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Clinical Psych > Clinical Psych Final (3/5/24) > Flashcards

Clinical Psych Final (3/5/24) Flashcards

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1
Q

Freud’s theories: seduction theory

A
  • saw women with ‘hysteria’ that had unexplained physical symptoms like partial paralysis, blindness and dizziness (actually PTSD symptoms)
  • assumed that they had been abused by their fathers, not well recieved by the psych ppl
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2
Q

Freud’s theories: Oedipus Complex

A
  • the women weren’t actually abused but had fantasies about their parent
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3
Q

Freud’s theories: drive theory

A

people run on basic drives and relationships are built on them

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4
Q

Freud’s theories: psychosexual stages + fixations

A
  • oral
  • anal
  • phallic (Oedipal/Electra)
  • latency (non-sexual stage)
  • genital
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5
Q

Freud’s theories: levels of consciousness

A
  • conscious mind
  • subconscious mind
  • unconscious mind (can’t access)
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6
Q

Freud’s theories: personality

A

id: pleasure principle
- primitive aggressive, sexual drives
- primary process thinking: dreams, images, instincts
- Eros: life energy
- Thantanos: death instinct
- libido

ego: reality principle
- the moderator
- secondary process: reality

superego: the ego ideal
- conscience
- guilt

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7
Q

Freud’s theories: defense mechanisms

A

1) repression - memories still in the mind but actively forgetting or not thinking about them
2) projection - putting feelings/actions onto someone else
3) reaction formation - expressing the opposite of how you feel
4) displacement/sublimation
- dis: taking the anger out of something else that is unrelated and won’t hurt the relationship
- sub: coming up with a way of protecting yourself without hurting yourself
5) regression - going backwards in development
6) rationalization
7) denial
8) identification - becoming like the thing you are having issues with

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8
Q

psychoanalysis techniques: projective assessment

A

supposed to be a clever way to draw out the unconscious and repressed memories

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9
Q

psychoanalysis techniques: free association

A
  • complete openness in therapy
    - therapist sits with their back to the patient and just has them speak
    - takes 7 years
  • view the unconscious
  • bring out the id
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10
Q

psychoanalysis techniques: transference

A
  • client projecting onto the therapist their experiences and relationships
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11
Q

psychoanalysis techniques: analysis of resistance

A
  • when you get close to the unconscious then the patient will shut down
  • might cancel sessions or abruptly start talking about something else
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12
Q

psychoanalysis techniques: well-timed interpretation

A

interpreting the client’s behavior and helping them figure out why they behave that way

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13
Q

psychoanalysis techniques: countertransference

A
  • how the therapist feels about the patient
  • therapist needs to undergo psychoanalysis as well
  • how the therapist feels about that person is often how others feel about the patient
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14
Q

psychoanalysis techniques: dream analysis

A
  • manifest: what you actually dreamed about
    vs
  • latent content: what your dream means
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15
Q

psychoanalysis techniques: secondary gain

A
  • a way to interfere with making the next step or moving on from the issues you truly have
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16
Q

psychoanalysis process

A
  • therapist as expert
  • 3-5 times a week for many years
  • therapist is neutral to promote transference
  • goals:
    - insight
    - reworking developmental stages
    - strengthening ego
    - restructuring personality
  • finishing the process
    - no more client resistance
    - indication of better functioning
    - more stable relationships
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17
Q

psychoanalysis adaptations: Anna Freud - child analysis

A
  • play therapy: giving children toys and having them play out their experiences
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18
Q

psychoanalysis adaptations: Kohut - self-psychology

A
  • narcissism
  • empathy
  • self-object: caregiver relationships affect how you feel about yourself
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19
Q

psychoanalysis adaptations: Erikson - psychosocial stages

A
  • more evidence for these than Freud’s psychosexual stages
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20
Q

psychoanalysis adaptations: object relations

A

focusing more on the actual relationship with parents and how that’s foundational to development

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21
Q

CBT: foundations

A
  • Watson, Skinner
  • Ellis: connecting btw thoughts, feelings and behavior
    • Rational Emotive CBT: stress comes from thoughts not the situation itself
  • Beck
    • automatic thoughts: ideas that just pop into someone’s mind
    • people can be trained to become more aware of them
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22
Q

CBT model

A
  • thoughts, feelings, actions/behaviors: recognizing the connection btw these and working towards positive change
  • present centered: focuses on measurable outcomes and relative progress
  • thoughts as circular
    thoughts about the world → appraisal → predictions → value judgements → thoughts about self → thoughts abt the world etc
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23
Q

types of logic flaws

A
  • overgeneralization
  • negative mental filter
  • discount the positive
  • magnifying
  • emotional reasoning
  • blame
  • labeling
  • should statements
  • all-or-nothing thinking
    - black and white: grey area = uncertainty
    - promotes feelings of failure
    - utterly obsessed or completely uninterested
  • jumping to conclusions
    - trying to fortune tell leads to catastrophizing or what if statements
    - trying to figure out exactly what’s going to happen in the future without knowing
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24
Q

CBT goals

A
  • challenge overgeneralization
  • look for contrary evidence
  • imagining life with a different filter and expand perspective
  • stay in the present
  • realize that you can’t ever really know what other’s are thinking
  • clear communication
  • identify and track bad habits
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25
Q

CBT general feelings

A
  • depression
  • anxiety
  • anger
  • compromised feelings lead to compromised decisions
  • thoughts and feelings are separate
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26
Q

CBT interventions

A
  • education
  • thought challenging
  • reframing
  • acceptance
  • distraction
  • experimentation
  • flexibility
  • positivity
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27
Q

family systems: concept

A
  • system in equilibrium
  • systems resist change: homeostasis
  • events push system into disequilibrium
    • development changes
    • life events
    • unexpected stresses or traumas
    • change by one family member
  • circular: parent relationships affect child relationships/development
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28
Q

family systems: Bowen - family origin work

A
  • people need to go back to the family origin and not just talk in therapy
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29
Q

family systems: Bowen - differentiation

A
  • balance between togetherness and individuality
  • autonomous: healthy awareness of self and separateness from family
  • undifferentiated: emotional dependence on family system
    • fusion or undifferentiated family ego mass
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30
Q

family systems: Bowen - intergenerational

A
  • patterns of dysfunction repeat across generations
  • people select partners with similar levels of differentiation (no evidence)
  • family projection: children have same level of diffentiation as parents
  • low differentiation associated with emotional distance in marriage
  • anxiety/stress from low differentiation leads to
    • marital problems
    • psychopathology
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31
Q

family systems: Bowen - triangles

A
  • model of parent-child relationships = alliance btw parents
  • dysfunctional
    • anxiety in one relationship projected onto a 3rd person
    • someone is excluded from the relationship by one of the dyads
    • alliance btw parent and child instead
    • triangulation: communication is indirect, through 3rd person
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32
Q

family systems: Bowen - process of therapy

A
  • work with individuals or couples
  • genogram or family diagram
    • 3+ gens
    • make emotional material more cognitive
    • indicate patterns: triangles/ coalitions
    • detriangulation: detachment from unhealthy patterns
  • direct communication
  • therapist role
    • guide questions to help client come to own conclusions
    • therapist must have good family relationships
    • focus on objectivity and cognitive methods
      - therapist as teacher/director
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33
Q

family systems: structural

A
  • marital relationship is primary
  • vertical parent-child
  • horizontal sibiling
  • healthy systems have appropriate alliances and coalitions
  • therapist jobs: monitor for alliances
    • joining the system temporarily
    • working with the whole system
    • alliance with the family, not individuals within
  • boundaries
    • violation of boundaries lead to issues
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34
Q

family systems: expressed emotion

A
  • families with intense exchanges of negative emotions are associated with development of psychopathology
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35
Q

Dialectical behavior therapy DBT: borderline personality disorder

A
  • not originally the reason DBT was created
  • disorder of emotional dysregulation: especially with intense emotions
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36
Q

DBT - biopsychosocial

A
  • biopsychosocial model
    • physiological: greater arousal to emotional events
    • environment further impairs the development of regulatory processes
    • maltreatment
    • trauma
    • unstable family relationships
    • invalidating environments: wide range of possibilities
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37
Q

BPD - treatment historically

A
  • historically there was no effective treatment
  • unable to access CBT bc skills were not for overwhelming emotions
  • tendency to go through many therapists because they saw relationships in black/white and quick to anger
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38
Q

DBT = zen + dialectical + behavioral therapy

A
  • zen
    • Western translation of Buddhism and Western mindfulness
    • awareness and acceptance of self: identifying judgemental thoughts
    • being in the present moment
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39
Q

DBT = zen + dialectical + behavioral therapy

A
  • dialectical
    • interconnectedness: client + therapist relationship is transactional
    • thesis, antithesis: statement and it’s opposite, synthesis: 2 seemingly contradictory statements can be true at the same time
  • balance btw acceptance and change
  • rational/logical mind → wise mind ← emotional mind
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40
Q

DBT client enhancements

A
  • enhancing client skills and capacities
  • enhancing client motivation
  • enhancing generalization
  • structuring the environment
  • enhancing therapist capacities: training and support structures
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41
Q

DBT therapies

A
  • group therapy: skills training
  • individual therapy: client motivation
  • telephone consultation: generalization
  • case management: structuring environment
  • consultation team: enhancing therapist capabilities
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42
Q

stages of DBT

A
  • pre-commitment: getting people to come, recognizing their lives need to change
  • stage 1: skill development to reduce self-ham/high risk behaviors
  • stage 2: increasing client capacity to experience full range of emotions
  • stage 3: development of self-respect
  • stage 4: resolve existential issues
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43
Q

techniques in DBT

A
  • collaborative, accepting, question asking
  • making contracts: commitments to reducing harmful behavior
  • change strategies: behavior chain analysis, making lemonade, confrontation
  • acceptance strategies
44
Q

attachment theory: Bowlby’s 44 juvenile thieves

A
  • looking at children diagnoses with conduct disorder
  • wanted to understand why they were behaving like this, found that they all had difficult relationships with their parents
  • early quality of care is critical for the development of self and regulation capacities
45
Q

attachment theory: evolutionary component

A
  • previous theories stress the importance of feeding
  • Harlow monkey studies
  • ethological theory
    • attachment promotes survival
    • attachment strategies are adaptive
    • experience expectant: everyone in the species will form an attachment
  • supportive evidence
    - cross-species data
    - deprivation studies
    - patterns found around the world
46
Q

attachment theory: cognitive component - internal working models

A

early care is important bc it helps develop expectations about self, others, relationships

47
Q

attachment theory: cognitive component - expectations

A

carries expectations forward in other relationships
- guides how children behave in relationships
- parenting becomes example

48
Q

attachment theory: cognitive component - sense of self

A
  • influences self-confidence, persistence
  • consistent with Kohut’s self-psychology
  • can also align with learned helplessness model
49
Q

attachment and secure base behavior

A
  • secure base
  • attachment: proximity seeking, contact
  • exploration
  • individual differences
    • what does infant do when distressed?
50
Q

attachment pathways: secure

A
  • parents reliably respond when baby needs something more often than not
51
Q

attachment pathways: anxious resistant

A
  • reactivity
  • clingy bc they know they need to be extra loud for their parents to help them
  • unreliable
  • results in lower self-confidence
52
Q

attachment pathways: anxious avoidant

A
  • greater levels of alienation
  • parents are neglectful of emotional needs
53
Q

attachment pathways: disorganized/insecure

A
  • dissociation
  • no coherent strategy for managing attachment
  • often found in babies who have been maltreated
54
Q

assessing attachment

A
  • infancy
    • strange situation or Q-sort

childhood
- representational measures

adolescence/adulthood
- Adult attachment interview (AAI): establish who raised them, ask them to reflect on their lives from 5-12, establish current attachment style, say 5 words that describe relationships with parent and then ask fro an example of each word

55
Q

attachment risks

A
  • relates to internalizing and externalizing behavior problem beginning in preschool
  • relates to peer relationships and social skills
  • relates to adult relationships like being a parent
56
Q

developmental psychopathology: normal and abnormal development

A
  • typical and atypical development
  • look at consequences of having it or not
  • atypical development leads to questions about typcial or normative process
57
Q

salient developmental issues of childhood: infancy

A

attachment

58
Q

salient developmental issues of childhood: early childhood

A

self-regulation
peer interaction

59
Q

salient developmental issues of childhood: middle childhood

A
  • peers/friends
  • academic competence
60
Q

salient developmental issues of childhood: adolescence

A

identity
romantic relationships
close friendships
academic competence

61
Q

salient developmental issues of adulthood: early adulthood

A

establish intimate relationships
establish work

62
Q

salient developmental issues of adulthood: middle adulthood

A

maintain intimate relationships
focus on next-generation
- peak of career
- empty nest transition

63
Q

salient developmental issues of adulthood: late adulthood

A

“legacy”
retirement
preparing for end of life

64
Q

developmental pathways: tree analogy

A

branches in the middle are more normative
the longer you wait and continue down maladaptation the harder it is to bring back

65
Q

developmental pathways: equifinality

A
  • many paths to the same outcome
  • people may have the same symptoms or disorders but not have the same path
  • how important is the path
66
Q

developmental pathways: multifinality

A
  • many outcomes from the same beginning
  • siblings have the same life situation but can end up in very different directions
67
Q

developmental pathways: outcomes as snapshots

A
  • development is always changing therefore whatever the outcome its not permanent and is subject to change
68
Q

developmental psychopathology: risk and resilience

A
  • risk factors make maladaptation more likely
  • with enough risks, development declines and positive outcomes are much less likely
  • promotive factors are the opposite of risk factors: good for everyone
  • protective factors moderate risk and create better outcomes: for those that need it most
69
Q

developmental continuity myth

A
  • development does not move in a straight line up
  • trying to identify what diagnoses look like from childhood forward
  • internalizing vs externalizing as a diagnoses approach for children
70
Q

therapy techniques for children

A
  • play
  • families
  • systemic interventions
  • use a variety of theoretical approaches
  • calibrate approach to child’s developmental level
  • medication (in some cases)
71
Q

health psychology: stress - GAS

A
  • general adaption syndrome
    • initial alarm reaction: fight/flight/freeze
    • stage of resistance: can cause physiological damage
    • stage of exhaustion: organ system break down
72
Q

health psychology: stress - individual differences

A
  • physiological
  • perceptual
  • cognitive
  • environmental
  • life history
  • stressor itself
  • racism and stress: stress equity
73
Q

health psychology: stress - psychoneuroimmunology

A
  • Yerkes-Dodson curve: brief and manageable stressors build immune functioning
    • optimal level of arousal = best performance
  • but prolonged stress exposure suppresses immune functioning
74
Q

health psychology: stress - timing

A
  • early development stress is especially disruptive
  • coping resources
  • ACEs: adverse childhood experiences
    • the higher you score on ACEs the higher chances of having mental and medical issues
75
Q

health psychology: stress - protective factors

A
  • coping strategies
    • problem-focused
    • emotion-focused
    • sharing negative feelings: to an extent, varies culturally
  • personality: optimism
76
Q

health psychology: stress - protective factors: social support models

A
  • model 1: mediator
    Social support → effective coping → wellbeing
  • model 2: direct effects
    Social support (someone to take you to the doctor) → wellbeing
  • model 3: third variable
    Social competence → social support and wellbeing
77
Q

risks for CVD

A
  • chronic stress
  • poverty
    • heightened stress
    • less healthcare resources
    • food resources
    • sedentary life
    • smoking
    • unhealthy work demands
  • racism
  • hostility levels
  • bidirectional relation btw CVD and depression
78
Q

physical consequences of resilience

A
  • Werner and Smith study in Kauai
    • studied children who were doing well after growing up in low-income and low-resourced places
    • found that those were were seemingly doing well had physical l health problems
  • “skin-deep resilience”
79
Q

psychosocial consequences of chronic illness

A
  • depression
  • anxiety
  • acting out
  • loss of social support due to compassion fatigue
  • unhealthy coping behaviors
80
Q

managing chronic illness

A
  • pain management
    • biofeedback
    • relaxation
    • CBT
    • validation and accepting the new normal
  • diabetes and cystic fibrosis
    - interventions w children to build awareness
    - adolescents at high-risk due to rebellion/body image concerns
81
Q

psychological consequences of severe physical illness

A
  • trauma model
  • five sages of grief model
  • reaching acceptance
  • coping skills
  • decision making
  • support networks
  • hospice care
82
Q

prevention/intervention: HIV

A
  • public health programs
  • prevention for tweens and teens
  • risk and transmission education
  • empowerment
  • consent
  • support groups
83
Q

long term maintenance

A
  • achieving short term improvement is easier
  • lifestyle changes beyond 1-2 years is low
84
Q

long term maintenance: health belief model and treatment adherence

A
  • perceived susceptibility to illness/severity: more likely to seek treatment if illness is more severe
  • how feasible, accessible and successful treatment is perceived
  • internal and external cues that influence health behaviors
  • demographic and personality variables
85
Q

long term maintenance: interventions

A
  • education about treatment
  • modification of treatment plan to make more realistic
  • behavior modification: reminders, contracts, relaxation and desensitization
86
Q

competence during a criminal trial

A
  • stand trial: understand proceedings and assist in defense
  • make decisions: waive right to attorney, confess
  • developmental competence
87
Q

competence during the crime

A
  • NGRI: not guilty by reason of insanity
  • GBMI: guilty but mentally ill
    • still guilty but required to get treatment while incarcerated
  • legal standard: mental illness or disability leads to lack of capacity to know actions were wrong
  • Hinckley case shifted burden of proof to defense
88
Q

dangerousness

A
  • likeness of harming others
  • likeliness of harming self
  • safety to parent
  • low base rates
89
Q

civil trials

A

torts: determine plaintiff’s psychological condition/distress
worker’s compensation claims: physical to mental, mental to mental, or mental to physical
competency evaluations to make decisions

90
Q

child custody

A
  • legal vs physical: who make decisions vs where child will live
  • joint custody is generally default
  • evaluation: appointed by judge or parent
    • GAL: guardian ad litum, when a child is appointed their own lawyer
91
Q

child custody assessment

A
  • observation of parent-child, interview family members, standardized testing
  • diagnoses for parents
  • teachers, neighbors etc, document review and full clinical history
92
Q

child custody: outcome

A
  • usually joint custody: often limited
  • best predictor of child outcomes is amount of parental conflict
  • prepare report and testify
93
Q

child protection

A
  • making the call
  • court or state appointed therapy
  • parenting assessments
  • testimony regarding best interest of the child
  • bar is low for safe parenting and high for termination
94
Q

expert witness testimony

A
  • testify about symptoms, behavior, diagnoses
  • provide assessment data
  • discuss research findings: eyewitness testimony, expertise about a diagnoses
  • explain use of testing instruments
  • ethical rules guide conclusions: direct assessment of individual
95
Q

special education law

A
  • IDEA: children with diagnoses are meant to receive extra resources
  • least restrictive environment (LRE): if children can function in general ed rather than elsewhere then they shld be placed in the least restrictive environment
  • educational vs medical diagnosis
96
Q

autopsies and profiling

A
  • help determine case of death or competency to modify a will: has questionable validity
  • some research links crimes to certain offender profiles: uncertain validity
97
Q

ethical principles: A

A

Beneficence and Nonmaleficence (A) - do no harm

98
Q

ethical principles: B

A

Fidelity and Responsibility (B0 - trustworthy and ethical in relationships

99
Q

ethical principles: C

A

Integrity (C)- accuracy, honesty, maintaining work standards

100
Q

ethical principles: D

A

Justice (D) - treatment of clients with fairness and justice

101
Q

ethical principles: E

A

Respect for People’s Rights and Dignity (E)

102
Q

ethics: confidentiality

A
  • exceptions: harm to self or others
  • children and adolescents
  • Tarasoff: if someone makes threat against someone else you have to contact that person directly if you know who they are
103
Q

ethics: assessment

A
  • must be in person (video counts), can’t be reviewing files
    • Trump and the Goldwater rule
  • in reports you have to explain what the assessment instrument tells you
  • makes limitations of data clear and what data should you include or not
  • assessments have implications for people’s lives
104
Q

boundaries

A
  • dual relationships
  • living in the community where you work
  • seeing a friend of a friend
  • what about a child’s friend
  • physical contact
105
Q

ethics: research

A
  • informed consent
  • IRB
  • who gets credit for work?
  • what conclusions can be made and shared
    • overgeneralization vs overly cautious

Clinical Psych (2 decks)

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