Clinical Psychology Flashcards
3 Levels of the Psyche in Psychoanalysis
- **Conscious: **
-thoughts, feelings, perceptions -
Pre-conscious:
-readily available to the conscious -
Unconscious:
-largest part, unavailable to conscious
-Stores threatening experiences
What is the goal of Freudian Psychoanalysis?
To bring the unconscious to the conscious
Structure of Psyche in Freudian Psychoanalysis
Ego:
-operates with reality
-works on all 3 levels of consciousness -Secondary processing
**Id: **
-impulsive, biological, pleasure seeking
-Primary processing
**Superego: **
-originates through internalized parental values
-Tries to moderate the Ids impulses
-Works on all three levels of consciousness
9 of them
Types of Freudian Defense Mechanisms
- Repression
- Denial
- Reaction Formation
- Rationalization
- Sublimation
- Unconscious employed to ‘solve’ problem
- Projection
- Sublimation
- Regression
Riley Doesn’t React Rationally Sometimes Until Projecting Sexual Rage
What does Freudian Analysis Target in Sessions?
- Transference/Countertransference
- Free association
- Resistance
- Dreams
-Therapist interprets
CCIW
Techniques Used in Freudian Analysis
- Confrontation
- Clarification
- Interpretation
-Links conscious to unconscious
-Leads to catharsis - Working through
-Assimilating new insights
Jungian Structure of the Psyche
-
Conscious
-Inner experiences we’re aware of -
Personal Unconscious
-Repressed memories
-Complexes that influence behaviour -
Collective Unconsious
-Wisdom shared by all people
-Passed generationally
-Archetypes: universal mental structures that predispose us to react in certain ways
Types of Jungian Archetypes
- Cultural symbols
- Persona: social mask
- Shadow: exiled parts
- Anima/Animus: masc/femme energy
MBTI
Jungian Personality Traits
- Introversion: direct energy inward
- Extraversion: direct energy outward
-
Personality functions:
* Sensing
* Thinking
* Feeling
* Intuiting
Techniques of Jungian Analysis
- Transference
- Active Imagination
- Dream interpretation
Goals of Jungian Analysis
2 of them
- Make the unconscious conscious
- Individuation: integration of the conscious and unconscious
What is the main component of Adlerian Psychology?
No elaboration, just singular answer
Style of Life
What is Style of Life?
- Innate social interest
- Ways that people strive for superiority
- Healthy or Mistaken SOL
- Influenced by first 5 years of life
Describe Healthy Style of Life
Have goals for personal accomplishment that are balanced with goals for the welfare of others
Describe Mistaken (unhealthy) Style of Life
- Overcompensation for feelings of inferiority
- Goals are self centred
Goals of Adlerian Therapy
Shift mistaken SOL to healthy SOL
3 Phases of Adlerian Therapy
- Rapport building
- Exploring development of SOL
- Develop social interest
Strategies used in Adlerian Therapy
- Early recollections
- Dream interpretation
- Encouragement
- Modelling
- ‘Prescribing the Symptom’
- ‘Acting As If’
Who can Adlerian Therapy be used with?
5 groups
- Individual
- Group
- Family
- Parent Training
* Systematic Training for Effective Parenting (STEP) - Teaching Training
* STET (teacher)
Who are the Neo-Freudians?
3 of them
-
Erich Fromm
* Character styles -
Karen Horney
* Basic anxieties, attachment coded -
Harry Sullivan
* 3 modes (PPS) basically development stages
Karen Horney’s Ideas
- Basic Anxieties: helplessness and isolation
-
Interpersonal Coping:
* Move towards
* Move against
* Move away
Healthy=use all three. Neurotic=use one
Receivers Exploit Hores Moving Product
Erich Fromm
Character styles (5), view of humanness
Theme: society impedes us recognizing our nature
5 Character Styles:
* Receptive
* Exploitative
* Hoarding
* Marketing
* Productive (only this one lets us see true nature)
Harry Sullivan’s Developmental Modes
- Protaxic Mode: no differentiation between self and external world. Pre-symbol
- Parataxic Mode: Private symbols. Differentiate some experience. Can see connections between events
- Syntaxic Mode: use symbols with shared meaning. Logical thought. Early distortions here cause neuroticism
How did Neo-Freudians Differ from Freudian’s?
Less focus on instinctual drives
Focus on social and cultural contributors
Anna Fried Erik Dipped in Heinz Ketchup
Who were the Ego Analysts?
4 of them
- Anna Freud
- Erik Erikson
- David Rappaport
- Heinz Hartmann
Ego Analyst’s View of Ego
Ego Autonomous Functions: non-conflict focused. Learning, memory, comprehension, perception
Ego Defensive Functions: resolution of internal conflicts
Focus on current experience
Pathology: Ego loses autonomy from Id
Focus of Object Relations Therapy
Therapeutic relationship
Reparenting
Use: empathy, support, acceptance
Techniques of Object Relations Therapy
- Resistance
- Transference
- Dream interpretation
What Causes Psychopathology in Object Relations Theory?
Problems with separation-individuation
Mahler’s 3 Stage Model of Object Relations
-
Normal Autistic Stage:
* aware only of self -
Normal Symbiotic Stage:
* aware of ext environment, but no distinguish self from others -
Separation-Individuation:
* Differentiation
* Practicing
* Rapprochement
* Beg. of object constancy
What are the Humanistic and Existential Therapies?
4 of them
Person centred therapy (Rogers)
Gestalt therapy (Perls)
Existential therapy (Yalom)
Reality therapy (Glasser)
Goal of Person Centred Therapy
Increase congruence and a flexible self-concept
Theme of Person Centred Therapy
All humans have a self actualizing tendency
Techniques and 3 Core Conditions of Person Centred Therapy
Empathy
Congruence of therapist
Unconditional positive regard
What is Incongruence within Person Centred Therapy?
- Discrepancy between self and experience
- Psychological maladjustment: distort/deny experience rather than be open
- May occur when conditional worth is put upon a child
Goal of Gestalt Therapy
Increase self-awareness and accountability for ones thoughts, feelings and actions
Gestalt Therapy: What is a Boundary Disturbance?
When an imbalance is created during the persons striving for homeostasis
Gestalt Therapy: What causes maladjustment?
Being unable to get a need met due to a barrier
Gestalt Therapy: Techniques
- “I” Statements
- Empty Chair
- Dream Work
CRIP D
Gestalt Therapy: Types of Boundary Disturbances
5 of them
-
Projection
* put unwanted parts on others -
Introjection
* take on others thoughts/beliefs -
Deflection
* avoid direct contact w/ others -
Confluence
* blurred separation of self and others -
Retroflection
* Do to self what you would like to do to other
Theme of Existential Therapy
Behaviour, feelings, personality a result of struggles with fears of: death, isolation, meaninglessness, freedom, responsibility
Types of Anxiety in Existential Therapy
2
Existential Anxiety: inevitable. must learn to cope with it to live
Neurotic Anxiety: out of proportion, sense of loss of free will, low accountability
Reality Therapy: 5 Basic Needs
- Survival
- Love & belonging
- Power
- Fun
- Freedom
Reality Therapy: Success Identity
Needs are met responsibly and do not infringe on rights of others
Reality Therapy: Failure Identity
Needs not met responsibly, harm self and others
Very Solution Focus Like
Reality Therapy: Techniques
6 CHIM RC
- Instruction
- Modelling
- Roleplay
- Contracts
- Confrontation
- Humour
Reality Therapy: Stages
WDEP
W: ID the wants, needs, perceptions
D: ID what they doing, clarify wanted direction
E: Engage in critical self-evaluation. Are my behaviours effective?
P: Plan for improvement and commit to change
What are the Cognitive Therapies?
6
- Beck’s CBT
- Ellis’s REBT
- Michenbaum’s Stress Inoculation Training
- Self Instructional Training
- Problem Solving Therapy
- Biofeedback
Beck’s CBT: 3 types of cognitions
- Automatic Thoughts: lead to dysfunctional behaviour
- Schemas: core beliefs, adaptive or maladaptive
- Cognitive Distortions
Beck’s CBT: What are the cognitive distortions?
5 SOAP D
- Arbitrary reference
- Selective abstraction
- Overgeneralization
- Personalization
- Dichotomous
Beck’s CBT: Techniques
7 of them (BASTRRR)
- Reality testing
- Reattribution
- Redefining
- Thought recording
- Socratic questioning
- Activity scheduling
- Behavioural rehearsal
REBT
Alphabet
A: activating event
B: belief about event
C: emotional/behaviour consequence of that belief
D: Dispute irrational belief
E: Effective, rational beliefs
REBT: Types of Irrational Beliefs
3
- Awfulizing
- “I can’t stand its”
- Damnation of self, others and world
Stress Innoculation Training: Goals
Michenbaum
- Skills training and modification of maladaptive cognitions
- Managing mild stress will improve ability to manage higher stress
Stress Inoculation Training: Phases
3
- Conceptualization: educate about stress and role of perceptions
- Skills Acquisition: Teach coping skills
- Application & Follow Through: imagination and then in-vivo. Slowly increase intensity
Stress Inoculation Training: what does it treat?
Primarily used for PTSD
Self Instructional Training: 5 Steps
- Cognitive Modeling
- Overt External Guidance
- Overt Self Guidance: do while voicing instructions
- Faded Overt Self Guidance: does task while whispering instructions
- Covert Self Instructions: client does while internally repeating instructions
Problem Solving Therapy: Theme and Goal
Mental health struggles related to low social problem solving skills
Goal: Define problem, apply rational problem solving
Types of Biofeedback
3
- Electromyography: muscle tension
- Electroencephalogram: brain wave
- Thermal: skin temperature
Family Therapies: What are they based on?
- Systems Theory
- Communication Theory
Systems Theory: Homeostasis
Tendency of systems to maintain state of stability
Systems Theory: Negative feedback
Information/actions that maintain the status quo
Systems Theory: Positive Feedback
Information/actions that cause deviation and lead to instability and change
Systems Theory: Equinfinality
Use of different theoretical orientations/strategies often results in similar outcome
Bowen’s Extended Family Systems Therapy
- Family is an emotional system
- Differentiation of self
- Multigenerational transmission
- Genograms common
- Emotional transmission
Systems Theory: Equipotentiality
Things with similar origins can travel different paths (e.g. siblings in same environment turn up differently)
Bowen’s 8 Concepts of Emotional Transmission
- Triangles
- Differentiation of self
- Nuclear family emotional process
- Family projection process
- Multigenerational transmission process
- Emotional cutoff
- Sibling position
- Societal emotional process
Minuchin’s Structural Family Therapy
- Boundaries
- Coalitions
- 4 stages
Structural Family Therapy: What are the 4 stages?
- Joining
- Formulation
- Exploring the past
- Restructuring together
Structural Family Therapy: what is a healthy family?
Balance between cohesion and individuation
Communications Theory
What is it? 4 types of comm.
- Patterns of interactions shape function of system
- Double Bind Comm: receives contradictory information but can’t comment on it
- Symmetrical Interactions: equality, lead to competition and conflict
- Complementary Interactions: inequality
- Levels of Comm: report and command levels
Post Modernism
Reality is created through social interaction. Therapy is a creative process, where the therapist helps clients construct new realities
Extended Family Systems Therapy: Techniques
- Genograms
- Process questions
- Relationship experiments
- Therapist has low emotional involvement
Structural Family Therapy: Types of boundaries
- Clear
- Rigid
- Diffuse
Structural Family Therapy: types of rigid family triads
-
Triangulation
2.** Detouring**: reinforce kids behaviour to distract from other problems - Stable Coalition: one member always ganged up on
Structural Family Therapy: Techniques
RUBE
- Enactment
- Reframing
- Boundary marking
- Unbalancing: taking the side of a scape goated member
Strategic Family Therapy: Views
Communication and power are key
Power hierarchies are required
Strategic Family Therapy: Goals
Change problematic interaction patterns
Strategic Family Therapy: Techniques
- Direct Directives: instructions that family agree to follow
- Indirect Directives: try to influence behaviour without instruction
- Paradoxical Intervention
Strategic Family Therapy: Intake session goals
- Social:speak to everyone
- Problem: ask questions about it
- Interaction: ask family members to discuss it, observe
- Goal setting
- Task setting
Milan Family Therapy: Unique qualities
- Team of 4 therapists
- Meet once per month, ~10 times
Milan Family Therapy: steps of session
- Pre-team talk
- Interview w/ family
- Team discussion
- Conclusion + task set
- Post discussion, next session plan
Milan Family Therapy: Techniques
- Hypothesizing
- Neutrality: of therapist
- Circular Questioning: introduce new info
- Positive Connotation: reframe, focus on need beneath behaviour
- Paradoxical Prescriptions
- Family Rituals: aim to disrupt the game
Solution Focused Therapy: the process
- Client describes the problem
- Collaborate on realistic goals
- Explore the exceptions
- Therapist feedback on how client could proceed
- Evaluate progress and next steps
Solution Focused Therapy: Techniques
- Exception questions
- Miracle question
- Scaling questions
- Formula first session task (e.g. HW-what is happening that you would like to continue?)
Multimodal Therapy: what is it?
-Developed by Lazarus
-Humans are biological beings that think, feel, act, sense, imagine and interact
-Seeks to reduce suffering as rapidly as possible
Multimodal Therapy: BASIC ID
- B: behaviour
- A: affect
- S: sensation
- I: imagery
- C: cognition
- I: interpersonal relationships
- D: drugs, diet, exercise
Multimodal Therapy: techniques
- Tracking: ‘firing’ order that leads to the problem
- Bridging: start with preferred of BASIC ID and build to least preferred
Transtheoretical Model: what are the stages?
- Pre-contemplative
- Contemplative
- Preparation
- Action
- Maintenance
- Termination
Transtheoretical Model: what 3 factors affect change?
- Decisional balance
- Self-efficacy
- Temptation
Motivational Interviewing: what is the goal?
To resolve ambivalence about change
Motivational Interviewing: 4 principles of treatment
- Empathy for the ambivalence
- Develop discrepancy by sitting w/ contradictions
- Roll with ‘resistance’
- Support self-efficacy
OARS
Motivational Interviewing: strategies
- O: open ended questions
- A: affirmations
- R: reflective listening
- S: summaries that support change
Interpersonal Psychotherapy: what type of approach is it?
- Biopsychosocial
- Manualized
- Developed for depression
- Focus on interpersonal triggers
Interpersonal Psychotherapy: the 4 problem areas
- Role transitions
- Role disputes
- Interpersonal deficits
- Complicated grief
Interpersonal Psychotherapy: 3 stages
- Diagnosis, interpersonal context
- Strategies for problem areas
- Review progress, relapse prevention
Group Therapy: considerations prior to starting
- Premature termination: screen for risk
- Group composition: similar people or different?
- Entry: closed/open, exclusion criteria?
- Group size: 7-10 is ideal
- Concurrent joint and individual?
Stages of Group Therapy (Yalom’s)
- Forming: orientation. norms and rules discussed
- Storming: transition. Anxiety, conflict as members test group rules/norms
- Norming: cohesive. group specific standards developed
- Working: performing. experiment w/ new ideas/behaviours. egalitarianism develops.
- Adjourning: termination. Review progress/learning, grieve the loss
Yalom’s Therapeutic Factors (11)
Cathy Existed Completely In Underwear Impartial About Correct Socialization In Idaho
- Catharsis
- Existential
- Cohesiveness
- Install hope
- Universality
- Impart info
- Altruism
- Corrective experience
- Social skills
- Imitative behaviour
- Interpersonal learning
Feminist Therapy: Goal
Empowerment of the individual and transformation of society
Feminist Therapy: techniques (6)
PASS CG
- Gender role analysis
- Power analysis and intervention
- Consciousness raising
- Assertiveness training
- Self-disclosure
- Social activism
Self-In-Relation Theory: What is it?
- A blend of feminist and object relations
- Girls identities form w/i relationship with mothers, boys with fathers
Etic: definition
People from all cultures are the same and therapy approaches can apply to everyone
Emic: definition
People from different cultures differ in important ways
Therapy approaches should be tailored
Cultural Encapsulation: definition
A counsellors inability to work well with people from different cultures
These counsellors lack awareness and think their way is right
Worldview: definition
- How people perceive, evaluate and react to situations
- 2 dimensions: Locus of control and Locus of responsibility (internal or external)
Acculturation: definition
Process of adaptation that happens when cultures come into contact
Berry’s Model of Acculturation
2 dimensions; 4 types
Two dimensions: retention of own culture; adoption of majority culture
Types:
1. Integration orientation: retain + adopt
2. Assimilation orientation: reject + adopt
3. Separation orientation: retain + reject
4. Marginalization orientation: reject + reject
Healthy Cultural Paranoia: definition
Distrust but it’s a normal response to systemic injustice
*Name the reality of your racial differences
Cultural Communication Styles: 2 types
- High-Context: relies on cultural meaning and is largely non-verbal
- Low-context: relies on verbal
Diagnostic Overshadowing: definition
Attributing mental health symptoms to an aspect of a persons identity
Racial/Cultural Identity Development: the 5 stages
CDR II
Atkinson, Morten, Sue
- Conformity: prefer dom culture
- Dissonance: recognize that not all of dom cultural is beneficial
- Resistance & Immersion: reject dom culture, prefer own
- Introspection: conflict due to rigid stance. question black and white attitude towards both cultures
- Integrative Awareness: resolve conflict, appreciate aspects of both cultures
Cross’s Black Racial Identity Development: 5 stages
- Pre-encounter: prefer white
- Encounter: start to challenge white culture
- Immersion-Emersion: dislike white, like black
- Internalization: security around identity, dislike towards white less
- Internalized-Commitment: internalized black identity, committed to activism
Helm’s White Racial Identity Model: 2 stages, 3 sub-stages each
-
Abandonment of Racism:
-Contact w/ racialized
-Disintegration: aware of inequality
-Reintegration: conflict resolved by adopting white superiority -
Nonracist White Identity
-Pseudo-independence: dissonance, but perpetuates racism
-Immersion-Emersion: what does it mean to be white and ant-racist?
-Autonomy: see pros and cons of whiteness. not threatened by difference.
Troiden’s Model of Homosexuality Development: 4 stages
Yesss (Siii)
- Sensitization: pre-puberty, feel different than others
- Identity Confusion: mid adolescence, noticing some same-sex attraction
- Identity Assumption: ‘tolerate’ their orientation
- Identity Commitment: internalize their identity
3 Levels of Prevention in Clinical Psych
- Primary: preventative
- Secondary: prevent from becoming a disorder
- Tertiary: relapse prevention
4 Types of Mental Health Consultations
- Client centered
- Consultee Centered: skill feedback
- Program Centered Admin: evaluate program
- Consultee Centered Admin: work w/ admins to improve
Behaviour Consultation: 4 stages
- Problem ID
- Problem analysis
- Treatment implementation
- Treatment evaluation
What is an Advocacy Consultation?
Consult to support a marginalized group by supporting them in how to advocate for their needs and negotiating with systems
3 types of health care systems
- Beveridge Model: public
- Private
- Bismarck Model: hybrid of both
What is the Cycle of Violence in DV?
- Tension Building: verbal abuse, strain
- Acute Battering: violence happens
- Loving Contrition: remorseful, promises change
4 Commonalities of Effective Therapy
- Extra-therapeutic factors: 40%, client characteristics
- Relationship: 30%
- Expectancy: 15%
- Techniques: 15%
Types of Therapy Research: Efficacy and Effectiveness
- Efficacy: RCT’s, maximizes internal validity but limits external validity
- Effectiveness: Done in ‘real world’. Extraneous variables a concern. Low internal validity, high external validity
5 Types of Data Collection for Assessments
- Self-report
- Interviews
- Multi-informant
- Direct observation
- Psychophysiological
Minnesota Multiphasic Personality Test
567 T/F questions; 10 clinical scales; 9 validity scales
Clinical scales:
1. Hypochondriasis
2. Depression
3. Hysteria
4. Psychopathic
5. Masc/femme
6. Paranoia
7. Psychosthenia
8. Schizophrenia
9. Hypomania
10. Social introversion
The Big 5: NEO-PI-3
O-openness
C-conscientiousness
E-extroversion
A-agreeableness
N-neuroticism
Strong-Campbell Interest Inventory
describe what it’s for, what it looks at
Career counselling
Looks at interests, occupational scales, personal style scales
Kuder Occupational Interest Survey
100 items, choose preferred activities from list of options
4 scales:
1. occupational
2. college major
3. vocational interest estimates
4. dependability indices
Holstead-Reiton Neuropsych Battery
-Assesses the condition and functioning of the brain, including the type and location of brain injury
-Ranges from normal functioning to severe impairment
-Measures 9 things:
1. laterality
2. psychomotor
3. sensory-perceptual
4. speech-language
5. visual-spatial
6. abstract reasoning
7. mental flexibility
8. attention
9. concentration
Luria-Nebraska Neuropsych Battery
Localizes brain dysfunction
11 scales:
1. motor
2. rhythm
3. tactile
4. visual
5. receptive speech
6. expressive speech
7. writing
8. reading
9. arithmetic
10. memory
11. intellectual processes
Bender Visual-Motor Gestalt Test
Looks at school readiness and LD’s
Visual motor integration skills ages 4-85
Stimulus card w/ a design, must replicate
Doesn’t directly screen for brain damage
Benton Visual Retention Test
Identifies brain damage in people 8+
Reproduce patterns from memory
Assesses:
1. visual perception
2. visual memory
3. visual-motor skills
Beery-Buktenica Developmental Test of Visual-Motor Integration
-Screens for visual-motor impairments that can cause learning and behavioural problems, also monitors progress of impairment
-Used on 2+
-Replicate increasingly complicated patterns
Wisconsin Card Sorting Test
- 6.5-80yo
- 4 stimulus cards & 64 response cards; must sort correctly based on external feedback
- Ability to form abstract concepts and shift cognitive strategies
- Screens for frontal lobe damage
- Low scored linked to Autism, depression, alcoholism, schizophrenia, malingering
Stroop Color-Word Interference
Tests for:
1. Cognitive flexibility
2. Selective attention
3. Processing speed
Low score linked to ADHD, depression, mania, schizophrenia
Tower of London
- Move 3 discs across pegs to match a picture
- Tests higher order executive functioning & working memory
- Low w/ frontal lobe damage, ADHD, Autism, depression
Mini Mental State Exam
Assesses for cognitive impairment
11 questions:
1. orientation
2. registration
3. attention
4. calculation
5. recall
6. language
7. visual construction
Score of 24 or less = cognitive impairment
Glasgow Coma Scale
Levels of consciousness following brain injury:
1. eye opening
2. motor response
3. verbal response
Rancho Los Amigos Scale of Cognitive Functioning
Tracks improvements in cognitive functioning following a head injury
10 pt scale used to measure
Beck Depression Inventory
21 items; ages 0-63
Lower scores = lower depression
Beck Hopelessness Scale
20 T/F items re: attitudes about future
For ages 17-80
Symptoms Checklist 90
90 items; 13+
Tests:
1. Somatization
2. Depression
3. Anxiety
4. Hostility
Indices:
1. Overall distress
2. Intensity of symptoms
3. No. of symptoms
Child Behaviour Checklist
Looks at externalizing and internalizing behaviours in kids and teens
Scales for parents, teachers, self-report, interview