Counseling families, diagnosis, neurocounseling, and advanced concepts Flashcards

1
Q

What is the DSM?

A
  • Book of nosology. DSM-III (1980) moved focus from psychodynamic to medical model, grow in size until the DSM-IV in 2000. Still need to use ICD codes for insurance
  • DSM-5 released in 2014 – lots of controversy.
    • Each chapter is a classification of similar disorders or spectrum of disorders that match the ICD and chapters follow age-related or developmental patterns. The new DSM is nonaxial
    • Includes gambling in section on additions and combined diagnoses of substance abuse vs. substance dependence
    • eliminated the term “mental retardation” replaced w/ intellectual disability, ASD replaces autistic disorder, Aspergers disorder, etc, ADHD is in the neurodevelopment category
    • depressive disorders include disruptive mood dysregulation disorder - intended to reduce the number of kids under 10 diagnosed and treated with bipolar disorder
    • gender identity disorder has been replaced with gender dysphoria - 6 months of feelings of difference assigned gender
    • etc etc
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2
Q

What are some of the benefits of a formal diagnosis?

A
  • gives counselors a shared language to communicate with other practitioners, clients, families, and health system
  • client might feel better knowing he/she is not the only person w/a given condition and family and friends might be more compassionate
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3
Q

What are some of the drawbacks of a formal diagnosis?

A
  • diagnosis becomes a part of person’s identification (I can’t help it, I have ADHD, etc)
  • Diagnostic labels make client feel like rate difficulty is outside of his or her control and therefor he or she is not responsible for various behaviors
  • could become scapegoat for family problems and not allowed to be independent
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4
Q

What happens to the client’s and counselor’s brains during counseling?

A

According to recent neuroscience research, both the client’s and counselor’s brains change during therapy. Recently, people believe it is helpful to know what is going on in the brain to help counseling and so use things like fMRI and PET scans to measure different types of brain activity.

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5
Q

What is neuroplasticity?

A

This is the concept that the human brain can change and new neural connections can be made even later in life, regardless of our genetics or life experience. It is as if the brain is rewiring itself.

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6
Q

What is neurogenesis?

A

neurogenesis is the concept that new neurons can be formed – exercise, for example, can boost serotonin release to fight depression.

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7
Q

How do different therapies influence neuroplasticity?

A

Counseling techniques that focus too much on the negative can have an undersirable impact by influencing the interaction between the amygdala and frontal cortex. Cognitive therapy or reframing does roughly the opposite and can increase serotonin and thus positive thoughts.

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8
Q

What is the mirror neuron concept?

A

The mirror neuron concept indicates that a neuron or neurons fire if you perform behavior and that the SAME neuron fires if you witness the behavior in someone else. We see this a lot in terms of how we feel empathy or, say, how we feel fear if we watch someone else being chased. These examples highlight IPNB (interpersonal neurobiology) and show that empathy can now be measured in the brain.

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9
Q

What are some other neurobiological observations about human behavior?

A
  • The brain fires at a high level when we see a face similar to our own
  • children growing up in an impoverished setting have higher than desirable levels of stress hormones like cortisol, which hinders performance and lessens the chance of escaping poverty
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10
Q

What is cognitive enhancement therapy (CET)?

A

Cognitive Enhancement Therapy (CET) is included in the evidence-based neurocounseling modalities. Here the clients, often diagnosed with schizophrenia, use neurocognitive video games and coaching to improve functioning.

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11
Q

What is some of the criticism of neurocounseling approaches?

A
  • Some say that our field grew out of a humanistic tradition and that this neurobiological approach fails to look into the entire human experience
  • Counselors and researchers might be attaching too much important to increased blood flow in various areas of the brain
  • Many researchers do not agree that fMRI and PET scans are safe. What might be necessary to decide about medical intervention might not be wise for research, diagnostic, or counseling purposes. And these specific tests might not be quite accurate enough.
    *
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12
Q

What is the concept of the identified patient?

A

This is a dynamic in which people come in looking for help for a kid or a family member but must counselors believe that the entire family system is dysfunctional and thus is the identified patient and in need of treatment. Historically the identified patient was seen as the person who was having the problem.

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13
Q

If you are seeing a couple in therapy, can you tell one member of the couple something the other member of the couple has confided in you in confidence?

A

No. According to ethics guidelines, counselors must not disclose information about one family member in counseling to another without prior consent.

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14
Q

What are the divorce statistics in the US?

A
  • The average divorce takes place after 8 years of marriage
  • About 50% of marriages end in divorce
  • 65% of second marriages end in divorce
  • 70% of third marriages end in divorce
  • Remarriages are common - 4 in 10 new marriages are remarriages
  • Most divorcees do not stay single for long: 30% remarry within 12 months of being divorced and on average, divorcees remarry in 3-4 years
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15
Q

Can a counselor engage in a romantic or sexual relationship with a student or supervisee ?

A

No. This is unethical. This refers to in person as well as electronic relationships.

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16
Q

Who is the fastest growing clientele for professional counselors?

A

People experiencing marriage and family problems. Coursework for CAACREP programs and those set forward to meet the AAMFT curriculum (for marriage and family therapists) are similar though not identical

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17
Q

What is circular/reciprocal causality?

A

Most family counselors believe in circular causality (vs linear causalitya causes b). This is when person A’s reaction influences person B’s response, which then influences person A’s next response, and so on. Thus, since everyone is influencing everyone else, the problem resides in the family rather than in a given individual.

Performing family therapy often seems to resemble group therapy, though most group models do not work well with families because they are a very specific kind of group.

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18
Q

What is cybernetics?

A

Cybernetics was pioneered in the early 1940s and named by MIT mathematician Normed Wiener. Weiner was asked to investigate how guns could be aimed to hit moving targets. In his work, which was initially related to machines, was ultimately used to analyze family therapy thanks to Gregory Bateson who suggested that the family has feedback loops that self-correct the family system.

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19
Q

What is homeostasis?

A

Homeostatsis, which can be good or bad, refers to maintaining a balanced state. Note that while this balanced state CAN be healthy, it is not necessarily. The family will attempt to hold onto a given pattern of functioning that, though stable, may be quite dysfunctional.

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20
Q

What is adaptability?

A

This refers to a family’s ability to change or to display flexibility in order to change. Adabptability is the ability of the family to balance stability (also known as morphostatis) as well as change (also known as morphogenesis).

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21
Q

What is enmeshment?

A

This occurs when family members are over involved with each other and thus lose their autonomy.

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22
Q

What is nonsummativity?

A

This is a concept suggesting that any system including the family is greater than the sum of its parts (I.e. the individuals in it) and therefore it is necessary to examine patterns rather than merely each individual’s behavior.

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23
Q

What is morphostatis and morphogenesis?

A
  • Morphostasis: the ability of the family to balance stability
  • Morphogenesis: a family’s ability to change.

Note that adaptability is the ability of a family to balance BOTH morphostais and morphogenesis.

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24
Q

What are mandatory ethics vs. aspirational ethics?

A
  • mandatory ethics are guidelines that are strictly enforced – if you violate a mandatory ethic, there are consequences for your actions. Mandatory ethics can also be called standards of practice
  • Aspirational ethics describe ideal or optimal practice. Pro bono services would fall into the category because it would be difficult to win an ethics’ violation against a counselor because he wouldn’t see a counselor for free! Counseling ethics do mention pro bono work, but they do not stipulate the principle as limited to “seeing a client for free’ so the best answer seems to be aspirational. There will likely be many vague questions about this stuff on the exam
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25
Q

What is experimental conjoint family therapy and who is it associated with?

A

Conjoint Family therapy is a type of therapy that implies two or more family members are in therapy at the same time and was created by Virginia Satir. She felt that a major goal of therapy was to improve communication between family members. According to Satir, four basic patterns prevented good communication under stress.

Satir also used family sculpting to help visualize family dynamics.

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26
Q

How did Satir’s experimental conjoint family therapy clash with Minuchin’s structural family therapy?

A

Virginia Satir was a social worker who began seeing families in private practice in 1951. She felt that the family could be healed via love, while Minuchin, the father of structural family therapy, felt that family therapy was a science requiring therapeutic interventions well beyond warmth. Satir and Minuchin clashed.

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27
Q

What are Satir’s defensive posters?

A

According to Satir, four basic patterns prevented good communication under stress. She called these defensive postures or stress positions.

  • placating - you try to please everyone out of a fear of rejection. This style causes the person to sacrifice his own needs as a way of dealing with stress. The placater is a people pleaser.
  • blaming - basically says “it’s your fault I’m the way I am” and might sacrifice others to feel good about himself or point fingers to avoid dealing with his own issues
  • being overly reasonable - likely to engage in the defense mechanism of intellectualization. This person is described as “functioning like a computer” to keep his or her emotions in check. This person is emotionally detached. Could also be called the responsible analyzer
  • being irrelevant - Will distract the family from the problem by constantly talking about irrelevant topics
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28
Q

Who is Ludwig von Bertalanffy?

A

He was the biologist who popularized the notion of the connectedness of all living things or the so-called systems theory model. The analogy is that the family is more than merely the separate persons but rather a system with rules and patterns that connect members, etc. Murray Bowen based his family therapy on systems theory.

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29
Q

Who was Carl Whitaker?

A

Carl Whitaker, sometimes called the dean of experiential family therapy, was fond of saying that experience not education is what changes families. He said that experience goes beyond consciousness and that the best way to access the unconscious is symbolically. Whitaker’s theory is also referred to as experiential symbolic family therapy.

Whitaker could be described as atheoretical. He asserted that theory is often used as an excuse to keep therapists emotionally distance from the family. Whitaker promoted “craziness” and creativity of family members.

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30
Q

How did Carl Whitaker interact with the family?

A

His posture would be to join the family and experience it as if he were a family member. Whitaker was a psychiatrist by training and he intentionally minimized the importance of theory, noting that therapeutic interaction is more of an art.

Whitaker also believed that a co-therapist is helpful.

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31
Q

What is psychotherapy of the absurd?

A

Whitaker would sometimes use “psychotherapy of the absurd” types of activities in his work. For example, he might ask a couple who was having a power struggle to actually have a tug of war in order to see who really had control.

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32
Q

Who is Maxine Maultsby Jr.?

A

Maultsby is a psychiatrist who is noted for creating rational behavior therapy (RBT) that is similar to Ellis’s REBT except it also has a written self-analysis.

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33
Q

What is David Premack’s principle or law?

A

Premack, a behaviorist, suggests that a family member must complete an unpleasant task (known as a low-probability behavior or LPB) before he or she would be allowed to engage in a pleasant task known as a high-probability behavior or HPB. This is known as Premack’s principle.

So, for example, the therapist might say to one of the family members, “you must complete your sociology essay before you can use the family car and go out with your friends”.

Note that behavioristic family and marriage therapists also generally rely on the same theorists as individual behaviorist therapists.

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34
Q

What is quid pro quo in the context of family therapy?

A

In Latin, quid pro quo means “one thing for another” or “something for something”. This is a technique that makes use of a behavioral contingency contract in order to get one person in the family to do something as long as the other member agrees to do something comparable. So for example, if the therapist suggested that since the child likes to play golf, every time he cuts the grass the father would take the kid to play golf – and has them sign a contract agreeing to the policy.

Note that quid pro quo can also refer to an ethical violation (or even legal violation), particularly in the context of sexual harassment – I.e. “I’ll supervise you as long as you sleep with me” is quid pro quo.

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35
Q

How do behaviorists think about time-outs?

A

Behvariorists consider time-outs to be a form of extinction. In this instance, the child is removed from an environment so that they do not receive reinforcement for dysfunctional behavior.

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36
Q

What is the concept of reciprocity in marriage and family therapy?

A

The concept of reciprocity in a marriage assets that in most cases, people will reinforce each other at about the same level over time (I.e. each will participate in the tasks of the marriage and household equally, each will appreciate and support the other equally, etc). When this doesn’t happen, it typically results in marital discord.

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37
Q

What is systematic desensitization and how might it be used in marital therapy?

A

Joseph Wolpe’s systematic desensitization pairs feared mental imagery with relaxation to eliminate the fear. This could be used in a case when, for example, a couple is having sexual problems based in anxiety.

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38
Q

What is thought stopping?

A

This is a behaviorist technique created by psychiatrist Robert Liberman and social worker Richard Stuart. Thought stopping is intended to…stop thoughts. A man who was fantasizing about his neighbor’s wife, for example, would be taught to yell “Stop!” in his mind as loudly as possible each time he had a sexual thought about his neighbor.

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39
Q

What is causal comparative research?

A

This is research that occurred in the past (ex post facto) and the researcher did not have control over the independent variable. A t-test COULD be used to explore whether there differences between two groups.

However, note that a t-test would not be used in a correlation study.

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40
Q

What is family sculpting?

A

Family sculpting, popularized by Virginia Satir, is an experiential/expressive technique in which a family member places other family members in positions that symbolize their relationships with other members of the family. Finally, the member places him or herself. This helps the therapist understand family dynamics that may have been missing from a mere discussion of family issues.

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41
Q

Which theorist is associated with psychodynamic family counseling?

A

Nathan Ackerman. Ackerman, an analytically trained child psychiatrist, recommended studying the family vs. just the child being brought in as the identified patient. Some experts consider this the true beginning of the family therapy movement.

Because he was analytically trained, Ackerman, unlike many family therapists, was concerned with the internal feelings and thoughts of each individual – as well as the dynamics between them. Prior to Ackerman, it was considered inappropriate to include family members in analytic treatment.

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42
Q

What is an object in psychoanalytic family therapy?

A

In this context, object means a significant other with whom a child wishes to bond. This is the notion that an individual (or an individual’s ego) attempts to establish a relationship with an object (often a person or part of the body) to satisfy needs. When this doesn’t happen, anxiety occurs.

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43
Q

What is does the term interoject mean?

A

In a psychoanalytic family therapy, the term introjects really means that the client unconsciously internalizes the positive and negative characteristic of their objects into themselves. Eventually these introjects (taking in personality attributes of others that become part of your own self-image) determine how the person will relate to others

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44
Q

What is the psychoanalytic concept of splitting?

A

Splitting occurs when the client sees an object (another person) as either all good or all bad. Splitting allows one to keep anxiety in check by making objects predictable. This tendency begins in childhood, usually by categorizing one’s mother as all good or all bad. It could be expressed in therapy as seeing the therapist as all good or all bad.

Removing dysfunctional introjects from childhood is curative.

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45
Q

What is first-order and second-order change in family therapy?

A
  • First-order change can be described as changes hat are superficial – behavioral changes occur but the organization or structure of the system do not change. First-order change often ameliorates symptoms but the changes are often temporary
  • second-order change is when the actual family structure changes in a way that altered and undesireable pattern of behavior. Second order change is more desirable than first order change.
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46
Q

What is a greek chorus in the context of family therapy?

A

A greek chorus refers to a consultant or supervisory team that observes a session from behind a one-way mirror and sends messages to the therapist or the family. This so-called treatment team approach is very popular with strategic therapists. The counselor may accept or reject notions put forth via the Greek chorus.

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47
Q

What is persistent depressive disorder

A

This was previously labeled dysthymia but was updated in the DSM-5 to refer to a low-level chronic depression that occurs for more days than not, for two years or more.

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48
Q

Who are James Framo and Robin Skynner?

A

James Framo and Robin Skynner are both famous psychoanalytic family therapists.

  • Framo believes that important objects (usually parents) often fuel “love-hate” feelings in kids. The more pathological the early life experiences are the more that person as an adult will make all relationships fit the internal “love-hate” scenario from childhood
  • Skynner is a British psychoanalyst who feels that kids who had poor role models as children possess protective systems. This means that such individuals harbor unrealistic expectations of people in current relationships carried over from childhood.
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49
Q

Who are Cloe Madanes and Jay Haley?

A

Cloe Madanes and Jay Haley are associated with the strategic family therapy, also known as the MRI approach.

In this paradigm, the therapist gives directives or prescriptions, often paradoxical. Reframing and relableing problems is comon in this modality. This approach warns us that double-bind communication could cause serious psychopathology.

More focused on techniques for change than theoretical constructs. Less concerned with changing family structure or hierchy than focusing on the faulty cycles of interaction that are set into motion by misguided attempts to solve problems. Lots of focus on circular causality, feedback loops, homeostasis and cybernetics.

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50
Q

What are some concepts and techniques in Jay Haley’s Strategic therapy?

A
  • Strategic therapy is pragmatic and often focuses on abating symptoms - it is very action-oriented and solution/symptom focused
  • Haley believed in giving clients directives (I.e. “if. your daughter threatens suicide this week, I want the entire family to stay home and nobody leaves for the day”)
  • Used paradoxical concepts like:
    • double-bind concept (a paradoxical directive - saying both to do and not do something)
    • prescribing the symptom - I,e. telling a smoker to go smoke a bunch
    • restraining - warning the family or individual about the negative consequences of change
    • positioning - when a helper accepts the client’s predicament and exaggerates it
    • relabeling - also called redefining and reframing - this is when you redefine a situation in positive context to make the situation or behavior seem acceptable to the client. The situation is described in a positive light to evoke a different emotional response.
  • Believed that a malfunctioning hierarchy is evident in most dysfunctional families – I.e. the perverse triangle (when two members are different hierarchical levels team up against a 3rd member)
  • Assets that a symptom controls a situation when everything else has failed. Symptoms are sometimes viewed as a metaphor for a difficulty being expressed by another family member
  • Also sometimes known as the MRI model or the communication model
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51
Q

What is Jay Haley’s double bind concept?

A

This is a no-win situation characterized by contradictory messages such as “never smoke again” (in example, this is told using hypnosis) and “smoke as much as you want”. It constitutes a paradox in the sense that the person is told he or she can engage in a behavior that they wish to abide. Although it is used therapeutically, Gregory Bateson believed that when parents repeatedly double-bind children it could result in schizophrenia. This is considered both a paradoxical intervention and a directive.

One of the reasons why this works is because when a person follows a paradoxical directive, the symptoms are under therapeutic control - I.e. the client could say, “you hypnotized me and I smoked 5 cigarettes after the session” and the therapist would say, “of course you didm I told you to smoke as many as you could”. Essentially, the helper prescribes what the client or family would probably do anyway and tells them to exaggerate it. This is known as prescribing the symptom

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52
Q

How does strategic family counseling consider the person with the power in the family?

A

Haley believed the person with the power in the family has the authority to make rules and enforce them. and he believed that you enhance the power of a family member within the context of therapy by speaking to him or her first during the initial session of therapy.

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53
Q

What is Cloe Madanes theory of family therapy?

A
  • Cloe Madanes believes in the concept that symptoms serve a function - I.e. a child sees her mom is depressed so throws a glass cup on the floor, which brings her mother out of the depressed state and makes her angry and powerful
    • This is also an example of incongruous hierarchy. In normal family hierarchy, the mother controls the daughter but in this case, since the daughter is in control, the hierarchy is incongruous.
  • She believed that one of the keys to family functioning is to help children find more direct ways to help their parents so that their symptoms (I.e. throwing a cup) no longer serve a viable purpose
  • Advocated somewhat paradoxical pretend techniques
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54
Q

What are Cloe Madanes’s pretend techniques?

A

Madanes used a pretending technique in which the family enacts a make-believe scenario of the problem (I.e. a child who has panic attacks pretends to have one during the session and the parents pretend to help him). Most experts maintain that the pretend technique is more gentle and less confrontational than traditional paradoxical interventions.

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55
Q

What is “restraining” in family therapy?

A

In restraining, the therapist may warn the family or individual about the negative consequences of change. The counselor might tell the family to take it very slow or expect a relapse. Restraining helps overcome resistance by suggesting that it might be best if the family does not change!

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56
Q

What is positioning?

A

Positioning occurs when a helper accepts the client’s predicament and then exaggerates the situation. Positioning paints an even more negative picture of the situation for the client than restraining (warning the family or individual about the negative consequences of change).

The strategic interventions of restraining, positioning, prescribing the symptom, and relabeling are all examples of paradoxical interventions since they defy common sense.

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57
Q

What is behavioral disputation?

A

This is associated with Albert Ellis’s REBT. In REBT the primary goal is to dispute and change the client’s cognitions. In behavioral dispute, the client tries to behave in a way that is markedly different from his normal, though undesirable, pattern.

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58
Q

What is cultural encapsulation?

A

This is when a counselor imposes goals from his or her own culture on people from another culture. This is a no-go in counseling.

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59
Q

What are some statements that are trends among African American families?

A
  • Fewer African American people are getting married
  • African American people are less likely to be concerned about gender roles (I.e. both men and women cook meals, work outside the home, etc)
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60
Q

What family therapy approach might make the most sense when working with an African American family?

A

Bowen’s family therapy, Minuchin’s structural therapy, or Haley’s strategic therapy. Several studies indicate that African American families are less likely to seek professional treatment because they often rely on the extended family and the church for support and guidance. When family counseling is utilized, problem-focused, brief, or multigenerational approaches seem to fare best.

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61
Q

What might the best approach be when counseling Asian American families?

A

Solution-focused/problem-focused modalities.

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62
Q

What are some mental health trends among Asian American families, according to recent research?

A
  • Asian Americans might be mentally healthier than the general population (8.6% had mental health symptoms compared to 17.9% for the population at large)
  • Those with a DSM diagnosis were less likely to seek treatment (34.1% for Asian Americans vs. 41.1% for the general population)
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63
Q

What are some trends among Latinx families?

A
  • They have a higher unemployment rate than the national average and often live in poverty. They earn high school diplomas and college degrees less than the national average.
  • Latnix people often expect mental health treatment to mimic treatment they receive from their medical doctors, so short-term behavioral family therapy or structural approaches work well
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64
Q

What is the family therapy term “cohesion”?

A

Cohesion refers to the level of emotional bonding between family members, as well as the family’s level of enmeshment or disengagement.

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65
Q

What is the circumplex family model?

A

The circumplex family model, created by Olson, Sprenkle, and Russell, suggests that family functioning can be described in two dimensions:

  • cohesion - the family’s level of emotional bonding between family members
  • adaptability - the family’s balance between stability and change or, in other words, between morphostatis and morphogenesis)

They believed that the key factor is that the family should have balance in both cohesion and adaptability.

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66
Q

What are some trends in Native American families?

A
  • They are a very diverse group, belonging to over 550 state-recognized tribes
  • extended family and the tribe are very important
  • A high percentage of children are placed in foster care homes, residential facilities, and non-Native adoption homes
  • Have significant issues with both alcoholism andsuidiced. Suicide is the leading cause of death among Native Americans/Alaska Natives between 10-34 and alcohol is involved in 69% of the suicides for all age brackets in this cultural groups. The high rates of suicide and alcoholism create issues with suicide bereavement, fetal alcoholism, and cirrhosis of the liver
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67
Q

What is Murray Bowen’s intergenerational family therapy?

A
  • One of the primary goals of intergenerational family therapy is differentiation - that one can separate one’s intellect from one’s emotional self
  • Believed in the phenomenon of triangulation - When a dyad having problems puts a third person in the middle to try to reduce stress on the dyad
  • Used genograms as a therapy tool – believed they must go back at least 3 generations.
  • Is concerned with the nuclear family emotional system (family’s emotional system is influenced by previous generations)
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68
Q

What is Bowen’s concept of triangulation?

A

Bowen’s concept of intergenerational family therapy asserts the phenomenon of triangulation: That when a dyad is under stress, a third person is recruited to help stabilize the difficulty between the original dyad. This could even be a child placed in the middle of the conflict. This rarely helps the situation and typically makes the situation between the original pair worse.

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69
Q

What is Bowen’s concept of differentiation?

A

Bowen understood differentiation as ability to be in emotional contact with others yet still autonomous in one’s own emotional functioning.

Fusion, the opposite of differentiation, occurs when individual choices are set aside in service of achieving harmony in the system. A person who does not possess differentiation does not have a clear sense of the self and others.

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70
Q

What is Bowen’s concept of the nuclear family emotional system?

A

This is concept that although the current family in therapy has an emotional system, this emotional system is influenced by previous generations, whether they are alive or dead. Bowen originally referred to the nuclear family emotional process as an “undifferentiated family ego mass” since families with difficulties display a high degree of fusion.

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71
Q

What is Salvador Minuchin’s structural family therapy?

A
  • Salvador Minuchin is the founder of action-oriented structural family therapy. This approach posits that an individual’s behavior can be interrupted by analyzing family interaction. A change in the family’s patterns of communication and interaction must occur to create a healthy family.
  • Used joining and mimesis (copying the family’s style) to help the family accept him as a helper
  • Uses enactment to allow the family to see an instant replay of what transpires in the family
  • Like strategic therapy (Haley), uses relabeling and reframing
  • Believed health requires clear boundaries (the physical and psychological entities that separate individuals and subsystems from others in the family) that should be firm yet flexible
72
Q

What is the miracle question?

A

This is a brief-therapy technique in which the therapist asks “suppose one night there was a miracle and this problem was solved. How would. you know? what would be different?”

73
Q

What is Minuchin’s technique of joining?

A

The therapist meets, greets, and attempts to bond with the family. The therapist will use language similar to that of the family and mimesis which means that he or she will mimic communication patterns.

Joining occurs during the initial session to boost the family’s confidence in the treatment process and reduce resistance. In subsequent sessions, the therapist will challenge the dysfunctional communication patterns and the structure of the family.

74
Q

What is Minuchin’s technique of enactment?

A

This is a strategy that allows the counselor to see an instant replay of what genuinely transpires in a family (I.e. “okay, I want you to play like you are at home and act out precisely what transpires when the subject of your daughter’s boyfriend is mentioned”).

75
Q

What is Minuchin’s concept of boundaries?

A

Minuchin – and the structural therapists - understand boundaries as the physical and psychological entities that separate individuals and their subsystems from others in the family.

When structural therapists attempt to help the family create healthy boundaries, this is known as changing boundaries or the boundary marking technique. In this technique, the family seating is often altered and family members are placed at a different distance from each other. Types of boundaries:

  • clear boundaries are considered healthy and refer to boundaries that are firm yet flexible. When boundaries are clear, persons in the family are supported and nurtured BUT each has the freedom to be his or her own person (I.e. to individuate)
  • rigid boundaries are characterized by individuals or subsystems being disengaged. When people are disengaged (I.e. a wife and husband in which the wife brings up a problem and the husband says “your on your own, I have my own problems”), they will often seek support outside the family system.
  • diffuse boundaries often manifest with the “I devote my life to my children mentality” (I.e. a mom who wants to accompany her 20 year old daughter on a date). He believes that if the spousal subsystem becomes obsessed with parenting, the child will be afraid to experiment and could mature slowly. This child will have trouble making friends outside of the home. And then, when such individuals get married, they rely far too much on their family of origin and may not feel comfortable when they are alone.
76
Q

Who are some intergenerational family therapists?

A
  • Bowen
  • Andrew Salter
77
Q

Who is Ivan Boszormenyi-Nagy?

A

Boszormenyi-Nagy is a Hungarian analytically-trained psychiatrist who discusses the importance of give-and-take fairness or relational ethics in a family. According to the notion of relational ethics, a healthy family can negotiate imbalances and preserve a senes of fairness and accountability.

He also introduced the term family legacy which refers to expectations handed down from generation to generation. He is also known for his family ledger technique. The ledger is a multigenerational balance sheet or accounting system that outlines who gave what to whom and who owes what to whom.

78
Q

Who are some systematic family therapists?

A

Murray Bowen is the primary systematic family therapist and he believed individuals are inseparable from their network of relationships. He believed in an intergenerational concept of therapy and change.

Strategic family therapy (Cloe Madanes and Jay Haley) is another form of systemaic family therapy. They examine family processes and functions, such as communication or problem-solving patterns, by evaluating family behavior outside the therapy session. Therapeutic techniques may include reframing or redefining a problem scenario or using paradoxical interventions to create the desired change. Strategic family therapists believe change can occur rapidly, without intensive analysis of the source of the problem.

Structural family therapy, designed by Salvador Minuchin, looks at family relationships, behaviors, and patterns as they are exhibited within the therapy session in order to evaluate the structure of the family. Employing activities such as role play in session, therapists also examine subsystems within the family structure, such as parental or sibling subsystems.

79
Q

What is disengagement?

A

Disengagement is often defined as an isolated lack of connectedness between family members – I.e. a family member who is emotionally distant.

80
Q

What is Haley’s perverse triangle?

A

The perverse triangle is a situation when two members who are at different levels of the family hierarchy (usually a parent and a child) team up against another family member. The alliance between the parent and the child might be overt or covert. In any event, the alliance against the other parent undermines his or her power and authority.

81
Q

What as Alfred Adler’s role in the early history of family therapy?

A

Adler opened over 30 child guidance clinics in Vienna in the 1920s that were later eliminated by the Nazis in 1934. These clinics would often perform open forum therapy in which Adler worked with the family as well as the open forum audience.

82
Q

What is solution-oriented family therapy?

A
  • Solution-oriented therapy focuses primarily on the future and puts little or no emphasis on understanding the problem
  • the therapist’s verbalizations center on the future and the therapist co-formulates a plan of action with the client or family, though there may be more than one appropriate course of action
  • Noteable solution-oriented therapy theorists/practitioners include William O’Hanlon, Insoo Kim Berg, Steve de Shazer, and Michelle Weiner Davis
83
Q

What is narrative therapy (NT)?

A

Narrative therapy highlights stories in counseling and is in a new category of treatment known as postmodernism or constructivism

  • Clients come up with a story about their lives and they can reauthor these stories in therapy – reality is invented or constructed, it is not objective
  • Associated with the work of Michael White, his wife Cheryl White, and David Epston who believe that every country and culture espouses a social narrative. Social narratives dictate what a family ought to be like
  • In narrative therapy, the therapist asks questions or uses language to externalize the problem (separate the problem from the person). The therapist teams up with the family to take on the “enemy” (the problem). Thus, a therapist working with a family w/an abusive spouse might say to the abuser, “I know you want to put an end to this violence. Tell me about a time when you stopped a violent episode that keeps you from being the loving husband you want to be”
84
Q

What is constructivism?

A

Constructivism or social constructivism asserts that a client constructs or invents the way he or she perceives the word. Narrative therapy fits into the category of constructivism. The theory stresses that therapy should be less hierarchical - the helper does not treat the client. Instead, the client and therapist have a conversation to work together in a collaborative way.

Constructivism is not really a unified therapy based on a single individual theorists but is associated with people like Tom Anderson and the Whites and Epston, etc.

85
Q

What was postmodernist Tom Anderson’s radical approach to family therapy?

A
  • Anderson’s postmodern method uses a one-way mirror and a reflecting team
  • He discovered his technique when he asked a family if they’d like to hear what the team was saying about them. The family said “yes”.
  • The family and the family therapist listen as the reflecting team discuss the case and then the therapist processes the family’s reaction to the team’s observations.
  • A number of schools of family therapy have now incorporated this technique.
86
Q

What is postmodernism?

A
  • Postmodernism assumes that there are no fixed truths in the world, only people’s individual perceptions of what constitutes reality or the truth.
87
Q

What is feminist therapy?

A
  • Feminist counselors often note that a psychological difficulty can be located in the environment or the political system rather than in the person. (I.e. a woman who is depressed because her partner beats her). (also called gender-fair counseling)
  • Feminist therapies are said to be gender-free in the sense that differences between men and women are seen to be the result of socialization
  • Like the postmodernists, feminist therapists attempt to have an egalitarian relationship w/the client, including avoiding clinical jargon and having a person-centered slant
  • Often use bibliotherapy, appropriate therapist disclosure, and assertiveness training.
  • This modality tends to dispute sex-role stereotypes and strive for equality
  • Feminist therapists are not in agreement whether a man can be a feminist therapist
  • Often work with male batterers – and ironically, the women’s counseling movement has also helped illuminate special issues in counseling men, masculinity, and men’s psychology
88
Q

What are some stereotypes of men that relate to their use and patterns in mental health services?

A
  • Society and parents are more tolerant of girls who adopt masculine behaviors than boys who adopt feminine behaviors
  • In childhood, girls are often reinforced for showing emotions while boys are not– instead they are reinforced for physical pursuits and not showing affective/emotional expression
  • Men are therefore less likely to seek out counseling services and may only do so when experiencing a crisis.
  • When men do engage in counseling services, their competitiveness can help them work hard to succeed
89
Q

What are some critiques feminist therapists have of traditional therapies?

A
  • They are androcentric (use male views to analyze personality)
  • They are gender centric (assume that there are two separate psychological developmental patterns - one for men and one for women)
  • They emphasize hereosexisim and debate same-sex relationships
90
Q

What are skeleton keys in Steve de Shazer’s brief solution-focused therapy (BSFT)?

A

The term skeleton keys refers to a standard or stock intervention that will work for numerous problems.

91
Q

What is brief solution-focused therapy (BST)?

A
  • Is an ecosystem approach – believes that larger systems (I.e. schools, church, health care system, etc) often impact client and family functioning and thus must be taken into account.
  • Created by Steve de Shazer
  • Uses techniques like:
    • skeleton keys - standard or stock intervention that will work for numerous problems
    • compliment - therapist hands the client or clients a sheet of paper w/a compliment on it
    • past successes - the therapist may compliment past successes without specifically relating them to current obstacles
  • Sometimes uses a treatment team behind a one-way mirror but it is not rerquired
  • often relies on paradox
92
Q

What are some criticisms of using cognitive-behavioral methods like REB with families or individuals in multicultural counseling?

A
  • The cognitive situation could go against cultural messages
  • Albert Ellis views dependency as unhealthy and some cultures see interdependence as a positive attribute
93
Q

What is integrative psychotherapy?

A

Integrative psychotherapy is the practice of integrating more than one therapeutic theory - which already seems to happen quite a bit in practice and is becoming increasingly popular and many therapists are eclectic. Two theories about why integrative counseling works:

  • One idea is that theories of counseling are helpful because they have elements that are common to all approaches. This is called a common factor approach.
  • the idea that regardless of the paradigm there are common stages of change
94
Q

What is a related measures within-subject design?

A

In the within-subjects design, each subject acts as his or own control. So for example, if a group of clients were each given a depression inventory, then were given 2 sessions of BST therapy and then given the same depression therapy. Scores were then compared using a t-test.

This is a less popular approach than the between groups design which relies on separate people in the control and experimental groups.

95
Q

What is a pre-experimental design?

A

Pre-experimental design is when a single group is used in research or when two groups that are not equivalent are used.

One type of pre-experimental design is the one-group only posttest design, depicted by XO. (The group only receives treatment (X) and a score (O))

96
Q

What ate the common abbreviations used in diagraming experimental designs?

A

Experimental designs are often diagrammed and often use the following abbreviations:

  • O - observation, measurement or score of the dependent variable in the experiment
  • X - treatment (independent variable)
  • E - experimental group
  • C - control group
  • R - random sampling
  • NR - no random sampling of groups.

So, for example, you could describe an experiment in which a NR (not randomly sampled) group of clients (E) was given a depression inventory (O), then given two sessions of BST therapy (X), then given another inventory (O) as:

  • Group: E (experimental group)
  • Subject assignment: NR (no randomized sampling of the group)
  • Pretest: O (since a score was accrued
  • Treatment: X (two sessions of brief-solution oriented therapy
  • Posttest: O (since another score was accused
97
Q

What is a time-series design?

A

A time-series design is quasi-experimental design that does not have random chosen control and experimental groups but rather relies on multiple observations of the dependent variable (I.e. the thing you are measuring) before and after the treatment occurs. So this would look something like: O1, O2, O3, X, O4, O5, O6

98
Q

What is the Solomon four-group?

A

The Solomon four-group is considered a true experimental design because each group is chosen via a random sample. In this design, there are four groups and one control group receives a preset and one experimental group receives a pretest, while the other control group and the other experimental group do not receive a pretest. This design helps weed out the impact of a pretest.

99
Q

Who is John Gottman?

A

Gottman is best known for creating a paradigm to predict which marriages would likely end in divorce. He postulates 6 predictors of divorce:

  1. Te marriage got off to a harsh “start up”
  2. The relationship is characterized via negativity which includes criticism, contempt, defensiveness, and stonewalling
  3. There is flooding in the sense that the negativity comes on suddenly and is overwhelming
  4. body language changes, such as a pulse rate of 110-165
  5. Attempts to repair the marriage fail
  6. a lack of fond memories from early days of the relationship

Detractors are quick to point out that Gottman did not rely on true experiments to come up with his theories.

100
Q

Who is Dr. Ellen Langer?

A

Dr. Ellen Langer is known for demonstrating that physical biomarkers of older adults can be reversed if they are placed in an environment from the past and told to act like they are living in the past.

When Langer placed 70-80 year old men in an environment commensurate with the one they had lived in 20 years ago and told them to act like it was 20 years earlier, their biomarkers of aging actually went backwards - people even thought they looked younger at the end of this research! Her book, Counter Clockwise, has become a classic in the mindfulness movement.

101
Q

What is propinquity?

A

Propinquity is another word for the “mere exposure effect”, indicating that the more you are around a person, the greater the liklikehood you will become attracted to them. Emerging research suggests this is even true, though to a lesser degree, for virtual relationships.

102
Q

What are the newest career theories?

A

The constructivist and cognitive approaches. Career experts wonder if traditional theories are applicable now since the majority of theories were based on research using white middle-class males which is hardly representative of the work market today.

103
Q

What is the TWA (theory of work adjustment) career counseling model?

A
  • The TWA career counseling model was created by Rene V Dawis and Lloyd Lofquist.
  • TWA stands for Theory of Work Adjustment
  • The theory posits that the person must fit the job – I.e. there must be a high correspondence or congruence between the individual and the work. It also says that the work must meet the needs of the person. Essentially, the relationship works both ways. this is called the PEC or Person environment correspondence
  • Higher work satisfaction generally results in greater productivity and that work adjustment is basically the match between the expectations of the employee and the expectations of the place he or she is working
  • Tests are routinely used to assess one’s work personality, abilities and needs
  • One criticism is that the theory doesn’t take into account that both the individual and the work environment change over time.
    *
104
Q

Are multigenerational homes increasing or decreasing?

A

Increasing. When the economy goes into a recession, young adults can’t afford to live on their own and live with parents. And as people live longer, older people are incapable of caring for themselves.

Note that the number of single adults are also increasing.

105
Q

How do you calculate the coefficient of determination?

A

You square the correlation coefficient. So if the correlation coefficient is .70, your coefficient of determination (aka variance) would be 49%

106
Q

If you have the coefficient of determination, how would you figured out the coefficient of non determination?

A

You would subtract the coefficient of determination from 100. So if you have a coefficient of determination (aka true common variance) of 36%, your coefficient of non determination would be 64%.

107
Q

What kind of theory is John Krumboltz’s model of career development?

A

Krumboltz’s theory of career development built on the social learning behvarioristic theory of Albert Bandura. (this is also often referred to as a cognitive theory because it emphasizes believes that clients have about themselves as well as the world of work).

Krumboltz insists that learning, not interests, guides people into a certain occupation. and changes of interest (hence jobs) occur due to learning. This theory notes that career decisions are influenced by:

  • genetic endowment and special abilities (I.e. a certain physique)
  • environmental conditions and events (I.e. a government policy or earthquake)
  • instrumental learning (I.e positive reinforcement for solving math problems) and/or association learning (I.e. a client wants to go to med school because everyone loves her uncle who’s a doctor)
108
Q

What is Krumboltz’s concept of self-observation generalizations?

A

When Krumbholtz refers to self-observation generalizations, he really means that in career counseling, your primary concern is the manner in which people view themselves and their ability to perform in an occupation.

He also felt worldview generalizations, generalizations regarding a given occupation and how successful the client would be in the occupation, are important.

109
Q

What is SCCT?

A

SCCT stands for Social Cognitive Career Theory, which asserts that self-efficacy beliefs can influence one’s career decisions. A woman, for example, may have excellent math skills but might not consider the field because she believes women aren’t as good at math as men.

Self-efficacy is essentially the question of “can I really do this and what will happen if I try to do this?”

110
Q

What are linear and nonlinear approaches to career decisions?

A
  • Linear approaches are noninteractive (like reading a book, hearing a speech, watching a video, etc) – the client has some control over the process.
  • Nonlinear approaches are interactive (like visiting a business, interviewing a worker, computer-based guidance system). Interactive approaches are often more expensive and reduce the influence or control the client has over the process.
111
Q

What is Urie Bronfenbrenner’s ecological systems theory of development?

A

Bonfenbrenner is credited with creating the theory of human ecology. Note that this is a developmental theory that is NOT a stage theory. Before Bronfenbrenner, people from different fields studied their fields but not how they all interacted together.

His theory stresses the way the following systems work together:

  • microsystem - any immediate or close relationships or organizations the child interacts with
  • mesosystem - the way Microsystems work together, like family and school
  • exosystem - the school, church, neighborhood, parents’ places of employment - places the child interacts with but not as often
  • macrosystem - the largest and most remote system including culture, wars, federal government, customs
112
Q

What is the standard deviation on an IQ test?

A

On an IQ test, the standard deviation is 15. So someone in the 84th percentile, would be about one standard deviation above the mean (100) so would have an IQ of about 115.

113
Q

How is z-score related to standard deviation?

A

The z-score is the same as standard deviation. So someone who scored two standard deviations below the mean would have a z-score of -2.

114
Q

What is VRT (Virtual reality therapy)?

A

VRT or Virtual reality therapy is a type of high-tech therapy the is useful for phobias. Clients are hooked to a computer by wearing a VR headset and the computer simulates a real-life situation that stimulates the phobia. The client experiencing the virtual environment generally has the same physiological symptoms as he would in the actual situation. Initial research on VRT shows it was as effective as exposure to the actual stimuli.

115
Q

What are the criterion for diagnosis with an intellectual disability?

A
  • IQ score of 70 or below on an individually administered IQ test
  • Onset of the condition prior to age 18
  • Client’s ability to adapt to normal life in school, work, or family is also impaired

Note that training can raise IQ scores.

116
Q

Who is Daniel Goleman?

A

Daniel Goleman would assert that EQ is more important than IQ. EQ would encompass traits like empathy, impulse control, motivation, and the ability to love. Goleman wrote a book saying that EQ, not IQ, determines success.

117
Q

What is the difference between an interval and a ratio scale?

A

An interval scale MUST operate based on time (I.e. if a slot machine paid out every 20 minutes, it would be fixed interval). In actuality, a slot machine is a variable ratio scale – it pays out after a certain number of turns but that number carries.

118
Q

What are some of the most common uses for behavior therapies based on classical conditioning?

A

Behavior therapies based on classical conditioning are commonly used to treat phobias but are also utilized for clients with OCD. One of the most popular forms of behavior therapy based on classical conditioning, Wolpe’s systematic desensitization, is based on Pavlov’s classical conditioning and is an excellent for phobic clients in both individual and group therapy.

119
Q

What is the Barnum Effect?

A

In psychometrics, the Barnum Effect (which can also be called the Forer Effect) refers to the fact that clients will often accept a general psychological test report, horoscope, or palm reading and believe that it applies specifically to them.

120
Q

What does neuroscience say about the impact of cognitive therapy?

A

Neuroscience has shown that cognitive therapy can raise serotonin in the brain, just like antidepressants.

121
Q

What is neurogenesis?

A

This is the process of generating new neurons. Learning, such as counseling, chess, solitaire, etc, all generate neurons in older adults.

122
Q

How does tryptophan relate to serotonin in the brain?

A

Research shows that when tryptophan is removed from the diet, memory, anxiety, sleep, and mood all go south and aggression rises.

123
Q

Which hemisphere of the brain is dominant in most people?

A

The left hemisphere is dominant in over 95% of the population. Damage to the left hemisphere often results in issues with the right side of the body.

124
Q

What is a somatic system disorder (SSD)?

A

In order to diagnose a somatic system disorder (SSD), the client must have a physical exam for the diagnosis to be valid - and that exam must show no physiological basis or medical condition to explain his reaction. The key factor is that emotional factors can cause somatic complaints and health concerns.

125
Q

What are the different types of panic attacks?

A
  • situationally bound panic attacks (also known as cued panic attacks) - panic attacks that have a cue or an environmental trigger
  • uncured or unexpected panic attacks - panic attacks that seemingly occur out of nowhere and no internal or external trigger can be identified.

Women experience panic attacks more frequently than men.

126
Q

What is dissociative identity disorder (DID)?

A

In any dissociative disorder, the client attempts to avoid stress by dissociating from the situation. In the case of dissociative identity disorder (DID) the client has often been sexually abused as a child. counseling can be useful in integrating the personality into a single entity.

127
Q

What are RS issues?

A

RS in this case mean “religious and spiritual”.

128
Q

How frequently does Binge Eating Disorder occur?

A

Binge eating disorder (BED) is the most common type of eating disorder. Clients with BED often eat alone and eat very rapidly, often to the point of pain even if they are not hungry.

129
Q

What is intersexuality?

A

Intersexuality describes an individual with male and female sexual characteristics and possibly male and female internal or external sex organs.

130
Q

What is a parametric inferential statistic?

A

Parametric statistics are used when the distribution is normal and random sampling has been utilized (parametric curves = bell curve).

Note that parametric designs use interval and ratio data while nonparametric designs use nominal and ordinal data.

131
Q

Are therapists allowed to use answering machines?

A

Yes, but unauthorized staff should not be allowed to listen to or retrieve messages. Some other ethical notes about phone usage:

  • never tell a caller whether or not a client is receiving services
  • anyone you say to a client over the phone could end up in court
  • be careful about leaving personal messages for clients on their answering machines
  • When using a cell phone, remember the call could be monitored by a third party
  • Same precautions apply to text
132
Q

What is the difference between progress and process notes?

A
  • progress notes are mandated by law. Also referred to as clinical notes. Progress notes are behavioral and focus on what the client does and says. Progress notes could include something about informed consent, assessment procedures or tests used, the client’s DSM diagnosis, symptoms, the type of counseling interventions used, the goals of counseling, progress, ROI issues, dates of sessions, and termination dates
  • Process notes are also sometimes called psychotherapy notes are not generally shared with clients or made available to them. Process notes are kept separate, are not required by law, and are intended just for the counselor who created them.
133
Q

Does conversion or reparative therapy work?

A

No – and it is also unethical. Research has shown that conversion or reparative therapy intended to change someone’s sexual attraction not only doesn’t work but can actually harm clients.

134
Q

What is the ethical requirement to have a transfer plan?

A

A therapist must have a transfer plan in the case in which a counselor becomes disabled, dies, or moves to another state. The transfer plan should be set up to protect the welfare of the client as well as his or her files. If the therapist is incapacitated, leaves the practice, or dies, the clients will have access to their records as well as their files.

All counselors should include a transfer plan in their informed consent document given to the client at the beginning of treatment, listing the new contact person and custodian of the records, with complete contact info. The new contact person should contact each client when he receives the record. Note that it is also preferable to use a mental health professional as this new contact person.

135
Q

How should a counselor deal with a situation in which the counselor believes that a diagnosis could harm the client or others.

A

According to ACA ethical guidelines, a counselor could refrain from making a diagnosis if it is in the best interest of the client. That said, a decision to refrain from making a diagnosis is ideally made in collaboration with the client - though the counselor has final say.

136
Q

How might a counselor deal with an agency who says you must diagnose every single client?

A

The ACA says a counselor can decide not to diagnose a client if it may harm the client or others. You could handle this by:

  • meeting w/supervisor and executive director to figure out how to get funding for the ct w/o a diagnosis
  • advocate for the client by explaining the situation to the insurance company and teach the client to advocate for herself by having her inform her insurance company that a diagnosis might not be in her best interest
  • Show supervisor, ED, insurance company, etc the actual ACA code of ethics – counselors are responsible to educating insurance companies, agencies, managed care firms, etc
137
Q

What kind of interventions might an ABA counselor use?

A

ABA (applied behavior analysis) is basically the new terminology for behavior modification. An ABA counselor might do things like VR reinforcement, FR reinforcement (fixed ratio), and thinning.

137
Q

What kind of interventions might an ABA counselor use?

A

ABA (applied behavior analysis) is basically the new terminology for behavior modification. An ABA counselor might do things like VR reinforcement, FR reinforcement (fixed ratio), and thinning.

138
Q

What is REM/EM?

A

These are terms associated with EMDR. EM = eye movement and REM = rapid eye movement. EMDR attempts to produced REM/EM during the course of the sessions.

139
Q

What is the memory device “IS PATH WARM”?

A

IS PATH WARM is a pneumonic device created by the American Association of Suicidology to help people assess the risk of suicide. It stands for:

  • I - ideation
  • S - substance abuse
  • P - purposelessness
  • A - anxiety
  • T - trapped
  • H - hopelessness
  • W = withdrawal
  • A = anger
  • R = recklessness
  • M - mood changes
140
Q

What is Child-centered play therapy (CCPT)?

A

Child-centered play therapy (CCPT) was created by Virginia Mae Axline, an associate of Carl Rogers who penned Dibs in Search of Self.

CCPT advocates that a therapist should be friendly, warm, and accept the child as he or she is. CCPT does not direct the child’s topics of conversation or behavior and recognizes that the process should not be rushed since the child leads and the therapist follows. This approach is also often called non directive child play therapy since it has a lot in common with the non directive Rogerian approach.

141
Q

What might a children’s career counseling group help children do?

A

A children’s career counseling group might help the kids have a sense of belonging, share feelings and ideas, and engage in desirable peer interaction.

142
Q

Does universality/mutuality appear in career groups?

A

Yes. Career groups allow members to see that others can also be struggling with similar issues related to work, vocation and career - and that other members of the group are in similar situations.

Also, research has shown that group career counseling is more effective than non counselor interventions.

143
Q

What are some elements that make career counseling groups work well?

A
  • The group (or workshop) should be structured - structured groups work better than unstructured groups
  • Group career counseling is more effective than non counselor interventions
  • special career counseling groups for specific populations work quite well (I.e. displaced homemakers, etc)

Group career counseling can be used in any country and is much more cost-effective than individual career counseling.

144
Q

What is the main purpose of a career group?

A

The main purpose of a career group is to provide information to participants and to help participants explored vocations and enhance their decision-making skills.

145
Q

What kind of impact does John Krumboltz believe career decisions have?

A

Krumbholtz believed that career decision issues are crucial in terms of one’s happiness.

146
Q

What are some advantages of group career counseling over individual counseling?

A
  • Other clients in the group can help you to rev up your motivation
  • you get to help other clients and they get to help you
  • participants can role-play situations like how to answer questions during a job interview
147
Q

What does Richard Nelson Bolles champion in his best selling career book What Color is your Parachute?

A

He champions the idea of securing a network of people who can help you with your job search. Bolles is not particularly interested in the existing career counseling theories and is generally a major fan of networking.

148
Q

What are Nathan Azrin’s job groups based on?

A

Azrin’s job groups are behaviorist in nature (Azrin studied with BF Skinner). His groups were NOT intended for career exploration – the individual had to have a good idea he wanted to get. Instead, the group was action-oriented and urged the members to forge forward in their job hunting goals (I.e. calling possible job sites, setting up interviews, etc).

These groups did provide support but also helped participants build skills and provided networking.

149
Q

What is DBT?

A

DBT, created by psychologist Martha Linehan, stands for dialectical behavior therapy and is a popular intervention for working with suicidal individuals, clients who are self-abusing, and those with addiction issues.

DBT relies on 4 modes:

  1. skills training
  2. phone counseling
  3. therapist consultation team
  4. individual treatment

When DBT is adapted to a setting where all 4 modes can’t be used, it is called DBT-informed or abbreviated DBT-informed practices (I.e. if a counselor could only do a skills group but not the other stuff). The entire 4-mode treatment is called standard DBT.

150
Q

What might be good interventions in a structured career group?

A

You could use activities like a game.

151
Q

How might Donald Super’s life career rainbow manifest in a career group?

A

Donald Super’s Career rainbow helps group members answer th question “where have you been in life and where are you going?” The group might examine the clients’ roles in life as a child, student, citizen, homemaker/parent, worker, citizen, etc. Super’s lines of questioning also open the door to discuss career crises like layoffs.

152
Q

What is the concept of plasticity?

A

The concept of plasticity drives home the point that every trait within a given individual can be altered through the course of the lifespan. Change is ongoing and not random.

153
Q

What is differential sensitivity?

A

Differential sensitivity refers to the idea that some people are more vulnerable than others to a particular experience due to genetic differences. This arises in many things, including prescription drugs and impact, side effect, etc

154
Q

What is the first step in conducting a program evaluation (PE_ for your 501c3 nonprofit counseling agency?

A

You should begin by getting the support of the staff, administration, and clients. Since the agency has nonprofit status, you would also want to get support from the board of directors .

155
Q

What are Program evaluations (PE)?

A

Program evaluation (PE) helps agencies, organizations, and centers make wiser decisions. PE takes place in a natural rather than a laboratory or controlled setting and helps programs answer questions posed via staff. Program evaluations help the program and are generally not intended to gear towards hypotheses or theories. Instead, an adept program evaluation answers questions including:

  • Is this program actually necessary?
  • If so, which clients should receive the services from the program and for what duration of time?
  • What are the outcomes of the program?

In the majority of cases, stakeholders such as the staff, the board, clients, and administrators pose the questions and conduct the research. Also, best practices are to use existing data whenever possible to keep costs down.

156
Q

What question does a cost-benefit analysis (CBA) answer?

A

A cost-benefit analysis (CBA) answers the question, “was the money wisely spent or does the counseling center need a new program”. Counselors often find it difficult to talk about CBA because it deals with the issues of whether or not it is worth the price to assist people.

157
Q

What does the ACA ethics say about fee splitting among therapists in a practice?

A

The ACA has taken the position that fee splitting could be a problem because you might be apt to refer the clients to staff who are paying a greater fee. to the agency rather than assigning clients based on a rotational basis or the competency o the clinicians on staff. Making referrals based on financial outcomes is not ethical. However, the owner of a practice could charge each helper a set amount for office use.

158
Q

What are OARS core skills?

A

OARS core skills are part of Motivational interviewing (MI) created mainly by William Miller and Stephen Rollnick. Motivational interviewing is particularly popular in use for addictions. Motivational Interviewing is considered to be a more goal-oriented offshoot of Rogerian counseling and is a brief form of therapy often implemented in 5 sessions or less.

OARS stands for:

  • Open questions (I.e. how is your gambling addiction impacting your life?)
  • Affirmations (any positive factors the counselor sees in the client’s life like awards, achievements, successes, etc)
  • Reflection
  • Summaries
159
Q

What is the order of the four processes that Motivational Interviewing (MI) uses?

A
  1. Engaging - first creating a relationship with the client. In MI the counselor is intended to be a partner vs. the expert.
  2. Focusing - this means that the conversation should be limited to the patterns of behavior the client wishes to change
  3. Evoking - stresses the client should use his or her own motivation to make change
  4. planning - the act of creating a smart measurable plan that works

The MI change must come from the client and not an outside source. The client must overcome his ambivalence towards change (I.e. I guess I could give up smoking but then I might gain weight). Aggressive confrontation, advice giving, and persuasion are not part of the MI process - and thus MI should not be confused with traditional brief therapy.

160
Q

How does Irvin Yalom think about therapists’ approach to death?

A

Yalom believes that most therapists are afraid of their own mortality and avoid the topic of death. He is convinced that we are all hardwired to have anxiety about death. Nevertheless when it crosses over to terror and immobilizes our life it is not healthy. He believes life can be richer by keeping death in mind. He uses the example that cancer patients faced with death would sometimes comment that they were sort they waited so long to learn how to live

161
Q

What is effect size (ES)?

A

The effect size (es) is a correlation/association between variables x and y. Basically, it shows how big the difference between two groups is (vs. just the results of an experiment which tell if there is a difference at all)

  • A small association is .2 or less
  • A medium association is .5 or less
  • a large/strong/big association is .8 or higher

In a true experiment that is statistically significant and rejects the null hypothesis, you must still provide an ES statistic because it is important to find out how large/strong the effect is. So if the ES was 3.15, the difference between the means of the two groups is very high so there is a VERY large effect. Essentially, the ES helps us analyze the magnitude of the differences when looking at correlations, tests of significance, or even a meta analysis.

162
Q

What was the outcome of a major meta analysis of 375 outcome studies using effect size?

A

This study revealed that psychotherapy had a strong effect, checking in at an .85 ES.

163
Q

Is pathological gambling considered a disorder in the DSM5?

A

Yes. It is a sirodered and is listed with substance-related and addictive disorders.

164
Q

Is bullying more common in person or online?

A

Online. Cyberbullying is more common and can take place via unwanted text messages or internet posts with negative or hurtful information. Some research, however, reveals that sibling bullying is a more common variety of school bullying.

165
Q

What is wilderness therapy?

A

Wildnerness therapy, a subset of adventure-based therapy, relies on trained staff and well-established theories of psychology, counseling, and change. It is NOT bootcamp therapy. Effective wilderness therapy settings use little or no source, confrontation, or point level systems. Some programs send young adults home after the program but others use aftercare centers or treatment-oriented boarding schools.

166
Q

What is accidental vs. contingent reinforcement?

A

Accidental reinforcement can occur regardless of the behavior. BF Skinner found this when he reinforced pigeons with food for no special reason and found that whatever the pigeon was doing at the time (I.e. pecking, spinning, etc) they tended to repeat in an attempt to cause the food to come.

Contingent reinforcement is what happens most of the time we use reinforcement: it is dependent on a given behavior. I.e. your dog knows that you give a treat (a reinforcer) when she comes to the door after you call her.

167
Q

What are some gender differences in major mental health issues?

A
  • Men commit suicide more than women
  • women suffer from depression more than men
  • Alcoholism occurs more in men than in women
  • Autism occurs more in men than in women
168
Q

What are dispositional attributions?

A

Attribution theories assign a cause, explanation, or reason for a behavior or outcome of an event. When the cause or outcome is generated by the person, it is a dispositional or internal attribution (I.e. Melissa flunked the exam because she didn’t study).

When the cause is attributed to factors outside the individuals, this is situational or external attribution (I.e. Melissa flunked the exam because the department created a test so hard no one could pass it).

169
Q

What is a fundamental attribution error

A

A fundamental attribution error (also called a fundamental attribution bias) occurs when a person attempts to look at someone else’s negative behavior, failure, or undesirable event and come up with an explanation. The tendency is to put more stock in dispositional explanations (personality, judgement, etc) than situational ones – essentially, the problem is attributed to the person.

Most people, however, attribute their own negative outcomes to situational/external things but see other peoples’ negative outcomes as dispositional/internal. This is known as the self-serving bias.

170
Q

What is the self serving bias?

A

The self serving bias is when people attribute their own negative outcomes to situational/external things but see other peoples’ negative outcomes as dispositional/internal. This is known as the self-serving bias.

Note, however, that someone who is depressed will typically do the opposite and will blame internal factors for failure. Ironically, research shows that depressed people often have a more accurate view of reality.

171
Q

What is a thought record and which modality might use it?

A

A thought record would likely be a part of CBT treatment. CBT, now considered the dominant force in psychotherapy, often uses thought records to help clients see how their thoughts are impacting their lives. The thought record is merely a chart depicting an activating event, the actual thought, the emotional consequence and/or behavior, and an alternative thought or perspective. On rare occasions, the log will also include the new emotional response based on the alternative thought

172
Q

What are first, second, and third-wave CBT?

A
  • First wave treatments were based on operant and classical conditioning such as the work of BF Skinner and Ivan Pavlov
  • Second wave interventions focused heavily on cognitions depicted by the work of Albert Ellis or Aaron T. Beck
  • Third wave or contemporary CBT incorporates DBT, motivational interviewing, and Acceptance and Commitment Therapy (ACT)
173
Q

What is the downward arrow technique?

A

The downward arrow technique is highly recommended to ferret out what the client is truly upset about and make the client aware of the issue. The therapist keeps asking the client for the next logical conclusion (I.e. if a client is upset he forgot to buy his wife a birthday gift, would ask, “what’s the worst thing that could happen”, then would ask again, and again until getting to the real issue known as the core belief of “she might be so upset she divorces me).

It’s like the nightmare question.

174
Q

What is the difference between classical conditioning and operant conditioning?

A

Classical conditioning is based on paired learning whereas operant conditioning is predicated on rewards or punishment.