Human Growth and Development Flashcards
Freud’s stages are psychosexual while Erik Erikson’s stages are:
a. psychometric
b. psychodiagnostic
c. psychopharmacological
d. psychosocial
d. psychosocial
The Freudian stages (oral, anal, phallic, latency, and genital) emphasize sexuality. Erik Erikson’s eight stages (e.g., trust versus mistrust or integrity versus despair) focus on social relationships and thus are described as psychosocial.
In Freud’s psychodynamic theory instincts are emphasized. Erik Erikson is an ego psychologist. Ego psychologists
a. emphasize id process
b. refute the concept of the superego
c. believe in man’s powers of reasoning to control behavior
d. are sometimes known as radical behaviorists
c. believe in man’s power of reasoning to control behavior
Development is defined as:
Systemic changes and continuities in the individual that occur between conception and death. These systemic changes occur in three broad areas: physical development, cognitive development, and psychosocial development.
Theories of how humans grow and develop fall into the following broad categories:
learning - including behavioral theories, social learning theories, and information-processing theories
cognitive theories
psychoanalytic - including the Neo-Freudian and ego psychology theories
humanistic theories and self theories
Human growth and development changes can be viewed as:
Qualitative: change in structure or organization (e.g. sexual development)
OR
Quantitative: change in number, degree, or frequency (e.g. intellectual development)
Continuous: changes are sequential and cannot be separated easily (e.g. personality development)
OR
Discontinuous: certain changes in abilities or behaviors can be separated from others which argues for stages of development (e.g. language development)
Mechanistic: this is the reduction of all behavior to common elements (e.g. instinctual, reflexive behavior)
OR
Organismic: because of new stages, there is change or discontinuity; it is more than stimulus-response; the organism is involved including the use of cognition (e.g. moral or ethical development)
Self-concept
Definition - your perception of your qualities, attributes, and traits
Birth - infants have no sense of self, changes in early months
by 24 months - most infants show signs of self-recognition; they can identify social categories they are in such as age and gender; “who is like me and who is not like me”; exhibit various temperaments
preschool - self-concept is very concrete and physical
by age 8 - can describe inner qualities
adolescence - self-concepts/self-descriptions become more abstract and psychological; stabilization of self-concept continues
cultural and family factors influence the development of attributes and some traits
developmental concepts
nature - includes genetic and hereditary factors
nurture - includes learning and environmental factors
genotype - genetic (inherited) makeup of the individual
phenotype - the way an individual’s genotype is expressed through physical and behavioral characteristics
tabula rasa - John Locke’s view that children begin as a “blank slate”, acquiring characteristics through experience
plasticity - for most individuals lifespan development is plastic representing an easy and smooth transition from one stage to the next
resiliency - the ability to adapt effectively despite the experience of adverse circumstances (e.g. some children, despite experiencing potentially damaging conditions and circumstances, seem to suffer few consequences)
neurobiology
neuroscience is sometimes referred to as the missing link in the mental health professions
ivey, d’andrea, and ivey believe that “the mind is the product of the activity occurring in the brain at the molecular, cellular, and anatomical levels, which are in turn impacted by a person’s interpersonal relationships, cultural context, and societal experience”
counselors, by using different theories, skills, and interventions promote release of various neurotransmitters which promote related brain changes. neurotransmitters affect various cognitive, emotional, psychological, and behavioral reactions that people have to their real life experiences.
neurotransmitters carry messages between neurons that stimulate reactions in the brain. these chemical reactions stimulate different parts of the brain leading to different cognitive, emotional, psychological, and behavioral outcomes.
four principal neurotransmitters important to counselors
acetylcholine - important for memory, optimal cognitive functioning, emotional balance and control
serotonin - affects feelings, behaving, thinking; critical for emotional and cognitive processes; vital to sleep and anxiety control
dopamine - important for emotional wellness, motivation, pleasurable feelings
GABA (gamma amino butyric acid) - helps reduce anxiety, promotes relaxation and sleep
different counseling and therapy skills help promote the production of each of these four neurotransmitters
abraham maslow (humanistic psychologist)
developed the hierarchy of needs
people are always motivated to higher-order needs:
food/water > security/safety > belonging/love > self-esteem/prestige/status > self-actualization
we go from filling our needs from the physiological level to the social level to the cognitive level
robert havighurst
identified stages of growth - each one requiring completion of the last one for success and happiness
developmental tasks arise from physical maturation, influences from culture and society, and desires and values of the person
developmental tasks are the skills, knowledge, behaviors, and attitudes that an individual has to acquire through physical maturation, social learning, and personal effort
behaviorism (john watson, b.f. skinner)
this is a learning approach. behaviorists believe the environment manipulates biological and psychological drives and needs resulting in development.
learning and behavior changes are the result of rewards and punishments. a reward is a positive-reinforcing stimulus which maintains or increases a behavior. when a behavior results in the termination of a positive-reinforcing stimulus or the beginning of a negative stimulus we have punishment. such a behavior should weaken or drop out.
we grow, develop, and learn through the nature of experience - the rewards and punishments we receive
law of effect
edward thorndike formulated this law which states that when a stimulus-response connection is followed by a reward (reinforcement), that connection is strengthened. in other words, a behavior’s consequences determine the probability of its being repeated.
conditioning principles
classical conditioning - food > salivation, bell > salivation
operant conditioning - pick up toys > get a hug or a cookie
reinforcement schedule - this schedule can be continuous or variable. behaviors established through variable or intermittent reinforcement are tougher to extinguish.
fixed ratio - reinforce after a fixed number of responses
variable ratio - reinforce, on the average, after every nth (e.g. 5th) response
fixed interval - reinforce after a fixed period of time
variable interval - reinforce, on the average, after every nth (e.g. 3rd) minute
spontaneous recovery - after a rest period, the conditioned response reappears when the conditioned stimulus is again presented
stimulus generalization - once a response has been conditioned, stimuli that are similar to the conditioned stimulus are also likely to elicit the conditioned response
psychoanalytic approach and psychosexual development (freud)
there is an interaction between our internal needs/forces and the environment. freud identified five stages of development.
oral - birth to 18 months
anal - 2 to 3 years
phallic - 3 to 5 years
latency - 6 to 12 years
genital - 12 to 19 years; others have said it never ends
the phallic stage has the oedipal (son attraction to mother) and electra (daughter attraction to father) complexes. these are conflictual times for the child.
the libido is the basic energy or force of life. it consists of life instincts and death instincts.
fixation - incomplete or inhibited development at one of the stages
other psychoanalytic concepts include - castration anxiety, penis envy, pleasure principle, and reality principle
erogenous zones are areas of bodily excitation such as the mouth, anus and genitals
defense mechanisms
defense mechanisms are unconscious protective processes that help us control primitive emotions and anxiety
repression - rejecting from conscious thought (denying or forgetting) the impulse or idea that provokes anxiety
projection - avoiding the conflict within oneself by ascribing the ideas or motives to someone else
reaction formation - expressing a motive or impulse in a way that is directly opposite what was originally intended
rationalization - providing a reason for a behavior and thereby concealing the true motive or reason for the behavior
displacement - substituting a different object or goal for the impulse or motive that is being expressed
introjection - identifying through fantasy the expression of some impulse or motive
regression - retreating to earlier or more primitive (childlike) forms of behavior
denial - refusing to see something that is a fact or true in reality
sublimination - may be viewed as a positive defense mechanism wherein anxiety or sexual tension or energy is channeled into socially acceptable activities such as work
erik erikson
erikson identified eight stages wherein a psychosocial crisis or task is to be mastered. the stages, corresponding ages, and resulting ego virtue are:
trust vs mistrust - birth to 1.5 years, virtue of hope, infant develops trust if basic needs are met
autonomy vs shame and doubt - 1.5 to 3 years, virtue of will/sense of self, infant asserts self, develops independence if allowed
initiative vs guilt - 3 to 6 years, virtue of purpose/goal setting, children meet challenges, assume responsibility, identify rights of others
industry vs inferiority - 6 to 11 years, virtue of competence, children master social and academic skills or feel inferior
identity vs role confusion - adolescence, virtue of fidelity/ability to commit, individual establishes social and vocational roles and identities or is confused about adult roles
intimacy vs isolation - early adulthood, virtue or love, young adult seeks intimate relationships or fears giving up independence and becoming lonely and isolated
generativity vs stagnation - middle adulthood, virtue of care/investment in future, middle-aged adults desire to produce something of value and contribute to society
integrity vs despair - late adulthood, virtue of wisdom, older adults view life as meaningful and positive or with regrets
erikson viewed life as in constant change, the social context is important in the development of personality
jean piaget
piaget studied cognitive development/intelligence. we inherit two tendencies - organization and adaptation.
organization - how we systematize and organize mental processes and knowledge
adaptation - adjustment to the environment
two processes within adaptation - assimilation, accommodation
assimilation - modifying the relevant environmental events so they can be incorporated into the individual’s existing structure
accommodation - modifying the organization of the individual in response to environmental events
schema is another word for a mental structure that processes information, perceptions, and experiences
piaget identified four stages of cognitive development
sensorimotor - birth to 2 - the child differentiates self from objects, can think of an object not actually present, seeks stimulation
preoperational - 2 to 7 - language development is occurring, child is egocentric, has difficulty taking another’s point of view, classifies objects by one feature
concrete operational - 7 to 11 - begins logical operations, can order objects (small to large, first to last), understands conservation
formal operational - 11 to 15 - moves toward abstract thinking, can test hypotheses, logical problem solving can occur
lawrence kohlberg
kohlberg studied moral development, thinking and reasoning are involved. he identified three levels relating to the relationship between self and society.
preconventional:
stage 1 - a punishment and obedience orientation exists
stage 2 - an instrumental and hedonistic orientation exists (obtaining rewards)
conventional:
stage 3 - interpersonal acceptance orientation prevails, maintaining good relations, approval of others
stage 4 - a law and order orientation exists, conformity to legitimate authorities
postconventional:
stage 5 - social contracts and utilitarian orientation exists, most values and rules are relative
stage 6 - a self-chosen principled orientation prevails, universal ethical principles apply
daniel levinson
levinson wrote: The Seasons of a Man’s Life. he identified three major transitions/times occurring between four major eras of life.
transitions:
early adult transition - 17 to 22
mid-life transition - 40 to 45
late adult transition - 60 to 65
in adulthood, the individual copes with three sets of developmental tasks:
build, modify, and enhance life structure
form and modify single components of the life structure such as: life dream, occupation, love-marriage, family relationships, mentor, and forming mutual relationships
tasks to become more individuated
levinson believed that the majority of the men he studied experienced midlife crisis, a time of questioning their life structure including their career, this occurred in the transition period of age 40 to 45
urie bronfenbrenner
bronfenbrenner took an ecological approach to the study of human development. he believed it was important to look at all levels and systems impacting a person. for example - a troubled adolescent is a part of several systems such as family, school, peers, community, etc. we must be sensitive to influences of all these symptoms.
social-learning models
these models see the importance of social environment and cognitive factors. these go beyond behaviorism, in other words, the simply stimulus-response paradigm because we can think about the connections between our behaviors and the consequences.
albert bandura developed a social learning theory. one of the central concepts of this cognitive behavioral approach is self-efficacy, the belief that we can perform some behavior or task. self-efficacy can help explain how it is that people change. one’s self-efficacy is facilitated through four mechanisms which are:
modeling after others’ behavior
vicarious experience - watching others perform the behavior
receiving verbal persuasion from others that one can do a task
paying attention to one’s own physiological states such as emotional arousal or anxiety involves in doing the behavior
william perry
perry developed a scheme for intellectual development and ethical development. h identified three general categories and nine positions.
dualism:
1. authorities know
2. there are true authorities and wrong authorities
3. good authorities may know but may not know everything yet
relativism is discovered:
1. there may not be right or wrong answers; uncertainty may be okay
2. all knowledge may be relative
3. in an uncertain world, i’ll have to make decisions
commitment in relativism:
1. initial commitment
2. several commitments - and balancing them
3. commitments evolve, and they may be contradictory
theories of how women develop
theories of women’s development are evolving. many writers argue that gender stereotyping, male-imposed standards, and the devaluation of feminine qualities have made women second-class citizens. in the mid 70s, nancy chodorow was one of the first to speak out against the masculine bias found in psychoanalytic theory.
in toward a new psychology of women, jean baker miller indicated that a large part of women’s lives has been spent helping others develop emotionally, intellectually, and socially. this caretaking is a central concept differentiating the development of women from men.
judith jordan and others affiliated with the stone center, wellesley college, presented a developmental theory of women in 1991 which was referred to as self-in-relation theory. this theory is now known as relational-cultural theory. the principal components of this theory included:
- people grow toward relationships throughout life
- mature functioning is characterized by mutuality and deepening connections
- psychological growth is characterized by involvement in complex and diversified relational networks
- mutual empathy and empowerment are at the core of positive relationships
- growth-fostering relationships require engagements to be authentic
- growth-fostering relationships stimulate growth and change in all people
- goals of development are characterized by an increasing ability to name and resist disconnections, sources of oppression, and obstacles to mutual relationships
other writers who addressed women’s issues included
harriet lerner in the dance of intimacy believed women needed to re-evaluate their intimate relationships which may not be working, and choose a healthier balance between other-oriented and self-absorption. competent relationships allow for each person to be appreciated and enhanced, and the woman should show strength, independence, and assertiveness.
in the mismeasure of woman, carol tavris indicated that women are judged and mismeasured by their fit into a male world. in fact, both genders are more alike than different but they are perceived as different because of the roles they have been assigned. society also pathologizes women.
carol gilligan, in a different voice and other writings, believed that women view relationships and experience of relationships differently than men do. their communication patters are also different.
women use different criteria than men in making moral judgments. consequently, they score lower on kohlberg’s moral dilemma test. men use the criteria of justice and rights; women use human relationships and caring. there is overlap between men and women on the instrument.
gail sheehy
she wrote passages: predictable crises of adult life in 1976. passages are transitional periods between life stages and are different for most individuals. these passages also provide opportunities for growth - through the crises we face in making constructive changes between life stages.
other sheehy books include:
the silent passage: menopause
new passages
understanding men’s passages
passages in caregiving: turning chaos into confidence
spiritual development
some research indicates that over 90 percent of the US population has a belief in a divine power or force greater than oneself. spirituality is viewed more broadly than belief in a religion. in any case, spirituality may directly influence clients in their view of self, relationships, worldview, as well as nature and cause of perceived problems. for many individuals, their spirituality is a key component in their definition of being whole and of wellness.
counselors must be willing and able to address and identify issues of spirituality important to the client’s situation. they may have to acquire the knowledge and the language to communicate effectively with clients who have a wide variety of spirituality issues and beliefs. essentially, this process may require counselors to examine their own spirituality.
intelligence
intelligence has been defined as an ‘adaptive thinking or action’ (piaget) or ability to think abstractly. charles spearman believed there was general intelligence (g) and special abilities (s). louis thurstone identified several primary mental abilities.
intelligence is not fixed or determined solely by genetics. one’s environment, experiences, and cultural factors influence intelligence.
intelligence testing may be biased against those who have not had the opportunities to learn or experience those things the test measures.
in emotional intelligence: why it can matter more than the IQ, daniel goleman proposed that one component of intelligence can operate out of human emotions, that is, independently of the person’s reasoning and thinking processes. this emotional intelligence is a learned developmental process beginning in infancy and processeding to adulthood through varying levels of development. an emotionally intelligent person is self-motivated, empathetic, grasps social signals and nonverbal messages, and develops strong interpersonal abilities.
propinquity
this is the concept that implies nearness or proximity. for example, in selecting a partner, one is most likely to become involved with someone who lives nearby.
midlife crisis
stress may occur as an individual encounters various transitional periods/stages. although levinson believes that most men experience midlife crisis, many writers do not. both men and women may experience a painful self-evaluation process but not at a crisis level.
clinical mental health counseling
in mental health counseling, normality is the baseline for understanding the human condition. wellness is the goal of counseling not the absence of psychopathological symptoms. this is in contrast to the typical medical model orientation which is narrowly focused on symptoms and deficits. mental health counseling:
- espouses a wholistic, wellness orientation
- views remedial and psychopathological issues from a positive, developmental orientation
- views the individual as embedded in larger systems including families, society, and environment
- stresses greater reliance and focus on education and prevention and less on remediation
psychological dysfunction
a breakdown in cognitive, emotional, or behavioral functioning. the dysfunction is unexpected in its cultural context and associated with personal distress or substantial impairment in functioning.
psychopathology
the scientific study of psychological disorders
prevalence
how many (what percent) of the population has a given disorder
incidence
how many new cases of a given disorder occur within a given timeframe such as a year
prognosis
the anticipated course of a disorder
etiology
what causes a disorder - i.e. why does it begin? biological, psychological, and social dimensions are involved
equifinality
there may be multiple paths to a given outcome. for example, depression may be caused by physical injury, loss or a loved one, or substance abuse.
comorbidity
an individual has two or more disorders a the same time
adaptive functioning
occurs when defense mechanisms are used to cope with stressors. mechanisms leading to optimal adaptation include anticipation, humor, and sublimination. at the other extreme, failure to regulate stress may lead to a break with reality resulting in delusional projection or psychotic distortion.
one-dimensional causal model
this model assumes that a disorder is caused by one factor such as a chemical imbalance. research does not support this linear model.
multidimensional causal models
these models assume that a disorder is caused by the interaction of several factors and dimensions. the context of the individual is important and includes the biology and behavior of the individual as well as cognitive, emotional, social, and cultural dimensions.
biology - includes genetic factors. genetic factors appear to make some contribution to all psychological disorders by influencing cognitions behaviors, and emotions. the nervous system influences psychological disorders primarily through biochemical neurotransmitters in the brain.
behavior and cognitive factors - how we acquire and process information, store and retrieve it, influences behavior. we also acquire and learn behaviors through conditioning and social learning.
emotions - have an important role in psychological disorders. the emotion of fear, for example, has an important influence on our bodies and influences on our behavior.
culture, social, interpersonal behaviors - influence our lives. gender is an important influence on the incidence of some disorders. the amount and kind of social relationships and contacts help predict longevity by reducing the incidence of certain physical disorders perhaps by influencing the immune system.
emotion is viewed as
temporary and short-lived, snapshot in time
mood is viewed as
more persistent period of emotionality, consistent over time
ego-dystonic symptoms or traits
the individual perceives the symptoms or traits as unacceptable and undesirable
ego-syntonic symptoms or traits
the individual perceives the symptoms or traits as acceptable
clinical assessment
clinical assessment is the process of determining the psychological, biological, and social factors which ay be associated with a psychological disorder.
diagnosis
the process of determining whether a presenting problem meets the criteria for a psychological disorder
biopsychosocial history
taking a biopsychosocial history of an individual is the examination of multiple facets to shed light on possible reasons for certain behaviors and attitudes.
bio - may include such concepts as physical traits, abilities/disabilities, genetic factors, neurological factors, medical history, diet, medications, sleep patterns, etc.
psycho - self-image and self-concept, mental states, emotions, trauma, abuse, drug use, psychological strengths and weaknesses, coping skills, etc.
social - relationships within family and with others, environment, cultural, socioeconomic and sociopolitical conditions, friendships, stress on the job, lifestyle factors, marital issues, religion or belief system, etc.
mental status exam
the mental health counselor may use the clinical interview to examine the mental status of an individual seeking services. a formal mental status exam covers the following five areas:
appearance and behavior
thought processes
mood and affect
intellectual functioning
sensorium - addresses the individuals orientation and awareness to surroundings, time, place, and identity
unlike the biopsychosocial history assessment, the mental status exam is a description of an individual at a specific point in time.
assessment interviews
this is the use of direct observation to assess formally an individual’s thoughts, feelings, and behavior in specific situations or contexts. the clinical interview provides one avenue of behavioral assessment. such interviews may be structured with questions and topics already established. semi-structured and unstructured interviews provide for flexibility but are less likely to address all the pertinent topics of a structured interview.
psychological assessment
psychological tests may measure cognitive functioning, emotional or behavioral responses, or personality characteristics.
standardized tests:
projective tests - rorschach, thematic apperception test, incomplete sentences blank
personality tests - minnesota multiphasic personality inventory (mmpi), california psychological inventory
intelligence tests - weschler adult intelligence scale
nonstandardized or informal methods of assessments may include any number of checklists and rating scales. these instruments provide more subjective estimates of attitudes and behaviors.
neuropsychological assessment
these instruments measure brain dysfunctions and measure such abilities as language expression, attention and concentration, memory, motor skills, and perceptual abilities.
examples:
luria-nebraska neuropsychological battery - measures organic damage and location of such injury
bender visual-motor gestalt test - often used with children, can measure brain dysfunction
diagnosis and case conceptualization
following the assessment process, the mental health counselor will be in a position to provide a diagnosis of the client. this diagnosis may change or be expanded pending further information. usually the diagnosis is based on or consistent with a formal classification system of mental disorders such as the DSM.
entities that counselors work for may expect the counselor to provide a formal diagnosis. this is especially true of third party funders such as insurance companies.
case conceptualization is essentially the clinical hypotheses the counselor develops based on the data from the assessment process. the diagnostic data provides a roadmap for any counseling activities that follow. the clinical hypotheses typically are consistent with the counselor’s theoretical orientation.
treatment plan
following diagnosis and case conceptualization, a treatment plan is devised. this is the therapeutic road map to help clients improve their mental health and daily functioning. minimally, the treatment plan helps an individual resolve enough problems so they can function at a higher level, and move to a less restrictive treatment environment.
continuum of care
many individuals in treatment move through a continuum of care. the most restrictive environment is inpatient hospitalization followed by partial or day hospital care, followed by group home or residential care. less restrictive possibilities include intensive outpatient programs, home healthcare, and outpatient services.
diagnostic and statistical manual of mental disorders, fifth edition (DSM-5)
the fifth edition of the DSM-5 was published in 2013 by the american psychiatric association. the international classification codes of the world health organization from its international classification of diseases (ICD) are also included in the DSM. ICD-10-CM (clinical modification) is now the current one.
codes from the ICD-10-CM are the HIPAA-approved code set for reporting diagnoses for insurance reimbursement purposes. unlike the ICD-10-CM, the DSM provides clinicians with criteria and definitions to determine a client’s diagnosis by thoroughly describing disorders. ICD-10-CM simply provides code numbers after a diagnosis has been made.
note - new versions of both DSM and ICD have been published since this study guide was published; newest versions are DSM-5-TR and ICD-11.
characteristics of DSM-5
v codes are conditions not attributable to a mental disorder but are important to intervention efforts. v codes provide for the client’s worldview, psychosocial and contextual information. relational problems, abuse, occupational, and acculturation issues may be included.
focus for identifying disorders is on pathological origins - a biological orientation. problems of growth and development of the brain or central nervous system impact behavior, learning, and social interactions.
one consequence of this biological approach is the potential to view treatment as pharmacological with the need for more prescriptions and drugs. a result may be a decrease in the belief in the need for psychotherapeutic (counseling) approaches and holistic client care.
the DSM-5 also relies on dimensional assessments not categorical descriptions of disorders. dimensional scales focus on the frequency, duration, and severity of the client’s experience with a disorder, not on the presence or absence of a particular symptom. symptoms are placed along a spectrum.
differential diagnosis
information about differential diagnosis is presented for the disorders in DSM-5. for example, disruptive mood dysregulation disorder is used for children (6 to 18 years of age) who are experiencing severe, recurrent outbursts of temper with an average frequency at least three times per week for at least 12 months or more. if these criteria are not met, a different diagnosis along the spectrum is in order. furthermore, if the child or adolescent experiences any manic or hypomanic episodes, the diagnosis of disruptive mood dysregulation disorder cannot be assigned.
depressive disorders
depressive disorders do not contain any disorders related to mania.
bereavement has been excluded as part of a major depressive episode.
physical causes for depression must always be considered.
the most common and effective treatment for depressive disorders include medication and psychotherapy. the two most effective psychotherapeutic interventions appear to be cognitive behavior therapy and interpersonal therapy.
specific disorders include:
a. disruptive mood dysregulation disorder
b. major depressive disorder, single episode and recurrent episode
c. persistent depressive disorder (dysthymia)
d. premenstrual dysphoric disorder
bipolar and related disorders
mania and hypomania criteria focus on changes in energy and activity. depression and anxiety are often viewed as comorbid with bipolar and related disorders.
mood-stabilizing medications and psychotherapy are the typical recommended treatments. specifically, psychoeducation, family-focused therapy, CBT, and interpersonal therapy have been shown to be effective.
specific disorders include:
a. bipolar I disorder
b. bipolar II disorder
c. cyclothymic disorder
anxiety disorders
fear and anxiety are a part of anxiety disorders as well as a variety of physiological symptoms such as heart palpitations, sweating, and shortness of breath. comorbidity with depressive disorders is common although anxiety is often characterized by anxious anticipation and fear unlike depressive disorder. anxiety disorders often have an early-age onset and suicide risk is important.
effective interventions include CBT, behavior therapy, and relaxation training.
specific disorders include:
a. separation anxiety disorder
b. selective mutism
c. specific phobia
d. social anxiety disorder (social phobia)
e. panic disorder
e. agoraphobia
obsessive-compulsive and related disorders
obsessive-compulsive disorders feature obsessive preoccupation and engagement in repetitive behaviors. previous classified in the anxiety disorders category, the principal feature of these disorders is not anxiety. comorbidity with other diagnoses is not uncommon and these include depressive and anxiety disorders, hypochondriasis, eating disorders, ADHD, and others.
treatment approaches for obsessive-compulsive disorders involve a combination of psychopharmalogical treatment and psychotherapy. CBT and a form of CBT called exposure and response prevention have shown to be effective.
specific disorders include:
a. obsessive-compulsive disorder
b. body dysmorphic disorder
c. hoarding disorder
d. trichotillomania (hair-pulling) disorder
e. excoriation (skin-picking) disorder
trauma- and stressor-related disorders
traumatic or stressful events may threaten an individual’s physical, social, emotional, cognitive, or spiritual wellbeing. these events include sexual or physical assault, combat, torture, disasters, severe care accidents, child abuse, and life-threatening illnesses. these events can occur once or be re-occurring and overwhelm a person’s coping ability.
a wide variety of psychopharmacological and psychotherapeutic approaches may be indicated for disorders in this broad category. variables such as age of the person from child to adult, nature of and duration of traumatic event, and the individual’s coping skills and support will help determine the appropriate psychotherapeutic approach to implement.
specific disorders include:
a. reactive attachment disorder
b. disinhibited social engagement disorder
c. posttraumatic stress disorder
d. acute stress disorder
e. adjustment disorders
gender dysphoria in children, adolescents, and adults
gender dysphoria refers to conscious or unconscious feelings (especially in children) that there is a mismatch between the gender a person was born as and their desire for the gender they want to be identified as. especially in adolescents and adults this discomfort often leads to the desire for gender reassignment through hormone replacement or surgery. although note listed as a disorder, being included in the DSM-5 will make such medication intervention more likely than if it was not included in the DSM.
the overall treatment that counselors should consider in their therapeutic approach is to support the client in coping with their feelings of incongruence and helping them promote optimal functioning. family therapy may be helpful for children who are gender variant including increasing the awareness of children and adolescents in how others react to them. in addition to possible medical interventions, counseling can help with adult clients’ awareness, understanding, and functioning.
there are diagnostic criteria for:
a. gender dysphoria in children
b. gender dysphoria in adolescents and adults
substance-related and addictive disorders
prevalence rates of substance use are very high in the US, with over 22 million individuals reporting use. substance-related and addictive disorders focus on ten classes of drugs. the concepts of abuse and dependence are no longer included in the diagnosis. severity of disorder can be specified as mild, moderate, and severe. a cluster of cognitive, behavioral, and physiological symptoms typify the disorder. other criteria cover social, occupational, and interpersonal issues as well as risk-taking, tolerance, and withdrawal.
treatment may include medical interventions including use of medically-controlled substitutes. adaptive coping mechanisms and substituting positive behaviors can be effective treatment options. mindfulness training has been found effective in some cases.
some of the ten substance-related disorders are:
a. alcohol-related disorders
b. cannabis-related disorders
c. hallucinogen-related disorders
d. inhalant-related disorders
e. opioid-related disorders
f. sedative-, hypnotic-, or anxiolytic-related disorders
g. stimulant-related disorders
h. caffeine-related disorders
i. tobacco-related disorders
j. other or unknown substance-related disorders
gambling disorder has similar neurochemical brain responses and risk-taking behavior.
see also: opioid crisis, item 36 in social and cultural diversity section
disruptive, impulse-control, and conduct disorders
some of the characteristics of these disorders include impulse-control; conduct disorders are aggressive or self-destructive behaviors, destruction of property, conflict with authority figures, and disregard for norms and outbursts of anger not proportionate to the situation. all disorders listed here include the common characteristic of problems with emotional or behavioral regulation and these disorders typically appear first in childhood or adolescence. there is high comorbidity with substance use disorders, depressive disorders, and anxiety disorders.
parent/family interventions including training and fostering positive time between parent and child may be the treatment of choice together with the appropriate psychopharmacological interventions especially for pyromania and kleptomania. CBT can help clients modify cognitive distortions and develop problem-solving skills.
specific disorders include:
a. oppositional defiant disorder
b. intermittent explosive disorder
c. conduct disorder
d. pyromania
e. kleptomania
specific behavioral disruptions
behavioral disruptions are classified into five distinct areas. they are grouped together because each of them will be disruptive in the behavior of the individual who has the disorder. although similar in this regard, the specific disorders vary widely.
for many of these disorders, medical interventions may be necessary including psychopharmacological treatment. the disorders are also apparently treated through psychotherapeutic means although the approaches may vary depending on the specific disorder. a trusting relationship wit ha counselor is necessary and the application of DBT may be helpful especially when other approaches have failed. the eating disorders and the elimination disorders may lend themselves to family counseling in addition to a range of medical and behavioral interventions.
examples of feeding and eating disorders include:
a. pica
b. rumination disorder
c. anorexia nervosa
d. bulimia nervosa
e. binge-eating disorder
elimination disorders include:
a. enuresis
b. encopresis
sleek-wake disorders include:
a. insomnia disorder
b. restless leg syndrome
sexual dysfunctions include:
a. erectile disorder
b. female orgasmic disorder
c. premature (early) ejaculation
paraphilic disorders include:
a. pedophilic disorder
b. voyeuristic disorder
c. fetishistic disorder
neurodevelopmental and neurocognitive disorders
these disorders are similar in that they very probably have a biological basis. it also means that counselors may not be the ones to diagnose them. a more formal background in medicine or neurobiology and neuropsychology will be necessary although once formally diagnosed, counselors can certain provide treatment, usually in conjunction with other providers. neurodevelopmental disorders typically begin in childhood whereas neurocognitive disorders may be more prevalent later in life, however, they can be found in people of all ages. it is important for counselors to recognize the signs and symptoms of a variety of neurodevelopmental and neurocognitive disorders in order to make referrals for assessment and appropriate clinical treatment. following diagnosis, counselors can work with such clients and their families in conjunction with any medical or pharmacological treatment. children and adolescents with neurodevelopmental disorders may initially be in contact with counselors in school and community mental health settings.
some neurodevelopmental disorders include:
a. intellectual disability
b. language disorder
c. autism spectrum disorder
d. attention-deficit/hyperactivity disorder
neurocognitive disorders include:
a. delirium
b. alzheimer’s disease
c. parkinson’s disease
schizophrenia spectrum and other psychotic disorders
these disorders are characterized by one or more of the following five symptom classes: delusions, hallucinations, disorganized thinking, disorganized or abnormal behavior, and negative symptoms. some of these symptoms may be temporary and found in individuals as a result of medication, drug, or alcohol use. many of the individuals who meet the criteria for psychotic disorders have a lifelong struggle with psychotic symptomatology.
if psychotic symptoms are identified in a client, counselors need to refer to medical personnel for definitive diagnoses. following such diagnosis and likely medications, counselors can provide psychosocial interventions to assist with coping and occupational functioning. CBT, psychoeducation, and family intervention and support may be appropriate. counselors may also find instruction and support useful to the client and family regarding medication management.
schizophrenia disorders include:
a. brief psychotic disorder
b. schizophrenia
c. schizoaffective disorder
dissociative disorders
these disorders represent a disconnection between things usually connected. these disconnections signify a disruption in the normal integration of consciousness, identity, memory, body representation, motor control and behavior. dissociative disorders are usually associated with trauma and can occur at any age. certain medical conditions, seizures, drug use, and brain injuries may result in dissociative symptoms.
comorbidity, especially with depressive, anxiety, and substance use may be signals for the counselor to be alert to self-injurious and suicidal behavior. a usual first level of treatment may be to establish a safe and stable environment for the client. working through traumatic memories with approaches such as CBT, DBT, and hypnosis may be adjuncts to possible psychotropic medication.
the five types of dissociation are:
a. depersonalization
b. derealization
c. amnesia
d. identity confusion
e. identity alternation
somatic symptom and related disorders
these disorders are characterized by the presence of physical or somatic complaints and the feelings, thoughts, and behaviors that go along with these complaints. individuals report distress and impairment because of these symptoms. although many of their complaints cannot be confirmed by examining physicians, to the individual they are real. because of stigmatization, the concept of hypochondriasis is not used. also, there may be cultural factors which contribute to an individual’s experiencing of symptoms. treatment begins with a physical exam to determine the validity of the somatic complaint. following any psychiatric intervention including medication, counseling may take a problem-solving approach. CBT, psychoeducation including how stress influences bodily sensations, and relaxation training may be helpful.
disorders in this category include:
a. somatic symptom disorder
b. illness anxiety disorder
c. conversion disorder
personality disorders
these disorders are characterized by persistent maladaptive patterns of behavior, affect, cognition, and interpersonal functioning. these patterns deviate from one’s culture and usually begin before adulthood. furthermore, these traits have an impact on an individual’s life and ability to function in home, school, or work. there is a tendency to see these maladaptive patterns as persistent throughout life thus making treatment difficult.
ten distinct types of personality disorder include:
a. paranoid
b. schizoid
c. schizotypal
d. antisocial
e. borderline
f. narcissistic
g. avoidant
h. histrionic
i. obsessive-compulsive
j. depdendent
these clients are often viewed as difficult and challenging to treat. some evidence seems to support that psychotherapy is more effective than psychopharmacological approaches. it is not always easy to distinguish normal from pathological personality functioning; personality is a very complex phenomenon.
mental health services
these concepts are related to abnormal human behavior and mental health services.
mental illness is a legal concept usually meaning severe emotional or thought disturbances that negatively affect an individual’s health and safety.
each state has civil commitment laws that describe how an individual can be declared legally to have a mental illness and be placed in a treatment facility.
beginning in the 1980s, the processes of deinstitutionalization, which moved many people with severe mental illness out of institutions, accelerated. an increase in homelessness and criminal justice system contacts occurred because not enough community mental health facilities and services were available.
right to treatment legislation has been passed assuring appropriate treatment for patients in mental health facilities. there is also a movement for patients to be able to refuse treatment legally. although this issue has not been finally settled, some court rulings have supported this notion.
