counseling families, diagnosis, neurocounseling, advanced concepts Flashcards
DSM
initially released in 1952, 100 diagnostic categories, 3rd edition 1980 psychodynamic->medical model, multi axial system; 4th in 2004 with 297 disorders; 5th in 2013 with 20 chps with grouping matching structure of ICD,
DSM 5
non axial, doesnt separate diagnosis of substance abuse and dependence.”retardation” is no longer used, ASD now encompasses other disorders like aspergers, easier to be diagnosed with ADHD, dysthymia is new dx, PMDD is new, greivment is no longer excluded from depressive disorder, no longer use term “gender id disorder”, gender dysphoria is new diagnostic categoy. Paraphilia is not a disorder and is not treated vs paraphilic where there is distress and others are harmed; 5 has more ratings or specifiers than previous editions (some exams use dimensionality to express severity)
allen francis
md chaired DSM taskforce and wrote final edition for 3rd edition and thought 5th was risky for patients and sad for psychiatry (thought many “normal” people would be labeled as having disorder)
billing to insurance
only ICD 10 codes are used to bill (HIPAA requirement) not DSM code
dr bonnie badenoch
helped convinced field of counseling that a neuroscientific mindset in counseling would be beneficial, ideally using fMRI scans to measure blood flow to brain to engage activity in different brain sites (also done by PET scans)
neuroplasticity
concept that the brain can change and new neural connections can be made at any point in life
neurogenesis
new neurons can be formed
mirror neuron concept
indicates that a neuron or neurons fire if you perform a behavior; same neurons fire if you witness the behavior in someone else
IPNB
interpersonal neurobiology. I.e. if a bear chases us we feel fear, if we witness a bear chasing someone else we feel fear, it is involuntary
CET
cognitive enhancement therapy; evidence based neurocounseling modality used with people with schizophrenia. Used neurocog video games and coaching to improve functioning
criticisms for neurocounseling
scanning can be unsafe, too much significance to blod flow in brain, not humanistic enough
confidentiality with families
you do not disclose info about one member to another unless with permission
AAMFT
american assoc. For marriage and family therapy. See marriage and fam therapy as seperate profession in and of itelf
IAMFC
international assoc. Of marriage and fam counselors; div of ACA, believe marriage and fam counseling is specialty mastered by someone with speicalized training
linear causality
assume that a causes b; generally accepted and valid concept in ind counseling
circular causality
more accepted by marriage and fam therapistsl related to cybernetics which gregory bateson became interested in. everyone influences everyone else so prob resides in family rather than ind.
cybernetics
analysis of informational interactions. How flow of info regulates and controls a system. Concept used by fam therapists, usually assoc with work of weiner. Family has feedback loops.
norbert weiner
1940s mathemetician pioneered cybernetics
homeostasis
can be good or bad but is a maintained balanced state. A family will attempt to hold onto given pattern of functioning that could be disfunctional.
adaptability
fams ability to change or display flexibility
enmeshment
family members are over involved with each other and lose autonomy
non sumativity
suggest that any system in the family is greater than the sum of parts. Better to examine patterns rather than ind. Behavior.
morphostasis
familys ability to balance stability
morphogenesis
familys ability to change
aspirational ethics
non mandatory ethics, describe ideal or optimal practice.
mandatory ethics
standards of practice
experiential conjoint therapy
closely related to virginia satir. conjoint = two or more family members are in therapy at the same time.
virginia satir
SW saw families in 1951, family could be healed via love, improve intrafamily communication, leading figure in experiential therapy
satirs stress positions
placating, blaming, being overly reasonable, being irrelevant
placating
trying to please everyone out of fear of rejection
blamer
basically asserts that “it is your fault i am the way i am”
persno who becomes overly reasonable
likely to engage in the defense mechanism of intelectualization; functions like a computer to keep emotions in check, aka responsible analyzer
being irrelevant
distracts family from problem via constantly talking about irrelevant topics
excitation
expressing true emotion
salvador minuchin
father of structural family therapy. Family therapy is science that required therapeutic interventions beyond warmth.
carl whitaker
dean of experiential family therapy. Liked to say that experience not education changes families, so best way to access unconscious is symbolically. Approach aka experiential symbolic family therapy. Liked to “join” with family and experience their dynamics, believed a co-therapist to be helpful. Assoc with. Psychotherapy of the absurd (actual tug of war when in power struggle). Promoted craziness and creativity of family members. Described as atheoretical.
luwig von bertalanffy
biologist who popularized notion of connectedness of all living things and systems theory model
murray bowen
based family therapy on systems theory. triangulation.
david premack
work suggests that a family member must complete unpleasant task before they can engage in a pleasant task. Unpleasant task=low probability behavior (LPB); pleasant task=high probability behavior (HPB)==premacks principle.
quid pro quo
one thing for another, makes use of behvaioral contingency contract based on the notion that one member will do something if another does something comparable.
time out
when a fam member is isolated so they do not receive reinforcement for dysfunctional behavior
reciprocity in marriage
in most cases, 2 ppl will reinforce each other about the same level over time and when this doesnt happen, marriage discord will result.
behavioral family therapy
1960s, focused on children in fam with problems,
gerald patterson
popularized parent training in home, pioneer of behavioral family therapy
psychologist robert liberman and richard stuart
pioneer o behavioral family therapy
family sculpting
virginia satir, experiential/expressive technique in which one member places other members in physical position that represents their relationships.
remarriage
4/10 new marriages, about 30% of divorced persons are remarried within 1 year
nathan ackerman
pioneer of psychodynamic family counseling. Was initially child psychiatrist who in 1938 recommended studying family. Before ackerman, it was innapropriate to include fam members in treatment.
object term psychodynamic family therapy
sig other with whom which a child wishes to bond. An ind. Attempts to establish a relationship with object to satisfy needs. When this doesnt happen, anxiety is manifested.
introjects term psychodynamic family therapy
client unconsiously internalized the pos and neg characteristics of the objects within themselves. Determines how individual will relate to others.
second order change
more desirable than first-order change. Structural change to family taht alters undesirable behavioral patterns.
first order change
superficial changes i.e. behavioral changes without structural changes. Ameliorates symptoms temporarily.
greek chorus
a consultant or supervisory team that observes session from one-way mirror and sends messages to therapist or family. Strategic therapy.
james framo
Famous psychoanalytic family therapist. Believes important objects fuel love/hate feelings in kids. More pathological early life is, the more the adult will fit relationships to love-hate scenario from childhood.
robin skynner
Famous psychoanalytic family therapist. Kids with poor role models possess protective systems.
jay hayley
Impacted by Erickson. Coined term strategic therapy. Believed in designing a strategy for each specific problem. Worked with Minuchin to train ppl. Believes in giving clients directives
strategic therapy
Chloe Madanes & Jay Haley. solution/sympotm focused and very action oriented. Madanes believed symptoms served function and advocated techniques using pretend techniques that are somewhat paradoxical.
directive/perscribing
strategic term. When therapist tells a client or family what to do. When a person follows a directive, symptoms are under control.
double bind (strategic therapy)
A no-win situation characterized by contradictory messages. Constitutes a paradox. A therapeutic technique.
paradox
strategic term. direct antithesis of common sense. Helper prescribed what the client would probably do anyway and cna even tell them to exaggerate it.
relabeling
relabeling/redefining/Reframing: strategic term. occurs when you redefine a situation in a positive context making the beheavior seem acceptable or positive to the client. Looking to evoke a diff emotional response. used by Hayley and followers
person with power in strategic therapy
one who makes decisions. Hayley believes you can enhance the power of someone in family by speaking to them first in the context of therapy
incongruous hierarchy
madanes/strategic term. When a member is in control who should not be (a child daughter in control of mother).
restraining
strategic term. a therapist may warn the ind or family about negative consequences of change. Helps overcome resistance by suggesting that it may be best if the family doesn’t change
positioning
strategic term. a helper accepts the clients predicament and then exaggerates the condition
behavioral dispute
REBT term. Client tries to behave in a way that is marketly diff from his/her normal undesirable path.
cultural encapsulation
term suggested by Wrenn. Results in a counselor imposing goals from his her own culture onto folx from another culture.
african american families
fewer are getting married and less likely to be concerned about gender roles. Best approach would be bowne’s family therapy, minuchins structural therapy or hayleys strategic family therapy. Problem-focused, brief or multigenerational approaches seem to fair best.
asian american families
solution-focused/problem-focused modalities seem to be best approach.
latino families
expectations are often that therapy should mimic medical treatment. Short term behavioral or structural approaches appear to work well.
cohesion
level of emotional bonding between family members
circumplex family model:
a key factor is that the family should have balance in cohesion as well as adaptability.
native american families
extended family is significant. High % of children are in foster homes, adoption homes non-native etc., theorists agree that the resulting factors are id confusion. Suicide is second leading cause of death. Alcohol is involed in 69% of suicides. Issues with suicide bereavement due ot alcohol abuse (issues with fetal alcohol syndrom etc.)
triangulation
when a diad is under stress, a third person is recruited to help stabilize the dyad.
differentiation
extent to which one can separate ones intellect from ones emotional self. Person w/o this does not have clear sense of self or others.
fusion
the intellect and emotional aspec tof the person merge.
genogram
family tree that relies on symboles. Three+ generational pictorial diagram.
interenerational family therapy
concerned with emotional systems of other generations of family members even if they are not directly involved in therapy and/or alive/dead
mri model
mental research institute model. Hayley’s model has also been called the MRI.
structural family therapy
ind behavior can only be interpreted by analyzing family actions and change in familys patterns of communication and interactionmust occur to create a healthy family. Important technique is joining.
joining
structural term. Therapist meets, greets and attempts to bond with the family. Mimics communication patterns. Reduces resistance, happens in initial sessions, boost confidence in treatment process.
mimesis
helper mimics communication patters
enactment
structural term. Allows counselor to see instant replay of what generally transpires in the family.
boundaries
tructural term. Physical and psychological entities that separate individuals and subsystems from others in family. Clear are healthy, people are supported and nurtured and have freedom to be their own person (aka individuate). Rigid: ind or subsystems being disengaged. Diffuse: would lead to challenges with individuating and people often feel uncomfortable when they are alone.
changing boundaries/boundary making technique
seating is altered and members are placed at different distance from each other. Structural technique.
intergenerational family therapists
bowen and ivan boszormenyi-Nagy (discusses importance of give and take, relational ethics,
relational ethics
healthy family can negotiate inbalances and preserve a sense of fairness and accountability
family legacy
Ivan-expectations handed down from generation to generation
family ledger
Ivan-multigenerational balance sheet or accounting system. Accounts for who gives what to whom and who owes what to whom.
disengagement
isolated lack of connectedness between family members.
perverse triangle
situation in which two members who are at diff levels of the hierarchy team up against another family member.
solution oriented therapy
focuses on future. No emphasis on understanding problem. Therapists co-formulate plan of action with client or family. William o’hanlon, insoo kim berg, steve de shazer, michelle weiner davis.
constructivism
aka social constructivism. Client constructs or invents the way he/she perceives the world. Therapy should be less hierarchical. Client and therapist are collaborating.
post modernism
no fixed truths-only individuals perceptions of what is reality/truth.
tom anderson
postmodernist, psychiatrist from norway. Used radical approach of one way mirror and reflecting treatment team.
feminist therapist critique of other therapies
androcentric, gendercentric and emphasis on heterosexism. Aka gender-fair counseling (on exam).
skeleton keys
standard or stock intervention that will work for numerous problems. Steve de shazers breif-solution focused therapy
complement
breif solution focused term. therapist hands client a sheet of paper with complement on it
past successess
brief therapy term. therapist complimenting past success without relating them to current obstacles
brief solutions focused therapy
bfft or bt. Sometimes uses a treatment behind a one way mirror but it is not required. Often relies on a paradox.
integrative psychotherapy
incorporating approaches from multiple modalities
common factor approach
otion that theories of counseling are helpful because they have elements of theories that are common between them.
breief strategic family therapy
ecosystems refer to the fact that larger systems often impact client and family functioning. Ecosystemic approach always takes these larger systems into account.
pre experimental designs
often diagrammed. x=treatment, 0=observation, measurement or score, e=experiemntal group, c=control group, r=random sampling, nr=non-random sampling.1 group only postest design.
time series design
quasi experimental design without randomly chosen control and experimental group. Relies on multiples observation of DV before and after treatment occurs.
Waltzlawick, Weakland, and Fisch
brief therapy. Book “Change Principles of Problem Formation and Problem Solution”
Solomon four group design
one group receives a pretest and one experimental group receives a pretest. The other control group and experimental group do not. Is true experimental design. Supposed to weed out impact of pretest.
John gottman
created paradigm to predict which marriages would end in divorce. 6 predictors: harsh start up, negativity relationship, (criticism, defense, stonewalling, contempt), flooding (negativity that comes on suddenly and is overwhelming), body language changes, attempts to repair fail, lack of fond memories from early days. Didnt use true experiments to come up with theory
Dr ellen langer
studied older men in environment similar to one 20 years ago and told them to act like they were 20 years younger, and biomarkers of aging went backwards. book= counter clockwise
Propinquity
mere exposure effect. More you are around them, more you are attracted to them.
TWA
theory of work adjustment. Dawis and Lofquist. Person must fit job and work must meet needs of person. Person environment correspondence (PEC). higher work satisfaction = greater productivity
Social learning behavioristic (career model)
kurmboltz career theory built on bandura social learning theory. Learning not interests guides ppl in occupation. Career Decisions are influenced by genetic endowment, environmental conditions, instrumental learning,
World view generalization
generalization regarding a given occupation and how successful the client would be in the occupation
SCCT
social cognitive career theory. Self efficacy beliefs can influence ones career decisions.
Nancy chodorow
psychoanalytic feminist. Domestic ideal caused oppresion in women.
James fowler
faith development
VRT
virtual reality therapy. Dr. barbara rothbaum, behavioristic. Stimulates real life situation. Client generally has same physiological reactions.
Dsm 5 intellectual disability
70 or below IQ, ability to adapt to school/family impaired, onset prior to 18.
Daniel goleman
wrote emotional intelligence: why it can matter more than iq.
EQ
empathy, impulse control, motivation, ability to love(emotional intelligence)
Meta analysis
use stats based on numerous studie to investigate an issue. Aka meta research.
Karl pearson
assoc. With concept of correlation. Created first stats dept at university. First person to use this technique.
Barnum effect
aka forer effect. Clients will accept a general psych test report, horoscope etc. and believe it applies to them.
Tryptophan:
amino acid, related to serotonin. Helps with memory, anxiety, sleep, mood.
Cued panic attacks:
AKA situationally-bound panic attacks. Has a cue or environmental trigger.
Uncued panic attack
AKA unexpected attack. Occurs out of nowhere and there is no identifiable internal or external trigger.
Dissociative identity disorder (DID)
Personality disorder in which ct. Attempts to avoid stress by dissociating from situation. Includes amnesia. Prev. known as multiple personality disorder (MPD).
Religious strain
: i.e. difficulty forgiving God. Causes higher stress, depression, suicidal feelings.
Bulimia
primarily occurs in women. Bulimia is more prevalent than anorexia. 90% of individuals with Bulimia & AN are women. Low body weight is not typical characteristic of bulimia or binge eating.
Women < men
lower income, not as comfortable when they are involved in competitive situations, less comfortable expressing anger and being assertive
gay men and women
basically have the same range of gender-role behaviors as do male and female heterosexuals
parametric statistics
used when dist’n normal and random sampling has been utilized, use interval and ratio data
nonparametric designs
rely on ordinal and nominal data
progress notes
equired by law. Aka clinical notes. Focus on what the client does and says.
process notes
aka psychotherapy notes. Not required by law. Not generally shared with client. Kept separately from client records.
constructivism in career counseling
belief that an individual’s career choice is influenced by his or her personal story & attempts to construct meaning out of the world of work
conversion or reparative therapy
iterature and studies on the topic show there is no way to alter same-sex attraction. Not evidence-based. ACA prohibits.
transformational ministries
name that religious organizations give their conversion services
ethical requirements to have transfer plan if
counselor becomes disabled, counselor dies, counselor moves to another state
transfer plan
included in informed consent document, new contact person & custodian of records should be listed w/complete contact info. Custodian of records is responsible for contacting clients on record.
NPI
national provider identifier. Required to file claims. NPI is standard unique identifier as a healthcare provider.
refraining from diagnosis
is ethical if it is in best interest of the client (best practice is to collab with client).
permissive parent
non-punitive, rarely says no, highly affectionate, more like a friend, few demands on the child
authoritative parent
champions give & take verbal exchanges with child, will produce happy child with desirable social skills
authoritarian parent
doesn’t champion give & take, expects child to follow orders with no explanation
parenting correlated with alcoholism, drug abuse and antisocial behaviors
permissive and authoritarian
aba
applied behavior analysis aka behavior modification
vr
variable ratio reinforcement
fr
fixed ratio reinfrocement
vi
variable intervale reinforcement
fi
fixed interval reinforcement
IS PATH WARM?
created by American Associatation of Suicidology (AAS).
Ideation, Substance abuse, Purposelessness, Anxiety, Trapped, Hopeless, Withdrawal, Anger, Recklessness, Mood changes
CCPT/child centered play therapy
AKA nondirective play therapy. Created by Virginia May Axline. Advocates that therapist be friendly, accepting of child, nondirective.
childrens career counseling group helps children…
feel belonging, share feelings & ideas, engage in desirable interaction…
adolescent career group
ost effective and promote peer identification
group career counseling
Main purpose is to provide info. More effective than noncounselor interventions (i.e. computer or software program). Structured groups and workshops work best. Advantages include: other clients can boost motivation, mutual helping occurs, participants can role play situations i.e. interview.r
richard nelson bolles
What Color is Your Parachute author. Championed the idea of securing a network of persons who can help you with your job search.
job club groups
Nathan Azrin created in the 70’s to provide support buildng skills, networking. Studies with B.F. Skinner (behaviorist).
fetal origins hypothesis
Diabetes, Adult heart disease, some emotional disorders may be due to fetal malnutrition
differential sensitivity
the idea that some ppl are more vulnerable than others to a particular experience due to genetic differences (includes pharmaceuticals)
program evaluation
helps agencies, organizations, and centers make wider decisions.. Takes place in a natural rather than lab or controlled settling and helps programs answer questions posed by staff. Not geared towards hypotheses or theories. Answers questions including “is this program necessary”.
cost benefit analysis
answers “was the money wisely spent?”
fee splittting
when a ct. is referred by one provider to another in return for a portion of the fee the provider receives for treating the patient. unethical according to ACA. Making referrals based on financial outcomes is unethical.
motivational interviewing
breif. Motivational interviewing created mainly by William Miller and Stephen Rollnick. Engaging (creating relationship), focusing (limiting conversation to patterns behavior client wishes to change), evoking ( stresses client should use motivation to make change), planning
oars:
open questions, affirmations, reflection, summary. MI core skill.
yalom
we are hardwired to have anxiety about death but terror that imobilizes is unhealthy. “Life can be richer”. Staring at the sun: overcoming the terror of death
effect size
EF statistic. small=.2 or less; medium=.5 or less; large/big/strong=.8 higher. Important to know how large/strong effect is. Unlike correlation, ES is based on cohen’s d. Es helps analyze magnitude of differences when looking at correlations, tests of significance or even a meta analysis.
major meta analysis by smith glass miller
in benefits of psychotherapy, 1980, often quotes, revealed psychotherapy had strong or so-called big effect checking in at .85. No key differences found between different modalities of therapy
important effect sizes to know:
.31 for lexapro; .26 for prozac; .24 zoloft; .3 cimbalta
contingent reinforcement
dependent on given behavior. Most of the time we do reinforce behavior it is contingent
accident reinforcement
can occur regardless of behavior. Receiving reward randomly.
dispositional/internal attributions
cause or outcome is generated by the person
situational/external attribution
cause of attributable factors is outside of the individual
attribution theories
assign cause, explanation, reason for behavior, outcome, event. Fritz heider is father of attribution theory
attribution error
when a person attempts to look at anothers negative behavior, undesirable event etc. and come up with explanation. Tendency is to put more stock in dispositional attribution than situational.
self serving bias
pos events occur because of something that you did/something great about you. Neg event occur because of external circumstances. Depressed cients typically do that opposite of a typical client.
dbt
tarted in 1980s with bpd and suicidal clients. Type of cbt. Four modes: Skills training, phone counseling/coaching, consultation team for therapist, individual treatment. When dbt isn’t using alll four modes at once, people call it “dbt informed”.
first wave cbt
ased on operant and classical conditioning (i.e. skinner and pavlov
second wave cbt
interventions focus heavily on cognitions depicts by the work of ellis and beck
third wave cbt
contemporary. Incorporate dbt, act, MId
downward arrow technique
david burns. Recommended to figure out what client is truly upset about and make client aware of this. Proces of asking questions to get to core belief.
