Clinical Psychology/Intervention Flashcards
Best treatment for chronic pain
Comprehensive tx, focusing on teaching coping skills to alleviate pain & increasing sense of control, incorporates hypnosis
6 phases of classical Adlerian psychotherapy
Support, Encouragement, Insight, Change, Challenge, MetaTherapy; there are 12 stages within these phases reflecting progressive strategies to awaken client’s underdeveloped sense of community
According to Ellis’ Rational Emotive Therapy, what is self indoctrination?
During early childhood, children internalize critical attitude of parents & perpetuate that as they grow older
Treatment of Specific Phobia
Brief In Vivo Exposure, often within 2 to 4 sessions; cognitive techniques may not improve effects substantially
Smith & Glass (1977)
1st meta analysis: allows researchers to stat compare several independent studies to yield single effect size indicating magnitude of IV’s effect
3 Categories of Behavioral Interventions
Based on:
Classical Conditioning
Operant Conditioning
Social Learning Theory
2 Broad categories of Class Cond Interventions
Counterconditioning
Classical Extinction
Interventions based on counterconditioning principles
Aversive Conditioning
Systematic Desensitization
Sensate Focus
Assertiveness Training
Reciprocal Inhibition
Foundational principle of counterconditioning
Idea that 2 incompatible responses cannot be experienced at same time, so stronger will inhibit the weaker
Aversive Cond
Only for deviant bxs;
CS paired w/stronger negative stim
Ex: smoking paired w/electric shock (in vivo)
Ex: smoking paired w/imagining lungs blackening (covert sensitization)
Short term benefit, high rates of recidivism
Theorist assoc w/Systematic Desensitization
Joseph Wolpe
Systematic Desens most commonly treats ____
specific phobias
Systematic Desensitization
Pt taught to relax deeply
Then create anxiety hierarchy
Teach client to relax while exposing to least to highest anxiety provoking event
*CS paired w/deep relaxation
True or False: Systematic Desens is the most efficacious tx for specific phobia.
False- prolonged & intense exposure (flooding) more effective
Sensate Focus
Masters & Johnson; reduce sexual perf anxiety by initially abstaining from intercourse, then focus on body massage until anxiety eliminated
- Targets the arousal sex cycle
- CS paired w/massage
Sexual Response Cycles (4 stages)
Masters & Johnson Excitement Plateau Orgasm Resolution
Assertiveness training
Social anxiety (CS) paired w/assertive bxs, leading to reduced distress & more effective coping start w/role plays move to real life situations
Interventions based on Classical Extinction
Flooding
Implosive Therapy
*CS presented repeatedly w/o US until CS no longer elicits CR
Flooding
Often don’t know what the US was to elicit fear response to CS, but tx focused on exposure to feared situation w/o option of fleeing
*Prolonged exposure (45 min) more effective than multiple brief periods
Implosive Therapy
Stampfl; imagination only, exposure to feared object & therapist interps psychosexual themes
2 Broad Categories of Intervention based on Operant Conditioning
Reinforcement
Punishment (or aversive control of bx)
Functional Assessment of Bx
Performed prior to operant conditioning based tx
Define target bx
Determine antecedents & consequences
Id contingencies (reinf & punishers) that maintain the bx
*this allows for creation of bx mod program
3 types of reinforcers
Primary- reinforce everyone (food)
Secondary-acquire value thru experience (praise)
Generalized Conditioned Reinforcers-not inherently reinforcing, but all access to other reinforcers (money)
Interventions based on reinforcement
Shaping Token Economy Contingency Contracting Premack Principle Differential Reinforcement Self Reinforcement
Contingency contracting
Focuses on bx in naturalistic environ, between 2 ppl
Id bxs ppl most want from one another, then negotiate a contract for their exchange
Differential Reinf of other bxs
combines extinction w/pos reinf
Ex: Ignore E when she whines, respond enthusiastically when she speaks like a big girl
Stimulus control
Narrow range of stimuli that elicit a particular bx (don’t have junk food around) & develop incompatible responses (go for walk instead of snacking)
Interventions based on punishment or aversive control of bx
Positive punishment
Escape Learning
Avoidance learning
Overcorrection
Escape learning
Aversive stim cannot be avoided, but can be stopped by emitting the desired bx
Ex: person being mugged can make assailant go away by giving wallet
Avoidance learning
Aversive stim can be avoided if you emit desired bx in time; there is typically a cue or discriminative stim to prompt bx
Ex: pay bills on time, avoid late fee
Overcorrection
Punishment that involves restitution of some kind & physical guidance
Ex: child makes mess in living room, must clean up that room plus another
Rational Emotive Behavior Therapy
Ellis; 1st CBT approach
Coined term irrational beliefs
Proposed ABC model to clarify role of cognition in bx
Not the Activating event itself, but the person’s beliefs about the event that dictate C
D-Disputing intervention
E-adoption of more effective belief
F-new feelings
Major procedural components of REBT
direct instruction
persuasion
logical disputation
*provides alt philosophical system by relying on reason as modifying beliefs
Beck’s CBT emphasizes ___ ___ ___, where clients are taught to test the validity of their beliefs; often uses ____ ___
empirical hypothesis testing; socratic questioning
In Beck’s CBT theory, psych symptoms are the result of ___
automatic maladaptive thoughts/logical errors
Beck’s Maladaptive Cognitive Triad
Negative view of the self
Negative view of the world
Negative view of the future
Meichenbaum’s Cognitive Behavior Modification: 2 programs
Self instructional training
Stress Inoculation Training
*Emphasized use of positive self statements
Self instruction training has been empirically supported as a tx for ____
ADHD
Self Instruction therapy: 5 steps
Meichenbaum
- Therapist Modeling
- Therapist Verbalization
- Patient Verbalization
- Patient silently talks through task
- Independent task perf
Stress Inoculation Training: Central concept
Meichenbaum: bolstering a person’s repertoire of coping resp to a milder stressor decreases vulnerability to more severe stress
3 phases of Stress Inoculation training
- Education & cognitive prep- taught about importance of cognitive interp of a situation in dictating stress response
- Coping skills acquisition (relaxation, coping self statements, imagery, thought stopping)
- Application of skills in imagination & in vivo
Self Control Model of Depression
Rehm; views depression & low rate of bx (i.e. anhedonia, lack of involvement) as a result of:
neg self evaluations
lack of self reinforcement
high rates of self punishment
Marlatt’s model of Relapse Prevention
Views addiction as an overlearned habit, where relapse is inevitable, pt taught to view relapse as a setback to be learned from
Marlatt proposed that the most common relapse trigger is _____
pt’s emotional state.
3 parts structuring personality, according to Freud
The Id
The Ego
The SuperEgo
The ID
primitive, instinctual part of psyche
basic drives- libido (eros) & aggression (thanatos
operates on pleasure principle
The Ego
Operates on reality principle-awareness of world & consequences
Main task: suspend or satisfy Id impulses through socially acceptable means
The Superego
Forces ego to satisfy id in a manner that is moral & ethical
Guilt is primary weapon
believed to evolve as the child successfully passes through the Oedipal stage
Freud: neurotic anxiety the result of ____, and leads to ____, so these forbidden impulses cannot enter consciousness
id impulses breaking through the ego; defense mechanisms
Freud: Repression
most common defense mech; “motivated forgetting”
**Fundamental aspect of ALL defense mechanisms (making the conscious unconscious)
Freud: Regression
guarding against anxiety by retreating to earlier, less demanding stage of dev
Freud: Projection
Seeing one’s unconscious urges in another person’s bx
suspicion common outcome
Freud: Displacement
Transference of emotions to a substitute object or symbolic representation
Can play a role in phobias- ex: fear of snakes related to underlying fear of sex
Freud:Reaction Formation
Engage in bxs exact opposite of id urges.
Freud: Intellectualization
Distancing self from feelings
Freud: Sublimation
finding soc acceptable ways of discharging energy from unconscious desires
Freud: Rationalization
come up w/self satisfying yet incorrect reason’s for one’s bx
Alloplastic vs autoplastic defenses
hint: pers d/os use alloplastic & neurotics use autoplastic
alloplastic: blame ext environ
autoplastic: blame self
Psychoanalysis involves 4 steps:
Clarification Confrontation Interpretation Working through *free association is cornerstone
Extensions of Psychoanalysis/Psychodynamic Theories
Ego Psych
Object Relations
Self Psych
Neo-Freudians
Major dynamic theorist departing from psychoanalysis
Adler (Ind Psych)
Jung (Analytical psych)
Ego Psychology proposes that the ego ____
acts as the guide to mastery of life, not as the helpless rider of the id
Major Ego Psychologists
Heinz Hartmann
Anna Freud
Erik Erikson
Heinz Hartmann
“Father of ego psych”
proposed parallel dev of id and ego; ppl not only driven by passion but also by thought
differentiated btwn defensive ego fxs & ego autonomous fxs
“conflict free sphere” for ego fxs that develop outside of conflict
Anna Freud
Noted the ego’s ability to reconcile drive conflicts w/demands of reality
Applied psychoanalysis to children, but allowed strong positive bond and interpreted words over play
Erik Erikson
Combined ego psych w/psychosoc life span theory: human bx result of interaction btwn internal world of the psyche & external social world
Proposed dev occurs in response to social crises, series of stages
Object Relations Theory
Focused on capacity to have mutually satisfying interpersonal relationships
Object= relationship of infant to another person
Proposed an inherent drive toward satisfying object relationships
Therapy focused on integrating split off parts of self
Melanie Klein
Object Relations theorist;
Described splitting as major defense mech when infant has hostile feelings toward loved object, which prevents object constancy (ability to recognize the object as one person w/good and bad tendencies
-Worked w/children, saw play as a form of free association
D.W. Winnicott
Emphasized importance of being a “good enough mother
Described pathology as result of abandoning true self for a false self
Importance of Transitional Object to link children to mothers
Margaret Mahler
Object Relations Theorist
Proposed development through processes of separation (become distinct phys entity through distancing) & individuation (become psychologically ind thru dev of mature ego fxs)
Self Psychology
KOHUT
Focused on infantile development of narcissism-healthy/natural focus on getting needs met
Appr caretaking satisfies selfobject needs (mirroring, idealizing, and twinship)
Self psychologists focus on ____ ___ w/pts and prefer __ __ interpretations
empathic attunement
experience near
According to Neo Freudians, pathology results from:
faulty learning
characterological maladaptive style of interacting w/environment
In therapy, NeoFreudians:
focus on identifying & correcting misinterpretations re:the bx of others
Major Neo-Freudian theorists
Harry Stack Sullivan
Karen Horney
Erich Fromm
Harry Stack Sullivan
neo Freudian
Interpersonal theory-personality only exists in emotional exchange w/other ppl
Sullivan’s 3 modes of existence
Prototaxic-birth to 7 mos, isolated sensory exp
Parataxic-8 to 11 mos, sequential sensations serves as only conception of causality
Syntaxic- 12 mos to 2 yrs; causal sensation, logic, ability to predict based on knowledge
Interpersonal Therapy (IPT): 4 commonly targeted areas
Based largely on Sullivan's work Focused on here & now 4 commonly targeted areas: Grief Role dispute Role Transition Interpersonal deficits
Karen Horney
NeoFreudian Neurosis is culturally defined construct 3 neurotic trends: 1. Moving compliantly toward others 2. Moving aggressively toward others 3. Moving detachedly away from others
Erich Fromm
NeoFreudian
Incorp concepts from Marx & existentialism
believed freedom frightened ppl
2 modes of existence: “having” and “being”
healthier ppl live in “being” mode
Alfred Adler
Asserted humans motivated by social (aggressive) rather than sexual urges
Happiness related to social connectedness & ability to transcend self
Pathology result of desire for belonging mistakenly channeled into power, attention, inadequacy or revenge
Acc to Adler, a person is more likely to engage in maladaptive bx if they _____
are more focused on struggle for power at the expense of social interest
Adler proposed that neurosis is result of compensation for natural feelings of ____by adopting unproductive lifestyle
Inadequacy
In therapy Adlerians look for ___ and _____; focus on encouraging the pt
mistaken goals; faulty assumptions
Adlerians emphasize a ____ view of bx, meaning that bx is seen as determined by future rather than the past
teleological
STEP Program
Systematic Training in Effective Parenting
Adler’s work applied to education & parenting
Democratic approach to parenting that values child’s contributions
Understand misbehavior as reflecting 4 mistaken goals (attention, power, revenge, giving up)
Jungian Psychology: structure of psyche incl:
Conscious ego
Personal unconscious
Collective unconscious
Collective Unconscious
Contains archetypes-primordial images/ideas that are inherited & common to all humans from beg of life
In Jungian Psychology, neurosis is result of
struggle to free from interference of archetypes w/progress toward personality integration
-we are striving toward psychological maturity, or individuation
Humanism/Existentialism focus on entering the pt’s subjective world, also known as a ______ approach
phenomenological
Hum & Existentialism emphasize____ and focus on ___
freedom, choice, meaning, purpose, autonomy; the present
Key figure in humanist psych, ___, believed we proceed thru hierarchy of needs toward self actualization
Maslow
Existentialists:
believe no internal nature, no intrinsic meaning, have to make something of what is meaningless
Client/Person Centered Therapy
Rogers
Central concept: Phenomenal self, or private work of experience & meaning; therapist creates accepting atmosphere where clients grow thru the rel, form more pos vioew of self, and direct themselves toward more self actualizing patterns of bx
therapist clarifies feelings, without judging or elaborating on them
3 characteristics of Client Centered Therapy
Empathy
Warmth
Genuineness
Gestalt Therapy
Perls
Focus of therapy is becoming aware of whole personality by discovering those aspects blocked from awareness
Perceptions based on gestalts (combos of figure-what is attended to- and ground- what is ignored)
*therapy is active & focused on awareness, experience, affective expression, not cognitive analysis of bx
Gestalt techniques
Empty chair-take both sides of conflict, pretend to speak to someone for whom client has unresolved feelings
Dreams- client take on different roles in the dream, reflecting different aspects of the person
Reality Therapy
Glasser
Key feature is responsibility- clarify pt’s values & help them evaluate current bx in relation to values
Help clients decide on realistic solutions, use of contracts
Choice Theory, or Control Theory
Key element of reality therapy
proposes we create an inner “need satisfying world” and bx is an attempt to control our perceptions of the external world to fit the internal world
Schools Without Failures
based on Glasser’s reality therapy
used to reduce dropout rates
Transactional Analysis (TA)
Berne
looks at intent behind communication and eliminates deceit
Involves structural analysis, transactional analysis, analysis of games, & script analysis
concept of life scripts
Conditions treated by hypnosis
Chronic pain-medium trance (relief) deep trance (like anesthesia)
asthma
conversion sxs
substance use
Common biofeedback procedures
Thermal biofeedback- treats migraines & renoads dis
Electromyography (EMG)-measures surface muscle tension; treats tension headaches, TMJ, back pain
Electroencephalography (EEG)-brain wave; ADHD, seizure disorders; targets alpha waves
Galvanic Skin Response-sweatiness, treats GAD
Feminist therapists
View sexism as underlying problems, don’t focus on pathology
Egalitarian relationship
Advocate for sociopolitical change
Transtheoretical Model of Bx Change
Prochaska Stages of Change Precontemplation Contemplation Preparation Action Maintenance
Five Factor Theory of Personality/The Big 5
OCEAN
Costa & McCrae
Factor analysis of previous research on pers traits yielded 5 basic traits:
Openness to experience
Conscientiousness
Extroversion
Agreeableness
Neuroticism-high scores are insecure, anxious, moody
____ is the big 5 trait most consistently assoc w/job success
Conscientiousness
2 Major Theories influencing Family Therapy
General Systems Theory
Cybernetics
Cybernetics
Circular nature of feedback loops;
neg feedback loops maintain status quo in the system
pos feedback loops increases change
Marital schism & marital skew
Lidz-psychodynamic family therapy
2 types of deviant marital relationships
Schism- severe discord between parents, seek support from children, attempt to diminish worth of other parent
Skew- skewed toward meeting needs of one family member at the expense of another
*Both lack role reciprocity (common understanding & acceptance of each other’s roles & values)
Can use family sculpting as a technique
Object Relations Family Therapy
Framo
Family members project unwanted elements of self onto others, such that therapy is focused on increasing awareness re: what is being projected
Framo known for meeting w/entire family of origin when working w/a troubled couple
Structural Family Therapy
Minuchin
Family viewed as a system, assessed along dimensions of:
Hierarchy of power
Clarity & firmness of boundaries
Sig alliances & splits
*Therapist acts as expert, diagnosing & correcting dysfunctional elements
Therapist 1st joins the family, then shifts family’s positions to strengthen parental hierarchy/create clear & flexible boundaries
Minuchin’s 3 chronic boundary problems
Triangulation-child caught in middle, ultimately becomes paralyzed
Detouring-false sense of harmony btwn parents, who blame one child for family difficulties
Stable Coalition-parent unites w/child against other parent
In structural family therapy, what strategies unbalance family’s homeostasis
Therapist taking sides, blaming, coalitions
Communications Family Therapists area also called the ___ group. They coined the term ___ ___
MRI; double bind
3 elements of double bind communication acc to MRI group
- injunction telling person that if they do or don’t do something, they will be punished
- second nonverbal injunction conflicting with the first at an abstract level
- tertiary injunction prohibiting victim from escaping the field
Communications family therapy sometimes uses paradoxical interventions, like _____
prescribing the symptom
Strategic Family Therapy
Haley
combo of structural & comm family therapies
Normal family fxing involves flexibility, repertoire for problem soliving, clear rules around hierarchy
*Tx focused on resolving presenting concerns without addressing underlying conflicts and pathology
Systemic Family Therapy
Milan group
General Systems theory, cyberkinetics (feedback loops), components of strategic theory (communication, reframing, paradox)
Key Aspects of Systemic Family Therapy
Circular Questioning- aims at gathering info while also introducing new info into family system. ex- each family member is asked to express views on relationships & differences between other family members
Prescription of Rituals- alters family’s direction; typically incl secrecy, isolation, recording in notebooks, parental outings framed as disappearance
Family Systems Therapy
Bowen; Central concepts:
Family Emotional System (oneness of emotions within family, definite patterns of reactivity)
Multigenerational transmission process of pathology
Originated genograms
Assesses degree to which families are fused
and emotional triangles
Goal of tx in Family Systems Therapy
Personal differentiation from family of origin
Therapist works to shift the “hot triangle” & works w/most psych available family member to achieve enough differentiation to avoid triangle happening again
Solution Focused Therapy
Steve de Shazer; brief 3 to 4 sessions
Clients encouraged to focus on strengths, id solutions
Built on assumption that expectations are powerful
Techniques assoc w/solution focused therapy
Miracle question-if this prob was miraculously solved, how would you know? What would be different?
Exception question- Think about a time you didn’t have this problem, what was different in your life?
Scaling question- rate problem on scale from 0 to 10, helps reduce all or nothing thinking
Narrative Therapy
Michael White
Pathology thought to be result of ppl developing stories that “problem saturated descriptions” filled w/powerlessness
Client asked to re-write story as struggle for control w/sx
Ex- encopretic boy writes story about “sneaky poo” writes about time didn’t give into sneaky poo. when there is success, might ask “what does this tell you about yourself?”
Behavioral Family Therapy
Believes pathology result of families reinforcing neg bx through attention
Interventions: changing contingencies of social reinf & improving communication
Cog Bx Family Therapy
Therapist assesses cog appraisals family members make of each other, promotes positive relationship related cognitions
Marital Bx Therapy
Involves: Behavioral analysis of couple Positive reciprocity established Communication is taught Problem solving skills improved
Richard Stuart Marital Therapy
Incorp operant learning & social exchange theory
proposes bx maintained in rel by ratio of costs to benefits, where daily bx exchanges contr to satisfaction or dissatisfaction
Strategy of caring days: each day spouse performs a bx requested by spouse
Yalom’s 12 therapeutic benefits of group treatment
Insight Instillation of hope Universality Imparting Info Altruism Corrective recapitulation of primary family group Dev of socializing techniques Imitative bx Interpersonal learning Group cohesiveness Catharsis Existential factor
_____ is the most critical component of group therapy success
Cohesiveness- greater acceptance & understanding, permit more conflict
3 stages of group tx, acc to Yalom
Initial Stage- participation hesitant, restricted, superficial interactions, members give & seek advice, mostly talk to therapists not each other
Second Stage- conflict among group members, rebellion toward leaders, attempts at dominance
Third Stage-only if 2nd successfully negotiated, closeness, intimacy, cohesion
Ideal group composition includes members who are ___ in term of ___ and ___ in terms of ego strength
Heterogeneous; conflict; homogeneous
Homeostatic equilibrium
Basis of crisis theory, proposes that at equil, usual coping skills are sufficient. During crisis, person faced w/obstacle insurmountable by customary problem solving
4 Phases of Crisis Situation (Caplan)
- Beginning, emotional tension, disorganization, efforts to cope w/previously learned mechanisms
- Existing coping doesn’t work, further disorganization
- Increased tension, help seeking, change of direction/goals
- If these efforts don’t work, extensive pers disorganization & emotional breakdown may occur
Steps of crisis tx
Estab rapport
Review steps leading to crisis
Help ct gain understanding of maladaptive reactions
Help ct develop more adaptive ways of coping
*Goal is restoration to pre-crisis level of fxing, different from therapy where goal is growth
Community Mental Health Centers Act (1963)
Root of community psych movement, estab comm mental health centers to provide continuum of services for early intervention
Goal of Community Psych
focuses on prevention, extends services beyond agencies & clinics to more natural settings (churches, schools, etc), allows for training of non professionals
4 Categories of Consultation (Caplan)
- Client centered-focused on a client
- Consultee Centered-focused on group of clients
Client centered case consultation-individual case
Consultee Centered case consultation-focused on helping therapist problem solve difficulties working w/clients
Consultee Centered Administrative consult-focused on targeting consultee’s issues that are impeding program change
Program centered admin consult-focus on development, expansion, or modification of a program
3 Levels of prevention in Community Psych
Primary-prevent occurrence of new cases of a disease or disorder, often focused on education & competence training Ex- Purple ribbon program, vaccinations
Secondary- Early id & prompt tx of an illness or d/o that already exists Ex- academic screening throughout schooling; psychological first aid after a tragedy
Tertiary- focused on reducing negative impact of an established, serious issue; ex- day treatment centers for schiz, 12 step programs
Expressive vs. Instrumental Spousal abuse
Expressive- less deliberate, result of emotional reactivity
Instrumental- More deliberate means of control
*left untreatment, expressive likely to become instrumental
Impact of divorce acc to age of child
3 to 6 yr old- feel responsible
7 to 12- decreased school perf
Adol-feel could have prevented divorce, but hurt & critical of parents
Recovery tends to take 3 to 5 years
Meta analysis of divorce outcomes
Adult children of divorced parents:
higher depression, marital probs, lower SES & health
Earliest meta analysis
Eysenck (1952)- found that ppl treated related to neuroticism did worse over 2 year period, highly criticized methods
Spontaneous improvement rate in psychotherapy
around 40%
Avg effect size of treatment
.85, so treated person better off that 80% of untreated sample
Client variable impacting tx response
Outcome research indicates that charac of pt account for most variability in effectiveness
Pt’s ability to relate & learn new skills primary factor
3 therapist factors accounting for 35% of treatment outcome variance
Attractiveness
Trustworthiness
Expertness
Methods for monitoring tx implementation, utilization, & quality
Total Quality Management
Quality Assurance
Utilization Review
Risk Management
5 premises of Total Quality Management
- Customer Focus
- Total involvement (all team members aware of what other members are doing)
- Measurement
- Systematic Support - innovative problem solving
- Continuous Improvement
Outcome research: what factors are most important for lack of improvement in psychotherapy?
Client factors (dx, motivation, severity)
Theme interference problems
Problems of the supervisee/consultee that impact pt progress; could be targeted with consultee-centered case consultation
Thomas Szasz,
whose somewhat controversial book, “The Myth of Mental Illness,” argues that psychiatric diagnoses are labels devoid of significance.
Avg effect size for psychotherapy outcome research
.85 (treated ppl do about .85 of a standard deviation better than untreated)
Jungian view of transference
projection of the personal and collective unconscious.
M Seligman’s theory of learned optimism
attributions of optimistic ppl are opposite of depressed ppl
external, unstable, specific attributions for neg life events
Basic requirements of token economy
Target bxs
Choice of reinforcer
Rate of exchange
