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GENED 1179 > Full Yeat > Flashcards

Full Yeat Flashcards

1
Q

How to define psychotherapy?

A

By task or goal:
- to help patients cope with trauma
- to enable them to reach their best self
- to equip them with skills to better deal with life’s challenges
- to teach them ways to regulate emotional ups and downs

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2
Q

How to define psychotherapy cont’d?

A

By setting or technology – modes of action

  • two people in a quiet room, free of distractions
  • boundaries: times regular; comfortable chair or couch
  • say anything do nothing
  • talk vs. pen-and-paper homework
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3
Q

Research perspective in psychotherapy

A
  • interpersonal (not-self help)
  • based on psychological principles (not medical)
  • therapist is trained, patient has a problem, mental disorder
  • remedial for disorder, problem
  • individualized for same
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4
Q

How has the case been made for psychotherapy’s scientific status

A
  • gap between clinical practice and research
  • psychiatry–ambivalent relationship to psychotherapy
  • clinical psychology – evidence based treatment/therapies
  • therapeutic practice – highly individualized, taught by means of apprenticeship model
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5
Q

Each system of therapy is structured around

A

model of mind/modal patient

theory of psychopathology – what causes someone’s distress

distinctive technology – talk and therapist’s self vs. worksheets/homework

theory of therapeutic action – what alleviates suffering?

ideal/expected outcome – what does successful treatment look like?

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6
Q

The pyschodynamic mind

A

dynamic - interaction and conflict between parts of mind

neither entirely rational or knowable

internally divided (id, ego, superego); (conscious and unconscious)

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7
Q

Theory of psychopathology for psychodyamic

A

Illness - when we cannot reconcile unconscious desires (id, unconscious) with conscience, sense of who we are (superego, ego)

sex and aggression - sources of conflict with society

Desire is dangerous; society demands repression of sexuality; individual - seeks sexual pleasure

aggression must be checked – we can’t get what we want

constant battle between parts of mind

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8
Q

Theory of therapeutic action for psychodynamic

A

talk, relationship-transference

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9
Q

The cognitive behavioral mind

A

We understand reality with “schemas” (cognitive frameworks that help us organize and interpret information)

Focus on mental representation of the world and “reality”
- usefully allows us to process vast amounts of information quickly
- at the same time allows us not to see what doesn’t fit in the schema

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10
Q

CBT Therapeutic action

A

Focus on the present not the past

Identify distorted thinking

Distinguish thoughts from reality

Understand the effect cognition has on feelings

Change inaccurate beliefs

Restructure patterns of thought, schemas

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11
Q

Cognitive errors

A

distortions/irrational beliefs

examples: Overgeneralizing, Selective Abstraction, excessive responsibility, self-references, dichotomous thinking

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12
Q

The cognitive therapist’s approach

A

Initial thought about a situation

What is the negative thinking behind initial thought

What is the source of the negative belief

Challenge your thinking

Consider the consequences of continuing to think this way

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13
Q

Magic

A

recast as the therapeutic alliance

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14
Q

Lumpers

A

common factors – commonalities more important in accounting for outcomes than differences

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15
Q

Splitters

A

dominant in research literature

Allegiance effect: allegiance of researchers strongly influences therapy outcome
- Studies by advocates of treatment usually favor that treatment
- allegiance effect: much stronger than differences among treatment

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16
Q

Common factors

A

common factors: patient engagement, affective experiencing, and the therapeutic alliance

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17
Q

Magic of words

A

Freud (1905): “Words are the essential tool of mental treatment”

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18
Q

Transference

A
  • Makes the relationship legible to science

Freud: patterns laid down in childhood produce “what might be described as a stereotype plate (or several such, which is constantly repeated in the course of a person’s life”

responding to another person as if they were someone from your past

3 people involved

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19
Q

Therapeutic Alliance

A
  • makes the relationship legible to science

refers to the direct human relationship between the therapist and the patient

used to refer to the part of the patient that wants to work with the therapist

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20
Q

Repetition and Enactment

A

When something we do not want to know or understand about ourselves plays out over and over in our lives

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21
Q

Projection

A

Being unaware of unwanted/unacceptable feelings in yourself and mistakenly seeing them in other people instead

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22
Q

Behaviorism

A

all behaviors learned through interaction with environment

psychology is a branch of experimental natural science

focus should be on observable behaviors, not internal states – can’t see thus can’t measure

all behaviors conforms to the model of stimulus-response

Behavior-therapy basics

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23
Q

Aaron Beck

A

CBT creator

“Man has the key to solving and understanding his psychological disturbance”

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24
Q

CBT

A

CBT envisioned as radical alternative to dynamic therapies and revision of behaviorism

developed in the 1950s
- hopeful–supplant psychoanalysis and dynamic therapies
- commitment to methodological rigor

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25
Q

Beck’s basic principles of CBT

A
  1. mental disorders are thinking disorders
  2. thoughts influence mood
  3. if patients can be taught to restructure thoughts, mood will improve
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26
Q

Beck’s model of depression

A

depressed patients experience streams of negative thoughts–called them automatic thoughts

3 categories: negative thoughts about themselves, the world, and the future

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27
Q

Dialectical perspective

A

“Contradictory truths do not cancel each other but stand side by side”

Linehan: dialectical perspective
How to understand the meaning of the patient’s behavior in the present
Individuals both accept themselves as they are AND accept that they need to change (acceptance and validation)

developed for people with BPD

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28
Q

BPD (borderline personality disorder )

A
  • emotional hyper-reactivity and resultant dysregulation
  • intolerance of aloneness
  • chaotic interpersonal relationships
29
Q

Why does attachment matter?

A

Independence is predicated on attachment

Ainsworth studies show that babies can have a close attachment to mother (secure base) that allows them to explore b/c they know that their mother will be there to soothe them

30
Q

What is group therapy?

A

Key assumptions:
- people act differently in groups vs. individual
- groups are greater than the sum of their parts
- groups have structure

31
Q

Basic characteristics of group therapy

A
  • one or two leaders, 6 - 12 members
  • meets 1/2 times a week
  • open or closed
  • usually strangers, screened by group leaders
  • outpatient or inpatient
32
Q

Why group over individual therapy?

A
  • cost effective
  • support from others with similar problems
  • focus is one the here-and-now – people’s patterns become evident in group process (Yalom calls this phenomenon “the group as social microcosm”)
33
Q

Where does group therapy have its origins?

A

Encounter groups at Esalen Institute and California Dreaming

34
Q

Freud and the group

A

Hypothesis: crowds held together by power of some kind (eros)

Individuals in groups animated by love of the other – individual gives up self for group

35
Q

Wilfred Bion (psychoanalyst) on groups

A

Groups form around external reality task.

Developed perspective in work w/ mlitary/veterans in military psychiatric hospital

Psychiatrist in such situation must act as commanding officer – how to sustain authority and have close emotional relationship with men

36
Q

What happens in a group?

A
  • people come together as a group for the purpose of preserving the group
  • fear over disintegration of the group
37
Q

B.W. Tuchman model of group forming

A

Forming: stage of information exploration and exchange in which individuals’ identities are revealed

Storming is the stage of conflict in which desired roles, positions and status are declared, and competition occurs over conflicting demands

Norming is the stage negotiation and resolution, during which time stable solutions to conflicting demands are achieved

Performing is the “steady state” of the group in which, having done the initially necessary social-emotional work, attention can be focused on task performance with only social-emotional maintenance being acquired

38
Q

Yalom’s perspective on group therapy

A

perfect setting for interpersonal issues “the group forms a social microcosm”

To what do patients attribute the success of group work?
Yalom: “Discovering and accepting previously unknown/unacceptable parts of myself”
“Being able to say what was bothering me instead of holding it in”
“Other members honestly telling me what they think of me”

39
Q

Yalom: some factors influencing change in group therapy

A
  • instillation of hope
  • universality - not alone
  • imparting information–educate
  • altruism–able to help others
  • corrective recapitulation of primary family group
  • development of socializing techniques
40
Q

Content vs. process

A

content is what they say, process is how they say it

41
Q

Managers vs. leaders

A

managers (competence, control) (stability, order)

leaders (inspiration, vision) (tolerance of chaos)

Attitudes toward goals: managers take an impersonal, passive outlook; goals arise out of necessities, not desires. Leaders take a personal, active outlook; and shape rather than respond to ideas. Set the direction of the company

Conceptions of work: Managers negotiate and coerce, avoid risk, and balance opposing views. Leaders develop fresh approaches to problems, increase options, and seek risk when opportunities appear promising

Relations with others: Managers prefer working with people but maintain minimal emotional involvement. Leaders relate to others directly, intuitively, empathetically; focus on the substance of events

Sense of self: managers feel part of the organization. Leaders feel separate from the organization and their sense of self comes from struggles to profoundly alter human and economic relationships

42
Q

Barriers to treatment – external and internal

A

external: non-internal reasons like financial constraints, lack of therapists

internal: reasons relating to one’s internal self such as the stigma, culture

43
Q

Disparities for POC

A

Research studies show discrimination at the point of entry: black people are less likely to get a call back from a therapist

Many therapists are known to exhibit a preference for patients they perceive as being young, attractive, verbal, intelligent, and successful (YAVIS)

44
Q

Cultural competency

A

Understanding help-seeking behaviors

Specific manifestations of distress

turn to “culturally endorses coping strategies”

For example: clients with few resources face logistical issues (transportation, childcare); and can’t miss work, mistrust of mental health system, stigma

45
Q

What is self-help?

A

actions taken by self

46
Q

Conversion therapy

A

Aim–change sexual orientation or gender identity

Method–aversion, behavioral exposure (nausea inducing drugs, electric shock)
historically (chemical castration)

Discredited–ineffective, cannot change orientation; harmful (suicide, depression) seen as torture

47
Q

Freud and psychoanalysis on homosexuality

A

Psychoanalysis “opposed to any attempt at separating off homosexuals from the rest of mankind as a group of a special character”

“All human beings are capable of making a homosexual object choice and have in fact made one in their unconscious

“From the point of view of psychoanalysis the exclusive sexual interest felt by men for women is also a problem that needs elucidating and is not a self-evident fact based upon an attraction that is ultimately of a chemical nature”

Homosexuality an achievement not a given

Freud petitioned on behalf of civil rights for homosexuals

48
Q

Sexology

A

scientific study of human sexual behavior

origins in the late 19th century

49
Q

Sexological principles

A
  • curiosity, lack of overt moralism
  • normative, but homosexuality is not a disease or crime
  • interested in variation
50
Q

Who is a therapist?

A

Shedler: there is no such thing as a licensed therapist. Legit professionals state their specific profession: psychiatrist, psychologist, etc.

51
Q

Ethics of practice

A

Confidentiality: laws protecting/laws mandating reporting of abuse
- record-keeping (subpoenas)

Boundary violations:
non-sexual (dual relationships (must wait a couple years but generally not recommended even after termination), gifts, barter)
sexual

52
Q

Boundary violations: short history

A

boundary violations – term not used till 1980s and 90s

malpractice suits brought by patients–rare before 1975

states began to criminalize therapists’s sexual exploitation of clients in early 1980s

53
Q

Singularity–therapist must

A

listen w/o judgment

side with patient against family, friends, co-workers

discover and ameliorate traumas

identify strengths and work on weaknesses

reflect back our best selves

support us through thick and thin

54
Q

Toll of being a therapist

A

Isolation

mental exhaustion

feelings of helplessness in the face of suffering

burnout

managing worry and concern for patients

affective exhaustion, indirect traumatization

challenges both in private practice and agency setting, dealing w/ insurance, family members, dysfunctional staff

55
Q

Eliza effect

A

as users interacted with the chatbot, they had strong emotional reactions. Some users told eliza private thoughts.

56
Q

Active listening

A

technique of person-centered therapy

is a widely used communication technique in which the listener repeats, rephrases, and asks for clarification of the statements made by the speaker

57
Q

Weizenbaum as dissenter

A
  • people did not realize they were talking to a computer
  • the relevant issue is ethical…since we do not now have ways of making computers wise, we ought not now give computers tasks that demand wisdom
  • wanted to outlaw “all projects that propose to substitute a computer system for a human function that involves interpersonal respect, understanding, and love”
58
Q

Appeal of chatbots

A
  • people disclose more to a chatbot
  • apps don’t judge, they’re neutral
  • scalability
  • access, convenience
  • illusion
  • cyberspace
59
Q

Challenges of internet-delivered CBT

A
  • works best when there is a trained guide/coach to check in over the phone (humans limit scalability and profitability)
  • not engaging enough

Woebot combats these challenges b/c its an automated coach that helps you practice good thinking hygiene and “he’s fun to talk to”

60
Q

Therapy Platforms

A

platforms market themselves as available on demand for patients but therapists are alarmed by this b/c limit-setting and boundary-setting are a part of therapy

“If you can’t manage to not talk to your therapist for four hours, you are very ill and need a higher level of care”

61
Q

Cyberspace

A

term coined in 1984 by William Gibson
“…figurative space, a representational space that must be actively programmed and created…an area or volume between specific boundaries…the reality of cyberspace, like the reality of physical space is an articulated gap [that] creates a space where reality and fantasy can be manipulated to create many desired possibilities.

Cyberspace is where fantasy and reality often collide

the individual can feel control as he manipulates reality

62
Q

Problem with Eliza

A
  • people believed the computer understood them
  • troubled by belief that program would replace human psychotherapists
  • asked in 1978: what are the limits people ought to impose on the application of computation to human affairs?
63
Q

What is psychotherapy?

A
  • interpersonal (not self-help)
  • based on psychological principles (not medical)
  • therapist is trained; patient has mental disorder, problem, complaint
  • remedial for disorder, problem, complaint
  • individualized for same
64
Q

Argument against chatbots

A

it doesn’t teach you to function in the world and relate to others. It teaches you how to indulge in a narcissistic fantasy

research shows that only 6% of apps backed by evidence of efficacy

65
Q

The bond

A

what patients want–interpersonal

66
Q

Argument for Woebot

A

it hinges on alliance, users were able to develop a bond w/ woebot

As it stands today, rules-based AI is more suitable for healthcare than generative AI

67
Q

Termination

A

a. psychologists terminate therapy when it becomes reasonably clear that the patient no longer needs the service, or is being harmed by continued service

b. psychologists may terminate therapy when threatened by the client

c. except where precluded by the actions of clients, prior to termination, psychologists provide pre-termination counseling and suggest alternative service providers as appropiate

68
Q

Insecure attachment

A

Insecure attachment is characterized by a lack of trust and a lack of a secure base. People with an insecure style may behave in anxious, ambivalent, or unpredictable ways. When adults with secure attachments look back on their childhood, they usually feel that someone reliable was always available to them.

69
Q

Family therapy

A

Families all have:
- structure
- boundaries
- alliances
- coalitions
- triangulations

Decenter problem and symptom bearer

Behavior is not individual but sustained by the system

Explore family patterns that maintain symptom

Explore what each brings from the past that influences present

What are family members doing that helps maintain the identified patient’s symptoms?

GENED 1179 (1 decks)

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