Essays

Question 1

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?

Answer 1

African Americans:
Kinship, social support
Single parent households - rely on relatives/friends (caregiver can be anyone)
Less likely to seek out help (high rate of termination)
have supportive community
suspicious/distrustful - “white” institution
Important to gain trust
Spirituality - supportive community
May be more problem focused than emotion focused

Asian Americans:
Collectivistic orientation
Authoritarian parenting, patriarchy
Value family over everything else - wellbeing of family over individual
Do not value emotionality or self-disclosure
May be quiet, reluctant to talk about feelings
Somatic distress over emotional (mind-body connection)
Under-utilize mental health services - may be dishonorable to ask for help
Acculturation - more acculturated, more likely to seek out help
Use problem-focused, time-limited approaches that incorporate cultural factors for the client

Hispanic
Poverty, unemployment, language barriers, legal documentation
Family is very important
Seek help from family before reaching out to providers
Children are to help in family too
Patriarchal
Gender roles - machismo (strong provider) and women as nurturing, self-sacrificing
Religion
Acculturation
Stigma associated with mental health

Implications:
Need counselors who are culturally sensitive and competent - open, non-defensive
Assess values and worldviews and how they see counseling
Need to assess identity development before working with client
Do not dismiss issues about discrimination/racism
Assess positive assets
Identify and incorporate client’s beliefs about etiology and tx
Discuss confidentiality and explain client’s role

Question 2

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?

Answer 2

Always consider stage in RCID model (determine if they should be in group with same race or opposite)
Resistance-Immersion may be best stage for group work
Trust is important in these cultures

African Americans
Most responsive to group therapy approach
Safety in numbers
Easy to disclose bc validation of experiences from others
Must consider ethnicity of whole group before placing
Hispanics
Natural orientation to community/group = well suited for group therapy
Take into consideration stigma about mental health
Language important - different dialects

Asian Americans
Emphasis on privacy and respect of family - not good for group work
Don’t share sensitive information

Question 3

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?

Answer 3

Classical conditioning - Pavlov - unconditioned stimulus, unconditioned response, conditioned stimulus, conditioned response
Operant conditioning - Skinner - positive/negative reinforcement/punishment

Mowrer’s 2-factor theory
Develop fear by classical conditioning - something happens, response is elicited and conditioned
Maintain fear - operant - avoiding the stimulus is negative reinforcement

Must stop the negative reinforcement - decrease the behavior associated with stimulus - possibly pair with another conditioned response
Extinction - exposure therapy, systematic desensitization

Question 4

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.

Answer 4

Cross-sectional - many different people at same point in time (can’t measure change)
Collect data about substance use disorder diagnosis and socioeconomic status in age groups (25, 35, 45, and 55)
Doesn’t take much time, doesn’t cost alot of money
Provides no info about change in developmental trends over time (shows cohort effects instead)

Longitudinal - data collected repeatedly over a period of time on one group - observe and analyze changes and trends (time consuming, expensive, attrition)
Collect data about substance use disorder diagnosis and socioeconomic status over time as their disorder gets better or worsens (in age group 35)
Large amounts of data collected
Can track developmental changes and trends over time
Takes lots of time (many years), requires lots of funding, attrition

Cross-sequential - mix - take data from multiple groups at one point, then again at later point in time to control for changes over time
Age changes in one cohort can be examined/compared to another
High attrition and expensive/time consuming
Collect the single data point about diagnosis of substance use disorder and SES in all age groups (A: 20, 25, 30) (B:25, 30, 35)(C:30, 35, 40), then collect it again in a year for 10 consecutive years.

Question 5

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.

Answer 5

Attachment: a close emotional bond between two people
Initial attachment of infant and caregivers are important for later attachment and social development

Bowlby:
Phase 1 - birth - 2 months - instinctively direct attention to any human
Phase 2 - 2-7 months - focus attachment mainly on primary caregiver - distinguish familiar
Phase 3 - 7-24 months - specific attachment and actively seeks primary caregiver
Final phase - 24 months + - become aware of others’ feelings and goals and using these to form own actions

Attachment theories:
Freud - oral satisfaction (who feeds them)
Harlow - comfort preferred over food (monkeys - cloth vs wire mother - all monkeys fled to cloth mother, even if fed by wire) - physical comfort (if caregiver is cold and unresponsive)
Erikson - trust from physical comfort and sensitive care
Bowlby - newborns elicit attachment behaviors

Baby’s temperament affects attachment process - if difficult, crying alot, caregiver may be less responsive

Sensitive, responsive, consistent based on safety and protection (survival)

Mary Ainsworth: strange situation to measure attachment (separation from caregiver, reunion with caregiver, and introduction to strangers)
secure attachment - distressed upon separation but warmly welcome the caregiver back through eye contact and hug-seeking.
Anxious-resistant attachment - frightened by separation and continues to display anxious behavior once the caregiver returns.
Avoidant attachment - reacts fairly calmly to a parent’s separation and does not embrace their return.
Disorganized attachment - odd or ambivalent behavior toward a caregiver upon return—approaching then turning away from or even hitting the caregiver

Outcomes later in life
Secure - parents as available for support and them being worthy of the support
executive functioning - positive emotional health, high self-esteem and confidence, and social competence, self-reliance - independence, perform better in school, successful relationships, less anxiety/depression
Adolescence - fewer behavioral problems (delinquency/drug abuse), romantic intimacy, peer relationships
Insecure - higher anxiety because knowledge of security wasn’t established (or reject), difficulty in peer relationships (correlational), personality disorders, conduct disorder, oppositional defiant disorder, Emotion regulation?

Question 6

Discuss the ethical and legal responsibilities of counselors with regard to both maintaining and breaking confidentiality.

Answer 6

Confidentiality - helps establish safety in room for client to open up
Not ethical to tell others about clients - breaks trust (sued or lose license)
Counselors have an ethical and legal responsibility with regard to both maintaining and breaking confidentiality.

By law and APA/ACA ethics codes - duty imposed on professionals to keep information disclosed in professional relationships in confidence, unless the patient gives consent for disclosure - embedded in ethics codes and state laws, and HIPPA Privacy Rule. Different levels of confidentiality based on different populations (children and couples therapy)

Break confidentiality -
Abuse is reported to vulnerable population (child, elder, handicap)
Report wanting to harm self or other specific person
Subpoenaed by court or judge

Priveleged communication - information can be withheld in legal proceedings to protect client’s confidential information

Tarasoff case - counselor must directly warn identified third party of threat

Counselor as legally mandated reporter - if client reveals abuse or if the counselor suspects abuse
DSS within 24 hours of abuse being made known to them
Only provide DSS with relevant case information - still as confidential as possible

Minors - both parents should get copy of records even if just one requests it - unless court order to not give it to a single parent

Group confidentiality - therapist request that information be kept confidential, but group not bound by law
Couples therapy - nothing is kept from each client

Question 7

Describe the purpose of professional documentation, emphasizing why documentation is so important. Discuss the ethical and legal issues associated with professional documentation.

Answer 7

Assist in therapeutic goals/client’s safety:
Continuity of care
Standard of care - services provided are best, and counselor is competent
Communicating with other professionals (other therapists, psychiatrists)
Objective! Client might read
Quality of care - preventative if things aren’t working well
Remembering certain things/behaviors/emotions - find patterns
Be sure counselor is safe:
Protect against lawsuits and complaints
Document consent and expectations
Rationale for tx or decisions - Document why you made certain decisions in counseling - tx plans
Document progress
Helps to know if tx could be replicated - if something worked, you want to know how
Peer-consultation

Ethics:
Create, safeguard, and maintain records
Succinct, timely documentation to facilitate delivery/continuity of services
Client progress and services
Must amend notes according to policies
Keep documents even after services are terminated
Legal:
HIPAA - protect sensitive information from being disclosed without patient’s consent

SOAP or DAP
Subjective, Objective, Assessment, Plan
Data, Assessment, Plan

Question 8

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.

Answer 8

Neurotransmitters - chemicals in the brain that send messages
Electrical signal flows down the axon of a neuron - signals neuron to release neurotransmitters
Released into synapse (where axon of one neuron meets dendrite of another neuron)
Neurotransmitters bind to receptors on receiving neuron
Signal to either fire or cease firing
Abnormality in this process = pathology
Level of neurotransmitters - Too much or not enough of neurotransmitter
blocking agents in receptors or not enough/too many receptors
neuron sensitivity or number of receptor sites on receiving neuron
More sensitive neurons = more receptor sites = more likely to fire
Neurotransmitters may be spending too much time or not enough time in synapse

Serotonin - regulates norepinephrine and dopamine
Norepinephrine (arousal/attention/fight-flight)
Dopamine (pleasure)
GABA (calming effect)

Depression - low levels of serotonin (norepinephrine and dopamine)
MAO inhibitors - slow down MAO break down of norepinephrine, serotonin and dopamine
Schizophrenia - high levels of dopamine in limbic area(positive symptoms) and low levels in cortical areas (negative symptoms)
Anxiety - low levels of GABA (not effect to produce calming effects)

Tricyclics and SSRI - work with blocking the reuptake process
Some people’s neurotransmitters don’t spend enough time in synapse (reuptake happens too soon and doesnt get a chance to stimulate receiving neuron)

Question 9

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.

Answer 9

Weakness:
categorical (putting people into strict categories, no overlap) - doesn’t reflect dimensions of various diagnoses
Oversimplification of vastness of human behavior (lose sight of individual)
labels/diagnosing can create preconceptions/stigma - misdiagnosing
Not multicultural (individualistic vs collectivist)

Strengths:
categorical - helps with insurance, helpful for discussions between practitioners, tx
Heuristic value = helpful for research and treatment
Provide “belonging” and normalizing of conditions - comfort for those diagnosed, able to find peers

Move towards more dimensional model
Expand research to more culturally diverse populations - include culturally bound disorders

Question 10

Discuss 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?

Answer 10

1960s - Diane Baumrind - “neglectful” added in 1980s
Authoritarian - restrictive, punitive, firm limits/control
Must obey parents
Little affection, more anger/rage
Militaristic
Children are fearful, unhappy, anxious, lack communication skills (no modeling)

Authoritative - limits but also encourage independence
Give and take between parents and child with parent still being ultimate authority
Punishment explained calmly
Warm, nurturing parents but firm in discipline
Children are happier, better self-control and self-reliance, cope better with stress

Permissive parents (neglectful or indulgent)
Indulgent - show affection but no rules/controls - free to do what they want
Children can’t control behaviors, poor emotional control, giving up easily, drug use

Neglectful - do not discipline or show affection - uninvolved (do not care)
Children are socially incompetent, immature, low self-esteem

Ethnicity and culture
Studies show authoritative parenting is best across cultures
Asian Americans - authoritarian but seen as caring and concern for child
Hispanic Americans - same - demanding respect but seen as positive and not punitive

Question 11

Discuss similarities and differences between Freud’s, Erikson’s and Piaget’s developmental theories.

Answer 11

Freud - early life experience impt fFreud - early life experience impt for later development (personality formed by young age)
Primary drive is sexual - personality determined by how we resolved conflicts in stages (fixation)
Psychosexual stages marked by erogenous zones
Oral stage (0-1) - mouth - id is dominant (immediate gratification)
Anal (1-3) - anus - ego developing and taking over id
Phallic (3-6) - genitals - superego develops - identify with same sex parent
Latency (6-puberty)
Genital stage (puberty - 18) - adolescence

Erikson - also psychoanalytic
Primary goal is social
Psychosocial stages - spanned entire life of individual - each stage has developmental task and crisis to be resolved
Stage 1 infancy (0-1): Trust Versus Mistrust.
Trust that basic needs will be met
Stage 2 (early childhood 1-3): Autonomy Versus Shame and Doubt.
independence
Stage 3 (play age 3-6): Initiative Versus Guilt.
Taking initiative
Stage 4 (school age 7-11): Industry Versus Inferiority.
Self-confidence or not
Stage 5 (adolescence 12-18): Identity Versus Role Confusion.
Experiment with identity
Stage 6 Early adulthood 19-29): Intimacy Versus Isolation.
relationships
Stage 7 (middle age 20-64): Generativity Versus Stagnation.
Contribute to society/family
Stage 8 (old age 65+): Integrity vs despair
Make sense of life and contributions

Piaget’s - cognitive development - construct understanding of the world
Schemas - mental representations of things in our environment
Adapt and adjust schemas with new experiences
Sensorimotor. Birth through ages 18-24 months.
Understand world through sensory experiences
Preoperational. Toddlerhood (18-24 months) through early childhood (age 7)
Represent world symbolically in words, images (beyond physical)
Concrete operational. Ages 7 to 11.
Reason logically about concrete events
Formal operational. Adolescence through adulthood.
Reason abstractly

Similarities:
Stage theories (discontinuity theory) - shaped by biology (not environment)
Freud and Erikson - both psychodynamic - unconscious drives, emotional development
Freud and Piaget - through childhood

Differences:
Piaget is not psychodynamic - cognitive development (aware of drives)
Erikson - all through life
Freud (sexual) vs Erikson (social)

Question 12

Compose a consent to treatment form. What are the key components that are required and why is it important to provide this information?

Answer 12

Legally informed to make the choice to engage in therapy (consent vs assent)
Legal protection for therapist

*Psychological services
What is therapy (and what it isn’t)
Active participation
Risks - unpleasant feelings
Positive side of therapy but no guarantees
*Confidentiality
Limits to confidentiality
Abuse of vulnerable population
Harm to self or specific other
Subpoenaed by court or judge
Record keeping procedures and privacy
Right to access records
*Treatment
Evaluation period
Diagnosis and where to find information
Right to ask questions about treatment/responsibilities of clinician
Orientation from which clinician practices
Typical length of tx and termination
Client’s right to refuse tx
*Relationship
Therapeutic only
*Contact information
When and how
Who to contact if out of town or emergency
*Client responsibilities
Missing a session or not canceling
Typical fees (session, phone calls, emailing)
How to pay
Overdue bills, insurance, bartering - payments
*Consent and agreement to treatment

Question 13

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

Answer 13

Assessment of bipolar 1
Content validity - making sure the assessment measures what it says it will measure (non-statistical) - carefully include items like “Have you been experiencing any sadness?” or “Have you had times where you didn’t need much sleep?” - these questions are asking about the symptoms of Bipolar 1 - be sure questions covered all aspects of symptoms
Concurrent - extent to which the test correlates with other measures of the same construct - I would be sure to compare my assessment to another assessment like the Mood Disorder Questionnaire
Predictive - ability of the assessment to predict future outcomes - my assessment would have high predictive validity if test takers that scored high later showed signs of depression.
Construct - degree to which a test measures what it claims to be measuring-concept - convergent (correlates with other similar tests) and divergent (does not correlate with tests that are different)
Make sure my test had convergent validity with tests that measure Bipolar 1 (Structured Clinical Interview for DSM-V
Factors that can influence performance on the test can include the environment that the test was administered in, how that individual is feeling that day (i.e., upset, sick, happy, etc.), do they want to be there taking the test?, and test bias, tester bias, scoring error

Question 14

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?

Answer 14

Educate her about the test - it will be used as a tool to help guide decisions and inform us of areas that could use attention to maximize Eric’s potential for cognitive functioning
It will not be used to label or stigmatize him.
Test will be interpreted by individual trained in human behavior and development - professional
The way the test is made is using individual who represent that population it will be used with. (normed)
Tests are much more culturally and racially sensitive now - broader assessment
2003 version of the Stanford-Binet test was standardized to 4800 people based on the 2001 census - included additional 3000 people with ADHD, giftedness and speech/hearing impairment
Tests now minimize test bias and use language and content that is applicable and understand across cultures and populations
Move from measuring achievement (crystalized knowledge that is acquired) to measuring aptitude or fluid knowledge (capacity for reasoning, thinking and acquiring new knowledge)
Differential Functioning analysis is used - applied to new versions of intelligence tests before they are administered - analyzes performance across various groups on the test and items that differ significantly are omitted.

Question 15

Compare and contrast 1st, 2nd, and 3rd generation behavior therapies. Provide examples of therapies from each generation.

Answer 15

First generation
Developed in 50s/60s as reaction to psychodynamic
Treated client’s overt problem behaviors (based on conditioning)
Emphasized changing external conditions influencing and maintaining the over problem behavior
Stimulus control (prompting, setting events)
contingency management (token economy, reinforcement/punishment)
Exposure therapies (brief/graduated, prolonged, intense)
Modeling therapies (skills training, vicarious extinction)
Wolpe, Eynseck, Skinner
Second generation
Mid-60s
Considered cognitive factors important determinants of problem behavior
CBT modify client’s dysfunctional thoughts and beliefs using specific cognitive change procedures as well as first-gen behavioral techniques
Cognitive restructuring (thought stopping, REBT, and CT)
Coping skills (self-instructional training, problem-solving therapy, stress inoculation training, and CBT couple therapy)
Ellis, Beck
Primary goal of first 2 generations was to eliminate and reduce problems
Third generation
90s
Goal is for client to actively accept various forms of psychological discomfort and pain as inevitable parts of their lives rather than viewing them as obstacles to fulfilling their life goals
Accept the pain while doing the things that are important to you
Change strategies are achieved through integration of first and second gen strategies
Acceptance and Commitment (ACT - Steven Hayes) and Dialectical Behavioral Therapy (DBT Marsha Linehan)

Question 16

Despite the fact that using diagnostic labels for psychological disorders is extremely common, discuss three ethical factors one ought to consider in the use of diagnostic labels.

Answer 16

Can help client receive the best, comprehensive care - treatment specific to disorder

*Diagnostic errors - may put individuals in the wrong categories
Fail to take sociocultural context into account
Symptoms and behaviors can be accentuated or ignored to fit into a category
*Confirmation bias - tendency to search for, interpret, favor and recall information in a way that confirms or supports one’s prior beliefs or values
tendency to see evidence of their mental illness in all of their actions
Alleviate responsibility for behavior bc of diagnosis (self-efficacy)
*Labeled for lifetime
Difficult to shed the label of being mentally ill
*Pathologizes the problem of living
Everyone can be sad, anxious, struggle with motivation - doesn’t mean there is a diagnosis
*Stigmatization - “mentally ill”
Consequences for how others perceive and respond to you
Dangerous, unpredictable, beyond hope
Can impact all aspects of life

Question 17

Using research to support your answers, describe whether mental disorders may or may not be a risk factor for violence. Then, discuss the challenges in predicting who will commit violent acts.

Answer 17

Research points out there is a relatively small number of people with a serious mental illness who have committed or have the potential to commit violence towards others
3-5% of violent acts occurring in the community are attributable to mental illness (very small group)
when neighborhoods are unsafe, poor, and high in crime, violence is an equally likely outcome whether a person has a mental illness or not.
Those who DO have the propensity towards violence are seen in psychiatric inpatient or forensic settings, only occasionally in private practice
When violence does occur, it is usually in combination with other issues
Substance use
Adverse childhood experiences
Environmental factors (unemployed, high-crime neighborhood)
2.9% of people with serious mental illness had committed violent acts between 2 and 4 years following the study’s baseline, compared with 0.8% of people with no serious mental illness or substance use disorder. However, 10% of people with both serious mental illness and substance use disorder committed such acts during that time (Social Psychiatry and Psychiatric Epidemiology, Vol. 47, No. 3, 2012).
Symptoms associated with violence are hallucinations (telling the client to harm others) and psychopathy (lack of empathy, poor impulse control, and antisocial deviance) - shown in a study of psychiatric inpatients at 20 weeks after discharge
Research has disproved the fact that mass violence is largely committed by people with mental illness
Research can be on both sides though - depending on definition of violence and symptoms that are being studied
Positive schizophrenic symptoms associated with violence, but now negative symptoms
There is a link between severe mental illness and violence, but most people with severe mental illnesses are not violent
Diagnosis alone can not tell us if someone is going to be violent

Question 18

Distinguish between the components of personality and the components of personality disorder. Additionally, why is psychotherapy so often ineffective in treating personality disorders?

Answer 18

Personality - enduring pattern of behavior, cognitions and emotions (overt and covert expressions of inner experience) that begins to develop in childhood
Influenced by environmental experiences (culture, social, heredity, experiences, relationships) and is stable over time
Traits that people have
BIG 5 model - provide understanding for complexity of human behavior (OCEAN)
Agreeableness tends to be worst predictor for mental illness, and neuroticism is best predictor for mental illness
Helps to determine behavior
Personality Disorders - enduring pattern of inner experience and behavior that is pervasive and inflexible, deviates from cultural norms, causes distress and impairment, and is stable over time
Clinically significant maladaptive personality traits (impaired functioning)
Can’t be diagnosed until 18 years old, unless symptoms for more than 1 year
No cure, but effective treatments
“Change resistant” - difficulty making changes even for their benefit
Seen as “just who they are” - not problematic
Tx can be extensive and difficult to adhere to
3rd wave treatment can be beneficial
Often more troubling to others
Pattern of behavior manifested in
Cognitions (thoughts/perceptions/interpretations of self, others, events)
Affect (intensity of emotional response, range of emotions, lability of emotion, appropriateness of emotion)
Interpersonal relationships
Impulse control

Cluster A - odd, eccentric
Schizotypal, schizoid, paranoid
Cluster B - dramatic, emotional, erratic
Narcissistic, histrionic, borderline, antisocial
Cluster C - anxious, fearful
Avoidant, OC, dependent

Question 19

What are the developmental functions of peer groups in children and adolescents?

Answer 19

In childhood - provide source of information and comparison about the world outside of their family
Feedback from same age peers
Evaluate their own abilities
Socioemotional development
Teach what is socially acceptable
Middle/late childhood - important!
Size of group increases, less adult supervision
Conflict resolution
Self-esteem, individuality
Adolescents
Intimacy increases - close friendships
Depend on friends more than parents for companionship
Supportive friendships, goal oriented
Social skills, problem solving, empathy

Question 20

Define the 4 D’s associated with abnormal behavior and their relationship to the DSM and diagnosis. Provide a clinical example of abnormal behavior consistent with each.

Answer 20

Distress, Deviance, Dysfunction, Dangerous

Distress interferes with daily life (anxiety, pain, sorrow)
Unpleasant and upsetting
Internal (distressing individual) or external (distressing friends/family)
Anxiety disorders (GAD, phobias, panic disorder, OCD)
Distressing to individual and external
Agoraphobia - distressing and fear of leaving home
Deviance - atypical, not culturally acceptable - not normal
OCD - not normal to wash hand 10 times
Schizophrenia - positive symptoms
Must be looked at culturally!
Dysfunction - disruption or disturbance in social, cognitive, behavioral and emotional patterns
All DSM disorders - needed to meet criteria
Major depressive disorder - not able to socialize, disturbance in emotions
Dangerous - harm to others and self
Conduct disorder - harm to others
Substance use

Question 21

Distinguish between the sympathetic and the parasympathetic divisions of the autonomic nervous system. For each division, provide an example of a situation in which the division would become active. Describe the effects on several bodily processes of the activity of each division.

Answer 21

Sympathetic - fight or flight (HPA axis)
Prepares body to react to stresses such as a threat or injury
Muscles contract, heart rate increases, bronchial tubes dilate, pupils dilate, saliva production reduces, digestion slows
Activated by anxiety disorders
Example: An individual is walking home from class late at night and sees someone walking behind her. She is nervous that this person is a threat. Her sympathetic nervous system kicks in and prepares her body for fight or flight
Parasympathetic - rest and digest
Functions of body at rest - muscle relaxation, resting heart rate
Body is in state of calm and able to rest and repair
Saliva production increases, digestive enzymes released, resting heart rate, bronchial tubes constrict, muscles relax, pupils constrict
Example: The individual reaches her home and realizes the person was not a threat- her parasympathetic system sets in and she is able to relax from the heightened state.

Question 22

Normal prenatal development occurs in 95% to 98% of all pregnancies. Identify two genetic or chromosomal abnormalities and two teratogens associated with birth defects in the remaining 2-5% of pregnancies. Describe the nature of their effects on development.

Answer 22

Genetic make up determined at conception
Trisomy 21 (Down syndrome) and Trisomy 13 (Patau syndrome) and cleft palate/lip
Down syndrome is most common chromosomal abnormality (1 in 800 babies, increasing as mother ages)
Moderate/severe intellectual disability and variety of health problems (heart defects, leukemia, alzheimers) - average life expectancy of 56
Patau - die soon after birth - neurological problems, mental/motor deficiencies, polydactyly, eye/heart/spine defects
Teratogens are substances that may produce physical or functional defects in human embryo or fetus after pregnant woman is exposed to the substance - four types (physical agents, metabolic conditions, infections and drugs/chemicals)
Metabolic - malnutrition, diabetes (heart development), thyroid disorder
Psychiatric medications - first trimester can cause malformations in fetal organs and skeletal structure.
Alcohol can cause fetal alcohol syndrome - minor facial abnormalities, damage to brain - learning, cognitive and behavioral abnormalities

Question 23

23. What are the strengths and weaknesses of punishment? How does this particularly relate to the use of punishment as a primary means of changing behavior?

Answer 23

Advantages:
Immediate influence provides strong reinforcement for the controller
Immediate influence reinforces use of aversive control in future despite negative long term disadvantages
Ex. spanking
Disadvantages:
Necessity of continuing punishment
Being in situation where previously punished behavior could be engaged in without being punished may excuse a child to do so (not with the parent/controller).
Punishment often induces respondent emotional states: aggression, fearfulness
Impact relationship with child/parent - negative association
Use of escape or avoidance bx by recipient
Modeled to others who may use or misuse it
It can justify inflicting pain on others.
Punishment elicits aggression toward the punishing agent & others.
Effect of punishment is only to temporarily suppress the behavior and does not establish new desirable behavior
It indicates what the organism should not do, not what it should do.
Punishment often replaces one undesirable response with another undesirable response.
e.g. lies become more sophisticated
Punishment can be reinforcing to the punisher - immediate response.
When should punishment be used?
In general, when wanting to permanently change a bx best to first use reinforcement (increase good behavior) or extinction strategies (ignoring when child doesn’t raise hand)
Supplement with punishment strategies
Physical punishment should never be used
Examples of alternatives to punishment
Circumstances causing the undesirable behavior can be changed.
Undesirable response can be satiated by letting the organism perform the undesired response until it is sick of it.
Simply let time pass (esp if the undesirable behavior is a fx of the child’s developmental).
Reinforce behaviors that are incompatible with the undesired behavior.
Ignore it. (extinction)

Question 24

M. is a second-year student in a graduate program in South Carolina. Her program emphasizes the development of cultural competencies as described by the Association of Multicultural Counseling and Development (AMCD). Based on this information, (1) list and define the three cultural competencies that should be addressed within this program, (2) identify strategies that will be useful for promoting the development of each of these three competencies, and (3) what are the implications if M. is not able to attain competency in these three areas by the time they are finished with the program?

Answer 24

awareness, knowledge, and skills. -
Awareness includes knowing one’s own culture, views, biases, and comfort levels of various backgrounds. Awareness can be developed via awareness activities which change the person’s attitudes, opinions and personal perspective (i.e. journal in multicultural class, immersion) - Knowledge refers to the therapist’s knowledge of the cultural group both currently and historically, their worldview, and any barriers that group may have faced. Can be developed by learning facts and seeking accurate data (i.e. research, reading books). - Skills refer to implementing culturally appropriate interventions and receiving and sending information in ways that take into account cultural background. Skill-building activities involve the application of awareness and knowledge in applied settings with diverse clients (i.e. seeking supervision on new skills)

Strategies for awareness: immersion in culture
Strategies for knowledge: accurate information (books, lectures, self-study
Strategies for skills: practice skills and get supervision

Limit what clients would develop therapeutic alliance with her (drop out)
Harmful effects on the client if not multiculturally competent
Unsuccessful treatment outcomes

Question 25

R. is a professional in your field who espouses a strong individualistic perspective. What kind of difficulties are they likely to face when dealing with clients with a different cultural outlook? What can they do to enhance their effectiveness with a broader range of clients?

Answer 25

Individualistic - not group oriented, about personal goals, values, strengths
Versus collectivist cultures - family oriented, not individual oriented - meet the needs of the group (Eastern cultures and also Native Americans)
May push clients to go against their cultural values if from a different culture
Be more multiculturally competent - see the client for their worldview/values and help define goals/treatment that will work for them and their culture

Question 26

Pick two of the stages/statuses identified in the R/CID (formerly MID) and describe the characteristics of someone who is at that level of racial identity development. What are the implications of these two identity statuses for this individual working with (1) a professional of their own race and (2) a professional who is White.

Answer 26

Conformity - minority that has conformed to dominant culture - don’t see race as a problem - trying to blend in with dominant culture (straightening hair) - may be hidden feelings but don’t see an issue with race
Dissonance - encounter happens - confusion, guilt, anger - event happens that might spark their interest - like black lives matter - “maybe it hasn’t happened to me but people like me are dying”
Resistance-immersion - resistance of dominant culture - withdraw/total disengagement from dominant culture and immersed in their group/pride - client with white therapist may no show, may be quiet, may not want to see you anymore - intense emotion
Introspection - pride for culture, looking inward - calmer feelings, heavily identify with culture but not eliminating dominant influences - peaceful, can appreciate dominant group and own
Integrative awareness - commit to social change, advocate, start speaking up

Conformity - preference for dominant culture (white) - lifestyle, values, characteristics highly valued - victims of ethnocentric monoculturalism - low internal self-esteem (“I’m not like them”)
Will prefer a white counselor - task oriented (won’t want to talk about race) - therapist should help client by modeling positive attitudes toward cultural diversity and help client work through need to over identify

Resistance- after dissonance/event and now resisting dominant nature (not confused, and angry) - will withdraw from dominant culture - may no show for white therapist, not want to build therapeutic relationship - may over-identify with therapist of own race - important for therapist to model positive attitudes towards both groups and help client work through intense emotions

Question 27

Describe ways in which religion and psychology are compatible and then discuss the view that psychology and religion are disconnected. In what ways is religiosity positively correlated with mental health? In what situations might religiosity be associated with poor mental health?

Answer 27

Most research supports positive associations between religiosity and spirituality and aspects of mental health, while a small proportion report mixed or fully negative associations.
Higher life satisfaction and meaning
Lower anxiety and depression, suicidal tendencies, substance use
Attachment - perceived relationship with god
Negative - fatalism (belief in fate/luck), prayer (not taking responsibility)
Careful with mindfulness - could see this as going against their religion (more eastern beliefs)
Behavioral activation - religious activities, reading bible, talking to clergy
Consultation with clergy
Psychology and religion are disconnected - taking responsibility, praying for change sometimes wont bring it, rationalizing behavior
Religion and poor mental health - if lgbtq+ and religion doesn’t accept that, not a multicultural way of viewing the world

Question 28

The Jones family is referred for treatment because their 9-year-old daughter has been acting out at school. During the intake, you learn that Mr. Jones, who has been the primary breadwinner, has been unemployed for the past 8 months. Ms. Jones works out of the home, but her income just barely covers rent, food, and gas. What are the effects of unemployment that you are likely to see in this family?

Answer 28

Stress about money = increased arguments and tension at home
Possible depression of father for lack of self worth/providing/weakness
Safety - may have had to move to unsafe neighborhood
Hunger - not doing well in school
Friend groups - may not be able to go out with friends or buy things
Intersectionality - effects compounded

Question 29

You are counseling/assessing Darrell, a 13-year-old boy who is depressed and falling behind at school. You learn that he is struggling with issues related to his sexual orientation. He recognizes that he has sexual feelings towards other men and is confused and anxious about this. You are the first person to whom he has mentioned this. Describe the process of coming out and how you might best help him navigate this process.

Answer 29

If he has internalized homophobia - may be better with a female therapist than a male therapist
Describe the process of coming out
1) Confusion-People in this stage of the coming out process start to notice their attraction to same-sex people and really question what it means. I don’t want to be gay
2) Comparison- a person may try to find an explanation for why they are having the feelings they are experiencing. I don’t act like other gay people
3) Tolerance- starting to accept being gay but not fully-begin to accept identifying as gay, lesbian or transgendered or bisexual. Some might come to terms with some parts of being a gay, but not fully embrace it.
4)Acceptance- begun to accept, rather than just tolerate their sexual identity
5) Pride- stage feel a sense of pride in their sexual orientation, and feel comfortable interacting in gay communities.
6) Synthesis- person’s sexual orientation is integrated into their whole identity. Sexual identity no longer defines them, they are a complete human with many other facets to their personality/identity.
Logical consequences - weigh the pros and cons

How you might best help him navigate this process.
1) Decision carefully considered:
whom they are going to come out to
possible effects and consequences self and recipient of information (both long and short term)
2) If decides to take step to come out:
Preparation on how it will be accomplished
Role play what to say
Discuss possible reactions: making sure there is a strong social support in place in case rejection occurs
3) Make sure he understands the emotions and other effects he will experience if there is a negative response such as
Self-esteem
Life satisfaction
Happiness
*** Explain internal (shame) and external heterosexism and that it is societal prejudice that is the problem, not him.
4) Let him know that this is a safe environment for him
-that his sexual orientation is not a psychological problem
Resources in the community