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EPPP > Clinical Psychology > Flashcards

Clinical Psychology Flashcards

1
Q

Psychodynamic Psychotherapies - Characteristics

A

Human behavior motivated by unconscious processes​

Early development on adult functioning​

Insight into unconscious processes = key component of psychotherapy​

General principles apply to everyone​

Conflicts affect personality development

About internal conflict

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2
Q

Freudian Psychoanalysis - Personality Theory

A

id, ego, superego

focus on sexual and aggressive forces

5 psychosexual stages of development (oral, anal, phallic, latency, genital) ​

Anxiety - essential in Freud’s personality theory; alert ego to an impending internal or external threat

Defense mechanisms (occur as a result of ego unable to ward off danger through realistic/rational means) – repression, reaction formation, projection, displacement, sublimation

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3
Q

id

A

Freudian Psychoanalysis - Personality Theory

At birth

Pleasure principle

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4
Q

ego

A

Freudian Psychoanalysis - Personality Theory

At 6mos

Reality principle

Postpones gratification of id’s instincts

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5
Q

superego

A

Freudian Psychoanalysis - Personality Theory

4 or 5yo

internalization of society’s values & standards;

permanently block id’s impulses

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6
Q

Freud’s 5 psychosexual stages of development

A 
oral (0-1yo)
anal (1-3yo)
phallic (4-6yo)
latency (6yo to puberty)
genital (puberty to death)
(OAPLG)

during each stage, the id’s libido (sexual energy) is focused on a different part of body

over-or-under gratification of one’s sexual needs in each stage is assoc. with a different personality outcome

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7
Q

Repression

A

most “basic” defense mechanisms

1st line of defense; core defense

occurs when id’s drives and needs are excluded from conscious awareness (maintained in the unconscious)

e.g., Jane forgets a traumatic experience

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8
Q

Reaction formation

A

Avoiding an anxiety-evoking impulse by expressing its opposite

e.g., turning hate into love

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9
Q

Projection

A

Occurs when a threatening impulse is attributed to another person/external source

e.g., you might hate someone, so you solve the problem by believing that they hate you

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10
Q

Displacement

A

Satisfying an impulse with a substitute object (e.g., safe & vulnerable substitute)

e.g., someone who is frustrated by the boss may go home and kick the dog

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11
Q

Sublimation

A

Satisfying an impulse with a substitute object in a socially acceptable way

e.g., sport (putting one’s aggression into sth constructive)

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12
Q

Freudian Psychoanalysis - View of Maladaptive Behavior

A

unconscious, unresolved conflict occurring during childhood​

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13
Q

Freudian Psychoanalysis - Therapy goals & Techniques

A

Goal: Bringing unconscious into conscious awareness & integrate repressed material into personality ​

Improvement via: insight & awareness, working through, & catharsis

Techniques:
Analysis (targets: free associations, dreams, resistances, transferences) via 4 processes:
confrontation, clarification, interpretation, & working through

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14
Q

Confrontation

A

Preconscious

Making statements or questions to help patient see behavior in a new way

Get client to elaborate & see things in a different light

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15
Q

Clarification

A

Conscious

Clarify patient’s feelings and restating remarks in clearer terms

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16
Q

Interpretation

A

Unconscious to conscious

More explicitly connecting current behavior to unconscious processes

Free association, dreams, resistances, transferences

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17
Q

Working through

A

an aspect of improvement in psychoanalysis (in addition to catharsis & insight)

final & longest stage

allows patient to gradually assimilate new insights into his/her personality

Ongoing confrontation and interpretation?

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18
Q

Transference & Countertransference

A

Transference:
Freud - client toward therapist (projection of earlier relationships; e.g., displacement)
Modification - an attempt to imbue that behavior with personal meaning; client’s reaction to therapist behavior (new behavior; interpret & help patient see how their current behavior is influenced by the past)

Countertransference:
Freud- therapist toward client (counter-productive from Freud’s perspective; e.g., displacement)
Modification - potential source of information about patient and importantly contributes to the curative process

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19
Q

Freudian Psychoanalysis

A

Role of unconscious instinctual (esp sexual) forces

Human beings are determined by:
irrational forces
unconscious motivations
needs and drives
psychosexual events
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20
Q

Adler’s Individual Psychology

A

Attention to social factors

Behavior as largely motivated by one’s future goals (teleological approach), rather than by past events

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21
Q

Teleological approach

A

Adler

Behavior as largely motivated by one’s future goals

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22
Q

Adler’s Individual Psychology - Personality Theory

A 
Key concepts:
Inferiority feelings
Striving for superiority
Social interest
Style of life
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23
Q

Style of life

A

The specific ways a person chooses to compensate for inferiority and achieve superiority

one’s style of life is well-established by 4 or 5 yo

Influenced by birth order, early family relationships, innate social interest, inferiority feelings, & striving for superiority

Healthy style of life: reflect optimism, confidence, concern about welfare of others

Mistaken style of life: self-centeredness, competitiveness, striving for personal power, lack of social interest (leads to substance abuse, antisocial behavior)

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24
Q

Adler’s Individual Psychology - View of Maladaptive Behavior

A

mental disorders = a mistaken style of life (as opposed to a healthy style of life) ​

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25
Q

Adler’s Individual Psychology - Therapy Goals & Techniques

A

Goal: Help client achieve a more adaptive style of life ​(incorporate teleological approach; set future goals)

“lifestyle investigation”: information about family constellation, hidden goals, and basic mistakes (distorted beliefs and attitudes)

Establish a collaborative relationship, identify & understand client’s style of life and its consequences​

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26
Q

Jung’s Analytic Psychotherapy

A

Adopted a broader view of personality dev than Freud

Libido as general psychic energy

Behavior = both past events & future goals/aspirations

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27
Q

Jung’s Analytic Psychotherapy - Personality Theory

A

Personality as consequence of both conscious & (personal & collective) unconscious factors

consists of 2 attitudes (extraversion & introversion) & 4 psychological functions (thinking, feeling, sensing, & intuiting)

Dev as throughout the lifespan (esp mid & late adulthood), similar to Erikson

Key concept = individuation (integration of conscious and unconscious aspects of psyche that leads to dev of a unique identity)

Dev of wisdom later in life (outcome of individuation)

Conscious ego - Thoughts, perceptions, ideas (how it’s similar to Freud’s)

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28
Q

Personal unconscious

A

experiences that were unconsciously perceived or were once conscious but are now repressed or forgotten

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29
Q

Collective unconscious

A

repository of latent memory traces that are passed down from one generation to the next

Universal to all people, to all time periods, to all cultures

includes archetypes

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30
Q

Archetypes

A

“primordial images” that cause people to experience or understand a certain phenomena in a universal way

includes: self, persona (public mask), shadow (dark side of personality), & anima (feminine) and animus (masculine) aspects of personality

Emotionally charged symbols; thought to be derived by our ancestors to continually repeating events

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31
Q

Jung’s Analytic Psychotherapy - View of Maladaptive Behavior

A

Symptoms as “unconscious messages” to the individual that sth is awry with the individual​

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32
Q

Jung’s Analytic Psychotherapy - Therapy Goals & Techniques

A

Goal: Bridge the gap between the conscious & the (personal and collective) unconscious ​

Techniques:

  • Interpretations (esp dreamwork)
  • Transference as projection of personal & collective unconscious (thus, crucial part of therapy) ​
  • Here-and-now
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33
Q

Object Relations Theory

A

Basic inborn drive = object-seeking (relationship to others; innate need to connect)

Emphasis on early relationship with objects, esp internalized mental representations (introjects) of self & objects

Object - mental representation of the person & feelings toward the person (e.g., mom, dad)

Splitting comes from object relations (all good or all bad; lack of resolution –> maladaptive behavior) –> Borderline Personality Disorder (mellow after 40yo)

Melanie Klein, Ronald Fairbairn, Margaret Mahler, & Otto Kernberg

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34
Q

Object Relations Theory - Personality Theory

A

Dev of object relations occurs during separation-individuation phase (4 to 5 mos of age) - Mahler

Differentiation
Practicing
Reapproachement
Object constancy

First, takes steps toward separation through sensory exploration (4mos)
Followed by, period of conflict between independence & dependence
Finally, by 3 yo, dev a permanent sense of self & object (object constancy) & able to perceive others as both separate & related

Separation-individuation phase (Mahler) - Leads to separate identity and object relations

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35
Q

Object Relations Theory - View of Maladaptive Behavior

A

Problems during separation-individuation ​process

Inadequate resolution of splitting ​(all good or all bad, instead of both good and bad)

Inability to tolerance ambivalence

e.g., patient with Borderline Personality Disorder

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36
Q

Object Relations Theory - Therapy Goal & Focus

A

Goal: Bring “maladaptive unconscious relationship dynamics into consciousness” so that dysfunctional internalized object representations can be replaced with more appropriate ones

Focus:
Splitting
Projective identification
Other defense mechanisms that maintain dysfunctional object relations

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37
Q

Humanistic and Constructivist Psychotherapies - Characteristics

A

Assumption that one must understand his/her subjective experience (as each person in unique)

  • present, here-and-now
  • focus on awareness and responsibility

Focus on current behaviors

Belief in the one’s inherent potential for self-determination & self-actualization

Therapy as an authentic, collaborative, & egalitarian relationship

Rejects ax techniques & diagnostic labels

Client’s perceived reality as indiv/socially constructed. Thus, focus of therapy on process of meaning creation than on accuracy or rationality of meanings

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38
Q

Person-Centered Therapy - Personality Theory

A

An innate “self-actualizing tendency” = source of motivation & guides people toward positive, healthy growth

Self must be unified, organized & whole to become self-actualized

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39
Q

Person-Centered Therapy - View of Maladaptive Behavior

A

self = disorganized (due to incongruence btw self & experience)

incongruence –> anxiety (self being threatened) –> alleviate anxiety via denial or distortion –> counter to self-actualization

e.g, worth (child finds out that positive regard from her parents is conditional rather than unconditional)

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40
Q

Person-Centered Therapy - Therapy Goal & Focus

A

Goal = help client achieve congruence between self & experience

Techniques = right environment by therapist will achieve congruence btw self & experience

“right environment” = 3 facilitative conditions

  1. unconditional positive regard (respect)
  2. genuineness (congruence)
  3. accurate empathic understanding

Avoid use of directive techniques

Do not view transference as necessary

Do not assign diagnostic labels

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41
Q

3 Facilitative conditions

A
  1. unconditional positive regard (respect)
  2. genuineness (congruence)
  3. accurate empathic understanding
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42
Q

Gestalt Therapy (Perls) - Personality Theory

A

each person is capable of assuming personal responsibility for his/her own thoughts, feelings, and actions and living as an integrated “whole”

Personality = consists of self & self-image
(which aspect dominates depends on early interactions with the environment)

To satisfy needs, person must interact with environment and point of contact with environment is the boundary

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43
Q

Self vs. self-image (Gestalt)

A

self = promotes individual’s inherent tendency for self-actualization and live as a fully integrated person

self-image = “darker side” of personality; hinders growth and self-actualization by imposing external standards

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44
Q

Gestalt Therapy - View of Maladaptive Behavior

A

Neurotic (maladaptive) behavior occurs due to abandonment of self for the self-image and lack of integration

Stems from disturbance in the boundary between self & external environment –> interferes with persona’s ability to satisfy one’s needs and maintain homeostasis

4 boundary disturbances: introjection, projection, retroflection, confluence

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45
Q

4 Boundary Disturbances (Gestalt)

A
  1. Introjection (likely to show up)
    - When one accepts accepts/facts from environment w/o understanding or assimilating them
    - trouble distinguishing “me” vs “not me”
    - overly compliant
    - should’s vs shouldn’t
    - take on behavior of someone’s else without assimilate to our own; impedes growth & unique identity
  2. Projection
    - disowning aspects of self by assigning them to other people
    - thinking what other might be thinking
    - other people
  3. Retroflection
    - doing to oneself what one wants to do to others
    - working against our need
  4. Confluence
    - absence of boundary/intolerance of differences btw self and environment
    - going with someone else’s need other than our own
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46
Q

Gestalt Therapy -Therapy Goals & Techniques

A

Goal = help client become a unified whole by integrating various aspects of self

Awareness (as primary curative factor): full understanding of one’s thoughts, feelings, & actions in the here-and-now

*awareness & integration

Techniques:
Empty-chair technique
Role-play
Guided fantasy (imagery) 
Dream work 
"I" statements
  • transference = counterproductive; avoid diagnostic labels; historical events important only when directly impinge upon one’s current functioning (confusion between fantasy & reality)
    (e. g., I’m your therapist, not your mother)
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47
Q

Existential Therapy

A

e.g. Logotherapy (Frankl)

Emphasis on personal choice & responsibility for developing a meaningful life

Assumes that people are in a constant state of evolving & becoming

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48
Q

Existential Therapy - View of maladaptive Behavior

A

Inability to cope authentically with ultimate concerns of existence - death, freedom, existential isolation, meaninglessness

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49
Q

Existential Therapy - Therapy Goals & Techniques

A

Goal= help clients live in more committed, self-aware, authentic, & meaningful ways

Therapist-client relationship = most important therapeutic tool

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50
Q

Reality Therapy (William Glasser) - Personality Theory

A

Based on choice theory; focus on how people makes choices that affect the course of their lives

5 innate needs as source of motivation: 
Love & belonging (most important) 
Survival
Power
Freedom
Fun

Success identity vs Failure identity

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51
Q

Success vs Failure Identity (Reality Therapy)

A

Success ID = when one fulfills needs in a realistic manner that doesn’t infringe on the rights of others to fulfill their needs

Failure ID =inability to satisfy one’s needs or does so in irresponsibly ways

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52
Q

Reality Therapy - View of Maladaptive Behavior

A

Failure identity underlies most forms of mental & emotional disturbance

Mental illness = result of individual’s choices

e.g., a person is depressed because he or she chooses to, as he may believe that doing so will help him obtain attention from others or allow him to avoid unpleasant activities

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53
Q

Reality Therapy - Therapy Goals & Techniques

A

Goal = help clients identify responsible & effective ways to satisfy one’s needs and develop a success identity

Techniques:
Questioning, encouragements, explore & eval behaviors, develop and commit to a realistic plan of action

focus on one’s ‘total behavior” (though focus on one’s behaviors & beliefs)

Rejects medical model, transference as detrimental

Stresses conscious processes, emphasize value judgments

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54
Q

Personal Construct Therapy (George Kelly) - Personality Theory

A

Focuses on how client experiences the world

Assumes people choose the ways that they deal with the world & there are alternative ways for doing so

Psychological processes = determined by the way one “construes” (interpret, perceive, predict) events

Involves the use of personal constructs

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55
Q

Personal Constructs

A

Are bipolar dimensions of meaning (e.g., happy/sad; friendly/unfriendly)

Begin in infancy

No two people have the same set of personal constructs

People act as scientists who continually test their personal constructs and revise them as needed

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56
Q

Personal Construct Therapy - View of Maladaptive Behavior

A

Result of inadequate personal constructs

Rejects medical model of mental illness; instead, replace it with description of anxiety, hostility, and other mal. beh.

anxiety - occurs when one doesn’t have constructs to help him or her determine how to behave in various situations

hostility - when one continues to rely on constructs despite invalidating evidence and tries to force people, objects, or events to fit those constructs

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57
Q

Personal Construct Therapy - Therapy Goals and Techniques

A

Goal = Help client identify & revise or replace maladaptive personal constructs so that client can make sense of his/her experiences

Use of ax techniques:
Repertory grid
Self-characterization sketch

Treatment strategies:
Fixed-role therapy

Therapist & client as mutual experts & co-experimenters

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58
Q

Repertory Grid

A

An assessment technique used in personal construct therapy

Client identify people who have various roles in his or her life and the ways in which those individuals are similar or different

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59
Q

Self-characterization sketch

A

An assessment technique used in personal construct therapy

When client describes him/herself from the perspective of someone who knows the client well

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60
Q

Fixed-role Therapy

A

A treatment strategy used in personal construct therapy

Help clients “try on” and adopt alternative personal constructs

e.g., client experimenting other ways of experiencing life by acting out in his/her daily life the role of a fictional character who is psychologically different from the client

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61
Q

Brief Therapies

A

time-limited (6 to 30 sessions)

Focus on current concerns; problem-focused

Therapist adopts an active role

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62
Q

Interpersonal Therapy (Lerman & Weissman) - View of Maladaptive Behavior

A

Related to problems in social roles & interpersonal relationships tat are traceable to a lack of strong attachments early in life

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63
Q

Interpersonal Therapy - Therapy Goals & Techniques

A

Goals:

  1. Symptom reduction
    - education, instill hope, pharmacotherapy (if needed)
  2. improving interpersonal functioning
    - target 4 areas:

unresolved grief,
interpersonal role disputes,
role transitions,
interpersonal deficits

-communication analysis, CBT, social skills, modeling, role-playing

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64
Q

Solution-focused Therapy - View of Maladaptive Behavior

A

Focuses on solutions rather than problems

View of maladaptive beh.: Understanding the etiology of problem behavior is irrelevant and focus on solutions to problems

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65
Q

Solution-focused Therapy - Therapy Goals & Techniques

A

Client as the expert; therapist acts as a consultant who poses different questions

Identify strengths & resources to help resolve presenting problems

Miracle question
Exception question
Scaling question

Formula tasks: ID positive aspects –> lead to solutions

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66
Q

The Transtheoretical Model (Prochaska & DiClemente) -View of Maladaptive Behavior

A

Analysis of 10 major approaches to therapy that led to 10 empirically supported change processes

Originally dev. as an intervention for cigarette smoking & other addictive beh but has applied to weight control, treatment complaince, IPV, financial management

View of Maladaptive Behavior - focus on factors that facilitate behavior change

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67
Q

6 Stages of Change (Transtheoretical Model)

A
  1. Precontemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
  6. Termination

Progression through the stages is not linear

Interventions = most effective when matching someone’s stage of change

Identifies decisional balance, self-efficacy, & temptation as mediating variables affecting motivation at various stages

Goal: Help patient move to the next stage of change

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68
Q

Precontemplation

A

Little insight/ denial/ uninformed/ unsuccessful in previous attempts

Strategies: empathy, acceptance, support

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69
Q

Contemplation

A

Aware of need for change (maybe I have a problem?)

Action within 6 mos, but not committed to change

Aware of both pros & cons

May be ambivalent about change and remain in this stage for extended period

Strategies: Consciousness raising (e.g., increase awareness of healthy behavior) & support; self re-evaluation (e.g., self-appraisal); emotional arousal (about positive behavior whether positive or negative)

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70
Q

Preparation

A

Plans to take action within 1 mo

Has a realistic plan of action for modifying his/her behavior

Identify effective change strategies

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71
Q

Action

A

Taking concrete steps to change behavior

Making public commitment to change

Will respond to specific strategies (e.g., systematic desensitization)

72
Q

Maintenance

A

Maintaining a change in behavior for at least 6 mos

Taking steps to prevent relapse

Will respond to specific strategies (e.g., systematic desensitization)

73
Q

Termination

A

Feels he or she can resist temptation

Confident there is no risk for relapse

74
Q

Decisional balance

A

the strength of perceived pros and cons of the problem behavior

role in all stages, but particularly important during contemplation stage

75
Q

Motivational Interviewing - View of Maladaptive Behavior

A

*Use during pre-contemplation or contemplation stage

Dev. for those ambivalent about changing their behavior

Derived from Roger’s client-centered therapy & Bandura’s notion of self-efficacy

View of Maladaptive Behavior: Focus on factors that impede an individual’s ability to change that behavior

76
Q

Motivational Interviewing - Therapy Goals & Techniques

A

Goal: Enhance client’s intrinsic motivation to alter his or her behavior

4 general principles:

  1. express empathy
  2. develop discrepancies between current beh & personal goals/values
  3. Roll with resistance
  4. support self-efficacy

Techniques (OARS):

  • open-ended question
  • affirmations
  • reflective listening
  • summaries
77
Q

Family Therapies

A

General Systems Theory:
• family is a system of interrelated components, and a change in one family member causes change in other family members.
• All family systems are open (vs. closed) to some degree.
• Family systems tend to maintain a state of equilibrium
(homeostasis).

Cybernetics:
• A system receives information through positive and negative
feedback loops.

Identified patient

78
Q

Negative Feedback Loop (Cybernetics)

A

Reduces deviation, maintains status quo

e.g., thermostat

79
Q

Positive Feedback Loop (Cybernetics)

A

Disrupts the system

Amplify change and deviation

In therapy, positive feedback promotes appropriate change in a dysfunctional family system

80
Q

Double-bind Communication

A

Bateson; dev of schizophrenia

“Do that and you’ll be punished” and “don’t do that and you’ll be punished” - with one injunction being verbally expressed and the other nonverbally

81
Q

Communication/Interaction Family Therapy

A

Mental Research Institute (MRI) by Don Jackson, Virginia Satir, Jules Riskin, Jay Haley & others

How specific communication styles affect family interactions & relationships

Assumptions

  1. All behavior is communication
  2. Communication has a “report” and “command” function. Problems arise when report and command functions are contradictory
  3. Communication patterns are either symmetrical or complementary
82
Q

Symmetrical Communications

A

Equal between communicators

May escalate into a “one-upsmanship”

83
Q

Complementary Communications

A

Inequality and max difference between communicators

e.g., one participant to assume the dominant and the other the submissive role

84
Q

Communication/Interaction Family Therapy - View of Maladaptive Behavior

A

Accepts a circular model of causality;

Symptom as both a cause and effect of dysfunctional communication patterns (e.g., blaming, criticizing, mindreading, overgeneralizing)

85
Q

Extended Family Systems Therapy (Bowen)

A

Extends beyond the nuclear family & general systems theory; Describes the function of extended family and its members

Key concepts:
Differentiation of self
emotional triangle
family projection process/Multigenerational transmission process

86
Q

Differentiation of self

A

Ability to separate intellectual vs emotional functioning

Lower differentiation = more likely to be “fused” with emotions that dominate the family

Undifferentiated family ego mass = family member who is highly emotionally fused

87
Q

Emotional triangle

A

A third being recruited to increase stability and reduce tension when a two-person system experiences stress

Lower differentiation = greater an emotional triangle is formed

88
Q

Family projection process

A

Process by which parental conflicts and emotional immaturity are transmitted to children

89
Q

Extended Family Systems Therapy (Bowen) - View of Maladaptive Behavior

A

Result of multigenerational transmission process

Progressively lower levels of differentiation are transmitted from one generation to the next

90
Q

Extended Family Systems Therapy (Bowen) - Therapy Goals & Techniques

A

Goal = to increase differentiation of all family members

Therapy techniques:

  • typically involves only two family members (therapist as the third)
  • may also work with family member who displays the greatest differentiation (can motivate others to self-differentiate)
  • use of genogram (go back at least 3 generations)
  • questioning (as a key technique)
91
Q

Structural Family Therapy (Minuchin)

A

All families have an implicit structure = determines how members relate to each other

E.g., of family structures

  • power hierarchies
  • family’s subsystems (e.g. husband-wife; parent-child)
  • boundaries (e.g., overly rigid/disengaged or too diffuse/enmeshed)

Key concepts:
Boundaries (disengaged/enmeshed)
Rigid triads (detouring, stable coalition, triangulation)

92
Q

Rigid triads

A

Boundary problems (Minuchin’s structural family therapy)

  • Detouring = when parents focus on child either by overprotecting or blaming child for family’s problem (e.g., scapegoating)
  • Stable coalition = when parent and child form a coalition and “gang up” against the other parent
  • Triangulation /unstable coalition = when each parent demands the child to side with him or her against the other parent (child being pulled in two directions)
93
Q

Structural Family Therapy (Minuchin) - View of Maladaptive Behavior

A

Result of inflexible (or diffuse) family structure –> inability to adapt to stress

94
Q

Structural Family Therapy (Minuchin) - Therapy Goals & Techniques

A

Long-term goal: restructuring the family (& unbalance family homeostasis)

Short-term goals: symptom relief

Techniques:

  1. Joining
    - blend with family, includes:
    a) *tracking (Id & use family’s values, themes & life events in conversations)
    b) *mimesis (adopting family’s affective & communication style)
  2. Evaluate family structure (like Bowen’s genogram)
    - construct a family structural map to clarify family interaction patterns
    - evaluate family’s structure (transactional patterns, power hierarchies, & boundaries)
  3. Restructuring the family
    - Use of *enactment & reframing to unbalance family’s homeostasis
    - manipulate mood, esculate stress
95
Q

Strategic Family Therapy (Jay Haley) - View of Maladaptive Behavior

A

Emphasize role of communication in maladaptive behavior, esp. how it’s used to exert control in a relationship

Symptom = interpersonal phenomenon
(“represents a strategy, adaptive to a current social situation, for controlling a relationship when all other strategies have failed”)

96
Q

Strategic Family Therapy (Jay Haley) - Therapy Goals & Techniques

A

4 stages: social, problem, interaction, goal-setting

Therapists: assume an active, take-charge role/ use of directives such as paradoxical intervention

97
Q

Paradoxical Interventions (Strategic family therapy)

A

Helps alter the behavior of family members by:
Helping them see a symptom in a different way, recognize they have control over their behaviors, or use their resistance in a constructive way

Ordeals = are unpleasant asks that client has to perform whenever a symptom occurs

Restraining = encouraging family not to change

Positioning = exaggerating the severity of symptom

Reframing = relabeling a symptom to give it a more positive meaning

Prescribing the symptom = instructing family member to deliberately engage in the symptom

98
Q

Milan Systemic Family Therapy (Mara Selvini-Palazzoli)- View of Maladaptive Behavior

A

Results when a family’s pattern becomes so fixed that members are no longer able to act creatively or make new choices about their lives

Premise = family system is a circular patterns of action & reaction

99
Q

Milan Systemic Family Therapy (Mara Selvini-Palazzoli) - Therapy Goal & Techniques

A

Goal = to help family members see their choices and assist them in exercising their prerogative of choosing

Techniques (designed to help members understand their relationships & problems in different ways, which then paves way to see new solutions & make new choices)

*Use of therapeutic team

  • Hypothesizing (testing hypotheses and revise as necessary)
  • Neutrality (ally of entire family)
  • Paradox (use of counterparadox/double-bind & positive connotation/reframing)
  • Circular Questions (help members recognize differences & similarities in their perceptions)
100
Q

Behavioral Family Therapy - View of Maladaptive Behavior

A

Based on operant conditioning, social learning theory, & social exchange theory

All behaviors, including maladaptive ones, are learned and maintained by its antecedents & consequences

101
Q

Behavioral Family Therapy - Therapy Goal & Techniques

A

Goal = alter environmental factors (antecedents & consequences) that are maintaining problematic behaviors

Techniques =

  1. Focus on observable behaviors
  2. Ongoing assessment of behaviors
  3. Increasing or decreasing target behaviors through contingent reinforcement
  4. Focus on improving communication & problem-solving skills

Recent trend to focus on maladaptive cognitions as well

102
Q

Object Relations Family Therapy - View of Maladaptive Behavior

A

Result of both intrapsychic & interpersonal factors

Primary source of dysfunction = projective identification (when family member projects old introjects onto another family member and then reacts to that person)

103
Q

Object Relations Family Therapy - Therapy Goal & Techniques

A

Goal = resolve each member’s attachment to family introjects (i.e., interpreting transferences, resistances, etc)

Therapists recognize multiple transferences in therapy

104
Q

Group Therapy (Yalom) - 3 Formative Stages

A
  1. First Stage - Orientation, hesitant participation, search for meaning, dependency (reliance on therapist; toward advice giving & problem-solving)
  2. Second Stage - Conflict, Dominance, Rebellion
    - social pecking order (anxiety, resistance, transition stage, hostility toward leader)
  3. Third Stage - Development of Cohesiveness
105
Q

Group Therapy (Yalom) - Therapeutic Factors & Therapist’s Role

A

Therapeutic Factors (group therapy as a social microcosm)

  • Most important: interpersonal input, catharsis, self-understanding, & cohesiveness
  • Least: Re-enactment, guidance, identification

Therapist Role

  • creation & maintenance of group
  • culture building (technical expert & participant/model)
  • activation & illumination of here-and-now
106
Q

Group Therapy (Others)

A

Concurrent group & individual therapy (neither necessary nor beneficial)

  • Prescreening can reduce premature termination (10-35% drop out during 12 to 20 sessions)
  • Preview orientation

Good candidate:

  • primary problems = interpersonal issues
  • motivated to change
  • has a positive view of group therapy
  • prefers to get involved in therapy slowly
  • finds peer support & feedback beneficial
  • is psychologically & verbally sophisticated
107
Q

Feminist Therapy - View of Maladaptive Behavior

A

Symptoms are considered:

1: to be related to nature of traditional feminine roles or conflicts
2: “survival tactics” or means of exercising personal power
3: arbitrary labels that society has assigned to certain behaviors to exert social control

108
Q

Feminist Therapy - Therapy Goals & Techniques

A

Goals: empowerment or helping women become more self-defining & self-determining

Techniques:

  • Striving for an egalitarian relationship
  • Avoiding labels
  • Avoiding revictimization
  • Involvement in social action
109
Q

Self-in-relation theory (Feminist)

A

Gender differences can be traced to differences in mother-daughter & mother-son relationship

  • males are taught to separate from mother, whereas females are taught to remain attached to mothers
  • thus, females define themselves in relation and males in separation
110
Q

Complementary & Alternative Medicine

A
  1. Hypnosis
    - acute stress, anxiety, obesity, insomnia, chronic pain, recover repressed memory
  2. Acupuncture
    - unblocks flow of qi along pathways/meridians
    - release of endorphines; alteration in blood flow
    - useful to reduce certain pain, manage chemo-induced nausea and vomitting
  3. Reflexology
    - applying pressure to re-establish balance and promote healing
    - restores energy flow
    - stress & anxiety, pain, premenstrual syndrome, others
111
Q

Community Psychology

A

Stresses prevention over treatment

Types: primary, secondary, tertiary

Techniques:

  1. Education
  2. Preventative health care
    - Health Belief Model (health behavior can be modified by targeting people’s knowledge and/or motivation to act)
    - Health Locus of Control Model (enhance one’s health behaviors by promoting patient’s sense of personal responsibility & control)
112
Q

Primary prevention

A

Group/ All members of an identified group or population

Aim at decreasing incidence of new cases

  • Stop it before it starts
  • Reduce prevalence

E.g., all students at Jollity High

113
Q

Secondary prevention

A

Self/Individual

  • Screen & intervene
  • Early detection

E.g., suicide hotline; crisis intervention

*Reduce severity of mental disorders

114
Q

Tertiary prevention

A

Decrease after effects & risk of relapse

  • Education & Rehab
  • Reduce duration & consequences of dx & chronicity

e.g., rehabilitation, halfway houses, AA

115
Q

Consultation - Stages

A

Entry
Diagnosis
Implementation
Disengagement

116
Q

Mental Health Consultation

A

consultant, consultee(s), or client/program

  1. Client-centered case consultation:
    - work with consultee to work more effectively with client
  2. Consultee-centered case consultation:
    - enhance consultee’s performance (focus on skills, knowledge, abilities, objectivity)
  3. Program-centered administrative consultation
    - working with administrators (consultees) to solve problems in an existing program
  4. Consultee-centered administrative consultation
    - help administrative- level personnel improve professional functioning
117
Q

Eysenck (1952)

A

Effects of psychotherapy are small and nonexistent; nothing more than spontaneous remission

People who don’t receive therapy do better (72%) than those with similar problems who receive eclectic therapy (66%) and psychoanalytic (44%) therapy

  • do better within 2 years
  • only 66 and 44% show substantial decrease
118
Q

Smith, Glass, & Miller (1980) meta-analysis

A

1st to use meta-analysis to psychotherapy outcome research

Mean effect size = .85

Average therapy client is better off than 80% of those who need therapy but remain untreated

119
Q

Lambert and Bergin (1994)

A

Therapy is not due to any unique or specific techniques but common factors such as catharsis, positive relationship with therapist, behavioral regulation, cognitive learning and mastery

120
Q

Howard et al. (1986) - Dose-dependent effect

A

Relationship btw treatment length and outcome “levels off” at ~26 sessions

Dose dependent effect: 75% of clients show marked improvement at 26 sessions and 85% at 52 sessions

121
Q

Howard et al (1986) - Phase model

A

Benefits of therapy vary depending on the phases

3 Phases:

  1. Remoralization - first few sessions (due to increased hopefulness)
  2. Remediation - focus on symptom relief - ~16 sessions
  3. Rehabilitation - “unlearning troublesome, maladaptive habitual behaviors & est. new ways of dealing with various aspects of life” (behavior & personality change)
122
Q

Efficacy vs. Effectiveness

A

Efficacy:

  • clinical trials (under well-controlled conditions)
  • less useful
  • limited generalizations
  • good internal validity
  • useful for est. whether or not a treatment has an effect
  • in lab; structured session format

Effectiveness:

  • correlational or quasi-experiental
  • best for assessing clinical utility (tmt’s generalizability, feasibility, cost-effectiveness)
  • better external validity
  • conducted in clinical and other applied settings
123
Q

Research on Psychotherapy with Members of Diverse Populations

A
  • While smaller proportion of Af-Am receive mental health services, a disproportionate share in emergency room, psychiatric inpatient setting, treatment for illicit drug
  • ethnic & cultural minority groups are more likely to terminate therapy prematurely
  • Ethnic matching reduced premature termination for Asian, Hispanic, & White Americans, but Af-Am; outcomes assoc with improved treatment outcomes for Hispanic American clients only
  • People with a strong commitment to their culture are more likely to prefer an ethnically similar counselor
  • Other factors such as education, similarity in values and worldview - are more important than race, culture, etc for many members of culturally diverse groups
124
Q

Interventions for older adults

A

Most common problems: anxiety, severe cog impairment, & depression

More heterogeneous than other age groups

Gatz et al (1998):

  • behavioral & environmental interventions
  • memory and cognitive retraining
  • cognitive, behavioral, & brief psychodynamic therapies
  • interventions most effective when tailored to specific needs and circumstances (e.g., incorporating caregivers & family members into an intervention)
125
Q

Interventions for IPV victims

A

20.4% (female) vs 7% (male)

Younger, heterosexual, American Indian/Alaska native, yearly incomes < $10,000

Interventions:

  • emphasize self-determination
  • appropriate to women’s needs
  • ensure safety & increase her self-esteem & sense of empowerment & control
  • separate services for victims & perpetrators?
126
Q

Diagnostic Overshadowing

A

When the presence of one diagnosis (e.g., Intellectual Disability or LD) causes a clinician to attribute all of a client’s symptoms to that diagnosis and overlook the possibility of a co-diagnosis

127
Q

Alloplastic vs Autoplastic interventions

A

Alloplastic:
-make changes to the environment

Autoplastic:
-changing the individual

128
Q

Therapist Distress

A

Suicidal statements = most stressful type of client behavior

Lack of therapeutic success = single most stressful aspect of their work

Issues related to confidentiality = most frequently encountered ethical/legal dilemma

129
Q

Psychiatric Hospitalization

A

Admission rates to state & county psychiatric hospitals = higher for men

Marital status: (highest to lowest) Never married > married or divorced/separated > widowed

Race/ethnicity: Whites represent largest numbers

Age: 25-44 yo for men and women

Diagnosis: schizophrenia (most common) for inpatients in the 18 to 44 age; age 65 (organic disorder, then affective disorder)

  • more women than men for outpatient admissions
  • whites represent 70% of admissions to both inpatient and outpatient mental health programs
130
Q

Diverse Populations - African Americans

A

Therapy: multisystems approach or extended family system

Gender roles = flexible; egalitarian; adopt multiple roles

Family = an extended kinship network (including church)

Emphasize interconnectedness;

group welfare > individual needs

131
Q

Diverse Populations - American Indians/Alaskan Natives

A

Therapy: Build trust & credibility by showing respect and familiarity with their culture; network therapy; incorporate traditional healing practices

Collateral social system that includes family, community, tribe (emphasis on extended family & tribe)

Adopt a spiritual and holistic orientation of life; emphasizes on harmony with nature

Time = personal & seasonal rhythms; present-oriented (than future-oriented)

132
Q

Diverse Populations - Asian Americans

A

Therapy: prefer a directive, structured therapy approach; expect therapist as a knowledgeable expert, given concrete advice, and as authority figure

Somaticize their psychological problems

Avoid open expression of emotion

Greater emphasis on family & community; adopt a hierarchical family structure & traditional gender roles

Emphasize harmony, interdependence, & mutual loyalty

133
Q

Diverse Populations - Hispanic/Latino Americans

A

Therapy: Utilize an active, directive, solution-focused approach; incorporate traditional healing practices

May somaticize their psychological problems

Gender role = clearly defined (patriarchal; sex roles = inflexible; parent-child bond is often stronger than husband-wife and other family relationships)

Family welfare > individual welfare (allegiance family over other concerns)

Consider discussing intimate personal details with strangers = highly unacceptable; problems be handled within family/other natural support system

Consider impact of religious & spiritual factors

134
Q

Internalized homophobia

A

when LGBT individuals “accept heterosexual society’s negative evaluations of them and incorporate these into their self-concepts”

consequences = low self-esteem, self-doubt, self-hatred, sense of powerlessness, denial of one’s sexual orientation, self-destructive behavior

Therapy = ID & correct cognitive distortions, training in assertiveness & coping skills, activating social support systems

135
Q

“Coming out”

A

lesbian and bisexual women who come out report higher levels of self-esteem & positive affec, lower levels of anxiety,

higher degree of outness = associated with lower levels of psychological distress for lesbian & bisexual women

136
Q

Cultural Competence

A
  1. Awareness
    - aware of own assumptions, values, & beliefs
  2. Knowledge
    - understand worldviews of culturally diverse clients
  3. Skills
    - Use therapeutic modalities & interventions that are appropriate for culturally different clients

Two critical processes critical when working with diverse clients: credibility & giving

137
Q

Indegenous Healing

A

Share 3 characterisitcs:

  1. Rely on community & family networks
  2. Religious & spiritual practices of the community are integrated into the healing process
  3. Healing process = conducted by a traditional healer or other respected member of community

Examples
Curanderismo
Ho’oponopono
Sweat lodge ceremony

138
Q

Acculturation

A

Degree to which a member of a culturally diverse group accepts and adheres to the values, attitudes, behaviors of his/her own group and the dominant (majority) group

Integration
Assimilation
Separation
Marginalization

139
Q

Integration

A

Biculturalism
Best mental health outcome

High in both (minority & dominant) cultures

140
Q

Assimilation

A

High in Majority

Low in minority

141
Q

Separation

A

Low in Majority

High in Minority

142
Q

Marginalization

A

Low in both (minority & dominant) cultures

Worst outcome; neither here nor there

143
Q

Worldview

A

How a person perceives his/her relationship to nature, other people, institutions, and so on

Impacted by one’s cultural background & experiences

Determined by 2 factors-
Locus on control
Locus of responsibility

White middle-class therapists: INTERNAL control & responsibility

African-American: EXTERNAL control & responsibility

  • Members of minority groups
  • increasingly likely to exhibit INTERNAL control & EXTERNAL responsibility
144
Q

Cultural encapsulation (Wrenn, 1985)

A

When therapists exhibit:
Limited worldview
Rigid, sterotyped views
No cultural differences

145
Q

Emic vs Etic

A

Emic = me in my culture; culture-specific theories

Etic = theory is universal; a universal orientation

146
Q

High- vs. Low-Context Communication

A

High-context = grounded in situation, group understanding, nonverbal cues, slow to change, unify a culture

Low-context = relies primarily on explicit, verbal message; change rapidly and easily

147
Q

Consequences of Oppression

A
  1. Internalized oppression
  2. Conceptual incarcerations = adopting a White Protestant worldview & lifestyle
  3. Split-self syndrome = polarizing oneself into “good” and “bad” components

Playing it cool & Uncle Tom syndrome = ways in which Af-Am disguise negative feelings to protect self from being harmed or exploited

148
Q

Cultural vs Functional Paranoia

A 
Cultural = healthy reaction to racism 
Functional = unhealthy condition

Ridley’s model

  • Intercultural nonparanoiac discloser (low in both)
  • functional paranoiac (high functional, low cultural)
  • healthy cultural paranoiac (low functional, high cultural)
  • confluent paranoia (high in both)
149
Q

Sexual Stigma

A

“shared knowledge of society’s negative regard for any nonheterosexual behavior, identity, relationship or community”

-create power differential between hetero and homosexuals

150
Q

Heterosexism

A

cultural ideologies, which are “systems that provide the rationale and operating instructions” that promote and perpetuate antipathy, hostility, & violence against homosexuals

151
Q

Sexual prejudice

A

negative attitudes that are based on sexual orientation, whether the target is homosexual, bisexual, or heterosexual

152
Q

Racial/Cultural Identity Development Model

A

Atkinson, Morten, & Sue (1993)

5 stages that people experience as they understand themselves in terms of own culture, dominant culture, & oppressive relationship between the 2 cultures

Stage 1: Conformity
Stage 2: Dissonance 
Stage 3: Resistance & Immersion
Stage 4: Introspection
Stage 5: Integrative Awareness 
(CDRIII)
153
Q

Conformity

Stage 1 of Racial/Cultural Identity Dev Model

A

“White is good”

Positive attitudes toward dominant cultural values
Depreciate one’s own culture

154
Q

Dissonance

Stage 2 of Racial/Cultural Identity Dev Model

A

Confusion & conflict; question treatment of white toward other groups

155
Q

Resistance & Immersion

Stage 3 of Racial/Cultural Identity Dev Model

A
  • Actively reject dominant society

- Appreciate attitudes toward self and members of their own group

156
Q

Introspection

Stage 4 of Racial/Cultural Identity Dev Model

A

Uncertainty about rigidity of beliefs in Stage 3; conflicts btw loyalty and responsibility toward one’s group and feelings of personal autonomy

157
Q 
Integrative Awareness
(Stage 5 of Racial/Cultural Identity Dev Model)
A

“multicultural; let’s all get along”

Experience a sense of self-fulfillment with regard to cultural identity

Strong desire to eliminate all forms of oppression

Adopt a multicultural perspectively

158
Q

Black Racial Identity Development Model

A

(Cross, 1971)
“race salience”

Stage 1: Pre-Encounter
Stage 2: Encounter
Stage 3: Immersion-Emersion
Stage 4: Internalization 
(PEIEI)
159
Q

Pre-Encounter

Stage 1 of Black Racial Identity Development Model

A

Race & racial identity have low salience

Adopt mainstream identity;
Negative beliefs about Blacks –> low self-esteem

Assimilation, miseducation, self-hatred identities

160
Q

Encounter

Stage 2 of Black Racial Identity Development Model

A

Exposure to a single significant race-related event(s) –> greater awareness and interest in developing a Black identity

Question dominant culture’s treatment of other groups

161
Q

Immersion-Emersion

Stage 3 of Black Racial Identity Development Model

A

Race & racial identity = high salience

Dev. black identity

Immersion

  • idealizes Blacks & Black culture
  • rage toward Whites
  • guilty & anxiety about previous lack of awareness of race

Emersion

  • intense emotions subside
  • rejects all aspects of White culture & internalize a Black identity
162
Q

Internalization

Stage 4 of Black Racial Identity Development Model

A

Race = high salience

Adopt one of 3 identities

1) pro-Black, non racist orientation
2) biculturist (Black identity with another salient cultural identity)
3) multiculturalist (Black identity with two or more other salient cultural identities)

163
Q

White Racial Identity Development Model

A

(Helms)

Two phases:

  1. Abandoning Racism (Statuses 1-3)
    - Contact
    - Disintegration
    - Reintegration
  2. Development a nonracist White identity (Statuses 4-6)
    - Pseudo-Independence
    - Immersion-Emersion
    - Autonomy
164
Q

Contact

Status 1 of White Racial Identity Dev Model

A

Little awareness of racism

Behaviors reflect racist attitudes & beliefs

IPS = Obliviousness & Denial

165
Q

Disintegration

Status 2 of White Racial Identity Dev Model

A

Increase awareness of race & racism –> confusion & emotional conflict

IPS = suppression of information & ambivalence

166
Q

Reintegration

Status 3 of White Racial Identity Dev Model

A

Attempts to resolve moral dilemmas by idealizing White society and denigrating members of minority groups

IPS: selective perception & negative out-group distortion

167
Q

Pseudo-Independence

Status 4 of White Racial Identity Dev Model

A

Personally jarring event(s) –> cause one to question own racist views

Acknowledge role that Whites have had in perpetrating racism

Interested in understanding racial/cultural differences but only does so on intellectual level

IPS = selective perception & reshaping reality

168
Q

Immersion-Emersion

Status 5 of White Racial Identity Dev Model

A

Explores what it means to be White, confronts own biases, begins to understand White privilege

Experiential & affective understanding of racism & oppression

IPS = hypervigilance & reshaping

169
Q

Autonomy

Status 6 of White Racial Identity Dev Model

A

Internalizes a nonracist White identity

Appreciation of and respect for racial/cultural differences & similarities

Seeks out interactions with members of diverse groups

IPS = flexibility & complexity

170
Q

Homosexual Identity Development Model

A

(Troiden, 1988)

Stage 1: Sensitization/Feeling Different
Stage 2: Self-Recognition/Identity Confusion
Stage 3: Identity Assumption
Stage 4: Commitment/ Identity Integration

171
Q

Sensitization/Feeling Different

Stage 1 of Homosexual Identity Development Model

A

Characteristic of middle childhood

Feels different from peers (e.g., different interests than same-gender classmates)

172
Q

Self-Recognition/Identity Confusion

Stage 2 of Homosexual Identity Development Model

A

Onset of puberty

Attraction to people of the same sex

Attribute feelings to homosexuality -> turmoil & confusion

173
Q 
Identity Assumption
(Stage 3 of Homosexual Identity Development Model)
A

Becomes more certain about one’s homosexuality

Deal with realization by various ways

  • trying to “pass” as heterosexual
  • align self with homosexual community
  • act in ways consistent with stereotypes about homosexuality
174
Q

Commitment/Identity Integration

Stage 4 of Homosexual Identity Development Model

A

Adopt a homosexual way of life

Public disclose of one’s homosexuality

175
Q

Telepsychology

A 
Telephone
Text
Emails
Chats
Interactive tele-video conferencing tech
virtual reality

Can cover crisis intervention, homebound patients, assessments & consultations, conduct therapy

176
Q

Healthcare systems

A

3 approaches to healthcare

  1. Private model
  2. Beveridge model (public funds)
  3. Bismarck model (mix of public & private funds)
177
Q

Triangular Model

A

Where organizational policies & prof knowledge form the foundation with the supervisor relationship at the core with the ultimate emphasis on providing service to clients

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