Essays Flashcards
You will be provided with the details of a clinical case and asked to do the following:
- Use the DSM to provide a diagnosis for the case, a defense of that diagnosis, and alternate diagnostic options considered
- From a cognitive-behavioral perspective:
a. develop a case conceptualization of their presenting concern/diagnosis
b. develop a treatment plan using evidence-based practice and indicate why you chose to
treat the individual this way
c. use the multicultural ADDRESSING model to discuss at least two aspects of the client’s
identity and how they impact your understanding of the case, treatment plan, and potentially the therapeutic relationship
age, developmental disabilities, acquired disabilities, religion, ethnicity, sexual orientation, socioeconomic status, indigenous group membership, nationality, gender
Discuss the major racial identities and help-seeking attitudes you may encounter with people identifying as Black/African American, Hispanic or Latinx, and Asian American. What are the implications of each of these for the counseling process?
Black/African American racial identities and help-seeking attitudes: Racial identities lie deeply in religion, family orientation, and interconnectedness to other black individuals through similar lived experiences. There is often a reluctance to seek therapy (from Black men), and usually therapy is sought via religious help. Help-seeking attitudes may come from a place of lived trauma from systemic oppression and racism, as well as grief therapy from losing fellow members of the Black community to police brutality. I think it’s important to remember that being a different race, I will never understand the racial disparities that black people go through, and if they are seeking therapy for these needs, I must be culturally competent in that area or possibly seek out a therapist that is part of the black community to better a therapeutic relationship.
Hispanic/Latinx racial identities and help-seeking attitudes: Hispanic individuals are also religious and closely tied to family bonds. Family is the most important aspect to these individuals, which sometimes inhibits help-seeking behaviors. Mental health is often disregarded, or the belief that religion can fix mental health issues is strongly held. Younger generations are shifting this perspective, however, and help-seeking behaviors could include family issues, depression/anxiety due to racism/possible deportation or having to leave their loved ones behind. It is important to bring the aspect of family as well as “espiritismo” into therapy, as these serve as assets. Although religion is usually not a part of a therapy relationship, using spirituality is beneficial with Latinx individuals.
Asian American racial identities and help-seeking attitudes: The collectivist nature of Asian Americans is an important racial identity, as well as the family unity. Help-seeking behavior may not come easily, as mental health issues are a sign of immaturity and problematic behavior. Because of the collectivist mentality, if one person of the group is experiencing mental health issues, there is the idea that everyone in that unit experiences mental health issues. Once therapy is sought, it may be for depression and anxiety from dealing with the stigma of mental health in the Asian community.
Co-construction is important to bring to therapy, as a collaboration of client and therapist working together to tackle the problem. By looking at the problem as a third-party, and the therapist and client being a pair, the collectivist mentality is being used as an asset for therapy.
Describe the responsiveness of each of the following groups to group therapy approaches: people identifying as Black/African American, Hispanic or Latinx, and Asian American. What are the implications of these perspectives for the counseling process?
Black: responsiveness for group therapy would be most beneficial for same-race groups; may hold some animosity or anger against dominant group, may feel as if the dominant group does not understand their struggles. The implications of this would mean that the counselor has to gauge what the reason for group therapy is, as well as if same-race therapy for this group may be more beneficial (interconnectedness of community, same lived experiences, religion/spirituality).
Hispanic: It might be more beneficial to use same-race rules here as well, but more for language purposes than interconnectedness. Using more spirited-based therapies might be of best interest. Involving group therapy for Latinx would most likely revolve around depression, anxiety, grief, and trauma about deportation and discrimination.
Asian American: Co-collaboration and group collaboration is important for doing therapy with Asian Americans. As a collectivist society, Asian Americans would do best with a collaboration between therapist and client in tackling the issue that is at hand. This also makes the issue of mental health a third party issue, and not an issue of the whole collectivist community.
Describe the processes of classical and operant conditioning. How do these processes apply to the development and maintenance of anxiety or fear-based behaviors? What are the implications of these processes for treatment?
Classical conditioning includes an unconditioned stimulus, an unconditioned response, a neutral stimulus, a conditioned stimulus and a conditioned response. An US (like food) creates salvation (UR). With the addition of a NS (bell) with an US (food), salvation will likely become a conditioned response to the now conditioned stimulus of the bell. For example, an individual now has a flight/fight response to flying. The US is the feeling in their stomach when taking off. It elicits an anxiety response (the UR). After a while, just seeing a plane elicits this anxiety response. The act of seeing a plane went form the neutral stimulus to conditioned stimulus, and the anxiety response is now the conditioned response. This creates the fear-based behavior.
Operant conditioning includes negative and positive reinforcements sand punishments. Reinforcements are what maintain the fear-based behavior. A negative reinforcement would be the avoidance of flying. A positive reinforcement would be the relief that is felt when not having to fly.
For fear-based treatments, exposure with response prevention is important. Working with the classical conditioning via not eliciting fear response by breathing exercises, validity in fear, TF-CBT, and mindfulness trauma focused modalities. Then we need to work on reinforcement behaviors. Exposure and lack of avoidance to feared stimuli will overtime create less of a fear response. Working slowly via fear hierarchy may be best, which desensitizes after a while.
Describe cross-sectional, longitudinal, and cross-sequential research designs, and discuss the advantages and disadvantages of each. Describe how each could be applied in a study of substance use disorder.
Cross-sectional: research on variables collected at one point in time across different samples/populations. The advantage of this research is that it is time effective and costs less money than other observational experiments. The disadvantage of this research modality is that there is no true cause/effect, and that it shows more differences than it does actual changes. A cross-sectional study for substance abuse disorder could include the rate of cannabis use in adolescents versus young adults.
Longitudinal: observational research on the same sample/population from different points in time. A major advantage of this is that by using the same population, you can clearly see changes over time and attribute those changes to a cause/effect relationship. A major pitfall is that longitudinal research is very expensive and time consuming. An example of longitudinal substance abuse research would be studying cannabis use at middle school and young adulthood within the same population/sample.
Cross-sequential: Cross-sequential morphs both longitudinal and cross-sectional by observation research of different groups (samples) of different ages compare over a period of time. An advantage of this is that by observing groups over periods of time, you can see a direct cause/effect. Another advantage is that you can compare the groups to each other to see differences. By choosing the groups, researchers can also get a better sample for the demographic that they wish to study. Disadvantages include those longitudinal studies, where studying groups over time is less cost effective and requires a long study time. A cross-sequential study of substance abuse would be watching adolescents, young adults, and mid-life adults over a period of ten years, tracking their cannabis use along the way. The research would look at differences between these groups and their use at each stage, as well as differences within each group overtime.
Define attachment. How does the process of attachment occur? Discuss factors that are important in facilitating attachment. Describe the effects of secure and insecure attachment for early (preadolescence) and later (adolescent and above) development, emphasizing the potential impact of the quality of attachment on the development of psychopathology.
Attachment is the lasting and emotional connectedness between two people.
The process of attachment occurs through either positive or negative caregiving experiences early in life, leading to insecure or secure attachment styles. The factors that facilitate attachment are: genetics, temperament, and early-life experiences.
Secure attachment in children allows for a trusting and loving relationship between caregiver and child. It allows the child to trustingly explore their environment around them and interact with others. Later in life, secure adults will have no problem building long-lasting relationships and no fear of abandonment from those relationships.
Insecure attachment can include anxious-ambivalent, avoidant, and disorganized. These come from distrust and abandonment with caregivers, and leads to fear of exploring environment, difficulty expressing or feeling emotions accurately, and having intense anger issues/not playing well with others (breaking toys, hitting others). Later in life, an insecure adult may have a fear of long-lasting relationships, may have difficulty expressing emotions in a sustainable way, or be emotionally dependent on those around them.
Discuss the ethical and legal responsibilities of counselors with regard to both maintaining and
breaking confidentiality.
Therapists and counselors are required to maintain confidentiality with their clients. Trust is an important facet of the therapeutic relationship, and breaches to trust and confidentiality can inhibit any progress in therapy. Peer consultation must only include factors where no one could identify the client. This means that there is no discussion with other individuals or parties unless first assessed with the client or the limitations to confidentiality. These include: harm to the self or someone else, harm to vulnerable populations, or a court-ordered/subpoena requirement. First, if the counselor suspects harm to the client or that the client will harm someone else, they are required to report. If the counselor suspects vulnerable populations (children, elderly, pregnant women, or physically/mentally disabled individuals) are at risk, they are required to break confidentiality. Finally, for a court order a counselor does not have to submit notes “I can neither confirm nor deny that is my client.” But for subpoena, you have to submit notes, but do so in chamber with judge. However, all of these limitations are discussed prior to informed consent and consent for therapy. In addition, the client will always be informed prior to law requirements of note submission. Maintaining confidentiality is a must in therapy, however, there are limitations.
Describe the purpose of professional documentation, emphasizing why documentation is so important. Discuss the ethical and legal issues associated with professional documentation.
The purpose of professional documentation is first and foremost to improve patient care and track patient progress. Treatment plans also can be subject to change, and documentation of such refer the patient to the modified plan. Informed consent and treatment consent are also part of documentation and consenting to therapy is necessary for pragmatic and ethical reasons. Informed/treatment consent are pragmatic because they allow the patient to understand the mechanisms that will take place during therapy and better understand their treatment protocol, changing what they need to in the process. Informed consent is also ethical because it covers legal issues for both the counselor and the patient.
Documentation also minimizes error, aiding to risk management. Proper notes, informed consent, treatment consent, etc. reduce the risk for the therapist, and if errors are made in therapy, it increases protection of the patient.
It is ethical to remain confidentiality in therapy, which includes proper safety of documentation (therapy notes, treatment plans, assessments, etc.). For legal reasons, sometimes documents can be requested by court order or subpoena. Therapists must abide with the law for court order, but with subpoena a therapist can neither confirm nor deny treatment. A client should always know when their documents could be subject to limits of confidentiality.
Explain, in general, the role of neurotransmitters in abnormal behavior and the factors which influence synaptic transmission. Specifically, show the role that neurotransmitters play either in depression or schizophrenia.
Neurotransmitters are chemical substances that move from neuron to neuron, transferring messages between them. There are different kinds of neurotransmitters, and even different subgroups of specific neurotransmitters. Seratonin, dopamine, GABA, glutamate, acetylcholine, histamine, and norepinephrine are of the most important ones that do most of the work in the brain and have effects on human behavior.
For the role of abnormal behavior, too many of the neurotransmitters are in the synapse, not enough neurotransmitters are in the synapse (fast reuptake), an outside substance can block neurotransmitter mechanisms, or the neurotransmitter may be too weak to conduct signals. There are many factors in which have influence on NT’s in the synaptic transmission, and those factors can influence abnormal behavior. For example, a lack of serotonin in the brain can lead to anxiety or depression. SSRI’s (selective-serotonin reuptake inhibitors) block reabsorption (reuptake) of serotonin so that it is increased in the brain. Schizophrenia, for example, involves too much firing of dopamine leading to psychotic symptoms. By blocking dopamine receptors, reduction in dopamine then reduced psychosis.
Overall, the body is trying to reach a state of balance and homeostasis. Sometimes the brain produces more of something, less of something, or the mechanisms behind the neurotransmission are askew. When this happens, abnormal behavior is present.
The use of diagnostic statistical manuals offers both strengths and weaknesses for the assessment and treatment of clients. Discuss three strengths and three weaknesses, including suggestions to overcoming the weaknesses
Strengths:
Documentation for insurance coverage: For most insurance companies, they will only cover therapy sessions if there is a “diagnosis” that can be turned in for approval. Having a documented diagnosis makes it easier for insurance companies to identify an “illness” that can be legally covered.
Guidance for treatment: certain diagnoses require certain treatments. For example, borderline personality disorder is often paired with DBT. Having a diagnosis may come in handy when a therapist is unsure which modality of therapy to use.
Guidance for medication: Depression, anxiety, manic depression, and many other disorders can be treated using a combination of traditional therapy and psychopharmaceuticals. For example, SSRI’s are great for treating panic disorder; without that diagnosis, however, therapists and psychiatrists would have a difficult time finding a good source of medicine that could help with therapy-resistant diagnoses.
Weaknesses
Putting patients in a box: While diagnosing is good, it may also not the best interest of the counselor to tell the client what they believe their diagnosis is. This may make the client feel as though their entire identity is rooted in that diagnosis and allow it to be a guiding factor for his/her entire life. A suggestion to this is to only disclose diagnoses if the client is comfortable with it or if they ask (as they have a right to now), but also allowing the client to discuss any feelings they have about their certain diagnosis. This allows them to understand their diagnosis, but also not to attach their entire existence to this diagnosis.
Putting counselors in a box: Diagnosing could lead the therapist to only view the clients’ behaviors and thoughts as a byproduct of their diagnosis. This could guide the therapist to only seeing certain modalities as being the best ones for that treatment, even though there may be other therapies that are best. A good way to bypass this would be to make sure that the therapist is competent in other areas of therapy, and always see the patient as a patient and not a diagnosis.
Immediately turning towards medicine: While medication may be a good route for some individuals, it may not be best for all of them. Diagnosing may lead instantly to wanting to medicate because it is the easiest route; however, EST’s exist for a reason. This may be an easy cop-out for therapists is they are overworked or disinterested in the client, and referring to a psychiatrist for medication is their first step when they haven’t even began a therapeutic relationship. This can be fixed by the therapist staying in their self-care routine, understanding when they are burnt out, referring when they need to, and setting boundaries that are healthy for themselves and their clients. With this, burnout rates would be lower, and therefore the therapist wouldn’t automatically refer a patient to medicine given a certain diagnosis.
XXXXXDiscuss the three main parental discipline styles (Authoritative, Authoritarian, and Permissive) described by Diana Baumrind. What factors affect which parenting style is seen in a family, and what are the possible consequences of each style on the child and family?
Authoritative: setting clear rules and boundaries but working with the child to understand those boundaries and solve problems; there is an open communication between parent and child, but actions do have consequences/punishments.
- Child consequence: friendly, energetic, cheerful, self-controlled, cooperative, kind and respectful.
- Family consequences: family comes up with problem-solving solutions together, more open communication between all parties, children respect their parents. Children look at parent as a boss (someone who is trying to help them become their best selves).
Authoritarian: parent-driven, strict rules and punishments with one-way communication of the parent to child; little consideration of child’s emotion/social needs.
- Child consequences: well-behaved, adheres to rules and instructions, more aggressive but shy, unable to make own decisions, poor self-esteem, possible rebellion as they get older.
- Family consequences: little involvement from parents, no open communication between family members, living in fear of strict rules, fear of punishment if something is not done correctly. Children look at parent as dictator rather than parent.
Permissive: child-driven, rarely any punishment or consequences for actions; no rules enforced and overindulges when conflict arises between parent/child.
- Child consequences: impulsive, rebellious, domineering, aggressive, low self-control or reliance on self.
- Family consequences: constant conflict in the family, looking at parents as more of friend than parent.
Factors: Parenting characteristics (mental health, temperament, personality), children characteristics (temperament, age, gender, behavior), and social/environment factors (SES, culture, nationality, school/work environment, other parent peers).
Discuss similarities and differences between Freud’s, Erikson’s and Piaget’s developmental theories.
Freud: personality is developed through pleasure-seeking behaviors, and those pleasure-seeking behaviors are different at each stage. Children either succeed past each stage or they become fixated at a stage, which leads to issues in personality. There are five different stages in Freud’s developmental theory, beginning with oral, followed by anal, phallic, latent, and genital stage. Each stage has an “erogenous zone,” that is responsible for the pleasure related to the behavior.
Erikson: personality is developed through eight stages of psychosocial development, where at each stage a person experiences a “crisis” which could either impact personality in a good way or a bad way. The stages involve psychological need of the person (thoughts, emotions, cognition), and needs of society (social aspects of being a person). Succeeding in each stage can lead to strong values and beliefs of personality, but failing at a stage has a negative impact on values/beliefs. There are eight stages, including: Trust vs mistrust Autonomy vs shame Imitative vs guilt Industry vs inferiority Identity vs role confusion Intimacy vs isolation Generativity vs stagnation Ego integrity vs despair
Piaget: this theory has more to do with cognitive development and the development of human intelligence. Children gradually (through stages) acquire knowledge through experiencing their environment, putting it away in their repertoire for use. Schemas (how we perceive our world) are direct influences on knowledge, as well as adding new information to old knowledge, and adapting old knowledge to new experiences. There are four stages of acquiring knowledge, including, sensorimotor stage (learning world through movement), preoperational stage (words represent their world), concrete operational (logical thinking for concrete events), and formal operational stage (abstract thinking and reason).
Compose a consent to treatment form. What are the key components that are required and why is it important to provide this information?
Precipitant: this is the one thing that pushed them to be distressed. It can be sudden job loss, recent break up with a partner, moved to a new city, etc. This is usually an event that leads to list of symptoms or problems that occur from the precipitant, but also are factors of origins/mechanisms, etc.
Problems list: this is a list of symptoms or problems that have occurred/been occurring as a result of the precipitant. This could be lack of motivation to get out of bed, poor eating habits, more sleep, less working out that occurred due to a recent job loss.
Maintenance: These are things that aid in the persistence of the problems list, which are usually due to thoughts/beliefs about the self. This could be not applying for new jobs because of fear of being fired or fear that they are not good enough.
Origins/Past: this is what is deeper than the precipitant. This spans back to early life experiences and how it plays a part in the problems list today.
Strengths and client factors: strengths include assets that the client brings to the table, while client factors are neutral things that the client possesses that will impact the therapy. For example, someone’s strength could be their support system, while they client factor is that they are a Muslim woman.
Case Conceptualization: taking all of these into account, the counselor comes up with a diagnosis that fits criteria.
Treatment: Treatment includes all of these factors, and uses the case conceptualization to form a treatment plan.
Going through each of these factors of treatment consent is important for explaining why certain treatment modalities are being proposed. It also includes going over any adverse affects from treatment, and allows the client to affirm/correct any of the information that has been taken during intake.
Choose a topic of interest and outline the types of items you would want to include in an assessment device to ensure that your measure has content, concurrent, predictive, and construct validity. Be sure to define each of these types of validity. Discuss factors that may influence an individual’s performance on this test
I am doing a research study on how depressive symptoms interact with peer relationships in high school aged students. The students will have a diagnosed depressive disorder and will be ages 14-18. The assessment will look at peer relationships, ranging on a Likert scale (disagree, somewhat disagree, neutral, somewhat agree, agree) and asking questions about pro-social behavior with friends.
- Face validity: the assess appears to address peer relationships.
- Content validity’s purpose is to ensure adequate measurement of the construct. The construct is peer relationships, and to ensure construct validity the assessment will include questions based off quality time, positive interactions, lack of disagreement, strong support, and mutual respect/loyalty. These are all important qualities of friendship.
- Construct validity: compares measurements to other similar and opposing measures. I would compare this scale to the CAYCI peer relationship scale, which measures the extent to which students feel support from their peers.
- Predictive validity: correlates with future outcomes; predictive validity is measured using a correlation coefficient, which correlates the assessment with the targeted construct. Using a statistical program, one can determine the correlation coefficient of predictive validity and whether or not the assessment can predict if depression has an effect on peer-relationships in high school aged kids.
Factor that may influence a student’s performance include:
Lack of peers due to bullying
If they attend school at home or online due to depressive symptoms
If they are being treated for depression in an inpatient facility
If they have a specific type of depressive disorder (bipolar)
Eric Johnson, an 8-year-old, African American boy, is a client of yours who is experiencing significant behavior problems in school. You want to refer him to a school psychologist to assess his cognitive functioning because you are concerned that he may have a learning disability. Ms. Johnson is concerned because she has heard that “those tests” are biased against minority students. What can you tell her to facilitate her support of the testing?
I would start by validating Ms. Johnson’s skepticism, because historically cognitive testing for minorities have done more harm than good. In the recent years, the APA has come out with different testing manuals so that there is no discrimination in testing for minorities. The manuals appeal to ethics codes, and has replaced old testing models with an inclusive model called, “The Culturally Different Model.” It takes different cultures into account, and doesn’t treat different ones as deficits, but is inclusive in testing for all walks of life.
The Culturally Different model…
- Avoids testing bias: testing bias only perceives a “dominant” culture and using testing bias can produce results that have different meanings across cultures, and in turn limiting accurate results to only one culture.
- Equitable treatment for all: all students taking exams are giving equitable timing and accommodation’s (each student has a different testing process depending on their needs), so that they can to the best of their ability.
- Equality in outcomes of testing: each student, regardless of group membership, receives the same kind of incentives for performing well.
- Opportunity to learn: students must receive learning in the construct that is being measured, and must have the same opportunities of learning the construct as others, regardless of group membership.
The APA has made positive steps towards creating equal testing for all students and has taken cultural differences into consideration. Ms. Johnson’s skepticism is accurate- in the past, cognitive testing has not been equitable, and often has led minorities to being stereotyped further. Recent adjustments in ethical codes and cognitive testing, however, has made it more equitable for all.
