Clinical Psychology

Question 1

Acculturation (Berry)

Answer 1

According to Berry, a person’s level of acculturation can be described in terms of four categories that reflect the person’s adoption of his/her own culture and the culture of the dominant group (i.e. integration, assimilation, separation, or marginalization)

Question 2

Acupuncture

Answer 2

Acupuncture is a traditional Asian method for restoring health and involves stimulating specific anatomical points on the body, usually with a thin metallic needle. The traditional explanation for its effects is that illness is due to a blockage of qui (vital life energy) and that acupuncture unblocks the flow of qi along the pathways through which it circulates in the body. Research suggests that its benefits may be due to the release of pain-suppressing substances or to an alteration in blood flow in areas around the needle in certain regions of the brain

Question 3

Adler’s Individual Psychology (Teleological approach, style of life)

Answer 3

Adler’s personality theory and approach to therapy stress the unity of the individual and the blief that behavior is purposeful and goal-directed. Key concepts are inferiority feelings, striving for superiority, and style of life (which unifies the various aspects of an individual’s personality). Maladaptive behavior represents a mistaken style of life that reflects inadequate social interest. Adler’s teleological approach regards behavior as being largely motivated by a person’s future goals rather than determined by past events

Question 4

Alloplastic vs. Autoplastic interventions.

Answer 4

In the context of psychotherapy, alloplastic and autoplastic refer to the focus of an intervention with regard to the environment.

The goal of an alloplastic intervention is to make changes in the environment so it better accommodates the individual

The goal of an autoplastic intervention is to change the individual so that he/she is better able to function effectively in his/her environment

Question 5

Black Racial (Nigrescence) Identity Development Model

Answer 5

Cross’s Black Racial Identity Development Model consists of four stages

• During the pre-encounter stage, race and racial identity have low salience
• In the encounter stage, the person has greater racial/cultural awareness and is interested in developing a Black identity
• In the immersion/emersion stage, race and racial identity have high salience and the person moves from intense Black invovlement (immersion) to strong anti-White attitudes (emersion).
• Finally, during the internalization stage, race continues to have high salience and the person adopts an Afrocentric, biculturist, or multiculturist orientation

Question 6

Communication/Interaction Family Therapy (Symmetrical vs. Complementary Communication)

Answer 6

The communication/interaction approach is associated with Jackson, Satir, Haley, and others and focuses on the impact of communication on family and individual functioning. It distinguishes between two communication patterns: Symmetrical communication occurs between equals but may escalate into a competitive one-upsmanship game, and complementary communication occurs between individuals who are unequal and emphasizes their differences

Question 7

Cultural competence

Answer 7

Sue and Sue (2003) describe cultural competence as involving three competencies: the therapist’s awareness of his/her cultural assumptions, values, and beliefs; knowledge about the worldviews of culturally diverse clients; and skills that enable him/her to provide interventions that are appropriate and effective for culturally different clients

Question 8

Cultural encapsulation (Wrenn)

Answer 8

Culturally encapsulated counselors interpret everyone’s reality through their own cultural assumptions and stereotypes and disregard cultural differences and their own cultural biases

Question 9

Cultural vs. functional paranoia (Ridley)

Answer 9

Ridley described nondisclosure by African American therapy clients as being due to two types of paranoia:
A client is exhibiting cultural paranoia (which is a healthy reaction to racism) when he/she does not disclose to a white therapist due to a fear of being hurt or misunderstood. A client is exhibiting functional paranoia (which is due to pathology) where he/she is unwilling to disclose to any therapist, regardless of race or ethnicity, as a result of mistrust and suspicion

Question 10

Cybernetics (Positive and negative feedback loops)

Answer 10

Cybernetics is concerned with the communication processes and distinguishes between negative and positive feedback loops.

A negative feedback loop reduces deviation and helps a system maintain the status quo, while
A positive feedback loop amplifies deviation or change and thereby disrupts the system

Question 11

Diagnostic Overshadowing

Answer 11

Diagnostic overshadowing was originally used to describe the tendency of health professionals to attribute all of a person’s pscyhiatric symptoms to his or her intellectual disabilities. Subsequent research found that diagnostic overshadowing also applies to other conditions and diagnoses

Question 12

Double-Bind Communication

Answer 12

As originally defined by Bateson, Jackson, Haley, and Weakland (1956), double-bind communication is an etiological factor for schizophrenia and involves conflicting negative injunctions (e.g. do that and you’ll be punished” and “don’t do that and you’ll be punished”- with one injunction often being expressed verbally and the other nonverbally. In addition, the recipient of the contradictory injunctions is not allowed to comment on them or seek help from someone else

Question 13

Efficacy vs. Effectiveness Research

Answer 13

An ongoing debate on psychotherapy outcome research is over the best way to evaluate the effects of psychotherapy. On one side of the argument are experts who support efficacy studies (clinical trials); on the other are those who prefer effectiveness studies, which are correlational or quasi-experimental in nature

Question 14

Emic vs. Etic Orientation

Answer 14

Emic and etic refer to different orientations to understanding and describing cultures.

An emic orienation is culture-specific and involves understanding the culture from the perspctive of members of that culture.

An etic orientation is culture-general and assumes that universal principles can be applied to all cultures

Question 15

Extended Family Systems Therapy (Differentiation, Emotional Triangle, Genogram)

Answer 15

Bowen’s approach to family therapy extends general systems theory beyond the nuclear family. Key terms include differentiation of self and emotional triangles:- Differentiation refers to a person’s ability to separate his/her intellectual and emotional functioning, which helps keep the person from becoming “fused” with the emotions that dominate the family. An emotional triangle develops when a two-person system attempts to reduce instability or stress by recruiting a third person into the system. Therapy often begins with the construction of a genogram, which depicts the relationships between family members, the dates of significant life events, and other important information. The therapist often sees two family members (spouses) and forms a therapeutic triangle in which the therapist comes into emotional contact with the family members but avoids becoming emotionally triangled. The goal is to increase the differentiation of all family members.

Question 16

Existential Therapy

Answer 16

The existential therapies are derived from existential philosophy and share an emphasis on personal choice and responsibility for developing a meaningful life. They describe maladaptive behavior as the result of an inability to cope authentically with the ultimate concerns of existence- i.e. death, freedom, existential isolation, and meaninglessness

Question 17

Eysenck

Answer 17

British psychologist known for his factor analysis of personality traits, contributions to behavior therapy, and 1952 review of psychotherapy outcome studies in which he found that 72% of untreated neurotic individuals improved without therapy, while 66% of patients showed a substantial decrease in symptoms. Based on these findings, Eysenck concluded that any apparent benefit of therapy is due to spontaneous remission

Question 18

Feminist Therapy (Nonsexist Therapy, Self-in-relation Theory)

Answer 18

Feminist therapy is based on the premise that “the personal is political.” It focuses on empowerment and social change and acknowledges and minimizes the power differential inherent in the client-therapist relationship. Self-in-relation theory applies feminism to object relations theory and proposes that many gender differences can be traced to differences in the early mother-daughter and mother-son relationship. Feminist therapy must be distinguished from nonsexist therapy, which focuses more on the personal causes of behavior and personal change.

Question 19

Freudian Psychoanalysis (Defense mechanisms, analysis)

Answer 19

According to Freud, when the ego is unable to ward off danger (anxiety) through rational, realistic means, it may resort to one of its defense mechanisms (e.g. repression, reaction formation) which share two characteristics: They operate on an unconscious level and they serve to deny or distort reality. In psychoanalysis, the analysis of free associations, dreams, resistances, and transferences consists of a combination of confrontation, clarification, interpretation, and working through.

Question 20

General Systems Theory

Answer 20

General systems theory defines a system as an entity that is maintained by the mutual interactions of its components and assumes that the actions of interacting components are best understood by studying them in their context. Consistent with general systems theory, family therapists view the family as primarily an open system and continuously receives input from and discharges output to the environment and is adaptable to change. This influence of general systems theory on family therapy is evident in the concept of homeostasis, which is the tendency for a family to act in ways that maintain the family’s equilibrium or status quo

Question 21

Gestalt Therapy (Boundary Disturbance, transference, awareness)

Answer 21

Gestalt therapy views “awareness” (a full understanding of one’s thoughts, feelings, and actions in the here-and-now) as the primary curative factor and defines neurosis as a “growth actions in the here-and-now) as the primary curative factor and defines neurosis as a “growth disorder” that is often attributable to a boundary disturbance (e.g. introjection) that leads to an abandonment of the self for the self-image. Gestaltians regard a client’s transference to be counterproductive and respond to it by helping the client recognize the difference between his/her “transference fantasy” and reality.

Question 22

Group Therapy (Formative stages, cohesiveness, premature termination)

Answer 22

According to Yalom, therapy groups typically pass through three formative stages;

(1) orientation, participation, search for meaning, and dependency
2) conflict, dominance, and rebellion
3) development of cohesiveness

Yalom describes cohesiveness as the most important curative factor provided by group therapy and the group therapy along for the therapist-client relationship in individual therapy. He proposes that prescreening of potential group members and post-selection preparation can reduce premature termination from group therapy and enhance therapy outcomes.

Question 23

Health Belief Model

Answer 23

The health belief model proposes that health behaviors are influenced by

1) the person’s readiness to take a particular action, which is related to his/her perceived susceptibility to the illness and perceived severity of its consequences
2) the person’s evaluation of the benefits and costs of making a particular response
3) the internal and external “cues to action” that trigger the response

Question 24

High vs. Low-context communication

Answer 24

Members of many culturally diverse groups in America exhibit high-context communication, which relies on shared cultural understanding and nonverbal cues. It helps unify a culture and is slow to change.

In contrast, Anglos are more likely to exhibit low-context communication, which relies primarily on the verbal message, is less unifying than high-context communication, and can change rapidly and easily. Differences in communication style can lead to misunderstanding in cross-cultural therapy.

Question 25

Homosexual (Gay/lesbian) identity development model

Answer 25

Troiden’s (1988) model of homosexual identity development distinguishes between four stages:

• sensitization/feeling different
• self-recognition/identity confusion
• identity assumption
• commitment/identity commitment

Question 26

Howard and colleagues (dose dependent effect; phase model)

Answer 26

Howard et al. (1996) identified a dose dependent effect of psychotherapy (i.e. about 75% of patients show measurable improvement at 26 sessions and that this number increases to only about 85% at 52 sessions. They also identified a phase model, which predicts that the effects of psychotherapy are related to the number of sessions and distinguishes between three phases: remoralization, remediation, and rehabilitation

Question 27

Hypnosis (Repressed memories)

Answer 27

Orne and Dinges propose that hypnosis involves experiencing alterations of memory, perception, and mood in response to suggestions and characterize its essential feature as a “subjective experiential change” Although hypnosis has been used to help people recover repressed memories, the research suggests that it does not seem to enhance the accuracy of memories, may produce more pseudomemories (inaccurate or confabulated memories) than accurate memories, and may exaggerate a person’s confidence in the validity of uncertain memories, especially for those that are inaccurate

Question 28

Interpersonal Therapy (Primary Problem Areas)

Answer 28

Interpersonal therapy (IPT) is a brief manual-based therapy that was originally developed as a treatment for depression, but it has since been applied to a number of other conditions. IPT focuses on symptom reduction and resolving one or more primary areas of interpersonal functioning: 
unresolved grief, interpersonal role disputes, role transitions, and interpersonal deficits

Question 29

Jung’s Analytical Psychotherapy (Collective Unconscious, Archetypes, Individuation)

Answer 29

Analytical psychotherapy views behavior as being determined by both conscious and unconscious factors, including the unconscious which is the repository of latent memory traces that have been traces that have been passed down from one generation to the next.

Included in the collective unconscious are archetypes (primordial images) that cause people to experience certain phenomena in universal ways. Therapeutic strategies include the interpretation of dreams and transferences (which reflects projections of both the personal and collective unconscious).

A key concept in Jung’s personality theory is individuation, which refers to an integration of the conscious and unconscious aspects of the psyche that occurs in the later years and leads to a unique identity and the development of wisdom

Question 30

Mental Health Consultation (Caplan)

Answer 30

Caplan distinguished between four types of mental health consultation:

1) Client-centered case consultation focuses on helping the consultee work more effectively with a particular client
2) Consultee-centered case consultation focuses on enhancing the consultee’s ability to deliver services to a particular group or population of clients.
3) Program-centered administrative consultation involves working with one or more administrators (consultees) to resolve problems related to a particular program
4) Consultee-centered administrative consultation involves enhancing the ability of administrators to develop, implement, and evaluate programs

Question 31

Motivational Interviewing (OARS)

Answer 31

Motivational interviewing was developed specifically for clients who are ambivalent about changing their behavior and combines the transtheoretical (stages of change) model with client-centered therapy and the concept of self-efficacy. The specific techniques of motivational interviewing are :

• Open-ended questions
• Affirmations
• Reflective Listening
• Summaries

Question 32

Multisystems Model (Boyd-Franklin)

Answer 32

Boyd-Franklin’s multisystems model is an ecostructural approach for African American families that addresses multiple systems, intervenes at multiple levels, and empowers the family by utilizing its strengths. Systems that may be incorporated into treatment include the extended family and nonblood kin, the church and other community resources, and social services agencies.

Question 33

Network Therapy

Answer 33

Network therapy has been identified as an effective intervention for American Indian clients and is often used as a treatment for alcohol and drug abuse. It is a multimodal treatment that incorporates family and community members into the treatment process and situates an individual’s problems within the context of his/her family, workplace, community, and other social systems.

Question 34

Object-Relations Family Therapy (Projective Identification, Multiple Transferences)

Answer 34

For object relations family therapists, maladaptive behavior is the result of both intrapsychic and interpersonal factors. A primary source of dysfunction is projective identification, which occurs when a family member projects old introjects onto another family member and then reacts to that person as though he/she actually has the projected characteristics or provokes the person to act in ways consistent with those characteristics. The primary goal of therapy is to resolve each family member’s attachment to family introjections and involves addressing multiple transferences (i.e. transferences of one family member to another, transferences of each member to the therapist, and transferences of the family as a whole to the therapist).

Question 35

Parallel Process

Answer 35

Parallel process occurs in clinical supervision when the therapist (supervisee) behaves toward his/her supervisor in ways that mirror how the client is behaving toward the therapist

Question 36

Person-Centered Therapy (Facilitative Conditions)

Answer 36

Rogers’ person-centered therapy is based on the assumptions that people possess an inherent ability for growth and self-actualization and the maladaptive behavior occurs when “incongruence between self and experience” disrupts this natural tendency. The therapist’s role is to provide the client with three facilitative conditions (empathy, genuineness, and unconditional positive regard) that enable the client to return to his/her natural tendency for self-actualization

Question 37

Personal Construct Therapy

Answer 37

George Kelly’s personal construct therapy focuses on how the client experiences the world. It assumes that a person’s psychological processes are determined by the way he or she “construes” (perceives, interprets, and predicts) events, with construing involving the use of personal constructs, which are bipolar dimensions of meaning (e.g. happy/sad, competent/incompetent) that begin to develop in infancy and may operate on an unconscious level. The gaol of therapy is to help the client identify and revise or replace maladaptive personal constructs so that the client is better able to “make sense” of his/her experiences

Question 38

Prevention (Primary, Secondary, Tertiary)

Answer 38

Methods of prevention are classified as primary, secondary, or tertiary:

• Primary preventions make an intervention available to all members of a target group or population in order to keep them from developing a disorder.
• Secondary preventions identify at-risk individuals who are showing early signs of a disorder and offer them appropriate interventions
• Tertiary preventions are designed to reduce the duration and consequences of an illness that has already occurred

Question 39

Psychiatric Inpatients (Demographic characteristics)

Answer 39

Research on the utilization rates of mental health services has provided the following information about the demographic characteristics of psychiatric inpatients:

1) For both men and women, admission rates into psychiatric hospitals are lowest among the widowed, intermediate for those who are married or divorced/separated, and highest for the never married)
2) Although whites represent the largest number of psychiatric inpatients, when population proportions are taken into account, patients from other races are overrepresented
3) For both men and women, the largest proportion of admissions is in the 25 to 44 age range.

Question 40

Racial/cultural identity development model

Answer 40

The Racial/Cultural Identity Development Model distinguishes between five stages that people experience as they attempt to understand themselves in terms of their own minority culture, the dominant culture, and the oppressive relationship between the two cultures. The five stages are:

• Conformity (positive attitudes for the dominant group)
• Dissonance (confusion and conflict over contradictory attitudes)
• Resistance and immersion (active rejection of the dominant group)
• Introspection (uncertainty about the rigidity of Stage 3 beliefs)

Question 41

Reality therapy

Answer 41

Glasser’s reality therapy is based on choice theory, which assumes that people are responsible for the choices they make and focuses on how people make choices that affect the course of their lives. It proposes that people have five basic innate needs (survival, love and belonging, power, freedom, and fun) that a person adopts a success (versus failure) identity when he/she fulfills these needs in a responsible way

Question 42

Separation-individuation (Mahler)

Answer 42

Mahler’s version of object relations theory focuses on the processes by which an infant assumes his/her own physical and psychological identity, and her model of early development involves several phases. The development of object relations occurs during the separation-individuation phase, which begins at four to five months of age. According to Mahler, adult psychopathology can be traced to problems that occurred during separation-individuation

Question 43

Sexual minorities (Internalized homophobia, coming out)

Answer 43

Issues faced by lesbian, gay, bisexual, and transsexual (LGBT) individuals include internalized homophobia and coming out: internalized homophobia occurs when LGBT individuals accept negative stereotypes about sexual minorities and incorporate them into their self-concept. Consequences include low self-esteem, self-doubt, and self-destructive behavior. Coming out (disclosing one’s sexual orientation) to family members,, friends, and others is associated with rejection and other negative consequences as well as with higher levels of self-esteem and positive affectivity, lower levels of anxiety, and other positive consequences. Research suggests that the age of coming out is about the same for gay males and lesbians.

Question 44

Sexual stigma, hereosexism, and sexual prejudice (Herek)

Answer 44

Herek (2004) argues that the term homophobia is ambiguous and imprecise and proposes that it be replaced with sexual stigma, hereosexism, and sexual prejudice. Sexual stigma refers to the “shared knowledge of society’s negative regard for any nonheterosexual behavior, identity, shared knowledge of society’s negative regard for any nonheterosexual behavior, identity, relationship, or community

Heterosexism refers to cultural ideologies, which are “systems that provide the rationale and operating instructions” that promote and perpetrate antipathy, hostility, and violence against homosexuals. Sexual prejudice refers to negative attitudes that are based on sexual orientation, whether the target is homosexual, bisexual, or heterosexual. Herek found higher levels of sexual prejudice among individuals who are older, have lower levels of education, live in Southern or Midwestern states or in rural areas, or have limited personal contact with homosexuals

Question 45

Smith, Glass & Miller (meta-analysis/effect size)

Answer 45

Smith et al. used meta-analysis to combine the results of psychotherapy outcome studies and found contrary to Eysenck, that psychotherapy does have substantial benefits. In one study, they obtained an average effect size of .85, which indicates that the typical therapy client is better off than 80% of individuals who need therapy but are untreated

Question 46

Solution-focused therapy (Questions)

Answer 46

Solution-focused therapists focus on solutions to problems rather than on the problems themselves. In therapy, the client is viewed as the “expert” while the therapist acts as a consultant/collaborator who poses questions designed to assist the client in recognizing and using his/her strengths and resources to achieve specific goals (e.g. the miracle question, exception questions, scaling questions)

Question 47

Strategic family therapy (paradoxical interventions)

Answer 47

Haley’s strategic family therapy focuses on transactional patterns and views symptoms as interpersonal events that serve to control relationships. Therapy focuses on symptom relief (rather than insight); and involves the use of specific strategies, especially paradoxical intervnetions (e.g. ordeals, prescribing the symptom, reframing) that are designed to alter the behavior of family members by helping them see a symptom in an alternative way to recognize they ahve control over their behaviors or by using their resistance in a nonconstructive way

Question 48

Structural family therapy (boundaries, rigid triads, joining)

Answer 48

Minuchin’s structural family therapy emphasizes altering the family’s structure in order to change the behavior patterns of family members. Boundaries (rules that determine the amount of contact that is allowed between family members) are one element of the family structure: When boundaries are overly rigid, family members are disengaged and when they are too diffuse or permeable, family members are enmeshed. Minuchin distinguished between three chronic boundary problems, or rigid triads: detouring, stable coalition, and triangulation

Question 49

Therapist-client matching

Answer 49

Research on therapist-client matching in terms of race, ethnicity, or culture has produced inconsistent results. However, matching may reduce premature termination for members of some groups (e.g. Asian and Hispanic/Latino). Some research suggests that other factors (e.g. similarity in values and worldview) are more important than similarity in terms of race, ethnicity, or culture)

Question 50

Transtheoretical model (stages of change)

Answer 50

Prochaska and DiClemente’s (1992) transtheoretical model of behavior change proposes that the change process involves six stages (pre-contemplation, contemplation, preparation, action, maintenance, termination) and that interventions are most effective when they match the person’s stage of change (e.g. consciousness raising, dramatic relief, and environment reevaluation are useful for helping clients transition from the pre-contemplation to the contemplation stage.

Question 51

Treatment manuals

Answer 51

Treatment manuals were originally developed to standardize psychotherapist treatments so their effects could be empirically evaluated and to provide guidelines for training therapists. They specify the theoretical underpinnings of the treatment along with treatment goals and specific therapeutic guidelines and strategies. A potential limitation of treatment manuals is that they may oversimplify the therapeutic process.

Question 52

White Racial Identity Development Model

Answer 52

According to Helms (1990) White racial identity development model involves two phases:

• abandononing racism (statuses 1-3) and developing a nonracist white identity (statuses 4-6). Her White Racial Identity Development Model involves six statuses (stages):
• contact (little awareness of racism)
• disintegration (increasing awareness of race and racism which leads to confusion and conflict)
• reintegration (idealization of White society and denigration of members of minority groups)
• psuedoindependence (questioning of racist views)
• immersion-emersion (confrontation of own biases), and autonomy (internalization of a nonracist White identity)

Question 53

Worldview (Sue)

Answer 53

As defined by Sue (1978), a person’s worldview is affected by his/her cultural background and is determined by two factors- locus of control and locus of responsibility. Differences in worldview can affect the therapeutic process. For example, White middle-class therapists typically have an internal locus of control and internal locus of responsibility (IC-IR) and are likely to have problems working with an African American client with an internal locus of control and external locus of responsibility (IC-ER) who may challenge the therapist’s authority and trustworthiness and be reluctant to self-disclose