Clinical Psychology Flashcards
Freudian psychoanalysis is this type of theory;
human beings are determined by _____
pessimistic, deterministic, mechanistic, reductionistic
irrational forces, unconscious motivations
Freud’s structural theory
id - pleasure (birth)
ego - reality - postpone gratification (6 mo)
superego - permanently block id’s impulses (4-5 yr)
defense mechanisms
deny or distort reality
repression- underlies all other defense mechanisms- keep id’s drives from consciousness
reaction formation - avoid anxiety provoking response by expressing its opposite
projection - threatening impulse is attributed to another person
goal of psychoanalytic therapy
reduce or eliminate pathological symptoms by bringing the unconscious into consciousness
psychoanalysis includes ____ and is a combination of these 4 stages
free associations, dreams, resistances, transferences – combo of:
confrontation - see bx in a new way
clarification
interpretation
working through - final and longest stage - client assimilates new insights into personality
catharsis - emotional release resulting from recall of unconscious
brief psychodynamic therapy
Prochaska & Norcross (2003)
time limited target specific interpersonal problem interpretation early on strong working alliance positive transference > neg transference
Adler’s approach is _____ and states that behavior is motivated by:
teleological – future goals
Adler’s individual psychology (4 concepts)
inferiority feelings - develop in childhood as result of weaknesses
striving for superiority - inherent tendency toward perfect completion
style of life - the way a person compensates for inferiority determines this, which unifies aspects of personality
social interest - differentiates bt healthy and unhealthy style of life (age 4-5)
Systemic training for effective teaching (STET)
based on Adler’s approach - all behavior is goal directed and purposeful
Jung says the libido is____; behavior is determined by____
and personality consists of these 6 things
libido = general psychic energy
behavior is determined by past and future goals
personality consists of:
extraversion and introversion
thinking, feeling, sensing, and intuiting
Jung’s analytical psychotherapy says personality is consequence of____
conscious and unconscious
collective unconscious
repository of latent memory traces that have been passes down from one generation to the next
archetypes
in collective unconscious
primordial images- experience and understand certain phenomena in a universal way e.g.,: self- unity of personality persona - pubic mask shadow - dark side of personality anima -feminine animus - masculine
Individuation
Jung
integration of conscious and unconscious - lead to development of unique identity
dvpt of wisdom
Object Relations Theory
relationship with others is basic inborn drive
early relationships become part of the self
Melanie Klein, Ronald Fairbairn, Margaret Mahler, Otto Kernberg
separation-individuation phase has these 4 steps and fully develops by what age?
Mahler’s theory
4-5 mo - development of object relations
differentiation
practicing
reapproachment
object constancy
taking steps toward separation through exploration
3 yo- child has permanent sense of self and object (object constancy)
person-centered therapy says people are motivated by ____ and disorganization happens when ___
Carl Rogers
client-centered and Rogerian
all people have innate “self-actualizing tendency” - major source of motivation
self becomes disorganized when experience and self are incongruent
defense mechanisms of perceptual distortion or denial
Roger’s three facilitative conditions
unconditional positive regard
genuineness
accurate empathic understanding
Gestalt therapy says each person is capable of _____ and incorporates these 5 elements
Fritz Perls
each person is capable of assuming personal responsibility for his/her thoughts, feelings, actions and living as a “whole”
1) closure
2) gestalts = current needs
3) whole > sum of parts
4) context
5) figure/ground
self and self-image
Gestalt
self = creative aspect of personality
self-image = darker side of personality that hinders growth
boundary disturbances (4 major ones)
Gestalt
abandonment of self for self image
introjection- accepts facts from envt without understanding them (compliant)
projection - disowning aspects of self; assigning to others (paranoia)
retroflection - doing to oneself what you want to do to others
confluence - no boundary between self and environment (guilt and resentment)
transference a la Gestalt
not productive
helping client recognize difference between transference fantasy and reality
Most important part of gestalt therapy—— and therapy techniques
Awareness: full understanding of thoughts, feelings, actions in here and now
empty chair, other games used- role play, guided fantasy, dream work - dreams rep diff parts of the self
Existential therapies
Frankl
emphasis on personal choice and responsibility for developing a meaningful life, satisfy needs
people are in constant state of evolving
reality therapy
Glasser
based on choice theory (control theory)- people are responsible for choices they make
successful identity/failure identity (reality therapy)
fulfills needs in responsible way
unable to satisfy needs in responsible way- underlies most psychopathology
personal construct therapy
George Kelly
how client experiences the world - ppl. choose the ways they deal with the world and there are alternative ways for doing so
client and therapist are “mutual experts”
use assessment e.g., repertory grid
fixed role therapy - experiment with alt. constructs
Interpersonal Therapy (IPT) is a combo of __
Klerman and Weissman; Adolph Meyer’s psychobiological approach to psychiatric disorders, Sullivan’s interpersonal theory, Bowlby
combines psychodynamic and CBT
primary problem areas in IPT
interventions target: unresolved grief interpersonal role disputes role transitions interpersonal deficits
Solution-focused therapy
de Shazar
“you get more of what you talk about”; focus on solutions to problems rather than problem themselves
therapist posed questions - Solution focused therapy
client is “expert”
miracle question - everything is better- what does this look like?
exception question - when did you not have this problem?
scaling questions
Transtheoretical model
Prochaska & DeClemente
originally - cigarette smoking and addictive bx - now for weight, compliance, IPV, $
change entails progress through a series of predictable stages
10 empirically supported change processes: consciousness raising, self liberation, social liberation, dramatic relief, self-reevaluation, counterconditioning, environmental reevaluation, reinforcement management, stimulus control, helping/supportive relationships
six stages of change (transtheoretical model)
pre contemplation - little insight; no intention to change
contemplation - aware and intends to take action in 6 mo
preparation - take action in 1 mo
action - takes steps to change
maintenance -
termination - no risk for relapse
decisional balance
self-efficacy
temptation (transtheoretical model)
db - strength of perceived pros and cons of problem (contemplation)
se - confidence to cope with high risk situations
temptation - intensity of urges
Motivational Interviewing
Miller & Rollnick
clients who are ambivalent about changing their behavior
addiction, eating disorders, diabetes, pain
Roger’s client centered therapy and Bandura’s self efficacy
OARS
open ended questions
affirmations
reflective listening
summaries - type of reflective listening for transitions
General Systems Theory
system is an entity that is maintained by mutual interactions of its component; context is important
family = open system homeostasis = family will try to maintain status quo
Cybernetics
family communication process
negative feedback loop: reduces deviation and helps a system maintain status quo
positive feedback loop: amplifies deviation or change and disrupts the system
family therapies
Kant; reciprocal view
focus on here and now, relational, freedom of choice, contextual, relativistic
Ackerman = grandfather of fam therapy
double-bind communication
Bateson
dvpt of schizophrenia
conflicting negative injunctions “ do that - punish; don’t do that - punish”
Communication/Interaction family therapy
Don Jackson, Virginia Satir, Jules Riskin, Jay Haley
all bx = communication
all comm has “report” (content) and “command” (nonverbal; statement about communicators) function
comm patterns = symmetrical or complementary
symmetrical communications
equality bt communicators but may escalate into competitive “one upsmanship game”
complementary communications
inequality and maximize diff bt communicators (dominant and submissive)
primary goal of commnication/interaction family therapy
alter interactional patterns that are maintaining the presenting sx
Extended Family Systems therapy
Murray Bowen
functioning across extended family:
differentiation of self
emotional triangle
family projection process
differentiation (extended fam systems)
ability to separate intellectual and emo functioning
lower: more emotional (e.g., undifferentiated family ego mass = highly emotionally fused)
choose mates with similar differentiation
emotional triangle
third person brought in to 2 person dynamic to diffuse stress
low level of differentiation - greater likelihood for emo triangle
multigenerational transmission process
behavioral disorders result from this-
progressively lower levels of differentiation are transmitted from one generation to the next
genogram
used in extended family systems
depict relationship between fam members
therapist role in extended fam system
coach - achieve greater differentiation
questioning
clients talk to therapist not each other
Structural family therapy
Minuchin- work with disorganized lower SES families
here-and-now, directive, concrete approach
all families have implicit structure that determines how family will relate to one another
power hierarchies
subsystems
boundaries
boundaries
“barriers” or rules that determine the amount of contact that is allowed bt family members
rigid triads
boundary problems
1) detouring - parent focus on child for problems
2) stable coalition - p and c form coalition and gang up on other parent
3) triangulation - each parent demand the child to side with him/her
structural family therapy techniques
actions precedes understanding
changing behaviors rather than insight
joining
evaluating family structure
restructuring the family
Strategic family therapy
Jay Haley
influenced by: communication/interaction, estrutural, and Milton Erickson’s hypnotic techniques
emphasize role of communication
symptom = interpersonal phenomena - strategy for controlling a relationship when other strategies have failed
therapy goals - strategic fam therapy
altering transactions and organizations, esp hierarchies and generational boundaries
therapist = very directive
stages of therapy - strategic fam therapy
first session- very structured:
1) social - therapist observes
2) problem - therapist gathers info
3) interaction - discuss problems
4) goal setting-
paradoxical intervention
alters behavior of family members by helping them se a symptom in an alternative way (by resisting directive, fam member ends up abandoning maladaptive bx)
ordeals - unpleasant task when symptom occurs
restraining - encourage not to change
positioning - exaggerating severity of a symptom
reframing -
prescribing the symptom - deliberately engage in symptom
Milan systemic family therapy
Mara Selvini-Palazzoli
circular patterns of action and reaction
goal: help fam members see their choices and in choosing
use of therapeutic team
techniques used in Milan systemic family therapy
hypothesizing - test with fam and revise
neutrality -
paradox - not for resistance but for solutions
circular questions- each fam member asked a question
Behavioral Family therapy
operant conditioning, social learning theory, social exchange theory
Object relations family therapy
maladaptive bx = result of both intrapsychic and interpersonal factors
projective identification
primary source of dysfunction in object relations family therapy
occurs when a fam member projects old introjects onto another family member and then reacts as though he has those characteristics
multiple transferences
transferences of one family member to another, to the therapist
Group therapy
every school of psychotherapy has been applied
3 formative stages of group therapy
Yalom
first stage - orientation, hesitation participation, search for meaning, dependency ; search for similarities, advice seeking
second stage - conflict, dominance, rebellion - members try to establish dominance
third stage - development of cohesiveness - unity, intimacy, and closeness become chief concerns * critical
therapists role in group therapy
creation and maintenance of the group
culture building -therapist is technical expert and participant/model
activation and illumination of the here-and-now-
premature termination
10-35% drop out during first 12-20 sessions
prescreening can reduce
post-selection preparation to clarify misconceptions
Feminist therapy
power differences bt men and women and impact on behavior
“personal is political”
goal: empowerment
nonsexist therapy
different from feminist therapy:
feminist therapy - sociopolitical factors
nonsexist therapy - individual factors and modifying personal behavior
self-in-relation theory
extends traditional object relations theory - many gender diff can be traced to diff in the mother-daughter and mother-son relationship
Hypnosis
effective for treating acute stress disorder, anxiety, obesity, insomnia, chronic pain
compliance does not always occur
hypnosis and repressed memories
1_ does not seem to enhance accuracy of memories - may produce pseudo memories
2) may exaggerate a person’s confidence in uncertain memories
3) often reflect issues that are relevant to treatment
acupuncture
method for restoring health - involves stimulating specific anatomical points on the body with a thin needle
benefits may be dt release of endorphins
pain and chemo-nausea
Primary preventions
reducing prevalence of mental and physical disorders
secondary preventions
decrease prevalence of mental and physical disorders
early detection and intervention
tertiary preventions
reduce duration and consequences of mental and physical disorders
e.g., rehab programs
health education
more useful for increasing info than changing practices
mass media campaigns do both
peer norms to alter health behaviors is effective, esp for adolescents
health belief model
health behaviors are influenced by
1) person’s readiness to take action
2) evaluation of benefits and costs
3) internal and external “cues to action” that trigger response e.g., health of family, advice, media
health bx can be modified by targeting knowledge/motivation
consultation
organizational - systems approach - entire organization is consultee
advocacy- consultant must have explicit value orientation to foster goals of disenfranchised group
Mental health consultation
client-centered case consultation - working with consulted to develop a plan that will help them work better with a client
consult centered - enhance consultee’s performance
program centered - working with administrators
consult centered administrative - help administrative level personnel improve professional functioning
parallel process
extension of transference
when a supervisee replicates problems with the supervisor that are happening with the client
Eyesenck
1952 article
effects of psychotherapy are “small or nonexistent”
72% of neurotic adults in no-therapy group showed improvement within 2 yrs
only 66% receiving eclectic therapy and 44% receiving psychoanalysis showed decrease in symptoms
meta-analysis
smith and colleagues - statistical technique to psychotherapy outcome research
combine results of multiple studies and involves calculating an effect size - converts data from diff studies to a common metric to combine and compare
mean outcome for treatment - mean outcome for control / SD of control group = diff bt average patients in treatment and control groups in SD
Smith, Glass, Miller (1980)
mean effect size of .85 - at the end of therapy, average therapy client is “better than 80% of those who need therapy but remain untreated”
Lambert and Bergin (1994)
no one type of therapy is better than another - except CBT for panic, phobias, compulsions
positive change in therapy = general factors
Howard and colleagues (1996)
relationship between tx length and outcome “levels off” after 26 sessions
75% of patients showed improvement at 26 sessions
85% showed improvement at 52 sessions = dose dependent effect
phase model of therapy
predicts the benefits of treatment will vary depending on # of sessions. effects in3 stages:
remoralization - hopeless and desperation respond quickly (first few sessions)
remediation - focus on symptoms (relief in 16 sessions)
rehabilitation - unlearning poor patterns (time depends on type and severity)
efficacy v effectiveness
efficacy = clinical trials effectiveness = correlational/quasi-experimental; Seligman
Jacobson and Christensen support both
utilization of MH services
AA - ER or psychiatric inpatient
Asians - underrepresented in outpatient and inpatient
Whites > AA and Hispanics for depression
AA> tx for illicit drug use
premature termination rates
minority groups > Whites to terminate prematurely (e.g., 50% v 30% of Whites
AA > White dropout
White> Asians dropout
Whites = Hispanics dropout
therapist-client matching
inconclusive
ethnic matching reduced premature termination for Asian, Hispanic and Whites but not AA
matching = better for Hispanics only
matching has a small, but not significant positive effect on # of sessions attended
preference dpends on: acculturation, client’s ethnic identity, gender, trust of Whites
similarity in values and worldview as well as education = more important in a therapist for many clients
MH problems for older adults
most common: anxiety, severe cognitive impairment, depression
older adults are more heterogeneous
1) behavioral and environmental interventions best for dementia
2) memory and cognitive retraining = probably efficacious
3) cognitive, behavioral, and brief psychodynamic therapist = probably efficacious for depression
best when adapted to circumstances
1 predictor of cessation of battering
family income
couples therapy for spousal abuse
MAck
may be OK when abuse is expressive - mutual, followed by remorse
No good when instrumental
factors affecting decision to remain in abusive relatioship
woman’s commitment to relationship
economic dependence, belief that the batterer will change, and fear that the batterer will retaliate
Treatment manuals
originally developed to standardize so effects could be evaluated
- oversimplify therapeutic process
+ help disseminate info
+ capitalize on empirically based approach
placebo effect
average effect size of .67when compared to no treatment
.48 when compared to treatment group
useful? unclear
diagnostic overshadowing
attribute all of clients problems to IQ
not related to theoretical orientation, expertise, experience and applies to other conditions, diagnoses, situations
alloplastic v autoplastic intervention
allo - make changes in environment
auto - change individual
psychiatric inpatients
marital status - highest for never married; lowest for widowed; intermediate for married or divorced/separated
race/ethnicity: Whites; but other races are overrepresented
age: 25-44
diagnosis: schizophrenia in 18-44 range; for 65+ organic disorder and then affective disorder
Guidelines for AA clients
interconnectedness
family is extended kinship network- immediate and extended
Roles are flexible
“healthy cultural paranoia”
use of ecostructural or ecological systems approach
multisystem model
for use with AA clients
type of ecological systems approach
addresses multiple systems, intervenes at multiple levels, empowers family by utilizing strengths
American Indians and Alaskan Natives in therapy
spiritual and holistic orientation
extended family and tribe
cooperation and generosity
listening - more important than talking
incorporate elders, medicine people, etc. into tx process
network therapy
for Indians, Alaskans
incorporates family and community members into the treatment process and situates problems within context of family, work, community
Asian Americans in therapy
aware of country of origin and acculturation status
emphasis on group
hierarchical family structure, traditional gender roles
harmony, interdependence, mutual loyalty
value restraint of strong emotions that might otherwise disrupt peace and harmony
somatic and behavioral complaints rather than emo
directive, structured, goal-oriented, problem solving approach - CBT
Hispanic/Latino Americans in therapy
family over individual welfare
interdependence and connectedness
discussing intimate details with strangers is unacceptable; problems should be handled in the family
active & directive - multimodal approach - behavior, affect, cognitions, relationships, biology
family therapy
somatic complaints
Sexual minorities
LGBT have higher rates of certain psych problems : depression, anxiety, substance use, suicidality d/t prejudice and discrimination
internalized homophobia
LGBT accept heterosexual society’s negative evals of them and incorporate these into self-concepts
low self esteem, self doubt, self hatred
therapy- id and correct cognitive distortions, assertiveness, coping skills, activating social support
coming out
may have neg consequences
can be helpful: lesbians have higher self esteem, positive affectivity, lower levels of anxiety, reduced likelihood of engaging in anonymous socializing
coming out diff for men and women
Savin-Williams and Diamond (2000) : first same sex attraction, self labeling, first same sex sexual contact, first disclosure
males had earlier onset except first disclosure was same
Grove, Bimbi, Nanin, Parsons (2006)- no gender diff; ppl age 18-24 coming out significantly younger than older generations
cultural competence
awareness
knowledge
skills
credibility
giving - client has gotten something from therapy
indigenous healing
curanderismo - holistic system practiced in latin american/hispanic countries - illness can arise from natural or supernatural forces; herbal medicine, massage
ho’oponopono “setting it right” - hawaiian - restoring harmony by senior family member
sweat lodge ceremony - Native American
Acculturation
degree that someone accepts and adheres to values of their own group v dominant group
integration - maintains own culture but incorporates dominant culture
assimilation - accepts majority culture while letting go of own culture
separation - withdraws from dominant culture
marginalization - does not id with either culture
worldview
how a person perceives relationship to nature, other people, institutions
locus of control
locus of responsibility
minority groups - IC-ER. big problem for IC-IR therapist
cultural encapsulation
disregard cultural differences
emic v etic orientation
emic - culture specific theories- see things through eyes of individual
etic - ppl from diff cultures as same
high v low context communication
high- grounded in the situation, depends on group understanding, relies on nonverbal cues, slow to change (minorities)
low - explicit, verbal, less unifying, can change rapidly (white)
oppression
internalized - system blaming, avoidance of whites, denial
conceptual incarceration - adopting a white worldview
split-self syndrome - polarizing oneself into “good” or “bad” (bad = AA)
playing it cool - concealing anger
uncle tom’s syndrome - adopting happy go lucky demeanor
cultural v functional paranoia
cultural - healthy reaction to racism when nondisclosure is d/t fear of being misunderstood
functional - unhealthy - unwilling to disclose to therapist d/t general mistrust and suspicion
sexual stigma
shared knowledge of society’s negative regard for non heterosexual behavior
creates power and status differential
heterosexism
cultural ideologies- systems that promote and hostility against homosexuals
sexual prejudice
negative attitudes based on sexual orientation
higher prejudice: heterosexual men, older, lower education, southern or midwestern, rural, limited contact with homosexuals
Racial/cultural identity development model
conformity - pref for dominant culture
dissonance - confusion (pref for minority therapist)
resistance and immersion - reject dom group, immerse in own group
introspection - uncertainty about rigidity in above stage
integrative awareness - multicultural perspective
Black racial (Nigrescence) identity development model
shift from black self hatred to black acceptance
pre-encounter - racial identity has little salience (assimilation - adopted mainstream identity; anti-Black- low-self esteem)
Encounter - exposure to race event leads to greater awareness and interest - prefer same race therapist
Immersion-Emersion - race has high salience - idealizes black culture; rage toward whites (emersion - reject white culture, internalize black identity
Internalization - race is imp; pro black, non-racist; biculturist orientation; multicultural identity
White racial identity development model
abandoning racism (1-3); developing non-racist identity (4-6) through information processing strategy (IPS)
contact status - little awareness of racism
disintegration - increasing awareness leads to confusion, conflict; IPS - suppression, ambivalence
Reintegration - resolve moral dilemma; may blame minorities, see whites as victims; IPS - selective perception and negative out-group distortion
Pseudo-Independence Status - question racist views, intellectually interested in understanding racial differences; IPS - selective perception and reshaping reality
Immersion-Emersion - what does it mean to be White, biases, understand benefits of white privilege; IPS - hpervigilence and reshaping
Autonomy - internalizes nonracist White identity, appreciates other cultures ; IPS - flexibility and complexity — most effective as therapist working with minority clients
progressive interaction
when therapists level of racial identity is at least one level more advanced than that of his client. this is most effective interaction in therapy
Homosexual identity development model
sensitization/feeling different- middle childhood -
self-recognition/identity confusion - puberty- realizes attraction to same sex
identity assumption - more certain of homosexuality
commitment/identtity integration - homosexual way of life, out in public
