Clinical Psychology (Theory, Intervention, and Research) Flashcards
Psychodynamic therapies share the following core assumptions: 1. 2. 3. 4.
- Human behavior is motivated by unconscious processes
- Early development has a profound effect on adult functioning
- Universal principles explain personality development and behavior
- Insight into unconscious processes is a key component of psychotherapy
The psychodynamic psychotherapies include: 1. 2. 3. 4.
- Freud’s psychoanalysis
- Adler’s individual psychotherapy
- Jung’s analytical psychotherapy
- Object relations therapy
Freud’s personality theory consists of two separate but inter-related theories:
1.
2.
Structural (drive) theory
Developmental theory (psychosexual development)
Freud’s Structural theory posits that personality is made up of 3 structures:
Id, Ego, SuperEgo
Id:
Developed at ____
Consists of ____
Operates on the basis of the _____ principle, meaning it seeks ____
Present at birth
Consists of person’s life or death instincts, is the source of psychic energy
Operates on the basis of the pleasure principle
Seeks immediate gratification of instinctual drives and needs in order to avoid tension
Ego
Developed at _____
Operates on the _______ principle, meaning:
The primary role is ______
Developed at 6 months old in response to the id’s inability to gratify all its needs
Operates on the REALITY principle, meaning it defers gratification of the id’s instincts until an appropriate object is available in reality, employing secondary process thinking (realistic and rational thinking and planning)
Primary role of the ego is to mediate the often conflicting demands of the Id, reality, and superego (when it later develops)
Superego
Develops at _____
Represents _______
Attempts to ________ the id’s socially unacceptable impulses
Develops at 4-5 years of age
Represents an internalization of society’s values and standards, which are conveyed to the child by his parents rewards and punishments
Attempts to completely block/shut out the id’s unwanted impulses (unlike the ego which delays them)
Freud’s developmental theory emphasizes ___________ and proposes that personality is formed ____________
The sexual drives of the id
Personality is formed during childhood as the result of experiences during five predetermined psychosexual stages of development
During each stage, the id’s libido (sexual energy) is focused on a different part of the body, and over- or under- gratification of needs at each stage results in a different personality outcome
What are Freud’s 5 psychosexual stages?
Oral Anal Phallic Latency Genital
Freud conceptualized anxiety as
An unpleasant sensation from the autonomic nervous system that functions to alert the ego to an impending internal or external threat
Internal threat- conflict between id and superego
External threat- actual threat in the external environment
The ego employs defense mechanisms when:
Defense mechanisms serve to:
The ego is unable to ward of danger through rational/realistic means
They serve to reduce anxiety
Defense mechanisms share two characteristics:
1.
2.
- They operate on an unconscious level
2. They distort or deny reality
What is the most basic defense mechanism?
Repression
This underlies all other defense mechanisms
Occurs when the id’s drives and needs are kept out of conscious awareness and maintained in the unconscious
Freud’s theory understands psychopathology to stem from:
An unconscious, unresolved conflict that occurred during childhood
Examples:
Phobia = the result of displacement of anxiety onto an object/event that is symbolic of an abject/event involved in an unresolved conflict
Depression = object loss coupled with anger toward the object turned inward
Mania = defense mechanism against libidinal or aggressive urges that threaten to overwhelm the ego
What is the goal of Freudian psychoanalytic therapy
Reduce/eliminate psychopathological symptoms by bringing the unconscious into the conscious awareness and integrating previously repressed material into the personality
Psychic determinism (Freud)
Freudian belief that all behaviors are meaningful and serve some psychological function
This principle underlies analysis (e.g., of dreams, free association)
Ex. Slips of the tongue (parapraxes) are not meaningless accidents but are expression of unconscious motives
In psychoanalysis, analysis (of dreams, free association, transference, etc) consists of a combination of these steps: 1. 2. 3. 4.
- Confrontation - making statements that help the client see the behavior in a new way
- Clarification - clarifying the client’s feelings and restating his/her remarks more clearly
- Interpretation - explicitly connecting conscious behavior to unconscious processes
- Working through - gradual assimilation of new insights into personality
Progress in psychoanalysis is attributed to:
1.
2.
3.
- Catharsis- emotional release resulting from the recall of unconscious material
- Insight - gaining understanding between unconscious processes and conscious behavior
- Working through - assimilating insights into personality
Recent modifications to Freudian theory include a __________ view of the therapeutic relationship and reconceptualization of ______________
More collaborative and egalitarian
Transference and countertransference
Recent reconceptualization of transference in psychoanalysis has moved away from _______ and instead conceptualizes transference as _______
Prior conceptualizations of transference as a distortion of reality
Current conceptualization of transference as the patient’s response to the therapist’s actual behavior and an attempt to make meaning of that behavior
In current psychoanalysis, countertransference is considered an important source of information about _______
The patient; can be an important contributor to the curative process when recognized and managed appropriately
Brief psychodynamic therapies have been developed and share the following characteristics:
1.
2.
3.
- They are time limited and target a specific interpersonal problem (usually identified in session 1)
- Begin using interpretation (connect conscious to unconscious) early in the process
- Emphasize the development of a strong working alliance
Adler’s teleological approach views behavior as:
Primarily motivated by a person’s future goals, rather than determined by past events
Adler and Freud agreed that __________
Adler disagreed with Freud about the importance of ____________ in the development of personality
All behavior is meaningful/purposeful
Unconscious instinctual forces (especially sexual drives)
What are the four key concepts in Adler’s Individual Psychotherapy? 1. 2. 3. 4.
- Inferiority Feelings
- Striving for Superiority
- Style of Life
- Social Interest
Adler’s concept of “inferiority feelings”
Develop in _________ as a result of ________
Inferiority feelings are important because…
Develop during childhood as a result of real or perceived weaknesses (can be biological, psychological, or social)
The way a person compensates for inferiority feelings determines their “style of life”,
Psychological symptoms may be maladaptive ways of compensating with these feelings
Adler’s “striving for superiority”
An inherent tendency toward perfect completion
The ways in which a person strives for superiority contributes to their “style of life”
Adler’s Style of Life
Is influenced by ____________ and is well established by _________
Healthy style of life is marked by goals that reflect ______
Unhealthy (mistaken) style of life is marked by goals that reflect ____
Represents the unified aspects of personality, determined by the ways an individual compensates for inferiority and achieves superiority
It is influenced by early experiences, particularly within the family, and is established by 4-5 years old
Healthy style of life is marked by goals that reflect optimism, confidence, and concern for the wellbeing of other
Unhealthy style of life is marked by goals that reflect self-centeredness, competitiveness, striving for personal power
How does Adler conceptualize psychopathology/maladaptive behavior?
Psychological symptoms/maladaptive behavior/mental disorders represent a mistaken/unhealthy style of life
Characterized by maladaptive attempts to compensate for feelings of inferiority, a preoccupation with achieving personal power, and a lack of social interest
Adlerian therapy involves:
1.
2.
3.
- Establishing a collaborative relationship with the client
- Helping the client identify/understand their style of life and it’s consequences
- Reorienting the client’s beliefs/goals so that they support a more adaptive lifestyle
Systematic Training for Effective Teaching (Dinkmeyer, McKay, & Dinkmeyer, 1980)
Based on ______’s approach
Assumes behavior is _________
Understands the misbehavior of young children as…
Based on Adler’s approach
Assumes all behavior is goal directed and purposeful
Understands the misbehavior of young children as motivated by having one of four goals - attention, power, revenge, or to display deficiency - which all represent an overarching desire to belong and faulty beliefs about what is needed to belong
ex. Attention-seeking behavior stems from a belief “I belong only when I am noticed”
Jung’s personality theory:
Personality is the consequence of both ______ and ______ factors
Personality consists of two attitudes, _________ and __________
It also consists of four basic psychological functions:
Personality is the consequence of both conscious and unconscious factors
Personality consists of two attitudes:
-Introversion and Extraversion
And four basic psychological functions:
-Thinking, Feeling, Sensing, Intuiting
Jung’s personality theory: conscious
Conscious is oriented to the __________ and governed by the ________.
The conscious represents:
Conscious is oriented to the external world and governed by the ego
It represents the individuals thoughts, feelings, ideas, sensory perceptions, and memories
Jung’s personality theory: personal unconscious
Contains experiences that were unconsciously perceived OR were once conscious but have now been forgotten or repressed
Jung’s personality theory: collective unconscious
The repository of latent memory traces that have been passed down from one generation to the next
Includes ARCHETYPES
Jung’s personality theory: Archetypes
Part of the collective unconscious
“Primordial images” that cause people to experience and understand certain phenomena in a universal way
The self- represents a striving for unity of different parts of the personality
The persona - the public mask
The shadow - the “dark side” of personality
The anima - feminine aspects of personality
The animus - masculine aspects of personality
Regarding development, Freud’s theory ___________ while Jung’s theory ___________
Freud’s theory emphasized early development, particularly the first 6 years of life
Jung viewed development as continuing throughout the lifespan and was most interest in development after the mid-30s
Jung’s personality theory- Individuation
Integration of the conscious and unconscious aspects of the psyche
Leads to the development of a unique identity
Later in life, leads to the development wisdom
Jung conceptualized psychological symptoms/maladaptive behavior as…
Unconscious messages to the individual that something is wrong, and that presents them with a task that demands to be fulfilled
The primary goal of Jungian therapy is ________
________ and __________ are emphasized
To rebridge the gap between the conscious and the personal and collective unconscious
Help client increase awareness of inner work
Dreamwork is emphasized to increase the awareness of the collective unconscious (due to symbolic nature of archetypes)
Transference is also important and is considered to be a projection of the personal and collective unconscious
Jungian therapy takes an optimistic view and focuses mostly on the here and now
Melanie Klein, Ronald Fairbairn, Margaret Mahler, Otto Kernberg
Are all ___________ theorists
Object Relations Theorists
Object Relations Theory
Object-seeking (seeking relationships with others) is a basic inborn drive
A child’s early relationships with objects and their internalized representations of those objects and relationships (interojects) become part of the self and influence interactions with others in the future
Mahler’s (Object Relations) Theory of Personality Development
Focuses on the processes by which an infant assumes their own physical and psychological identity
She has a model of development that includes several phases and sub phases
Mahler - Stages of Development: Normal Infantile Stage
When:
What:
Occurs during the first month of life
During this phase, the infant is self-absorbed and oblivious to the external environment
Mahler - Stages of Development: Normal symbiotic phase
When:
What:
After the first month of life (1-4 months old)
The child becomes aware of the mother, but is unable to distinguish between “me” and “not me”
Mahler- Stages of Development: separation-individuation phase
When:
What happens:
The outcome:
Begins at 4-5 months of age, lasts until age 3
The development of actual object relations begins to occur.
First, the infant takes steps towards separation through exploring the environment
Then goes through a conflict between independence/dependence (separation anxiety)
By age 3 has developed a permanent sense of self/the object (sees self as separate and related)
How do Object Relations Theorists conceptualize psychopathology/maladaptive behavior
In general…
Mahler thought….
Kernberg thought….
In general, OR theorists see maladaptive behavior as caused by abnormalities in the development of early object relations
Mahler: adult psychopathology can be traced to problems during the separation/individuation phase
Kernberg: in infancy there is a tendency to split object relations into categories (good vs bad) and inadequate resolution of this splitting is a cause of adult psychopathology (ex Borderline Personality Disorder)
Primary goal of therapy from Object Relations perspective
Bring maladaptive unconscious object relations dynamics into consciousness so that dysfunctional internalized object representations can be replaced with functional ones
The humanistic psychotherapies share the following characteristics: 1. 2. 3. 4.
- A phenomenological approach- to understand a person you must understand their subjective experience
- Focus on current behavior
- A belief in the individuals inherent potential for self-determination and self-actualization
- View of therapy as involving an authentic, collaborative, and egalitarian relationship between therapist and client
- Rejection of traditional assessment techniques and diagnostic labels
The humanistic therapies include: 1. 2. 3. 4.
Person-centered therapy
Gestalt therapy
Existential therapy
Reality therapy
What are the constructivist therapies?
Kelly’s personal construct therapy
Incorporate many other approaches, especially humanistic
Distinguished by their emphasis on the client’s perspective of reality, which is viewed as being, to some degree, individually and socially constructed
Goal of therapy is to examine the process of making meaning, as opposed to the accuracy/rationality of meaning that has been previously constructed
Person Centered therapy was created by ______
Also referred to as:
__________ or ___________
Carl Rogers
Rogerian therapy, client-centered therapy
The central belief of person centered therapy is that…..
All people have an innate “self-actualizing” tendency that serves as the major source of motivation and guides them towards healthy, positive growth
Carl Roger’s personality theory:
Conceptualized the “self” as:
Roger’s believed all people can become self-actualized, but to do so the self must_____
The self - “the organized, consistent, conceptual gestalt composed of:
- perceptions of the characteristics of the “I” or “me”
- perceptions of the relationships of the “I” or “me” to others or various aspects of life
- the values attached to these perceptions
To become self-actualized, the self must remain unified, organized, and whole
How did Roger’s conceptualize psychopathology/maladaptive behavior
When a person experiences incongruence between the self and experience
Often related to conditions of worth (e.g., a child discovering love from parents as conditional)
Incongruence is experienced as “unpleasant visceral sensations” anxiety which serve as a signal that the unified self is being threatened, and the individual may employ defenses (distortion, denial) that relieve distress in the short term but interfere with self-actualization
The primary goal of person-centered therapy is:
To help the client achieve congruence between the self and experience so they can become a more fulfilled, self-actualizing person
Rogerian therapy is based on the premise that ___________
When the right environment is provided by the therapist, the client will achieve congruence and then be carried by their own inherent tendency towards self-actualization
Rogerian therapy uses these three “facilitative conditions” in therapy:
1.
2.
3.
- Unconditional positive regard / Respect
- Genuineness / Congruence
- Accurate Empathetic Understanding
Gestalt therapy was founded by
Fritz Perls
The basic premise of Gestalt therapy is:
Each person is capable of assuming the responsibility for their own thoughts, feelings, and actions and living as an integrated whole
Gestalt therapy draws from principles from psychoanalysis, phenomenology, and existentialism, as well as these key principles from Gestalt psychology: 1. 2. 3. 4. 5.
- People tend to seek closure
- People’s “gestalts” tend to reflect their current needs
- A person’s behavior represents a whole that is greater than the sum of its parts
- Behavior can be fully understood only in it’s context
- A person experiences their world in accord with the principle of figure/ground
Gestalt therapy - Personality theory
Personality consists of _________ and _________
Which aspect of personality is dominant depends on ________
Personality consists of:
self - creative aspect of the person that promotes the inherent tendency towards self-actualization
Self image - the “darker side” that hinders growth and self-actualization by imposing external standards
Which aspect is dominant is dependent on a child’s early interactions with the environment
Fritz Perls/Gestalt therapy conceptualizes maladaptive behavior (“neurotic” behavior) as:
A “growth disorder” that involves the abandonment of the self for the self image
Results in a lack of integration
Often stems from a disturbance in the boundary between the self and the external environment that interferes with an individual’s ability to satisfy their needs and maintain homeostasis
The four “boundary disturbances” described by Fritz Perls are: 1. 2. 3. 4.
- Introjection
- Projection
- Retroflection
- Confluence
Perl’s boundary disturbances:
Introjection
Occurs when a person “psychologically swallows” whole concepts
E.g., when a person accepts facts, standards, etc from the environment without actually understanding or assimilating them
Interojects are often overly compliant and struggle to distinguish between “me” and “not me”
Perl’s boundary disturbances:
Projection
Disowning aspects of the self by assigning them to other people
Paranoia = extreme projection
Perl’s boundary disturbances:
Retroflection
Doing to oneself what one wants to do to others
Ex. Turning anger towards another person inwards instead
Perls’ boundary disturbances:
Confluence
Refers to the absence of a boundary between oneself and the environment
Causes intolerance of any difference between the self and others
Often underlies guilt and resentment
The primary goal of Gestalt therapy is:
To help the client become a unified whole by integrating the various aspects of the self
The primary curative factor in Gestalt therapy is thought to be:
Awareness
Defined as a full understanding of one’s thoughts, feelings, and actions in the here and now
What are some techniques used in Gestalt therapy to build awareness and work towards understanding and integration of parts of the self? 1. 2. 3. 4.
- Empty chair technique
- Role Play/Games of dialogue (e.g., role play a conversation between two parts of the self)
- Guided fantasy (guided imagery- visualize an event in the here and now)
- Dream work (dreams symbolize different parts of the self- clients role play elements of the dream to lead to integration)
Logotherapy is one form of ___________ therapy that was created by _______
Existential
Victor Frankl
Existential therapies:
Are derived from ________
Share an emphasis on _________
Assume that people are __________
Derived from existential philosophy
Emphasize personal choice and a responsibility for creating a meaningful life
Assume that people are not static, but are in a constant state of evolving and becoming
Existential therapists conceptualize maladaptive behavior as:
An inability to cope authentically with the ultimate concerns of existence:
- death
- freedom
- existential isolation
- meaninglessness
Existential therapists differentiate between existential anxiety and neurotic anxiety:
Existential anxiety:
Neurotic anxiety:
Existential anxiety is considered a normal response to ultimate concerns
-can serve as motivation to grow and change
Neurotic anxiety is often an attempt to avoid existential anxiety
- is out of proportion to the situation that elicited it
- is often outside of conscious awareness
- can be immobilizing
What is the primary goal of existential therapy?
Help client’s live in more committed, self-aware, authentic, and meaningful ways
Help clients recognize their freedom to choose their own destinies and accept responsibility for changing their own lives
Reality Therapy was created by
William Glasser
Reality therapy:
Based on _____ theory
Assumes:
Focuses on:
Based on choice theory (previously known as control theory)
Assumes that people are responsible for the choices they make
Focuses on how people make the choices that affect the course of their lives
Glasser (reality therapy): Personality Theory
People have these five innate needs, which serve as the primary source of motivation: 1. 2. 3. 4. 5. \_\_\_\_\_\_\_\_\_ is the most powerful
- Survival
- Love and belonging
- Power
- Freedom
- Fun
Love and belonging is the most powerful
Glasser (Reality Therapy) - Personality theory
Based on how people are/are not able to fulfill their innate needs, people develop either:
_________ identity
_________ identity
Success identity
Failure identity
Glasser (Reality Therapy)- Personality theory
Success Identity
Achieved when a person fulfills their needs in a responsible way
- a conscious and realistic manner that does not infringe on the rights of others
Glasser (Reality Therapy) Personality theory:
Failure identity
Occurs when a person is unable to fulfill their needs or when they fulfill them in irresponsible ways
This identity is believed to underlie most mental illness
How does William Glasser (Reality Therapy) conceptualize maladaptive behavior/mental illness?
Fundamentally assumes that mental illness is the result of an individual’s choices
E.g., a person is not depressed because of a childhood event or chemical imbalance, but because a person has chosen to “depress themself”
What is the primary goal of reality therapy?
Help clients identify responsible and effective was to satisfy their needs and thereby develop a success identity
Emphasize the thoughts and behaviors that can be controlled by the client
Personal construct therapy is a form of __________ therapy and was developed by ______
Constructivist therapy
George Kelly
Kelly’s Personal Construct therapy:
Focuses on:
Assumes that:
Focuses on how a client experiences the world
Assumes that people choose the ways they experience/deal with the world, and that there are always alternative ways of doing so
Kelly’s (Personal Construct Therapy) Personality theory
A person’s psychological processes are determined by….
The way the person “construes” - perceives, interprets, and predicts - events
Construing involves the use of “personal constructs”
Kelly’s (Personal Construct Theory) Personality Theory:
Personal Construct
Bipolar dimensions of meaning (happy/sad, competent/incompetent, friendly/unfriendly)
Begin to develop in infancy
Are unique to each person
May operate on a conscious or unconscious level
Are constantly under revision throughout life
How did George Kelly (Personal Construct therapy) conceptualize maladaptive behavior/mental illness?
Anxiety, hostility, and other forms of maladaptive behavior are the result of inadequate personal constructs
Ex. Anxiety = a recognition that a person does not have adequate constructs to deal with a situation
hostility = continuing to use constructs despite contradictory evidence, and trying to force others/the world to comply with your constructs
Practitioners of Personal Construct Therapy consider therapists and clients to be ________ and _________
Mutual experts and co-experimenters
They work together to create tasks that help the client identify and revise/replace maladaptive personal constructs
How is assessment used in personal construct therapy?
Techniques used:
Assessment is used to identify maladaptive personal constructs - identify the content and process of a persons construing
Involves techniques such as:
- Repertory grid: identify close individuals in a client’s life and have them describe how they are similar/different
- self-characterization sketch: have client describe self from the perspective of another person
One treatment technique used in Personal construct therapy is _____________ therapy
Fixed Role therapy
Helps clients “try on” and adopt alternative personal constructs
Involves having the client experiment with different constructs by assigning them to live life as if they are someone psychologically different from themselves
Brief therapies differ in terms of theoretical orientation, goals, and processes but share these characteristics:
1.
2.
3.
- Time limited (6-30 sessions)
- Focus on current concerns (rather than the past)
- Therapist takes on an active role/actively encourages the client to participate in the change process
Interpersonal Therapy (IPT) was developed by
Klerman and Weissman
Interpersonal Therapy (IPT) was originally developed as a brief treatment for ________
Depression
Has been successfully applied to bipolar disorder, bulimia, and substance use disorders
Interpersonal therapy (IPT) was influenced by the following theories:
Meyer’s __________
Sullivan’s _________
Bowlby’s ________
Psychobiological approach to psychiatric disorders
Sullivan’s Interpersonal Theory
Bowlby’s Attachment Theory
Interpersonal Therapy (IPT) conceptualizes maladaptive behavior/mental illness as:
Related to problems in social roles and interpersonal relationships that are traceable to a lack of strong early attachments
Interpersonal Therapy (IPT) - treatment goals
The focus is on:
The primary goals are (2):
The focus is on Current social relationships
The primary goal of treatment is reduction of symptoms and improvements in interpersonal functioning
Interpersonal Therapy (IPT) approaches improving interpersonal functioning through targeting one or more of these four Primary Problem Areas 1. 2. 3. 4.
- Unresolved grief
- Interpersonal Role Disputes
- Role Transitions
- Interpersonal Deficits
Interpersonal Therapy (IPT) involves three stages. The initial phase involves an assessment which focuses on ascertaining:
- the client’s diagnosis
- The interpersonal context in which symptoms occur
- The problem area which will be the focus of treatment
Interpersonal Therapy (IPT) involves three phases. During the middle phase…
The therapist uses specific strategies to:
Strategies include:
The therapist uses specific strategies to address the problem area
Strategies include
- encouragement of affect
- communication analysis
- modeling and role-playing to establish new ways of interacting
Interpersonal Therapy (IPT) involves three phases. During the last phase, the therapist:
1.
2.
3.
- reviews the client’s progress
- discusses termination.
3 makes plans for relapse prevention
Solution-Focused Therapy (de Shazar) is based on the assumption that:
You get more of what you talk about
Discussion in treatment focuses on solutions to problems, not the problem itself
Solution-focused therapists believe that the etiology of maladaptive behavior is _________
Irrelevant
They focus instead on solutions to the problems
In Solution-Focused Therapy, the client is viewed as _________ and the therapist takes on a role of _____________
The client is viewed as “the expert” and the therapist takes on the role of “consultant/collaborator”
In Solution-Focused Therapy, the therapist poses different types of questions to help the client recognize their strengths and identify solutions to specific problems
Types of questions used in Solution-Focused Therapy:
1.
2.
3.
- The Miracle Question (e.g., if you woke up tomorrow and a miracle had happened and solved your problem, how would you know? What would be different?)
- Exception Questions (can you think of a time in the last week when X was not a problem?)
- Scaling Questions (on a scale of 1-10, how did you feel last week?)
Transtheoretical model of behavior change (Prochaska et al)
Recognizes that change occurs when an individual progresses through a series of predictable stages
Was developed through analysis of 18 different therapeutic approaches which led to the identification of common and empirically supported change processes
The transtheoretical model intervention was originally developed to address _________
Cigarette smoking and other addictive behaviors
Has since been applied to many other areas including treatment compliance, weight control, intimate partner violence, financial management
The six stages of change in the current transtheoretical model include: 1. 2. 3. 4. 5. 6.
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Termination
Transtheoretical Model- Stages of Change
- Precontemplation Stage
- little insight into the need for change
- does not intend to change
- may be in denial about the problem
- may be uninformed about the problem and it’s consequences
- may have been unsuccessful in past attempts to change
Transtheoretical model - Stages of Change
Stage 2: Contemplation Stage
- aware of the need to change
- intends to take action in the future (next 6 months)
- is not committed to change
- is aware of both the pros and cons of change
- is ambivalent about change
Transtheoretical Model - Stages of Change
Stage 3 - Preparation Stage
- plans to take action in the immediate future (in the next month)
- has a realistic plan of action for modifying their behavior
Transtheoretical Model - Stages of Change
Stage 4 - Action Stage
- takes concrete action to change behavior
- often begins with making a public commitment to change
Transtheoretical Model - Stages of Change
Stage 5- Maintenance Stage
- has maintained a change in behavior for at least 6 months
- is taking steps to prevent relapse
Transtheoretical Model - Stages of Change
Stage 6 - Termination Stage
Person feels that they can resist temptation and there is no risk of relapse
An assumption of the transtheoretical model of change is that progression through the stages is ________________ and people may _______________
Progression is not always linear
People may re-cycle through some or all of the stages several times
The transtheoretical model assumes that interventions are most effective when _______
They match an individual’s current stage of change
The Transtheoretical model identifies three mediating variables that impact motivation at different stages of change. They are:
1.
2.
3.
- Decisional Balance
- Self-Efficacy
- Temptation
Transtheoretical Model:
Decisional Balance
Refers to:
Has greatest impact on motivation during the _________ stage
Refers to the strength of the perceived pros and cons of the problem behavior
Plays a role during all stages, but has the greatest impact on motivation at the contemplation stage
Transtheoretical Model:
Self-Efficacy
Refers to:
Has the most influence on the client’s ability to move from _____to____ and ______to______
The client’s confidence that they will be be able to cope with high-risk situations without relapsing
Impacts ability to move from contemplation to preparation and from preparation to action stages
Transtheoretical Model:
Temptation
Refers to:
Is inversely related to __________
Is usually _______ during initial stages and ________ during later stages
Refers to the intensity of urges to engage in the problem behavior
Is inversely related to self-efficacy
Is usually high during the initial stages and lower during later stages
Motivational interviewing was developed by ________________ for clients who ___________
Miller and Rollnick
For clients who are ambivalent about changing their behavior
Was originally designed for alcohol addition but has been applied to many other populations/problem behaviors
The basic assumptions and procedures of Motivational Interviewing were developed from _____________ and ____________
Roger’s client-centered therapy
Bandura’s notion of self-efficacy
What is the primary goal of motivational interviewing?
Enhance the client’s ____________ by helping the client examine/resolve ___________
Enhance the client’s intrinsic motivation motivation to change their behavior
Examine/resolve their ambivalence about changing
What are the four general principles that guide the strategies used in therapy in Motivational Interviewing? 1. 2. 3. 4.
- Express empathy
- Develop discrepancies between current behavior and personal goals/values
- Roll with resistance (don’t oppose)
- Support self efficacy
What are the specific strategies (micro skills) used in Motivational Interviewing? OARS 1. 2. 3. 4.
- Open-ended questions that cannot be answered with or yes/no
- Affirmations that express empathy and understanding
- Reflective listening that builds rapport and includes restatements, paraphrasing, and reflection of feeling
- Summaries - a type of reflective listening that can be used to facilitate transitions
Family Therapy approaches differ based on theoretical orientation, concepts, and strategies, but all were influenced to some degree by ___________ and _________
General Systems Theory
Cyberkinetics
General Systems theory was first described by ______________ , a biologist
Ludwig von Bertalanffy
General systems theory defines a system as an entity that is maintained by the ___________ of it’s components
The actions of components are best understood by ___________
Systems are maintained by the mutual interactions of its components
The actions of each component are best understood by examining them within their context
Consistent with general systems theory, the family is seen as an ________ system
Families are seen as an open system
They receive input from and discharge output to the environment
They are adaptable/able to be changed
Homeostasis is a concept in family therapy that is influenced by ___________ theory.
Homeostasis is:
General systems theory
Homeostasis is the tendency for the family to act in ways that maintain the family’s equilibrium or status quo
_____________ is a mathematical principle developed in the 1940s that was later applied to family communication processes
Cybernetics
A key feature of cybernetics that has been applied to family therapy is the concept of a _______________ through which a system receives communication
Feedback Loop
Cyberkinetics: negative feedback loop
Reduces deviation and helps maintain status quo
Cybernetics: Positive feedback loop
Amplifies deviation or change and therefore helps disrupt/change a system
Family therapy uses a __________ feedback loop to promote change in a dysfunctional family system
Positive
Family therapy and most forms of individual therapy have different underlying world views
Traditional individual therapy emphasizes _____________ cause-effect relationships, while family therapy emphasizes __________ cause-effect relationships
Individual therapy emphasizes linear cause/effect relationships
- A causes B, but B does not effect A
- this is a western, Lockean, and scientific view
Family therapy emphasizes reciprocal cause/effect relationships
- A and B influence each other
- this is a Kantian view
_______________ was a child psychiatrist who became known as the “grandfather of family therapy”
He integrated principles of psychoanalysis with a systems approach and saw family members together in therapy.
Nathan Ackerman
________________ had a background in anthropology and ethnology, applied ideas drawn from systems theory and cybernetics to the treatment of families.
He is most known for his work on the role of “double-bind communication” in the development of schizophrenia
Gregory Bateson
Double-bind communication
Plays a role in the development of _____________
Involves _______________
Described by Bateson, this plays a role in the development of schizophrenia
Involves “conflicting negative injunctions” (do this and you will be punished, don’t do this and you will be punished) which are stated verbally and non-verbally
___________________ Family Therapy grew out of research conducted at the Mental Research Institute (MRI) in Palo Alto in 1960s, which led to the recognition of the impact of communication on family and individual functioning
Communication/Interaction Family Therapy
The communication/interaction approach is based on the assumption that all behavior is __________
All behavior is communication
People are always communicating, even when they are “doing nothing”
Communication/interaction family therapy is based on the assumption that:
All communication has both: \_\_\_\_\_\_\_\_\_\_ function (the content/information of the communication)
and ________function (nonverbally conveyed content that makes a statement about the relationship between the communicators)
A. Report function
B. Command function
Problems arise when the report function and command function are contradictory
Communication/Interaction therapy assumes that communication patterns within a family are either _________ or ___________
Symmetrical or complementary
Symmetrical communication patterns
- reflect equality between the communicators
- can escalate into a competitive “one-upping” game (communicators try to outdo each other)
Complementary Communication patterns
- reflect inequality
- maximize the difference between communicators
Example: a common complementary pattern is for one party to assume a dominant role and the other to assume a submissive role
Communication/Interaction family therapists accept a ________ model of causality of symptoms/maladaptive behavior
Understand symptom as ___________
Circular
Understand symptoms as both a cause and effect of dysfunctional communication patterns
The primary goal of Communication/Interaction therapy is:
To alter the interactional patterns that are maintaining symptoms
Murray Bowen created :
Extended Family Systems Therapy
Bowen is to __________ therapy as Minuchin is to __________ therapy
Bowen - Extended Family Systems Therapy/Systemic therapy
Minuchin - Structural Family Therapy
Extended Family Systems Therapy (Bowen) described the functioning of the extended family in terms of several overlapping concepts, including:
1.
2.
3.
- Differentiation of Self
- Emotional Triangle
- Family Projection Process
Extended Family Systems Therapy (Bowen):
Differentiation of the Self
Refers to:
The lower a person’s level of differentiation, the more likely they are to become “____” with the emotions that dominate the family system
Refers to a person’s ability to separate their intellectual and emotional functioning
lower differentiation leads people to be “at the mercy of their emotions”
They are more likely to become “fused” with the emotions that dominate the family system
Extended Family Systems Therapy (Bowen):
undifferentiated family ego mass
refers to a family whose members are highly emotionally fused
Extended Family Systems Therapy (Bowen):
Emotional Triangle
When a two person system (parent-child, spouse-spouse) experiences instability or stress, a third person is recruited to reduce tension/increase stability
Extended Family Systems Therapy (Bowen):
The _____ the level of differentiation in the family members, the ______ the likelihood that an emotional triangle will form
Lower differentiation
Higher likelihood of an emotional triangle
Extended Family Systems Therapy (Bowen):
Family Projection Process
The process by which family conflicts and emotional immaturity are transmitted to children
Causes children to have a lower level of differentiation than parents
Most likely to involve the oldest child, a child born during a time of stress, or a child perceived to be “special”
Bowen (Extended Family Systems Therapy) understood symptoms/maladaptive behavior to be the result of:
A multigenerational transmission process, by which each generation has lower levels of differentiation than the last
The primary goal of Extended Family Systems Therapy is:
To increase the differentiation of all of the family members
Bowenian therapy often includes _______ family members, allowing the therapist to form a __________
Two ; therapeutic triangle
If the therapist remains objective, their presence helps reduce fusion between family members and increase the differentiation of all members
Extended Family Systems Therapy:
Genoa ram
Part of the initial assessment
Depicts the relationships between family members, dates of significant life events, and other important information
Structural Family Therapy was developed by:
Salvador Minuchin
Minuchin (Structural Family Therapy) assumed that all families have an implicit structure that determines how family members relate to one another.
Structure is composed of:
1.
2.
3.
- Power hierarchies
- Subsystems
- Boundaries
Structural Family Therapy (Minuchin):
Power Hierarchies
Determine how family members join forces in times of conflict
Structural Family Therapy (Minuchin):
Subsystems
Smaller systems within a family structure (parent-child, spouse-spouse)
Structural Family Therapy (Minuchin):
Boundaries
The barriers or rules that determine the amount of contact allowed between family members
Structural Family Therapy (Minuchin)
When boundaries are ________ , family members are disengaged (isolated) from one another
When boundaries are __________, family members are enmeshed (overly dependent and close)
Overly rigid
Too diffuse/permeable
Minuchin (Structural Family Therapy):
Rigid Triads
Definition:
Three types:
1.
2.
3.
Chronic boundary problems
- Detouring
- Stable Coalition
- Triangulation
Structural Family Therapy (Minuchin): Rigid Triads
Detouring
When the parents over-focus on a child either by overprotecting or blaming (“scapegoating”) the child for the family’s problems
Structural Family Therapy (Minuchin): Rigid Triads
Stable Coalition
When a parent and child form a cross-generational coalition and constantly “gang up” on the other parent
Structural Family Therapy (Minuchin): Rigid Triad
Triangulation
Also known as “unstable coalition”
When each parent asks a child to side with them against the other parent, pulling the child in different directions
Minuchin (Structural Family Therapy) viewed family dysfunction as caused by:
Inflexible family structure which prevents the family from adapting to maturational and situational stressors in an adaptive way
Minuchin (structural family therapy) found that _________________families (ones where a child has a life-threatening medical illness) often have _________________ which limits individual autonomy
In these families, a child’s symptoms diffuse family conflict by diverting attention away from the family dysfunction
Psychosomatic
A high degree of enmeshment
What is the primary long term goal of Structural Family Therapy?
Restructuring the family
Short term goals can also include symptom reductio using other therapeutic techniques (behavioral techniques)
Structural Family Therapy is based on the premise that _________ precedes __________
Action precedes understanding
Focuses on changing behavior rather than fostering insight
Structural Family Therapy involves three overlapping steps
1.
2.
3.
- Joining
- Evaluating the Family Structure
- Restructuring the Family
Structural Family Therapy (Minuchin): Phases of therapy
Joining
The therapist develops a ‘therapeutic system” by blending with the family
Uses “tracking” (identifying and using family values, life themes, and life events in conversation) as well as “mimesis” (adopting and using the family’s affective style
Structural Family Therapy (Minuchin): Phases of therapy
Evaluating the Family Structure
Evaluate the family’s structure including transactional patterns, power hierarchies, and boundaries
Make a “structural diagnosis” to guide specific treatment goals
Construct a “family (structural) map” that helps clarify interactional patterns
Structural Family Therapy (Minuchin): Phases of therapy
Restructuring the family
Techniques include:
- __________ - family members role play relationship patterns so they can be changed
- __________ - relabeling behaviors so they can be viewed more positively
Therapist uses a variety of techniques to deliberately unbalance (stress) the family’s homeostasis
Techniques include:
- Enactment
- Reframing
_____________ developed Strategic Family Therapy, and was influenced by the communication/interaction and structural schools of family therapy
Jay Haley
Strategic Family Therapy (Jay Haley) emphasized the role of ___________ in maladaptive behavior
Emphasized the role of communication in maladaptive behavior
Particularly how behavior is used to exert control in a relationship
In Strategic Family Therapy (Haley), a symptom is….
An interpersonal phenomenon that represents a “strategy, adaptive to a current social situation, for controlling a relationship when alternatives have failed”
The goal of Strategic Family Therapy (Haley) is to alleviate current symptoms by …..
Altering a family’s transactions and organization
Particular focus on hierarchies and generational boundaries
In Strategic Family Therapy (Haley) the first session is very important to treatment. It is \_\_\_\_\_\_\_\_\_\_ and involves four phases: 1. 2. 3. 4.
Highly structured
- Social Stage
- Problem Stage
- Interaction Stage
- Goal-setting stage
Strategic Family Therapy (Haley) Stages of therapy- first session
Social Stage
Therapist observes the family’s interactions and encourages the involvement of all family members
Strategic Family Therapy (Haley) - Stages of Therapy - first session
Problem Stage
The therapist gathers information about why the family came to therapy
Strategic Family Therapy (Haley): Stages of Therapy - first session
Interaction Stage
The family talks about the identified problem while the therapist observes/gathers more information
Strategic Family Therapy (Haley) - First Session stages
Goal Setting Stage
Therapist and family members agree on a contract that identifies the goals of treatment
Strategic Family Therapists take an __________ role in treatment
Active, take charge role
They often offer specific directives during treatment or assignments to complete outside of therapy
Strategic Family Therapy (Haley):
Paradoxical Intervention
Alters the behavior of a family member by helping them
- see a symptom in an alternative way
- recognize they have control over their behavior
- use resistance constructively (e.g., refusing to complete a paradoxical intervention = stopping the problem behavior)
Strategic Family Therapy
Ordeal (type of paradoxical intervention)
Unpleasant tasks a client must perform every time a symptom occurs
Milan Systemic Family Therapy was developed by _____________ who trained as a child psychoanalyst, but altered her treatment approach to involve families when she found this was a more effective treatment for Anorexia Nervosa
Mara Selvini-Palozzi
Milan Systemic Family therapy is based on the premise that:
There are circular patterns of action and reaction in a family system
Maladaptive behavior occurs when these patterns become so fixed that family members are no longer able to act creatively or make new choices about their lives
The primary goal of Milan Systemic Family Therapy is to help families ______________ and assist them in ________________
See their choices
Assist them in exercising their prerogative in choosing
A distinguishing characteristic of the Systemic Family Therapy treatment approach is the use of the ________________
Therapeutic Team
One or two team members will join sessions with a family, while other members observe. One or both therapists may be called out of session by the observers for a “strategic conference”
Milan Systemic Family Therapy involves these four treatment techniques: 1. 2. 3. 4.
- Hypothesizing
- Neutrality
- Paradox
- Circular Questions
Milan Systemic Family Therapy - Therapeutic techniques
Hypothesizing
Therapists collect information from families during the initial sessions to create “hypotheses” about family functioning. These hypotheses are tested and revised throughout treatment
Milan Systemic Family Therapy- Treatment Techniques
Neutrality
The therapist remains neutral and an ally to all family members throughout treatment
Does not get recruited into family alliances or coalitions
Milan Systemic Family Therapy - Therapeutic techniques
Paradox
Therapists use paradoxical interventions to help provide family members with information that will drive them to the solutions to the own problems
Examples: Counterparadox (therapeutic double bind) Positive connotation (reframing)
Strategic family therapists use paradoxical interventions to ________________ , while systemic family therapists use paradoxical interventions to _________________
Elicit and make constructive use of resistance
Help families gain information to solve their own problems
Milan Systemic Family Therapy - Therapeutic Interventions
Circular Questions
Questions are asked to each family member (eg. Go in a circle and ask each person the question) in order to demonstrate differences and similarities in perspectives
Behavioral Family Therapy is a broad category which includes:
1.
2.
3.
- Behavioral Marital Therapy
- Behavioral Parent Training
- Conjoint Sex Therapy
Behavioral family therapies are based on the principles of operant conditioning, social learning theory, and social exchange theory. They share the following characteristics: 1. 2. 3. 4.
- A focus on observable behavior
- Ongoing assessment of behavior to identify targets of therapy and evaluate it’s effects
- Emphasis on increasing or decreasing target behaviors through use of contingent reinforcement
- Focus on improving communication and problem solving skills
Behavioral family therapists view maladaptive behavior as:
Learned and maintained by it’s antecedents and consequences (like all other behavior)
The major goal of behavioral family therapy is to alter ____________
The environmental factors (antecedents and consequences) that are maintaining problematic behavior
Object Relations Family Therapists view maladaptive behavior as the result of __________ and _________ factors
Intrapsychic
Interpersonal
For example, family dysfunction is traced to the extended family, and is seen as the result of unresolved conflict in the family of origin that replicates in current relationships
Object Relations Family Therapy
Projective Identification
Seen as a primary source of family dysfunction
Occurs when a family member projects old introjects onto other family members, then acts as if that family member actually has those characteristics
May also provoke that family member into behaving consistently with the old introjects
The primary goal of Object Relations Family Therapy is ….
To resolve each family member’s attachment to family introjects
In Object Relations Family Therapy, _________ is considered essential for change
Insight
Insight is built by examining and interpreting transference, resistance, and other factors
Object Relations Family Therapy
Multiple Transferences
Object relations family therapists recognize and interpret multiple forms of transference
Transference from one family member to another
Transference from each member to the therapist
Transference from the whole family to the therapist
_______________ described the three formative stages of group therapy in his book “The Theory and Practice of Group Psychotherapy”
Irving Yalom
Yalom’s three formative stages of group therapy were:
1.
2.
3.
- Orientation, Hesitation, Search for Meaning
- Conflict, Dominance, and Rebellion
- Development of Cohesiveness
Yalom’s First Formative Stage of Group Therapy:
Orientation, Hesitant Participation, Search for Meaning
Characterized by attempts to determine ____________
Communication style is ___________
Content focuses on _____________
Members tend to talk ______________
Characterized by attempts to determine the group’s structure and meaning
Communication style is stereotyped, restricted, and rational
Content focuses on a search for similarities between group members and advice giving/seeking
Members tend to talk directly to the group leader
Yalom’s Second Formative Stage of Group Therapy:
Conflict, Dominance, Rebellion
Group members attempt to _________
A ________ emerges
Advice giving is replaced by __________
Group members attempt to establish their own amount of initiative and power
A hierarchy/social pecking order emerges
Advice giving is replaced by criticism, judgement, and negative comments
Yalom’s Third Formative Stage of Group Therapy:
Development of Cohesiveness
As a result of the development of cohesiveness, ________________ become chief concerns
Trust and self-disclosure ________
Attendance _______
Intimacy, unity and closeness become chief concerns
Trust and self-disclosure increase
Attendance improves, and group members are concerned when another is absent
Yalom considered _____________ to be a crucial aspect of group therapy (analogous to the therapist-client relationship in individual therapy)
Cohesiveness
The client’s relationship to the group leader, the other group members, and the group as a whole
Research shows that which “curative factors” do individuals rate as most important/helpful in group therapy?
1.
2.
3.
- Interpersonal input
- Catharsis
- Self-understanding
- Cohesiveness
According to Yalom, the three primary goals of the therapist in group therapy are:
1.
2.
3.
- Creation and maintenance of the group - initially organizes the group and minimizes threats to cohesiveness (tardiness, no shows, inappropriate behavior)
- Culture building - creates a group culture that maximizes cohesiveness/effectiveness and establish appropriate behavioral norms
- Activation and illumination of the here and now - helps members understand what is happening in the present (processes of the current group)
Yalom thought that concurrent individual and group therapy is:
Not necessary or beneficial except in extreme circumstances (client in crisis)
____ to ____ % of group members drop out of group therapy in the first 12-20 sessions (premature termination)
10 to 35% drop out
An individual is a good candidate for group therapy when:
Primary problems are _________
When the individual is…
Primary problems are focused on interpersonal issues
When the individual is motivated to change, has a positive view of therapy, finds peer support and feedback helpful, and is verbally and psychologically sophisticated
Contra-indications for group therapy include
Characteristics such as:
Symptoms/diagnoses
Characteristics such as difficulty following appropriate behavioral norms/inability to tolerate the group setting
Some symptoms/diagnoses such as severe mental illness (depression, withdrawal, psychosis), brain damage, sociopathy
An essential characteristic of feminist therapy is the emphasis on:
Power differences between men and women
How those power differences impact both men and women’s behavior
According to feminist therapists, intrapsychic events always occur, and must be interpreted, within __________
An oppressive social context
According to feminist therapists, maladaptive behavior/symptoms are conceptualized as:
- Related to _________
- “Survival tactics” ______
- Arbitrary labels that society has ascribed to certain behaviors in order to ______
- Related to the nature of traditional feminine roles/conflicts inherent to those roles
- “Survival tactics” - a means of exercising personal power in response to those roles/role conflicts
- Arbitrary labels that society as ascribed to certain behaviors in order to impose sanctions/exert social control
A primary goal of feminist therapy is :
Empowerment
Helping women become more self-defining and self-determining
Techniques that distinguish feminist therapy from other types of therapy include:
- Striving for _______
- Avoiding ______
- Avoiding ______
- Involvement in _______
- Striving for an egalitarian relationship - minimize power differential
- Avoiding labels - to avoid pathologizing a client’s problems
- Avoiding re-victimization - avoid blaming women for their current problems, focus on influence of others/society and focus on women’s strengths
- Involvement in social action - in order to be effective therapists must be social and political activists
In order to help create an egalitarian therapeutic relationship, feminist therapists use the following strategies:
- make appropriate self disclosures
- demystify the therapy process
- encourage clients to set their own goals and evaluate their own progress
Feminist therapy and non-sexist therapy are similar in that they both:
1.
2.
Recognize the impact of sexism
Avoid the use of gender based techniques
Key difference between feminist and non-sexist therapy:
Feminist therapy focuses on the _________ factors impacting psychological functioning
Non-sexist therapy focuses on the ________ factors
Feminist therapy focuses on sociopolitical factors that influence behavior; emphasize the need for social change
Non-sexist therapy focuses on individual factors; emphasizes modifying personal behavior
Some feminist theorists have incorporated _______________ theory
This provides a way to understand how social and environmental factors, as opposed to biological factors, determine gender differences
Object relations theory
Self-in-relation theory proposes that many gender differences can be attributed to the _______ and _____ relationships
Mother-son
Mother-daughter
Males are taught to separate from their mother (and define self in separation from mother) and females are taught to remain attached (and define self in sameness)
This influences self esteem, values, achievement orientation, beliefs about gender roles
Hypnosis has found to be effective in treating:
Acute stress disorder Anxiety disorders Obesity Insomnia Chronic pain
Orne and Dinges (1989) suggest that hypnosis involves experiencing alterations of memory, perception, and mood in response to suggestion
They describe the essential feature is ___________
Subjective experiential change
When using hypnosis to recover “repressed memories”:
Hypnosis produces _____(more/same/fewer)_____ false memories than actual memories
Hypnosis produces MORE false memories (pseudo-memories) than actual memories
When using hypnosis to recover repressed memories:
Hypnosis may lead to __________ confidence in the accuracy of a memory, and this is particularly true for ___________ memories
Hypnosis leads to increased confidence in the accuracy of memories
This is particularly true for inaccurate or false memories
Memories recovered under hypnosis often reflect/contain elements of _______
This can lead to _______ of symtpoms
Issues and experiences related to treatment
This can lead to improvement of symptoms
Related to acupuncture, what is “Qi”?
The vital energy of life
Practitioners of acupuncture believe illness is due to _______
Acupuncture works to _________
A blockage of Qi (vital life energy)
Acupuncture unblocks the flow of Qi along the meridians (pathways) through which it circulates in the body
Research on the neurobiological mechanisms of acupuncture suggests benefits may be related to:
Release of endorphins and other pain-suppressing mechanisms
Changes in blood flow around the needle or in key (pain modulating) brain regions
Reflexology:
Assumes that there are pressure areas in the ____________ that correspond to all other glands/organs
Applying pressure to these regions_______
Hands and feet
Applying pressure to these regions re-establishes the body’s balance and promotes the healing process
Reflexology has been used as a treatment for stress, anxiety, and types of pain. Research findings show it is ______________ effective.
It is not consistently effective
The beneficial effects of Reflexology may be due to:
Restoring _________
Increasing circulation of ___________
Producing a state of __________
Restoring energy flow throughout the body
Increasing circulation of the blood and lymphatic systems
Producing a state of relaxation
According to Yalom, how could you reduce “premature termination” in group therapy?
1.
2.
- Pretreatment screening
2. Post-selection preparation focusing on clarifying any misconceptions and unrealistic expectations
The principles of community psychology were derived from the field of _________
Public health
Community psychology emphasizes __________ over __________
Emphasizes prevention over treatment
Primary Prevention
Aims to reduce the PREVALENCE of mental disorders by decreasing the incidence of new cases
Accomplished by making a program/strategy promoting health available to all members of an identified at-risk group
Examples: immunization programs, prenatal nutrition programs for low SES mothers
Secondary Prevention
Aim to reduce the prevalence of disorders by REDUCING DURATION and impact through early screening and intervention
Example: screening first graders for reading disabilities so they can be provided with intervention
Tertiary Prevention
Focus on reducing the DURATION and CONSEQUENCES of mental/physical disorders
Example: rehabilitation programs
Community psychology focuses on the use of __________ and ____________
Education
Preventative health care
In community psychology, the major goals of education are:
1) reduce ___________
2) improve ____________
Reduce the incidence of health problems by increasing preventative activities
Improve the care of the ill by educating people about the nature of problems and their treatments
The Health Belief Model (Becker, 1974) proposes that health behaviors are influenced by:
A person’s:
1)
2)
3)
1) a person’s readiness to take a particular action
2) the persons evaluation of the costs and benefits of a particular action
3) internal and external “cues to action” (e.g., advice from family/friends, media)
The Health Locus of Control Model (Lau and Ware, 1982)
Health related behavior’s are related to a person’s locus of control
People may believe ______________,
or alternatively, they may believe _________
People may believe they have the ability to control their health (internal locus of control)
Or they may believe that health is determined by luck or other uncontrollable factors (external locus of control)
Consultation is defined as:
A process in which a human services professional assists a consultee with a work related problem within a client-system, with the goal of helping both the consultee and the client system
Organizational consultation is unique in that it:
Adopts a _____ approach
Defines the ___________ as the consultee
Adopts a systems approach
Defines the entire organization as the consultee
Four stages of consultation:
1.
2.
3.
4.
- Entry - identify consultee needs - often met with resistance
- Diagnosis - gather info, define problem, set goals
- Implementation - choosing and implementing an intervention/plan
- Disengagement - evaluation of success of intervention/plan, termination, planning follow up
Mental Health Consultation is derived from the medical/psychiatric model and is largely attributed to the work of:
Gerald Caplan (1970)
Parallel Process
An issue in supervision
Issues in the therapist -client relationship are replicated in the supervisor-supervisee relationship
Ex. If a client is anxious and frustrated with therapist, the therapist may come to supervision anxious and frustrated
Eysenck
Known for publishing the first research on therapy outcomes
What did Eysenck’s 1952 study results suggest about the effectiveness of therapy
He reviewed the results of 24 research studies (1920-1950)
Found little to no differences in outcomes between people with and without therapy
This was largely due to improvements in symptoms in no therapy control groups
Was criticized for methodology and failure to recognize other factors that might be lead to improvement in controls (other than spontaneous remission)
Who was the first researcher to apply the statistical technique of meta-analysis to therapy outcome research?
Smith et al
Smith, Glass, and Miller (1980)- first meta-analysis paper
The results of the meta-analysis by Smith, Glass, and Miller (1980) contradicted _______ prior work
Eysenck
Smith et al (1980)’s meta analysis showed that therapy had a mean effect size of ________
This effect size can be interpreted as ___________
.83
Interpretation: “the average therapy client is better off than 80% of those who have not received therapy”
According to Smith et al (1980), the effect size of therapy interventions are _____________ compared to the effects of medical and educational interventions
Equal to or exceeding
Howard and colleagues (1996) studied the relationship between therapy outcomes and duration of treatment, and found that treatment effects “level out” after ________ sessions, at which time ___% of patients show improvement
26 sessions
75%
The finding by Howard et al (1996) that therapy outcomes are related to the duration of treatment/number of sessions is referred to as a ___________
Dose dependent effect
Howard et al.,
Phase Model of therapy
Predicts that \_\_\_\_\_\_\_\_\_ Includes 3 phases: 1. 2. 3.
Predicts that the benefits of treatment vary depending on the number of sessions
Phases:
- Remoralization - hopelessness and despair improve rapidly in the first few sessions
- Remediation - improvement in symptoms that brought patient to therapy, takes ~16 sessions
- Rehabilitation - unlearning longstanding problematic patterns of behavior, length varies based on type and severity of the problem
_________ studies are clinical trials
_____________ are correlational or quasi experimental in nature
Efficacy
Effectiveness
Efficacy studies establish _____________
Effectiveness studies establish _____________
Efficacy studies establish whether a treatment has an effect
Effectiveness studies establish whether a treatment can be applied/has clinical utility in the real world
Research on therapy outcomes in racial/ethnic minority groups shows:
____________ are likely to show some improvements
Of Hispanic, Anglo, Asian, and African American groups, ______ showed the most improvement and _______ showed the least
All groups are likely to show some improvement
Hispanic showed the most improvement, African American showed the least
In the middle: Anglo, Asian
Research on therapy across cultural groups shows that non-white individuals are more likely to _____________________ than white individuals
Drop out of therapy
Sue (2003) found that ___% of non-white patients drop out of treatment after one session, as compared to ___% of white patients
50% of non-white patients drop out
30% of white patients
The research on therapist-client matching on culture/identify factors has found ___________
Therapist-client matching may be most beneficial for _________
Inconclusive results, small but not statistically significant benefits
Matching may reduce termination for White, Asian, and Hispanic clients, but not African American (Sue et al., 1991), but only improved outcomes for Hispanic
May be most beneficial for individuals who identify strongly with their ethnic/racial identity
According to the APA (2002), the most common MH problems affecting older adults (in order) are:
1.
2.
3.
- Anxiety
- Severe cognitive impairement
- Depression
Research on the effectiveness of psychotherapy in older adults (APA, 2004) has found that compared to younger people, treatment response of older adults is characterized by _________
They benefit from a variety of interventions to a similar degree, but tend to respond more slowly
Alloplastic intervention
Makes changes to the environment in order to better accommodate the individual
Autoplastic intervention
Make changes to the individual to help them better function in their environment
___________ intervention focuses on changing the environment, while ____________ focuses on changing the individual
Alloplastic
Autoplastic
Guy et al. (1989) found that ____% of therapists reported experiencing work related distress in the past 3 months
74%
The most commonly encountered ethical/legal dilemma is issues related to _______
Issues related to confidentiality
Therapists find __________ to be the most stressful client behavior
Suicidal statements
Therapists find ___________ to be the most stressful aspect of their work
Lack of therapeutic success
The rates of treatment in outpatient facilities are higher for ____(males/females)_____
The rates of inpatient admissions are higher for ________(males females)_____
Outpatient treatment and overall mental illness prevalence rates are higher for women
Inpatient admission rates are higher for men
Rosenstein (1986) reported the following demographics about patients admitted for inpatient psychiatric treatment:
Marital status:
Race/ethnicity
Marital status: highest rates of never married people
Race/ethnicity: minority groups are over-represented
Age: most admissions are ages 25-44
Diagnosis: Schizophrenia is the most common diagnosis in the 25-44 age range; organic and affective disorders are most common for older adults
Research by Eysenck (1952) showed that ___________________________
Psychotherapy had no to small effects - in a summary of studies from the 20s to 50s patients who did/did not receive therapy made similar improvements
His work was methodologically criticized
Smith, Glass and Miller were the first reasearchers to use _________________ to examine psychotherapy outcomes
Meta analysis
Smith, Glass and Miller (1980) showed that _____% of people who received psychotherapy were better off than those who didn’t
They concluded that the effect sizes of psychotherapy were _____________ compared to other medical interventions
80% benefitted
Effect sizes were similar or better than medical interventions
Dose - dependent effect
Howard and colleagues (1996)
The effects of therapy “level off” after about 26 sessions
Phase model of therapy
Howard et al.,
Benefits of therapy vary based on the length of treatment- there are three different phases with different results/outcomes associated
Howard et. Al
Phase Model of therapy
Phase 1: Remoralization
client’s feelings of hopelessness/despair resolve quickly at the start of therapy
Occurs over the first few sessions
Howard et al.
Phase model of therapy
Phase 2: Remediation
Focus on the symptoms that brought the client to therapy
Usually address symptoms in about 16 sessions
Howard et al.
Phase Model
Phase 3: Remoralization
Unlearning troublesome, maladaptive habitual behaviors and establishing new ways of life
Final stage, length of time needed varies based on client and presenting challenges
According to Mack (1989), couples therapy to address domestic violence is indicated when violence is _____________ and is contraindicated when violence is ________
Couples therapy can be helpful when violence/abuse is EXPRESSIVE - with the goal of expressing emotion, is mutual/reciprocal, and followed by remorse
Couples therapy is not indicated when violence/abuse is INSTRUMENTAL- executed to achieve a specific goal/outcome (e.g., control), is not mutual/reciprocal, and not followed by remorse
It is recommended to use an _____________ approach when working with African American families
Ecostructural
Ecological systemic approach
Boyd-Franklin (1989) developed the _______________ model of therapy
It’s an example of an ______________ approach
Multisystems model
Example of an ecostructural approach
Developed for working with African American families
Multisystems model
Boyd Franklin
Intervenes on multiple systems, at multiple levels, and empowers the family through a strengths focused approach
Systems include family, non-blood kin, church, community resources, social service agencies
The African American worldview emphasizes ______ over_____
Group welfare over individual needs
Roles within African American families:
Are often flexible
Relationships between men and women are egalitarian
Adults and children can hold multiple roles
Network therapy
Recommend for American Indian populations
Incorporates family and community members
Situates individual problems in the context of family, community, and other social systems
When working with Asian American clients a __________ approach is recommended
Directive, structured, goal oriented, problem solving approach
The strongest bond in Hispanic-American families tends to be
Parent-child
In Hispanic families, gender roles tend to be
Inflexible and patriarchal
Cultural Competence involves three competencies:
1.
2.
3.
- Awareness - aware of assumptions, values, beliefs, own cultural background
- Knowledge - understand the history and experiences of different cultural groups
- Skills - use culturally appropriate interventions
Curanderismo
Holistic system of healing practiced in some Latin American cultures
Assumes illness arises from natural or supernatural forces
Healing sessions lead by a healer (curandero or curandera) and combine religious and spiritual rituals
Ho’oponopono
“Setting it right”
Traditional Hawaiian spiritual healing ritual to restore harmony among family members
Senior family member/elder identifies problem and leads discussions to resolve, followed by sharing a meal
What are the four stages of acculturation:
Into America Some Move
Integration
Assimilation
Separation
Marginalization
Stages of acculturation:
Integration
Stage 1
Person maintains the minority culture but also incorporates many aspects of the dominant culture
Also called biculturalism
Types of acculturation:
Assimilation
The person accepts the majority culture and relinquishes own culture
Types of acculturation:
Separation
Person withdraws from the dominant culture and identifies with their own culture
Types of acculturation:
Marginalization
The person does not identify with either the dominant culture or their own culture
Cultural encapsulation
Happens when a therapist: 1 2 3 4 5
- Defines everyone’s reality according to their own cultural beliefs
- Disregards cultural differences
- Ignore evidence that disconfirms their beliefs
- Rely on techniques and strategies to solve problems
- Disregard own cultural biases
Emic
Culturally specific theories, concepts, research strategies
Attempts to understand culture by seeing it through the eyes of members of that culture
Etic
Universal / culture-general phenomena
View people from different cultures as essentially the same
High context vs low context communication
High context- grounded in the situation, relies on nonverbal communication, depends on group understanding, slow to change
Low context - verbal, explicit parts of the message. Less unifying, changes fast.
Sue and sue (2003) describe two “survival mechanisms” African Americans may adopt to disguise negative feelings in response to white oppression
- Playing it cool - concealing anger by acting calm/composed
- Uncle Tom syndrome - adopting a passive or “happy go lucky” demeanor
When understanding non-disclosure by African Americans clients in treatment, Ridley (1984) distinguished between ________ and _________ paranoia
Cultural paranoia - healthy reaction to racism, hesitancy to disclose to a white therapist for fear of being hurt or misunderstood
Functional paranoia - unhealthy condition, unwillingness to disclose to ANY therapist regardless of race due to general mistrust
Ridley’s model of paranoia:
Intercultural Nonparanoic Discloser:
_____ functional paranoia, ____ cultural paranoia
Low functional paranoia , low cultural paranoia
Willing to self disclose to any therapist regardless of race
Ridley’s model of paranoia:
Functional paranoic:
_____ functional paranoia, ____ cultural paranoia
High functional paranoia, low cultural paranoia
Clients are not willing to disclose to either Black or White therapists, and this is due primarily to pathology/general mistrust
Ridley’s model of paranoia:
Healthy cultural paranoic:
_____ functional paranoia, ____ cultural paranoia
Low functional paranoia ; high cultural paranoia
Will disclose to Black therapists, but not to White therapists as a healthy response to past experiences of racism
Ridley’s model of paranoia:
Congruent paranoic:
_____ functional paranoia, ____ cultural paranoia
High functional paranoia ; high cultural paranoia
Will not disclose to either Black or White therapists, due to a combination of pathology and the effects of racism
Racial/Cultural Identity Development Model (Atkinson, Morten, Sue 1993): What are the 5 stages? 1 2 3 4 5
- Conformity
- Dissonance
- Resistance and Immersion
- Introspection
- Integrative Awareness
Racial/Cultural Identity Development Model (Atkinson, Morten, Sue 1993):
Conformity stage
Positive attitudes towards and preference for the dominant culture
Deprecating attitudes towards one’s own culture
Racial/Cultural Identity Development Model (Atkinson, Morten, Sue 1993):
Dissonance stage
Confusion and conflict about the contradictory attitudes one has about themselves and towards others of the same and different groups
Racial/Cultural Identity Development Model (Atkinson, Morten, Sue 1993):
Resistance and Immersion stage
Actively rejects the dominant society
Have positive attitudes towards self and members of their own group
Racial/Cultural Identity Development Model (Atkinson, Morten, Sue 1993):
Introspection
Characterized by uncertainty about the rigidity of the beliefs held in the resistance/immersion stage (negative towards dominant and positive towards self)
Conflicts between loyalty to the group and personal autonomy
Racial/Cultural Identity Development Model (Atkinson, Morten, Sue 1993):
Integrative Awareness
Develop a sense of fulfillment with respect to cultural identity, strong desire to eliminate all forms of oppression
Adopt a multicultural perspective
Examine values/beliefs of own and others groups before accepting or rejecting them
Black Racial Identity Development Model (Cross, 1971, 1991, 2001):
Describes identity development as from ____ to _____
The four stages are:
Describes identity development as a shift from Black self-hatred to Black self-acceptance
Four stages:
- Pre- encounter
- Encounter
- Immersion - Emerson
- Internalization
Black Racial Identity Development Model (Cross, 1971, 1991, 2001):
Pre-encounter stage
Race and racial identity have low salience
May have adopted a mainstream identity, have negative beliefs about Blacks, and have low self-esteem
Black Racial Identity Development Model (Cross, 1971, 1991, 2001):
Encounter stage
Exposure to significant race-related events lead to greater racial/cultural awareness and interest in developing a Black identity
Black Racial Identity Development Model (Cross, 1971, 1991, 2001):
Immersion-Emersion stage
Race/racial identity have high salience
Immersion sub stage- idealization if Black culture, rage towards Whites, guilt about own previous lack of awareness
Emersion - rejects all aspects of White culture, begins to internalize Black identity
Black Racial Identity Development Model (Cross, 1971, 1991, 2001):
Internalization stage
Race continues to have high salience
Individuals have adopted one of three identities:
- Afrocentric (pro-black, non racist)
- biculturalist (integrates black with one other salient cultural identity)
- multiculturalist (integrates black and two or more salient cultural identities)
White Racial Identity Model (Helms, 1990):
Two phases:
6 statuses:
Phase 1: abandoning racism (status 1-3)
Phase 2: development of non-racist White identity (status 3-6)
Status:
- Contact status
- Disintegration status
- Reintegration status
- Pseudo-independence status
- Immersion-emersion status
- Autonomy status
White Racial Identity Model (Helms, 1990):
Contact status
Individual has little awareness of racism and own racial identity
Behavior reflects racist attitudes and beliefs
White Racial Identity Model (Helms, 1990):
Disintegration status
Increasing awareness of race and racism leads to confusion and emotional conflict
Person May over-identify with minority cultures, be paternalistic, or retreat into white society
White Racial Identity Model (Helms, 1990):
Reintegration status
Attempts to resolve moral dilemmas by idealizing white society
Blame minority groups for problems
View whites as victims of reverse discrimination
White Racial Identity Model (Helms, 1990):
Pseudo-independence status
Cultural events cause person to question own racist beliefs and acknowledge the role that whites have had in perpetrating racism
Interested in understanding racial/cultural differences but does so only at an intellectual level
White Racial Identity Model (Helms, 1990):
Immersion-Emersion status
Individual explores what it means to be White, confronts own biases, begins to understand the way he/she benefits from white privilege
Increased experiential and affective understanding of racism and oppression
White Racial Identity Model (Helms, 1990):
Autonomy status
Individual internalizes a non-racist white identity that includes an appreciation of and respect for racial/cultural differences and similarities
Actively seeks out interactions with diverse groups
Homosexual (Gay/Lesbian) Identity Development Model (Troiden, 1988):
What are the 4 stages?
- Sensitization/feeling different
- Self-recognition/identity confusion
- Identity assumption
- Commitment / identity integration
Homosexual (Gay/Lesbian) Identity Development Model (Troiden, 1988):
Stage 1: Sensitization / Feeling Different
Often in middle childhood
Individual feels different from peers
Interests differ from those of same-gender classmates
Homosexual (Gay/Lesbian) Identity Development Model (Troiden, 1988):
Self-recognition/ identity confusion
At onset of puberty, individual realizes they are attracted to people of the same sex which leads to turmoil and confusion
Homosexual (Gay/Lesbian) Identity Development Model (Troiden, 1988):
Stage 2: Identity Assumption
Individual becomes more certain of homosexuality
May try to “pass” as heterosexual, align self with homosexual community, act in ways consistent with societal stereotypes of homosexuality
Homosexual (Gay/Lesbian) Identity Development Model (Troiden, 1988):
Stage 4: commitment / identity integration
Individuals have adopted a homosexual way of life
Publicly disclose their homosexuality
