Clinical Psychology Flashcards
Similarities in psychodynamic psychotherapies
Human behavior is motivated largely through unconscious processes
Early development has a profound impact on functioning
Universal principles explain personality development
Insight into unconscious processes is key for psychotherapy
Types of psychodynamic psychotherapies
Freudian psychoanalysis
Adler’s individual psychology
Jung’s analytical psychotherapy
Object-relations
Freud’s Personality Theory is comprised of what two subtheories
Structural (drive) theory
Developmental theory
Freud’s structural (drive) theory
Id, ego, superego
Id - present at birth, life and death instincts, operates on pleasure principle
Ego - develops at 6mo, moderates conflict between id and reality (to-be superego), operates on reality principle
Superego - develops 4-5yo, internalization of society’s values learned through rewards and punishment as a child
Freud’s developmental theory
Emphasizes sexual drives of the id.
Personality is based on your navigation of five psychosexual stages (oral, anal, phallic, latency, genital).
Over- or under-stimulation is related to a certain personality outcome
Freudian anxiety
Anxiety is a warning to the ego of an impending threat
When the ego cannot rationally defend off the threat, defense mechanisms are utilized
Are defense mechanisms good or bad
Can be adaptive, but when they become the ego’s default way of managing conflict, they can lead to dysfunction
Types of defense mechanisms
Repression (most basic) - keeps ids drives and needs unconscious
Reaction formation - avoiding an anxiety-provoking impulse by expressing its opposite
Projection - when a threatening impulse is attributed to someone else
Commonalities among defense mechanisms
They are unconscious
Serve to deny or distort reality
Psychoanalytic theory of dysfunction
Stems from unconscious and unresolved conflict
Phobia - displacement of anx onto a symbolic object
Depression - object loss coupled with anger toward the object turned inward
Mania - defense against libidinal or aggressive urges that threaten to overwhelm the ego
Goals of psychoanalytic therapy
Make the unconscious conscious
Integrate previously repressed material into the personality
Psychoanalytic treatment techniques
Primary: analysis of free association, dreams, transference…
Three components of psychoanalytic analysis
Confrontation - making statements to help the client see their behavior in a new way
Clarification - clarifying feelings and restating their remarks in clearer terms
Interpretation - connecting current behavior to unconscious processes
Psychoanalysis has been improved through what three techniques
Catharsis - emotional release resulting from the recall of unconscious material
Insight - into relationship btwn unconscious and current behaviors
Working through - assimilate new insights into his or her personality
Approach adopted by Adler
Teleological approach - behavior is largely guided by a person’s future goals
(Rather than determined by past events)
Teleological Approach
Developed by Adler
A persons behavior is motivated by future goals
Rather than determined by past events
Personality theory of Adler’s Individual Psychology
How you choose to compensate for feelings of superiority (and work towards superiority) determines your style of life (personality)
Style of Life
Adler’s Individual Psychology
- How you work to achieve superiority
Healthy - goals that reflect optimism and care for others
Unhealthy (mistaken) - goals that reflect personal achievement and power
Around what age does your Style of Life develop
Fairly well established by 4-5 years of age
Healthy Style of Life
Adler’s Individual Psychology
Marked by goals that reflect optimism, confidence, and concern for the welfare of others
Unhealthy (mistaken) Style of Life
Characterized by goals reflecting self-centeredness, competitiveness, and striving for personal power
Adler’s view on maladaptive behavior
Mental disorders represent a mistaken style of life and maladaptive ways to compensating with inferiority
- Preoccupation with power
- Disregard for social interest
Adlerian Lifestyle Investigation
Used to identify the clients style of life
Yields information about a clients family constellation, hidden (fictional) goals, and distorted beliefs and attitudes (basic mistakes)
Goals of Adlerian psychotherapy
Help the client understand their style of life and it’s consequences
Reorient beliefs and goals to support a more adaptive lifestyle
Therapeutic techniques in Adler’s Individual Psychology
Systematic Training for Effective Teaching (STET)
- all behavior is purposeful and goal-directed
Personality from Jung’s Analytical Psychotherapy
Personality is the consequence of conscious and unconscious factors
Conscious - governed by the ego - your thoughts, feelings, ideas, sensory perceptions, and memories
Unconscious - personal unconscious and collective unconscious
Jung’s “Conscious”
Governed by the ego
Represents the individuals thoughts, feelings, sensory perceptions, ideas, and memories
Jung’s unconscious
Personal unconscious - experiences that were unconsciously perceived, or were once conscious that are now repressed
Collective unconscious - latent memory traces that have been passed down generationally (includes archetypes)
Personal unconscious
Jung’s Analytical Psychotherapy
Experiences that were unconsciously perceived, or were once conscious and now repressed
Collective unconscious
Jung’s Analytical Psychotherapy
Latent memory traces that were passed down generationally
(Includes archetypes)
Archetypes
Jung’s Analytical Psychotherapy
Primordial images that cause people to experience and understand certain phenomena in a universal way
Types of archetypes
Persona - public image
Shadow - the “dark side” of the personality
Anima/animus - feminine and masculine aspects of the personality
Jung’s personality theory consisted of two attitudes
Introversion and extroversion
Basic tenant to Jung’s Analytical Psychotherapy
Behavior is determined by BOTH past events and future goals and aspirations
Individuation
Jung’s Analytical Psychotherapy
The integration of your unconscious and conscious psyche that lead to the development of a unique identity (occurs in your mid 30s)
An important outcome of individuation is the development of wisdom (when a persons interests turn towards philosophical and spiritual issues)
View of maladaptive behaviors through Jung’s perspective
Symptoms are unconscious signals to the person that something is wrong with him… He will be presented with a task developmentally that will need to be fulfilled
Goals of therapy per Jung’s Analytical Psychotherapy
Bridge the gaps between your personal unconscious, collective unconscious, and conscious experience
Jungian therapy techniques
Interpretations
Dreamwork
Focus on transference
Emphasizes positive and healthy aspects of a persons personality
Basic tenant of Object-Relations Theory
Object-seeking (forming relationships) is a basic inborn drive
Introjects
Object Relations Theory
Child’s early internalized representations of objects
Early Object Relations psychologists
Klein
Kernberg
Mahler
Fairbain
Object Relations approach to personality
[Mahler]
Infant normative autism - focused on self and oblivious to environment
Normal symbiotic phase - child becomes aware of mom
Separation-individuation phase - child begins to explore environment, conflicts between independence and dependence (separation anxiety)
By 3-4 yo, child has a permanent sense of self and objects
Object Relations perspective on maladaptive behavior
Result of abnormalities in early object relations
[Mahler] Issues occurs during separation-individuation phase
There is a natural tendency to split things into “good” and “bad”
[Kernberg] BPD persons never fully integrated positive and negative aspects of their experiences with others, resulting in shifts between contradictory ideas
Object Relations therapeutic principles
Primary focus is on splitting
Restore clients ability to relate to others in meaningful ways
Replace dysfunctional object relations with functional ones
Similarities in Humanistic and Constructivist Psychotherapies
To understand someone, you must understand their subjective experience
Focus on current behaviors
Belief in the individual’s inherent potential
Therapy is authentic and collaborative
Rejection of assessment and diagnostic labels
Types of Humanistic and Constructivist Threapies
Person-Centered Therapy Gestalt Therapy Existential Therapy Reality Therapy Personal Construct Therapy
Psychologist associated with Person-Centered Therapy
Carl Rogers
Basis for Person-Centered Therapy
Everyone has an inherent self-actualizing tendency that serves as a major motivator towards positive, healthy growth
Person-Centered personality theory
A function of the “self” or a unified, whole person who is consistent in their relationships with others
Person-Centered view of maladaptive behaviors
Incongruence between self and experience leads to a disorganized sense of self
Incongruence = anxiety that signals the unified self is being threatened
How can a person alleviate anxiety in a Person-Centered framework
Defensive maneuvers of perceptual distortion or denial.
May be temporarily effective, but counter self-actualization
Goals of Person-Centered Therapy
Help client achieve congruence between the self and experience, so that they can become self-actualized
Conditions for Rogerian therapy
When the right environment is provided by the therapist, the client will achieve congruence (and will be carried by their own inherent tendency towards self-actualization)
Three facilitative conditions of Rogerian (Person-Centered) Therapy
Unconditional positive regard (respect) - genuinely care, affirm their worth as a person, no overt judgement of client (+ or -)
Genuineness (congruence) - honestly communicate your feelings when appropriate
Accurate empathetic understanding - see the world as the client sees it (nodding, maintaining eye contact, reflection of feeling)
Unconditional positive regard
Rogerian, Person Centered Therapy
Aka respect
Genuinely caring for the client, affirming their worth as a person, no positive or negative judgements of the client
Genuineness
Rogerian (Person Centered) Therapy
Aka genuineness
Communicating your feelings openly and honestly to the client when appropriate…authenticity
Accurate Empathetic Understanding
Rogerian (Person-Centered) Therapy
Seeing the world as the client sees it
Eye contact, nodding, reflection of feelings
Things to avoid in Person-Centered Therapy
Directive techniques
Diagnosis
Being in an authoritative roll
Don’t use transference…it’s neither interpreted nor fostered
Psychologist associated with Gestalt Therapy
Fritz Perls
Basis of Gestalt Therapy
Each person is capable of assuming responsibility for their thoughts, feelings, and actions to live as a “whole”
Foundational schools of thought for Gestalt Therapy
Existentialism
Psychoanalysis
Phenomenology
Gestalt Psychology (focuses on perception)
Gestalt personality theory
The personality consists of the self and the self image
Self - creative part of personality that works towards self-actualization
Self-image - “dark side” that hinders growth, imposes external standards
The part of the personality that dominates depends on early development experiences (appropriate support yields a stronger self)
Gestalt view of maladaptive behavior
Neurotic behavior is a growth disorder wherein you reject the self for the self-image (resulting in a lack of integration)
Results in a boundary disturbance between the self and the environment
Four boundary disturbances in Gestalt Therapy
Introjection - when a person psychologically swallows whole concepts (accepts facts from env without fully assimilating them)
Projection - disowning aspects of the self by assigning them to another person
Retroflection - doing to oneself what you want to do to others
Confluence - no boundary between self and env (intolerant of differences between self and others…guilt and resentment)
Therapy goal of Gestalt
Help client become a unified whole by integrating various aspects of the self
Therapy techniques of Gestalt Therapy
Primary curative factor is awareness
Full understanding of one’s thoughts, feelings, and actions in the here-and-now
Empty chair, guided fantasy (imagery…visualization), and dreamwork
Foundation of Existential Therapy
Emphasize personal choice and responsibility for developing a meaningful life
(We are in a constant state of evolving and becoming)
Existential Therapy view of maladaptive behavior
Maladaptive behavior is the result of an inability to cope with concerns of existence (death, freedom, meaninglessness)
Existential anxiety (normal) v neurotic anxiety (attempts to avoid existential anxiety)
Existential Anxiety
Existential Therapy
Considered a normal response to ultimate concerns that serves as a motivator for change and growth
Neurotic Anxiety
Existential Therapy
The result of attempts to avoid existential anxiety - it is often out of proportion to the situation that started it, unconscious, and immobilizing
Therapy goals and techniques for Existential Therapy
Help clients recognize their freedom to choose their own destinies and accept responsibility for changing their own life
No specific interventions, but the client-therapist relationship is seen as the most important thing!
Paradoxical intention requires the client to focus on an exaggerated and humorous notion of the feared situation
Paradoxical Intention
Existential Therapy
To reduce a clients fear
Requires the client to focus in an exaggerated or humorous way on the feared situation
Psychologist associated with Reality Therapy
William Glasser
Basis for Reality Therapy
Based on choice theory
Assumes people are responsible for the choices they make and focuses on how they make choices that affect the course of their lives
Personality theory according to Reality Therapy
Five basic needs serve as our motivation: belonging/love, freedom, fun, power, and survival (love is most important because relationships help us to fulfill all other needs)
If you fulfill your needs in a positive way, you adopt a success identity
If you fulfill your needs in irresponsible ways, you adopt a failure identity
Reality Therapy’s view on maladaptive behavior
Result of adopting a failure identity
(Mental illness is the result of an individual’s choices)
Ex. Depressed because you choose to depress yourself to fulfill a need (obtain attention)
Primary goal of Reality Therapy
Help clients identify responsible and and effective ways to meet their needs and develop a success identity
Psychologist associated with Personal Construct Therapy
George Kelly
Basis for Personal Construct Therapy
People choose the way they deal with he world, and there are always alternative ways for doing so
Personal Construct personality theory
Psychological processes are governed by how you construe events
Personal constructs = bipolar dimensions of meaning (happy/sad, friendly/unfriendly)
Personal Constructs
George Kelly’s Personal Construct Therapy
Personal constructs are bipolar dimensions of meaning
(Happy/sad, friendly/unfriendly, competent/incompetent)
Develop in infancy and operate consciously or unconsciously
No two people have the same constructs, and we act s scientists to alter and revise the constructs that we have
Personal Construct perspective on maladaptive behavior
Result of inadequate personal constructs
Anxiety - when you don’t have the construct in place to help you deal with a new situation
Hostility - when you rely on old constructs despite invalidating evidence, trying to force people or things in to fit those constructs
Therapy techniques in Personal Construct Therapy
Repertory grid - identify people who have played a role in your life
Self-characterization sketch - describes self from the perspective of someone who knows them well
Fixed-role Therapy - help clients try on or adopt new personal constructs
Commonalities among brief therapies
Time limited (6-30 sessions)
Focus on current concerns, rather than on the past
Therapist takes an active role, and encourages the client to become an active member in the change process
Types of Brief Therapy
Interpersonal Therapy
Solution-Focused Therapy
Transtheoretical Model (Stages of Change)
Motivational Interviewing
Psychologists who created Interpersonal Therapy
Klerman and Weissman
Origins of Interpersonal Therapy
(IPT - Brief Therapy)
Used to treat depression, now used for other things
Interpersonal Therapy view of maladaptive behaviors
Distress and maladaptive behavior stems from problems in social roles and interpersonal relationships, traceable back to a lack of strong attachments in early life.
Goals of Interpersonal Therapy
Symptom reduction and improved interpersonal functioning
Focus on current social relationships (rooted in early attachment, but focused on current relationships)
Interpersonal Therapy techniques
Focus on one of four problem areas:
Unresolved grief, interpersonal deficits, interpersonal role disputes, role transitions
Three stages: (1) therapist conducts assessment to obtain dx, context for deficits, problem areas (2) target problem areas with specific strategies (encouragement of affect, communication analysis, modeling, role-playing), (3) reviews progress, discuss termination, plan to avoid relapse
Four problem areas in Interpersonal Therapy
Unresolved grief
Interpersonal deficits
Interpersonal role disputes
Role transition
Three stages of Interpersonal Therapy treatment
1 - conduct an assessment to obtain a dx, gain context for interpersonal struggles, and identify problem areas
2 - use specific strategies (encouragement of affect, communication analysis, modeling, role play)
3 - review client progress, discuss termination, methods of relapse prevention
Basis of Solution-Focused Therapy
Focuses on solutions to the clients problems and not on the problems themselves
Solution-Focused Therapy view on maladaptive behavior
The etiology or maladaptive behavior (or personality) is irrelevant
Stay solution-focused
Overarching therapeutic approach in Solution-Focused Therapy
The client is the expert and the psychologist acts as the collaborator who’s job it is to pose questions designed to help the recognize their strengths to achieve goals
Three questions used in Solution-Focused Therapy
Miracle Question - when you wake up in the morning, how would things be different
Exception Question - can you think of a time when you did not have this issue or didn’t have it as bad
Scaling Question - on a scale from 1-10…
Miracle Question
Solution-Focused Therapy
If you woke up tomorrow, how would things be different
Exception Question
Solution-Focused Therapy
Can you think of a time when you did not have this issue, or when it wasn’t as bad
Scaling Question
Solution-Focused Therapy
On a scale of 1-10…
- how motivated are you
- how did you feel last week
- etc.
Basis of Transtheoretical Model
(Aka stages of change)
Change entails progress through a series of predictable stages
Ten empirically supported change processes (interventions) in the Transtheoretical Model
Consciousness raising Self liberation Social liberation Dramatic relief Self-reevaluation Counterconditioning Environmental reevaluation Reinforcement management Stimulus control Helping/supportive relationships
Transtheoretical view if maladaptive behaviors
Doesn’t have one. Focuses instead on factors that facilitate behavior change
Six stages of change in Transtheoretical Model
Precontemplation - no insight, denial, little interest to change
Contemplation - aware of need for change, not committed, ambivalent…plans to take axn within six months
Preparation - plans to take axn in the next month, realistic plan for action
Action - takes concrete steps to change, maybe a public commitment
Maintenance - maintained change in behavior for at least six months, taking steps to prevent relapse
Termination - feels they can resist temptation, confident no risk for relapse
Precontemplation stage
Stages of Change/Transtheoretical Model
Individual has little insight into the problem, has no desire to change, denial of any problems
Contemplation Stage
Stages of Change/Transtheoretical Model
Aware of need for change, ambivalent, not committed yet, plans to commit within six months
Preparation Stage
Stages of Change/Transtheoretical Model
Plans to take action within a month, has a plan for action
Action Stage
Stages of Change/Transtheoretical Model
Taking concrete steps to change the behavior, usually begins with a public commitment to change
Maintenance Stage
Stages of Change/Transtheoretical Model
Has maintained change for at least six months, working towards ways to prevent relapse
Termination Stage
Stages of Change/Transtheoretical Model
Person feels they can resist temptation and is confident they are no longer at risk for relapse
Assumption of the Stages of Change/Transtheoretical Model
Progression through the stages is not necessarily linear
People may go through some or all of the stages several times
Interventions are most effective when they match the person’s stage of change
Transtheoretical Model techniques for helping someone transition from precontemplation to contemplation stage
Consciousness raising
Dramatic relief
Environmental reevaluation
Transtheoretical Model approaches for helping clients transition from the action to maintenance stage
Helping relationships, counterconditioning, reinforcement management, stimulus control
Meditating variables for change
Decisional balance - strength of the perceived pros and cons to change (important for motivation in contemplation stage)
Self-efficacy - clients confidence that they can manage situations without relapsing (important for contemplation to preparation to action stages)
Temptation - intensity of the urges to engage in the problem behavior (high in initial stages, but decreases as you go through stages)
Decisional Balance
Stages of Change
Strength of the pros and cons to changing a behavior
Serves as an important motivator in the contemplation stage
Self-Efficacy
Stages of Change
Clients confidence that they can cope with high-risk situations without relapsing
Contributor your ability to move from contemplation to preparation to action stages
Temptation
Stages of Change
Refers to the intensity of the urges to engage in the problem behavior
Inversely related to self-efficacy
Usually high in the early stages, but lowers as you progress through
Basis for Motivational Interviewing
Developed for clients who were ambivalent
Deals with their beliefs about their ability to change
Motivational Interviewing view of maladaptive behavior
None. Doesn’t focus on etiology, but in the factors that impede on the individual’s ability to change their behavior
Primary goal of Motivational Interviewing
Enhance the clients intrinsic motivation to alter their behavior
(Examine And resolve ambivalence about changing)
Main technique in Motivational Interviewing
OARS
Open-ended questions
Affirmations that express empathy and understanding
Reflective listening (restatements, paraphrasing, reflection of feeling)
Summary statements
Four general principles of Motivational Interviewing Therapy
Express empathy
Develop discrepancies between current behavior and goals/values
Roll with resistance
Support self-efficacy
General influences to family therapies
General systems theory - family is an open system that takes and gives information to the environment… family attempts to maintain homeostasis (as an issue improves, it’s likely to reappear elsewhere)
Cybernetics - negative feedback loop amplifies change and disrupts the system… positive feedback loop maintains homeostasis within the system (can be beneficial or cause breakdowns)
General systems theory
Family therapy
Family is an open system…continuously receiving input from, and discharging output into the environment
Adaptable to change
System likes to maintain status quo or homeostasis
Cybernetics
Family Therapy
Highlights the concept of the feedback loop
Negative feedback loops reduce deviation and help the system maintain the status quo
Positive feedback loops enhance deviation and change, and can disrupt the system (this can be beneficial or detrimental
Traditional schools of psychotherapy are influenced by…
Western, Lockean, Scientific tradition that emphasizes linear cause-and-effect relationships
Systems theory and cybernetics influences on family therapy is best described as
Kantian, here and now, collectivistic
Early contributors to family therapy
Ackerman - grandfather of family therapy
Bateson - promoted emphasis of double-bind communication in schizophrenia
Bowen - study of families with a schizophrenic child (repetitions of a behavior across three generations is involved in the development of disorder)
Double-bind communication
(Family Therapy - Bateson)
Conflicting negative injunctions, wherein one is expressed verbally and one is expressed nonverbally
(Ex. Do this and you’ll be punished, don’t do this and you’ll be punished)
The recipient cannot comment in the statements or seek help from others
Types of Family Therapy
Communication/Interaction Therapy (symmetrical v complementary)
Extended Family Systems Therapy (genograms, differentiation, emotional triangle)
Strategic Family Therapy (paradoxical intervention)
Object Relations Family Therapy (projective identification, multiple transferences)
Focus of Communication/Interaction Family Therapy
Recognition of communication on family and individual functioning
- all behavior is communication (so you’re always communicating)
- communication has report (content) and command (nonverbal And makes a statement about the relationship of the communicators) functions
Report and comment content
(Communication/Interaction Therapy)
Report function - content or informational aspect
Command function - nonverbal, makes a statement about the relationship of the two people communicating
When do issues develop according to Communications/Interaction Family Therapy
When report and command functions are contradictory
Two communication patterns in Communication/Interaction Family Therapy
Symmetrical Communication - reflects equality between communicators but may escalate to competitive one-upsmanship
Complementary Communication - reflects inequality between the two persons (one in a dominant role and one in a submissive role)
Communications/Interaction Family Therapy view of maladaptive behavior
Circular Model
Symptoms are both a cause and effect of dysfunctional communication patterns
(Blaming and criticizing, mindreading, overgeneralizing)
Problematic communication strategies according to Communications/Interaction Family Therapy
Blaming and criticizing
Overgeneralizing
Mindreading
Goals and techniques of Communication/Interaction Family Therapy
Goal - alter the Interaction always patterns causing dysfunction
Techniques - pointing out the issues, use of paradoxical strategies
Psychologist associated with Extended Family Systems Therapy
Bowen
Important concepts for Extended Family Systems Therapy
Differentiation of self - ability to separate your emotional and intellectual self (lower differentiation means more reactivity)
Emotional triangle - when two people experience instability or stress and rely on a third to restore balance or decrease tension
Family projection process - when parental issues and conflicts are transferred to the children (causing child to have lower differentiation than the parents)
Differentiation
Extended Family Systems Therapy
The ability to separate intellectual from emotional self
Lower the differentiation the more emotionally reactive someone is
(Higher the chance you will become fused with the emotions of the family)
Undifferentiated Family Ego Mass
(Extended Family Systems Therapy)
Family whose members are highly emotionally fused
(People tend to choose partners whose level of differentiation is similar to their own)
Emotional Triangle
(Extended Family Systems Therapy)
When two people are experiencing stress or conflict, and a third is brought in to restore balance or reduce stress/tension
The lower the differentiation, the greater the chance an emotional triangle will form
Family Projection Process
(Extended Family Systems Therapy)
When parents conflicts and emotional immaturity are transmitted to the children
Causes a child to have lower differentiation than their parents
Views of maladaptive behaviors in Extended Family Systems Therapy
Behavioral disorders are the result of multigenerational transmission where progressively lower levels of differentiation are transferred from one generation to the next
Primary goal in Extended Family Systems Therapy
Increase differentiation across all members
Methods used in Extended Family Systems Therapy
Use only two people (so therapist can be third in the triangle), or work with most differentiated to serve as a motivator
(1) assess history of family’s problems thru a genogram
(2) May send clients home to family of origin to improve differentiation
(3) encourage family members to go through the therapist to communicate
Psychologist associated with Structural Family Therapy
Minuchin
How are Family structures defined according to Structural Family Therapy
Power hierarchies - how members combine forces in times of conflict
Family subsystems
BOUNDARIES - rules that determine the amount of contact that is allowed between family members
Minuchin’s three chronic boundary problems
(Structural Family Therapy)
Aka RIGID TRIADS
1 - detouring - when parents overprotect or scapegoat a child for the family’s problems
2 - stable coalition - when a parent and child gang up against the other parent
3 - triangulation - aka unstable coalition - when each parent demands the child side with them
Structural Family Therapy view of maladaptive behavior
Dysfunction is a result of inflexible family structure that prohibits them from adapting to stressors in a healthy way.
Structural Family Therapy goals
Restructuring the family
Change behaviors > insight
Structural Family Therapy techniques
Joining - therapist joins the family and uses tracking (identifying goals and values in conversations) and mimesis (adopting affective and communication style)
Evaluating family structure - evaluating hierarchy, structure, and transactional map - Family structural map helps clarify Interaction patterns
Restructuring the family - unbalance the family, use enactment (role play their relationship patterns to identify and alter them) and reframing (relabeling behaviors so they can be viewed more positively )
Strategic Family Therapy perspective on maladaptive behaviors
Communication used to exert control
Dysfunction happens when one person denies the intent to control the other person
Goals of Strategic Family Therapy
Alter a family’s hierarchies and generational boundaries
Behavioral change results in changes in perceptions and emotions
The stages in Structural Family Therapy
Social Stage - observe family interactions and encourages involvement of all family members
Problem Stage - gather info on why the family came to therapy
Interaction Stage - family members discuss problems and therapist observes their interactional patterns
Goal-Setting - family agrees to a contract that defines goals for treatment
Paradoxical Intervention
Most closely tied to Strategic Family Therapy
Helps family see a symptom in an alternative way, or recognizing you have control by using resistance in a constructive way
Types of paradoxical interventions - ordeals, restraining, positioning, reframing, prescribing the symptom
Types of paradoxical interventions
Ordeals - perform an unpleasant task whenever a problematic symptom occurs (giving a gift when you argue with someone you don’t like)
Restraining - encouraging family not to change
Reframing - relabeling a sx to give it a more positive meaning
Positioning - exaggerating the severity of a symptom
Prescribing the symptom - Instructing a family member to deliberately engage in a symptom
Ordeal
Paradoxical intervention
Engaging in an unpleasant task whenever a symptom occurs
(Giving someone a gift every time you argue with them)
(Strategic Family Therapy)
Restraining
Paradoxical intervention
Encouraging the family not to change
Strategic Family Therapy
Positioning
Paradoxical intervention
Exaggering the severity of the symptom
Strategic Family Therapy
Reframing
Paradoxical intervention
Relabeling a symptom to give it a more positive meaning
Strategic Family Therapy
Prescribing the symptom
Paradoxical intervention
Instructing a family member to deliberately engage in the symptom
(Strategic Family Therapy)
Origins of Milan Systemic Family Therapy
Initially created for children with anorexia, but then realized how important the whole family is
Milan Systemic Family Therapy view of maladaptive behavior
Dysfunction arises when a family’s pattern of action and reaction becomes so fixed that no one is able to act creatively or make new choices about their lives
Goal of Milan Systemic Family Therapy
Help family members see their choices and encourage them to want to make choices
(Find new solutions to problems)
Techniques used by Milan Systemic Family Therapy
Hypothesizing - created based on family interactions, family tests them and revises as necessary
Neutrality - therapist remains advocate of whole family
Paradox - therapeutic double-bind and reframing so Family can work to solve their own problems
Circular Questions - family members work to identify similarities and differences in their perceptions
View of maladaptive behavior from Behavioral Family Therapy
Maladaptive behavior is learned and reinforced through antecedents and consequences
Therapy targets for Behavioral Family Therapy
Focus on observable behaviors
Ongoing assessment of behaviors and treatment effects
Increase desirable behaviors through contingent reinforcement
Improve communication and problem solving skills
View of maladaptive behavior from Object Relations Family Therapy
Maladaptive behavior is the result of intrapsychic and interpersonal factors
(Unresolved conflict that is replicated in current relationships)
Primary source of dysfunction according to Object Relations Family Therapy
Projective identification
When a family member projects old introjects onto a family member, who then reacts similarly to the old introject
Goal of Object Relations Family Therapy
Resolve each family members attachment to family introjects
What do Object Relations Family Therapy clinicians address in therapy
Multiple transferences
Transferences from one family member to another
Transfers from the family members to the therapist
Transfers from the whole family to the therapist
Three stages of group therapy (per Yalom)
First stage - orientation, hesitant participation, search for meaning, dependency (advice giving, members talk to leader instead of each other)
Second stage - conflict, dominance, rebellion (criticism, judgement, social pecking order is established)
Third stage - development of cohesiveness (trust and self-disclosure increase, attendance improves, members show concern)
First stage of group therapy
Orientation, hesitant participation, search for meaning, and dependency
Group members use a very controlled and rational communication style, look for purpose in the group, talk to the therapist instead of each other, search for similarities
Second stage of group therapy
Conflict, dominance, rebellion
Work to establish preferred level of power and initiative, advice giving is replaced with criticism, may be hostile towards therapist when they won’t pick favorites
Third stage of group therapy
Development of cohesiveness
Unity, intimacy, more self-disclose, express concern for each other, good attendance
Most important factors in Group Therapy
Interpersonal input
Catharsis
Self-understanding
Cohesiveness
Roles of a group therapist
Create the group
Minimize threats to group cohesion
Foster appropriate behavioral norms through directives
Use co-therapists and self-disclose as appropriate
Focus on the here and now and development of those patterns of behavior
Yalom’s opinion on group and individual therapy
Don’t need to happen together unless special circumstances
Group member experiences a crisis, or requires extra sessions to keep them from early termination
Statistics on premature group termination
10-35% drop out in the first 12 to 20 weeks
To prevent: prescreen, post-selection preparation
Characteristics of good candidates for group therapy
Primary problems are related to interpersonal issues
Motivated to change
Has a positive view of group therapy
Likes peer feedback
Psychologically and verbally sophisticated
Characteristics of bad candidates for group therapy
Severe mental illness
Noncompatibility with group norms and acceptable behaviors
Inability to tolerate group settings
Focus of Feminist Therapy
Focus on power differentials between women and men and how that differential impacts men and woman’s behavior
Feminist Therapy view of maladaptive behavior
Symptoms are considered to be
Related to the traditional gender roles and their inherent conflicts
Survival tactics as a means of exercising power
And/or arbitrary labels that society has assigned to behaviors to impose sanctions or control
Feminist Therapy techniques
Striving for egalitarian relationship with client
Avoiding labels like dx, or traditional ways of describing emotions or feelings
Avoiding revictimization by not blaming women for their current problems
Involvement in social action (therapists must be involved in social and political actions)
How feminist therapy and nonsexist therapy differ
Feminist therapists emphasize sociopolitical factors
Nonsexist therapist discuss individual factors
Complementary and Alternative Therapies
Hypnosis (false memories, may increase confidence in false memories, but memories false or not may be representative)
Acupuncture (needles)
Reflexology (apply pressure to certain areas)
Origins of Community Psychology
Public health and prevention
Three types of Community Psychology prevention
Primary - decrease incidence of new cases
Secondary - reducing duration of cases
Tertiary - reduce the duration and consequence of disorders in general
Primary Prevention
Decrease prevalence of mental health disease through reducing the number of new cases
Make a preventative program for all members of a specified population
Secondary Prevention
Decrease the prevalence of mental health disease through shortening the duration of the disease
Done through early detection and intervention (screening tests)
Tertiary Prevention
Reduce mental heath disease by shortening duration and consequence of the disorder
Done by creating rehabilitative programs, educational programs, and providing alternative programs to hospitalization (overall community improvement)
Primary goals of community health education
Reduce incidents of problems by increasing preventative activities
Improve care of the ill by educating the public on the disease and treatments
How community psychology works towards prevention (two ways)
Education
Preventative health care
Health Belief Model
(Part of preventative healthcare)
Says health behaviors are influenced by
(1) readiness to take action
(2) evaluation of pros and cons to a response to the health issue
(3) internal and external cues to action
Organizational consultation vs advocacy consultation
Organizational consultation - the entire system is the consultee
Advocacy consultation - consultant adopts a specific set of values in order to foster the goals of a disenfranchised group
Three entities involved in consultation
Consultant
Consultee
Client or program
Four stages of consultation
Entry
Diagnosis
Implementation
Disengagement
Entry stage of consultation
Identifying consultee needs
Contracting
Physically entering the system
Avoid resistance by clarifying your role and being collaborative
Diagnosis stage of consultation
Define problem
Set goals and possible interventions
Collect data
Implementation stage of consultation
Chose intervention
Formulate a plan
Follow through
Disengagement stage of consultation
Evaluate the consultation
Reducing involvement
Four types of mental health consultation
(Caplan)
Client-centered case consult - how to work better with one particular client
Consultee-centered case consult - improve delivering services to a particular population
Consultee-centered administrative consult -help admin-level personnel improve their functioning
Program-centered administrative consult - work with administrators to revolve an existing problem
Client-centered case consultation
Working to develop a plan to work with one person more effectively
Consultee-centered case consultation
Help a consultee’s performance with a population of people
Consultee-centered administrative consultation
Help admin-level staff perform better to be more effective in their job
Program-centered administrative consultation
Work with a program to resolve preexisting issues
Consultation v supervision
Supervisor has power and is in same profession as supervisee
Consultant not so much
Parallel processing
(Supervision)
When a supervisee replicates problems and symptoms of their client with the supervisor
Eysenck’s research
First outcome study of psychotherapy
Found effect of psychotherapy were nonexistent (due to spontaneous remission)
(72% of neurotic adults found improvement with no treatment within 2yrs…66% with eclectic psychotherapy, 44% with psychoanalysis)
Critiques to Eysenck’s study
The severity of sx between tx and nontx groups were likely different
The nontx group could have been on medication (many were)
Smith, Glass, and Miller study
1980
Used meta analysis of psychotherapy studies
0.85 effect size: avg therapy client is better off than 80% of of those who need therapy but remain untreated
Psychotherapy treatment effect sizes are equal or greater than those of medication or educational treatment studies
Meta-analysis
Used to combine the results of several studies into a common metric so they can be measured and compared
Involves calculating an effect size
Effect size
Mean outcome score of control group - mean outcome of tx group
[divided by]
Standard deviation of the control group
Result indicates the difference between average patients in treatment and control groups in terms of standard deviation units
Howard et al findings in treatment duration
Relationship between treatment length and outcome begins to level off at around 26 sessions
Dose-dependent effect
Howard et al
Relationship between the dosage of therapy (number of sessions) and the outcome of treatment
Effects begin to level off at 26 sessions (the curve of the improvement becomes less steep)
Three stages of therapy treatment
Howard et al
Remoralization - hopelessness and desperation decrease in first few
Remediation - symptom relief in 16 sessions
Rehabilitation - unlearning causes for symptoms varies depending on severity of symptoms
Remoralization
Howard et al
First stage of therapy
Clients feelings of helplessness and desperation respond quickly to therapy, within the first few sessions
Remediation
Howard et al
Second stage of therapy
Second stage brings focus onto the symptoms the client is experiencing that brought them into therapy…symptomatic relief usually occurs in about 16 sessions
Rehabilitation
Howard et al
Third stage of therapy
This stage involves understanding the maladaptive or troublesome behaviors that created the symptoms, and establishing new ways of dealing with life… the length of this process varies depending on the type and severity of the clients problems
Efficacy studies
Aka clinical trials
Most useful for establishing whether or not a treatment has an effect
Effectiveness studies
Correlational or quasi-experimental studies
Best for assessing clinical utility - cost-effectiveness, feasibility, generalizability, etc.
Efficacy vs effectiveness studies
Efficacy studies are good for determining whether or not a treatment has an effect - BUT because clinical trials are so stringent, important variables may be left out of consideration
Effectiveness studies are less experimental (correlational or quasi-experimental), but speak better to the clinical utility of a treatment (cost-effectiveness, generalizability, feasibility, etc.)
African Americans and treatment utilization
Smaller numbers receive mental health services compared to whites
But African Americans are disproportionately seen in hospital emergency rooms and psychiatric inpatient settings
Asian Americans and treatment utilization
This population is underrepresented in inpatient and outpatient settings
Racial differences in the treatment of depression
More whites receive treatment for depression than Hispanics or African Americans
Racial disparities in drug use treatment
Larger proportions of African Americans receive drug treatment than other ethnic or racial groups
Ethnic differences in therapy termination rates
Cultural minority groups are more likely to terminate early compared to whites
Effects of therapist-client matching
This is done when you match the cultural or ethnic identity of the therapist to the client
Results on whether or not this is effective is inconclusive
It’s effectiveness may largely be driven by the cultural commitment of the client
Most common mental health problems in older adults
Anxiety
Neurocognitive impairment
Depression
Response rates of older adults to psychotherapy
They tend to respond just as well to a wide array of treatments, similar to younger adults
Older adults may just respond a little slower due to memory decline
Clinical focuses for battered women
Self-determination, safety, empowerment, self-esteem
How to select treatment modalities for victims and abusers of violence
Conjoint (couples) Therapy is best when the abuse is expressive (followed by remorse, includes expression of emotion…)
Individual therapy is most indicated when the abuse is instrumental (committed without provocation, unilateral, not followed by remorse) because safety of the victim is key
Factors that correlate with an abused woman staying in a relationship
Commitment to the relationship (saving the relationship)
Economic dependence
Belief the batterer will change
Fear of retaliation against self or children
Positives and negatives to treatment manuals
Positive - standardizes treatments, disseminates information, provides guidelines for training, can improve clinical judgement
Negative - oversimplify the therapeutic process and can lead to the misuse of the manual
Placebo effect (As defined by psychotherapy research)
Providing participants with common factors treatment (attention and support), rather than a specific therapeutic modality
Placebo psychotherapy groups typically show greater improvement than those with no treatment
Diagnostic overshadowing
Tendency to attribute all of someone’s symptoms to their intellectual disabilities
Alloplastic vs autoplastic interventions
Alloplastic - where you change the environment to better accommodate the individual
Autoplastic - when you change the individual to better cope with their environment
Causes of therapist distress
Suicidal statements are the most stressful type of client behavior
Lack of therapeutic success is the most stressful aspect of work
Issues related to confidentiality are the most encountered ethical dilemma
Rates of mental illness among genders
Always higher in women across all age groups
Admission rates at higher among men due to acting out behaviors
Marital status and psychiatric hospitalization
Rates of hospitalization are highest in those never married
Intermediate for those married or divorced
Lowest in those widowed
Psychiatric hospitalization and age
Largest proportions are people ages 25-44 for men and women
Race/ethnicity and psychiatric hospitalization
White represent the largest number of inpatients
But patients from other races are overrepresented
Diagnosis and psychiatric hospitalization
Most common in persons ages 18-44 is schizophrenia
In people 65+ it is an organic disorder followed by affective disorder
Gender and outpatient programs
Women more than men
What percentage of psychotherapy clients form ethnic minority groups drop out of treatment after the first session
50
Client-therapist matching may be beneficial for what ethnic groups
Asian, Hispanic, White
No effect on African American therapy clients
Women are more likely to be the victim of spousal abuse when they are…
Younger
Heterosexual
American Indian/Native
And in families with yearly incomes of less than 10,000
Considerations for counseling African Americans
Emphasize group welfare over individual needs
Extended family focus, may include church
Roles are flexible, men and women are egalitarian
May exhibit signs of healthy cultural paranoia
Suggested mode of therapy for African Americans
Multisystems Model
Addresses multiple systems at multiple levels and empowers the family to use their own strengths
Cultural considerations for working with American Indians and Alaskan Natives
Problems caused by disharmony with nature
Emphasis on extended family and tribe
Present focused, go by seasons
Consider listening more important than talking
Therapeutic modality for working with America Indians and Alaskan Natives
Network therapy
Situates the individual’s problems within their community and other social systems
Considerations for working with Asian Americans
Collectivist, hierarchical with gender roles
Value interpersonal relationships
Refrain from showing strong emotions that may disrupt peace or shame the family
Therapeutic guidelines for working with Asian Americans
Emphasize formalism
Shame reinforces prescribed roles and responsibilities
Modesty and self-deprecation aren’t indicative of depression
Establish credibility early
Providing some immediate benefits to treatment
Focus more on behaviors than emotions
Asian Americans may express psychological stress as somatic complaints
Considerations for working with Hispanic or Latino populations
Emphasize family welfare
Discussing intimate personal data with a stranger is unacceptable
Adopt a concrete approach
Many life events are attributed to natural phenomena or God
Guidelines for counseling Latino and Hispanic populations
Formalismo then personalismo
Parent-child bond is stronger than husband-wife bond
Differences in the degree of acculturation may be cause for issues
Maybe express as somatic complaints
Acknowledge emphasis on religion
Mental health statistics and sexual minorities
Higher rates of psychological problems than cis-gendered and heterosexual peers
Anx, dep, SUD, suicide - due to prejudice and discrimination
Internalized homophobia
When a sexual minority individual accepts heterosexual society’s judgements about them and incorporates that into their self-concept
Tx: identifying and correcting cognitive distortions, create coping skills, emphasize social support
What three competencies comprise cultural competence
Awareness - aware of their own values and beliefs and when they may be detrimental to others
Knowledge - make attempts to understand the worldviews of others
Skills - use therapeutic modalities appropriate for culturally different clients
What two processes are critical to working with culturally diverse clients
(Sue and Zane)
Credibility - when the client views the therapist as trustworthy
Giving - clients perception that he or she is benefiting from therapy
Indigenous healing practices
Culture-specific ways of dealing with human problems and distress
Rely on community and family
Incorporate religious spiritual practices
Conducted by a traditional healer
Acculturation
The degree to which a member of a culturally diverse group accepts and adheres to the values, attitudes, and behaviors of his or her own group and the dominant (majority) group
Four categories of acculturation
Berry et al, 1987
Integration - maintains own cultural identity while integrating some of the majority culture
Assimilation - accepts majority culture and rejects their own
Separation - rejects majority culture for their own cultural practices
Marginalization - rejects both personal and majority identities
Integration
Form of acculturation
When the person maintains their own cultural identity and also accepts parts of the majority culture
Assimilation
Category of acculturation
When the person rejects their own culture and identifies with the majority culture
Separation
Type of acculturation
When the person rejects majority culture and instead wholly identifies with their own culture
Marginalization
Type of acculturation
When the person does not identify with their own culture or 5e majority culture
Worldview
How a person perceives his or her relationship with nature, other people, institutions, etc.
Depends on locus of control and locus of responsibility
(IC-IR therapists may struggle with working with cultural groups)
Cultural encapsulation
When a therapist accepts their own values and beliefs as that of everyone else,
disregards cultural differences,
Disregards their own cultural biases,
And ignores evidence that disconfirms their beliefs
Emic orientation
References culture-specific theories, concepts, and strategies
Attempt to see things through the eyes of other cultures
Etic orientation
Viewing everyone as being generally the same, without regard for different cultures
Traditional theories of psychotherapy are etic in nature
High-context Communication
Grounded in the situation, depends on group understanding, relies heavily on nonverbal cues, helps to unify a culture
Low-context Communication
Explicit, verbal part of a message
Euro-American
Three recognized consequences to oppression
Internalized oppression - acting out and blaming system
Conceptual incarceration - adopting white worldview
Split-self syndrome - characterizing parts of self as good and bad, African American parts are often what are characterized as bad
Internalized oppression
Acting out against the system, system blaming, and avoiding whites
May turn to drug use, or educational attainment to elevate one’s self-worth
Conceptual incarceration
Adopting a white worldview
Split-self syndrome
Polarizing oneself into good and bad components
Bad components tying most closely to African American identity
Two behaviors elicited by African Americans for social protection and acceptance
Playing it cool - concealing anger or other unacceptable feelings
Uncle Tom syndrome - adopting an overly positive, hard working demeanor
Cultural paranoia
Healthy reaction to racism
Decide not to disclose to a therapist for fear they will be harmed or misunderstood
Functional paranoia
Unhealthy
When a person does not disclose to a therapist due to general distrust and suspicion
High cultural paranoia and high functional paranoia
Confluent Paranoiac
Treat with components of functional and healthy cultural paranoiacs
High functional paranoia and low cultural paranoia
Functional paranoiac
Nondisclosive to everyone, due to pathology
Best treatments are targeted towards their pathology
Low functional paranoia , high cultural paranoia
Healthy Cultural Paranoiac
Disclose to African American therapists but not white therapists, likely due to past experiences with racism
Tx involves confronting the meaning of the paranoia
Low functional paranoia, low cultural paranoia
Intercultural Nonparanoiac Discloser
Three terms petitioned to replace the word “homophobia”
Sexual stigma - society’s negative regard for anything non-hetero
Heterosexism - cultural ideologies that promote hostility towards homosexuals
Sexual prejudice - negative attitudes based on sexual orientation
Sexual stigma
Shared knowledge of society’s disregard for any nonheterosexual behavior or identity
Creates a power and status differential between homosexual and heterosexual groups
Heterosexism
Cultural ideologies that promote and perpetrate hostility and violence towards homosexuals
(Sexual minorities are deviant and threatening - inherent in laws and other cultural institutions)
Sexual prejudice
Negative attitudes based on sexual orientation
Regardless of what the orientation is
Four identity models
Racial/cultural identity model (CDRII)
Black racial identify model (PEII)
White racial identity model (CDR PIA)
Homosexual identity model (SSIC)
Stages of the racial/cultural development identity model
1 - Conformity - positive attitudes towards the dominant culture
2 - Dissonance - confusion over conflicting attitudes towards self and others
3 - Resistance and Immersion - rejects dominant culture
4 - Introspection - question the rigidity of wholly rejecting dominant culture
5 - Integrative Awareness - strong desire to eliminate all oppression
Stages of black identity (nigrescence) development
1 - Pre-Encounter - mainstream identity, may have anti-Black beliefs
2 - Encounter - exposure to race-related events increases racial awareness and interest in developing an black identity
3 - Immersion-Emersion - high racial identity, anti-White
4 - Internalization - pro-black, bicultural, multicultural orientations
Two main stages of white identity model
1-3 - contact, disintegration, reintegration
Focus on abandoning racism
4-6 - pseudo-independence, immersion-emersion, autonomy
Focus on developing a nonracist identity
Six stages in white racial identity development
Contact - little awareness, unsophisticated racial behaviors
Disintegration - awareness of racism leads to confusion
Reintegration - resolve moral conflict by idealizing Whiteness
Pseudo-Independence - question racist views
Immersion-Emersion - confronts own biases as privilege
Autonomy - respect for cultural and racial differences
Four interactions that deal with racial identity between the therapist and the client
Parallel - levels of racial identity are equal
Progressive - therapists level of racial identity is at least one level above client
Regressive - clients level of racial identity is at least one level above that of the therapist
Crossed - when both parties attitudes oppose the other race
Stages to the homosexual identity development model
Sensitization - middle childhood, realize you’re different than peers
Self-Recognition - puberty, attracted to same sex, turmoil and confusion
Identity Assumption - becomes certain of identity and can try to pass as heterosexual or join into the homosexual community
Commitment - public disclosure of homosexuality
