavioral). Disputing interventions, Effective philosophy adopted, Feelings (new feelings result)
Selective Reinforcement
A behaviorist technique in which only the desired behaviors are rewarded in order to modify behavior
Rehm’s Self-Control Model of Depression
Based on Kanfer’s general model of self-regulation, which explains some bx persist in the absence of reinforcement. Depression occurs due to deficits in each of the self control process: self-monitoring, self-evaluation, and self-reinforcement. Ex. selective monitoring of negative events, little self-reinforcement for adaptive behaviors, and excessive self-punishment.
Rehm’s self-monitoring deficits include:
Attending only to negative events to the exclusion of positive ones; immediate, instead of long-term outcomes of bx.
Rehm’s self-evaluation deficits include:
Setting stringent, perfectionistic self-evaluative standards; making inaccurate and depressive attributions for one’s own behaviors
Rehm’s self-reinforcement deficits include:
Administering too few self-rewards; excessive self-administered punishment
Five step procedure for self-instruction
Therapist modeling, therapist verbalization, patient verbalization, patient silently talks through, independent task performance
Who created Self-Instruction
Meichenbaum. Goals is to build adaptive cognitions in performing tasks. It is effective testament for ADHD.
Michenbaum’s Stress-Inocculation
Modifying cognitions to be healthier, adaptive, and practical will increase more functional emotions and behaviors.
Three phases of stress-inoculation
Conceptualization (providing adaptive perspective and understanding of negative reactions to stressful events), Skills acquisition and rehearsal (teaching cts specific skills and rehearsing them), and Application and follow-through (practice of new skills in gradually more stressful situations).
Programmed learning
A training program in which the student proceeds at his or her own pace through small, increasingly difficult lessons and their accompanying tests.
Personal Construct Therapy
George Kelly. People develop constructs, which are hypotheses based on the interpretations of events that affect them. Individuals then develop a way to interact with their world, which becomes their personality. Processes are channeled by the ways we anticipate events (interact w/the world in a way congruent w/our expectations)
Kelly’s Corollaries
Eleven corollaries that explain how we interpret information, why we see the world differently and how we influence the perceptions of others. Criticized for being confusing and overly simplistic, but still well utilized
Who believed in the “person-as-scientist?”
George Kelly. Humans have the capacity for meaning making and revision of personal systems of knowing. We formulate our own hypothesis (constructs) about our life to make life meaningful and predictable. These systems of meaning are continually revised, extended, and refined.
Kelly’s Core Constructs
Non-verbalized meanings, but are critical to one’s construct systems and embody basic values, sense of self, and social embededness. Core constructs find validation in relational, family and cultural contexts.
William Glasser
Reality Therapy. Rooted in choice theory, imposes a sense of personal accountability in choice and change. Components are irresponsible fulfillment of needs results in “failure identity”. Needs: survival, power, belonging, freedom and fun.
Reality Therapy’s Primary Goal
Replace failure identity with success identity discovering responsible and effective means to satisfy needs.
Requisites for Reality Therapy
Comfortable relationship between therapist and client. Client ability/willingness to openly evaluate life to identify changes.
Feedback loops
In a form of family therapy known as cybernetics, focuses on the positive feedback loops that maintain the family’s dysfunction.
Feminist Therapy Theory
Goal is to help client become more self-defining and encompass more than just a woman’s view of the self. Focus is on mutual education and psychoeducation, egalitarian relationship, thus acknowledging inherent power differential and seeking to minimize it in the client-therapist relationship. Key issues are social context and oppression.
Feminist Therapy Techniques
Egalitarian (self-disclosure of one’s own personal experiences), Pluralism (teaching ct multiple ways to view the world), External emphasis (Stressing the oppressive aspects of reality).
Psychoanalytic Feminist Therapy
Nancy Chodorow. Freud’s assertion that the individual is born bisexual and the mother is the first sexual object. Combines feminist perspective to object-relations by proposing the child forms its ego in reaction to the dominating figure of the mother. Sons form independence easily because identify w/father. Only suffer w/dyadic relationship.
Nonsexist Therapy
Therapeutic modality that focuses on an individual’s personal responsibility and behavior. A nonsexist therapist uses empathy to foster a caring environment that will enable an individual’s ability to change. The impact of sex roles is also explored; however, social change is not part of this therapy (individual change is most important).
Nonsexist Therapy’s three distinct issues
Sexual stigma (shared society’s negative regard any non-heterosexual behavior, identity, relationship, or community), Heterosexism (societal beliefs and systems that encourage/perpetuate violence, hatred, and antipathy agains sexual minorities), and sexual prejudice (negative attitudes and belief based on sexual orientation or romantic affiliation).
Multitheoretical Psychotherapy (MTP)
Jeff Brooks-Harris. Integrate training and treatment, with the premise that thoughts, feelings and actions interact and are shaped by biological, systemic, interpersonal, and cultural contexts. Integrates cognitive, behavioral, biopsychosocial, psychodynamic, systemic, and multicultural treatment appropaches.
Self-reference
A persistent tendency to direct a discussion or the attention of others back to oneself
Response cost
An Operant Conditioning procedure in which certain responses result in the loss of a valued commodity
Thinning
A schedule of reinforcement in which there is a gradual change from continuous to intermittent reinforcement
Behavioral Family Therapy (BFT)
Modifying behaviors and improving functioning by targeting presenting symptoms. Behavior is maintained by consequences and these can be modified. Two parts: Behavioral Parent Training (BPT) and Behavioral Couple Training (BCT)
Behavioral Parent Training
Parents trained to respond to child’s behaviors with operant conditioning techniques
Behavioral Couple Training
Assesses strengths and weaknesses of parent’s interaction; teaches communication and problem-solving skills;techniques include behavior exchange procedures (partners clearly verbalize needs to one another) and contingency contracting (if you do this for me, I’ll do that for you)
Cognitive-Behavioral Family Therapy
Similar to behavioral therapy; includes an emphasis on cognition and may implement tools addressing underlying dysfunctional patterns of thoughts in the family members.
Negative feedback loop
Restores equilibrium, minimize deviation, maintain status quo
Positive feedback loop
Disrupt dysfunctional transactional patterns, help members reassess their methods of engaging, alter rules of family system
Minuchin’s structural approach
Focus on the family interrelated system, assess/changes hierarchies, boundaries, alliances/splits.
Haley’s Strategic Approach
Emphasis on family unit, assess/change hierarchies, communication, and interaction to address/resolve a presenting problem
Triangulation: Coalition
One individual colludes with another against a third. Alliances/coalitions are when groups of family members are against another member or other part of the family.
Enmeshment
Undifferentiated ego mass, which is defined by over-dependence on another family member, addressed in Bowenian family systems therapy.
Extended Family Systems Therapy
Incorporation of multiple generations and intergenerational issues
Goals and Techniques of Minuchin’s Structural Family Therapy
Goals: Altering perceptions of the problem (reframe) and enhancing adaptive patterns.
Techniques: Joining (therapist becomes “family member” to work to restructure family), Family Maps (Id’ing of boundaries, coalitions, and alignments), and Enactment/Role-plays (create boundaries that force parents to unite, demoting child from authority).
Minuchin’s “detouring”
Distress expressed through third party (often child), blaming them for negativity or uniting for the sick child.
Therapeutic double-bind
Occurs when therapist instructs the patient to behave in a way that forces him or her to either resolve the presenting problem or engage further in the therapeutic process (ex. encouraging family not to change)
Goals of Haley’s Strategic Family Therapy
Therapists track improvements and actively direct reduction in symptoms, focus on the presenting problem only (not underlying causes), behaviorally defined objectives and criteria, may utilize disruption of feedback cycles, clarification of hierarchies, and paradoxical interventions like prescribing the problem.
Premise of Haley’s Strategic Family Therapy
Directive problem-focuses approach to reduce dysfunctional, symptomatic problems in the family
According to Haley, what are the source of family problems?
Misguided solutions that create chronic problems resulting in positive feedback in the family system, structural problems with incongruous hierarchies (power and control), and functional problems with members of the system covertly protecting and maintaining symptoms in the family.
According to Haley, what do functional families do?
Have flexible problem-solving approaches, larger repertoire of problem-solving abilities, and maintain hierarchy within the family.
Differentiated
A term used by Bowen to describe the separation between intellect and emotions as well as separation of self from others
Bowenian triangles
Two family members recruit a third member to alleviate stress. The two members may be enmeshed and emotionally cut off.
Structural family therapy triangulation
Occurs when each parent demands that the child take their side against the other parent
Strategic Family Therapy triangulation
Cross-generational coalitions in which a member of one generation colludes with a member of another generation against a third member (usually a parent).
Bowenian Family Therapy: Core Concepts
Differentiation, fusion, triangulation, emotional cutoff, and family projection
Bowenian “differentiation”
How individuals view themselves objectively in the midst of intense family emotion; increasing individuation of most differentiated member may motivate individuation of other family members.
Bowenian “fusion”
Lack of maturity where emotionality overpowers objective reasoning and individual lacks individuality; results in undifferentiated; results in undifferentiated family ego mass–overdependence or enmeshment among family members
Bowenian triangulation
Two-against-one; in a conflicted dyad one member recruits a third person, which may represent an attempt to reduce stress or conflict; may result in covering-up of defusing the conflict. Multigenerational process occurs when the triangulation develops across generations–can lead to severe psychopathology
Bowenian “emotional cutoff”
Denying and isolating one’s problems from the rest of family; used to cope with unresolved attachments to their families or origin.
Bowenian family projection
Procedure in which parents come together for the sake of the child and his/her problems. The child will likely develop the problematic symptoms of his or her family.
Bowenian therapeutic interventions
Shifting the hot triangle, working with the most available family members to achieve differentiation, de-trinagulating, repairing emotional cut-offs.
Failure of Complimentarity
A term from Nathan Ackerman’s theory of family therapy from a psychoanalytical perspective; complimentarity refers to harmony in social roles in a family system.
Complimentarity
The influence that partners have on each other and their relationship so that if one changes, the other has to.
Retribalization
The first stage of network therapy; involves bringing together the client’s support system.
Interpersonal (Context) Therapy
Meeting with those of significant importance to the client
Structural Therapy
Chole Madanes: Challenging and undermining family systems in order to shock them into realigning and developing better ways of functioning.
Virginia Satir’s Key Assumptions
The presenting problem is rarely the actual problem, the real problem is how one copes with problems, change is possible, responsibility for both behaviors and internal experiences, familiarity is a driving factor in making choices for many people.
Satir’s Four Coping/Survival Stances
Placating, blaming, super-reasonable, irrelevant
Stages of Group Therapy
Forming, storming, norming (more intimacy and trust), performing (open discussion and resolution of conflicts), adjourning
Training of the person
The suggestion that the instructions given to the person during a debriefing might be the most important factor in stress debriefing
Psychological First Aid
Three goals are recreate a sense of safety, establish meaningful social connections, establish a sense of efficacy
Advocacy Consultant
Consultive approach that emphasizes social interventions. Goal is to promote social change.
Behavioral consultant
Focuses on promoting specific behavioral changes in clients
What is the key name in Mental Health Consultation?
Gerald Caplan
Client-centered case consultation
Expert assessment of a client’s problems and suggests ways to handle it
Consultee-centered administrative consultation
Focus on how consultee’s knowledge, attitudes, or behaviors affect the program
Consultee-cented case consultation
Consultant works with consulted and indirectly assists the client through the consultee
Program-centered administrative consultation
Direct assistance to the program
Theme interference
Past or present unresolved personal problems that are unconsciously projected onto work tasks
Diagnositc overshadowing
Occurs when a therapist erroneously attributes abnormal behavior to an intellectual disability
Process consultation
An organizational development technique in which a consultant facilitates the client’s ability to achieve group goals using processes such as communication, desicion-making, interpersonal relations, and task performance
Primary prevention
Programs that keep people from developing psychological disorders, and programs that foster healthy lifestyles
Secondary prevention
Works on early identification of problems to prevent them from getting worse, like and early warning system
Sue’s 1978 Minority Worldview
2x2 grid: Locus of control vs. Locus of responsibility
Sue: IC-IR
Dominant cultural view of the US, most minority groups assume the other three. Characteristically white, middle-class. Emphasis on uniqueness, individuality, independence, self-reliance
Sue: EC-ER
Poor conditions attributed to an exploitive system and inability to change it themselves (learned helplessness). May adopt “placater” attitude: going along with the system to avoid reprisal. Passivity is a form of defense. “Uncle Tom Syndrome” in AA cts (concealing feelings that are unacceptable to whites).
Sue: EC-IR
Responsible for one’s conditions, helpless to change it. Marginilization and non-belonging may lead to self-hatred largely because they feel inferior to majority and feel responsible for that position.
Sue: IC-ER
More likely to be demonstrated by minority groups that become aware of their own cultural identity and impact of racism on their lives.
Cross’ Pre-encounter
Believe world operates as being non-Black, devaluing of Black identity/idealization of whiteness, denial of racial oppression, prefer white therapists
Cross’ Encounter
Startiling personal/social event challenges previous thoughts, receptive to new frame of reference/interpretation of identity, increased racial/cultural awareness, prefer same-race therapist
Cross’ Immersion-Emersion
Race/racial identity highly salient. Immersion: Idealize blackness, immerse self in black culture, rejection of non-black values, rage toward whites. Emersion: Anger and anxiety fade, internalize a black identity
Cross’ Internalization
Internalizes elements of immersion experience, inner security, satisfaction and confidence in black identity, increased comfort with acceptance of other cultures
Cross’ Internalization-Commitment
Confidence debelops into commitment, oriented toward change for comunity, adopt one of three identities: Black nationalist identity (pro-black,non-racist), Biculturalis identity (integration of black and white/other identity), Multiculturalist identity (integration of black with multiple other). Acceptance of diverse backgrounds
Atkinson, Morten, and Sue: Minority Identity Development Model
Five stages: Conformity, dissonance, resistance and immersion, introspection, and integrative awareness
MID conformity
Self-deprecationg, group deprecation to others of same minority group, discriminatory to others in different minority grow, and group-appreciating of dominant group
MID Dissonance
Individual feels a conflict between himself and all of the other groups (same minority, other minority, dominant group)
MID Resistance and Immersion
Self-and-same-group appreciating, conflict between feelings of empathy for other minority experiences and of personal problems as a result of oppression, dominant group deprecating
MID Introspection
Concerned with basis of self-deprecation, concerned with the nature of unequivocal appreciation for the same minority group, concerned with ethnocentric basis for judging others and concerned with the basis of dominant group depreciation
MID Integrative Awareness
(prior name synergetic articulation and awareness). Self-and all-group-appreciating, with selective appreciation for the dominant group
Goal of the Minority Identity Development Model
Recognition that all cultures have some positive and some negative attributes
Helm’s White Racial Identity Model
Premise: Development of healthy racial identity depends on the racism in society. Two phase, each with three distinct statuses. Each stage has specific Information Processing Strategy (IPS)
Helm’s Phase One
Abandonment of racism. Contact status: Uncomfortable and unsophisticated relationships with people of other races or ethnicities. Racist and lack awareness of racism. IPS: Denial and obliviousness. Disintegration Status: Acknowledge “whiteness” and question long-held beliefs. IPS: Suppression of information and ambivalence. Reintegration status: Retreat from dissonance fo prior status and consciously choose racism. IPS selective perception of negative out-group distortion
Helm’s Phase Two
Establishment of non-racist white identity. Pseudo-independence status: Results from personally jarring event; questioning of previous definitions of whiteness and justifiability of racism. IPS: Selective perception and reshaping reality. Immersion-emersion: Movement away from paternalistic efforts to help other groups toward internalized desire to change oneself in a positive way. IPS: Hypervigilance and reshaping. Autonomy status: emotionally and intellectually internalize new non-racist white identity, including respect and appreciation for cultural differences. IPS: Flexibility and complexity.
Cass’ 1979 Model
First non-pathologizing model for gay and lesbian
Cass’ Confusion
Question assumptions about sexual orientation, experience turmoil, behavior is perceived as correct/acceptable, correct/undesirable, or incorrect/undesirable, may adopt strong anti-homosexual stance
Cass’ Identity Comparison
Accept the possibility that one may be gay; isolation from both gay and heterosexual people
Cass’ Identity Tolerance
Accept that they are gay and seek out gay and lesbian people; with positive experiences, feelings of isolation and self-hatred will decrease
Cass’ Identity Acceptance
Selectively reveals his or her sexual orientation; increasing interactions with other gay people is important
Cass’ Identity Pride
Experience incongruence between one’s own acceptance of identy and society’s rejection, pride in gay culture may be present or disclosure of one’s sexual orientation as a demonstration of pride.
Cass’ Identity Synthesis
Gay or lesbian matures into an overall view of self, more positive contact with members of socially dominant group develops
Sophie’s Model
First sexual identity model exclusively for lesbians: First awareness, testing and exploration, identity acceptance, identity integration
Troiden’s Model
Following Cass, a model of gay and lesbian identity development. Sensitization (consider self heterosexaul but have experiences that cause them to feel different of marginalized), identity confusion (consider the possibility that they may be gay or lesbian), identity assumption (coming out process), identity commitment or integration (individual obtains a certain level of comfort with and commitment to homosexual self-discovery
Myers’ Minority Stress Model
Argues that gay individual’s face chronic stress due to stigmatization like other minority groups
Homosexism
An ideological system that denies, denigrates, and stigmatizes among non-heterosexual forms of behavior, identity, relationships, or community sexism
Homonegativism
Any prejudicial attitude or discriminatory behavior toward homosexuals or homosexuality
Seven universal facial expressions
anger, contempt, disgust, fear, happiness, sadness, surprise
Paralinguistic communication
Nonverbal elements of communication that convey meaning
High-context communication
Relies more on nonverbal or paralinguistics. Often associated with AA and other minorities
Low-context communication
Tends to rely more on the content of the words. Often associated with Whites
Blended biculturals
View two cultures as non-conflicting and integrated
Alternating biculturals
Acknowledge American heritage, but are more influenced by their ethnic background
Bicultural identification: Separated
Distance self from their ethnic background and are more invested in developing American identity.
Autoplastic
Changing oneself (beliefs of behaviors that are contributing to distress)
Alloplastic
Changing the environment that are contributing to the distress
Etic
A description of a behavior or belief by an observer, in terms that can be applied to other cultures; that is, an etic account is culturally neutral
Emic
Behavior or belief in terms of meaningful (consciously or unconsciously) to the actor; an emit account is culture-specific
Self-Disclosure Key Figures
C.R. Ridley and Nancy Boyd-Franklin
Intercultural non-paranoia
Fairly high levels of self-disclosure
Functional paranoia
Medium levels of self-disclosure
Healthy cultural paranoia (paranorm)
Med. levels of self-disclosure
Confluent paranoia
Both cultural and pathological paranoia, present with high levels of cultural mistrust and low levels of self-disclosure as well as suspiciousness and uncooperativeness, will prefer to work with someone from same cultural background.
Split-Self Syndrome
All-good of all-bad thinking. Splits off part of self representing”African me” as it is devalued in European-American system.
Ethnographic
Research and therapeutic approach that focuses on observing human interactions in social settings and activities
In Latino-American clients, what is the strongest family bond?
Mother-son
Geriatric clients
Paranoia is relatively rare. Usually suspicion, perscutory ideation, paranoid delusions. Antipsychotics (neuroleptics) are effective in combo w/therapy.
Most common and second most common demential in elderly.
Most common is Alzheimer’s followed by Vascular Dementia
Anxiety in geriatric patients
Generally presents as fear
Psychotherapy and geriatric population
Fewer instances of mental illness in elderly than other age groups
Three common pharmocotherapy treatments for alcoholism
Acamprosate (calcium acetyl-homotaurine): Restores glutaminergic neurons to normal activity level, increases treatment completion and associated with higher abstinence rates); Naltrexone (often used in relapse prevention, improves coping with cravings and reduces use of alcohol); and Disfulfiram (a deterrent medication that involves aversive symptoms like flushing, headaches, nausea, decreased blood pressure, constriction in airways when the person consumes alcohol). Noncompliance with meds is common.
Marlatt and Gordon’s (1985) Relapse Prevention
Relapse is a common event in recovery; Increase awareness of high-risk situations; Build appropriate coping skills; Minimize negative outcomes from a relapse; Reinforce view of relapse as learning opportunity to reduce stigma/shame and encourage resumption of treatment/abstinence; Focus on relapse as a learning event, not evidence of treatment failure
What percentage of relapses are due to negative affective states, interpersonal conflict, or social pressure?
75%
Being around drinkers
Social environment can increase the likelihood or resuming consumption of alcohol and can trigger a relapse, but is less significant than negative emotions
Overconfidence in alcoholism
Believing one is impervious to cravings or social pressures and that one has “conquered” their addiction can result in engaging in risking behaviors which ultimately can trigger a relapse
Alzheimer’s stage 1
No impairment
Alzheimer’s stage 2
Very mild cognitive decline (difficult to distinguish from normal aging)
Alzheimer’s stage 3
Mild cognitive decline (early-stage AD). Family, friends, and co-workers notice changes. May be measurable with detailed clinical interview.
Alzheimer’s stage 4
Moderate cognitive decline (mild or early-stage AD). Declines evident in clinical interview. Deficits in memory for recent events, complex tasks.
Alzheimer’s stage 5
Moderately severe cognitive decline (moderate or mid-stage AD). Some assistance with ADLs required. Memory loss for personal details (phone number, address). Confusion related to time and place. Difficulty with personal history.
Alzheimer’s stage 6
Severe cognitive decline (moderately severe or mid-stage AD). Personality changes; distorted personal history; not recognize close family members, spouse or caregiver; wandering is problematic.
Alzheimer’s stage 7
Very severe cognitive decline (severe or late-stage AD); Loss or responsiveness to environment; general incontinence; abnormal reflexes; swallowing impaired.
Neurobiological correlates of AD
Plaques and neurofibrillary tangles through cerebral cortex and hippocampus in ACh neurons. ACh biggest part in early stages; serotonin, norepinephrine, and glutamate in later stages.
Parkinson’s Disease
A brain deisease affecting dopamine-producing cells that affects motor movements and commonly presents with resting tremors
Vascular Dementia
The second most common form of dementia, presents in a stage-wise decline of function due to impaired blood flow to the brain from various insults such as a stroke
HIV and aging
HIV often causes dementia in the elderly; can be mistaken as AD because of not recognizing sexual activity in elderly population; HIV proceeds to AIDS 2x as fast in elderly
What percentage of those with conduct disorder go on to develop antisocial personality disorder?
40%
Parent Management Training
Developed by Gerald Patterson for conduct disorder; Teaches parents to reinforce prosocial behaviors and use time-outs and loss of privileges for aggressive or antisocial behaviors; alters parent-child interactions; improves sibling behavior and reduces depression in mothers; reduces rates of criminal offenses. (PMT better than other techniques)
Multisystemic Treatment (MST)
For conduct disorder; intensive and comprehensive community treatment; targets adolescents, parents, school, and peers; treatment delivered at home, school, or local rec centers; emphasizes individual and family strengths; identifies context for conduct problems; interventions require daily and weekly efforts by family members
Intellectual Distortion
Client mislabeling an emotion or other experience because of underdeveloped communication skills
Psychosocial masking
Atypical behaviors due to poor social skills or life experiences that misrepresent another disorder
Baseline exaggeration
Prior to onset of disorder, there are high levels of unusual behaviors
Malingering
Exaggeration of symptoms or full fabrication of symptoms for secondary gain
Tourette’s Disorder
2+ motor tics, 1+ vocal tic, for a minimum of one year, onset prior to age 18. Most cases mild. Affects 4x more males than females; exacerbated by stress
Comorbidities with Tourette’s
ADHD - 50%; OCD - 40%; LD also common, ODD common, intellectual ability typically average or above with some knowledge of their tics
Neurological findings of Tourette’s
Reduced caudate nucleus volume, possible damage to caudate nucleus and putamen (structures of basal ganglia); overactivation of dopamine (particularly D2 receptors) appears responsible for exaggerated, isolated, or random activation of the putamen resulting in involuntary vocalizations
Dopamine agonist medication and Tourette’s
May worsen symptoms of ADHD
Primozide
A neuroleptic drug used to help reduce tics of Tourette’s Disorder
Fluoxetine
An antidepressant used to treat OCD and depression
Clonodine
A drug originally developed to treat high blood pressure; it may be helpful in controlling tics, ADHD symptoms, and for some stabilizes mood
Illusion of control
Occurs when an inflated sense of control and efficacy for completing taks helps buffer against anxiety, stress, and depression and promotes well-being
Severe manic episodes
Feature grandiose delusions or hallucinations
Medications for mania
Lithium - high risk of toxicity; anticonvulsants, such as valprioc acid and carbamazepine
Etiological Theories regarding phobias
Psychoanalytic: No difference between social or specific, anxiety is a result of repressed id impulses. Biological theory: Genes and autonomic nervous system lability cause phobias. Cognitive Theory: Specific phobias arise from classical conditioning and are maintained through operant conditioning. More difficult to treat because they arise from both cognitive and behavioral factors.
What is the first widely used behavioral treatment for phobias?
Systematic desensetization - utilizes relaxation and exposure to progressively more fearful stimuli in process known as reciprocal inhibition
Reciprocal practice
Similar to systematic desensitization that involved gradual exposures. Also engages client in other behavioral activities to overcome the fear
Interoceptive exposure
Exposure to internal cues that resemble panic-like symptoms
Meds helpful for phobias?
Benzos, antidepressants, and anxiolytics. Paroxetine (Paxil) and Gabepentin (Neurontin) indicated for social phobia.
Gender differences with Schizophrenia
Men and women get it equally, but men develop earlier (mid-20s) than women (late-20s). Women have better premorbid functioning and prognosis, display more affective symptoms, paranoid delusions, and hallucinations. Men display more negative symptoms and have worse premorbid functioning and worse prognosis
Good prognostic indicators for Schizophrenia
Paranoid type; positive symptoms
Neurotransmitter disturbances with Schizophrenia
Dopamine theory: prefrontal damage causes dopamine neurons to be under active. Serotonin, glutamate and GABA also involved.
Schizotypal Personality Disorder
Characterized by eccentric interpersonal style, magical thinking, and illusions
Schizoid Personality Disorder
Characterized by a lack of desire to form social relationships, withdrawn, secretive
Derealization
A person’s detached sense of reality from the environment
Five stages of burnout
Honeymoon, awakening, brownout, despair, hitting the wall
Three components fo burnout
Emotional exhaustion (drained by work demands), depersonalization and cynicism (treating others as objects), and low personal accomplishments or ineffectiveness (powerless, difficulty coping, difficulty understanding others’ problems)
Habituation
A decrease in responsiveness resulting from repeated exposure to a stimulus
Inhibition
The weakening of a conditioned response through extinction, and unconditioned response through habituation, or by the occurrence of a distracting stimulus.
Beck Hopelessness Scale
20-item scale; High BHS scores and high BDI-II have very high risk of suicidal ideation
Personalization
AKA attribution, it is assuming you or other directly caused things when that may not have been the case; when applied to others this is an example of blame
Watson
Known for his work in Classical Conditioning
Skinner
Most commonly associated with Operant Conditioning
Bandura
Best known for work on Social Learning Theory
Labeling
Related to overgeneralization; rather than describing the specific behavior, you assign a label to yourself or someone else that puts that person in absolute and unalterable terms
Mental filter
Focusing exclusively on particular aspects of something while ignoring the rest, usually negative or upsetting aspects are those attended to
Automatic speech
Speech that erupts involuntarily; it sometimes occurs as a consequence of senility, dementia, heightened emotional states, and in a small amount of people with Tourette’s
Functional explanation
Emotional disturbance as an imbalance within the whole organism that interferes with normal functioning
Lockean Psychology
People are born with a blank slate; all knowledge is learned; we gain knowledge through accidental associations from interactions with the physical world.
Lockean primary qualities
Sensations that correspond to physical attributes (shape, mobility, solidity)
Lockean secondary qualities
Sensations with no physical attribute, but are perceived and organized by the person, such as color, smell, and taste
Relativism
An approach to understanding human behavior that posits all human behavior is shaped by cultural patterns
Complementary Communication
Watzlawick, Beavin, and Jackson. In complementary communication, one person leads the other person. In symmetrical communication, leadership is equal and either person takes the lead.
Elaborative Rehearsal
A type of rehearsal proposed by Craik and Lockhart (1972) in their Levels of Processing model of memory. In contrast to maintenance rehearsal (which involves simple rote repetition) elaborative rehearsal involves deep semantic processing of a “to be remembered” item, resulting in the production of durable memories.
Mystification
Where a family member befuddles, confuses, or masks what is really going on, as when he or she speaks with such generalities as “the feeling just isn’t there”.
Pseudohostility
Superficial bickering that masks the real conflicts between people
Social Exchange Model
Thibaut and Kelley. Exchanges of behavior over time, whereby behaviors in one person induce corresponding behaviors in another.
Narrative Therapy
White: A theoretical approach to treatment that values the stories of experiences shared by clients
