Midterm Flashcards
Cultural intersections
When someone is a part of two different marginalized cultures
Culturally informed practice
Cultural knowledge when it comes to diagnosis, psychodynamic, behavioral, family systems, pharmacology, etc
Code that has overarching principles and specific rules for culture
APA ethics code
Multicultural therapies
Cultural relativism and cultural universality
Therapist awareness, education, efforts to invite discussion
Multicultural theory
Comceptualizes problems as
- Understandable reactions to unacceptable pressure
- Reactions that need to be understood and channeled productively
Psychopathology of cultural differences
Discrimination, acculturation, microaggressions, immigration, internalized isms, limited in group support
Macro level isms
economic and health care disparities, white cis/hetero normatively
Client does not need to be fully aware of these to be affected
5 commonalities among psychodynamic theories
Much of mental life is unconscious
Thoughts, emotions, motivations about something can conflict
Personality formation begins in childhood
Mental représentations of self, others, relationships guide interactions and psychological symptoms
Development - movement from an immature, socially dependent state to a mature, independent state
The ID
Demanding- Pressure principle
The EGO
Peace officer - ruled by the reality principle
SUPEREGO
The judge - ruled by the moral principle
Ego defense mechanisms
Normal, UNCONSIOUS processes that distort reality
Help the individual cope with anxiety
Projection (defense mechanism)
I’m not mad, you’re mad
Discplacement (defense mechanism)
Anger towards dad is directed on brother
Sublimation (defense mechanism)
Turning my anger against mom into athletics
Reaction formation (defense mechanism)
Homosexual attraction channeled into violence towards gay people
Fixation (Freud)
Failure to resolve core issues in a psychosexual stage
Oedipus complex
Phallic stage of development
Feelings of desire for opposite sex parent
Competition with same sex parent
Can result in fixation
Erik Erikson’s psychosocial stages
Helped to bring psychoanalysis to focus on “ego psychology”
Stages emphasize social development and drive for mastery and competence
Goals in psychoanalysis
Make the unconscious conscious
strengthen the ego so it can tolerate reality and use defenses flexibly
Psychodynamic approaches - what the therapist does - four things
Preserve the analytical framework
monitor ego strength
Generate/discover intrapsychic material
Interpret the material
Psychodynamic approach: Preserve the analytic framework
Boundaries of time, setting and roles stay the same
Blank screen, rigid environment
Psychodynamic approach: Monitor ego strength
Bring unconscious material to consciousness
Psychodynamic approach: generate/ discover intrapsychic material
Including therapeutic strategies (free association, dream analysis, etc)
Mainly: Allow transference to develop, analyzing resistance
Transference
Allow client to transfer feelings/ thoughts/ emotions from someone else onto the therapist
Client reacts to the therapist as he did to an earlier significant other
Countertransference
The reaction of the therapist toward the client that may interfere with objectivity
Resistance
Anything that works against the progress of therapy and prevents the production of unconscious material
hesitation answering questions, cancelling appointments, etc
Analyzing this helps the therapist to understand the patient better
Psychodynamic approach: Interpret the material
Confronting and clarifying
Interpreting and telling the patient what you interpret, noticing the patient’s reaction when you tell them
Working through (main part, takes the longest)- becoming conscious of impulses and defenses
Psychodynamic therapy effectiveness
Better than supportive control therapies or no therapy but same or less efffective than CBT
Limited time (brief) psychodynamic therapy
Make this type of therapy competitive in the marketplace by making it empirically testable and deliverable
Limited amount of sessions - get to the point quicker
Limitations of psychodynamic therapies
May not be appropriate for all cultures and SES groups
Stuidied by old whit emen
Lengthier treatment may not be practical or affordable
Minimizes the role of the environment on functioning
Requires extensive therapist training
difficult to study empirically
Evidence based practice (EBP)
Policy makers argue that effectiveness claims of therapy should be evidence based
Integration of: patient unique characteristics, clinical expertise, best available research evidence
Issue with EBP - what counts as evidence?
The therapy works only for the people who the therapy worked for, and these are the people who are documented
How does Tolin et al argue that EBP should be handled?
Should be more emphasis on Empirically supported treatment (EST) and THEN consider patient characteristics and clinical expertise
What makes a good EST?
Efficacy- benefits are due to the effects of the treatment and not confounding factors
Randomized controlled trial (RCT)
Randomized control trial
Causal inference, control group, falsifiability, transparency
Falsifiability
There is an expectation for what is supposed to happen/ what is supposed to improve
Hypothesis can be supported or cannot be supported – can’t change your mind for what your expectation is
Transparency
Clear roadmap for how these trials are supposed to occur
Stages of EST
Open trial- figure out if it even has a chance of working before you spend a ton of money
Efficacy- does it work? Under ideal conditions? Better than another treatment? Holding everything else constant?
Effectiveness- Does it work under real conditions?
Criticisms of EST’s
Treatments are adapted to meet the research designs rather than vice versa (tail wags the dog)
Gold standard treatment - treatments viewed as the optimal treatment rather than the example
Straw man problem- control conditions are not representative of what clinicians are actually doing
Allegiance effects- favored treatments usually win over competing treatments
External validity problems (different settings, patients, cultures, outcomes)
Behaviorism and opinion on mentalism
Cannot directly observe mental thoughts, beliefs, unconscious so it is not important
Classical conditioning
UCS = UCR
UCS + NS = UCR
NS = CR
Baby Albert and white bunny
Operant conditioning
Reinforcement and punishment
Criticism to conditioning methods
These approaches are “reductionist”
No two people’s earning histories are the same, behavior must be understood in context, treatment is highly individualized
Anxiety symptoms and conditioning - how does it work
Fear association develops through classical conditioning
Fear association is maintained through operant conditioning (negative reinforcement)
Fear response and habituation, extinction
Habituation: fear cannot be maintained for too long so it will subside eventually. More exposure = more habituation = lesser response to stimulus over time
Extinction- results after the person has the stimulus + no fear = no more fear
Classical conditioning and fear development
Getting bit by snake = fear = don’t want to do that again
Operant conditioning and fear maintaining fear
Avoidance is negatively enforced- staying further away = less fear
Approach behavior is positively punished- approach snake = fear, anxiety
Treatment of exposure therapy how it works
Aims to “unlink” the conditioned stimulus to fear response through exposure
Prevent avoidance
Allow habituation and extinction to occur
Systematic desensitization (exposure therapy)
Graduated expose to feared situation or event
Goals are habituation and extinction
ABC Model
Antecedents- constants of how and why the habit happens
Behaviors - the habit
Consequences- come up with ways that make them not want to do the behavior
Social Learning Approach
Gives importance to the interactions between a person’s behavior and the environment
Social learning and family processes
Child learns from how their parent reacts to them for good or bad behavior. This then generalizes into social exchanges outside of the household (school, peers)
Child behavior management strategies
Reinforcement over punishment- token system reinforces positive behaviors
Consistency and follow through
Non-harsh
Limitations of behavior therapy
heavy focus on behavioral exchange may detract from client’s emotions and thoughts
Does not place emphasis on insight
Focuses on symptoms rather than underlying causes of maladaptive behaviors
Power imbalance- chance for the therapist to manipulate the patient with this approach
Systems perspective
Look at why something is happening rather than just acknowledging that it is happening
Family systems perspective
Understand individuals by how they interact with their family
Family systems - symptoms
an expression of dysfiunction within a family
Identified patient
why the family is coming to therapy, the problem
The symptom bearer
person who has the problem in the family - bearing the weight of the family
Scapegoating
blaming one person for the family’s problems
Organization lens
How is the family organized?
Embedded subsystems, power hierarchy, boundaries, autonomy of individuals in the family
Family genogram
Teleological lense
What is the identified problem? Purpose that the family is in therapy?
Sequences and patterns lens (face to face)
Real time interactions that happen within the family, patterns
Sequences and patterns lens (routines)
The specific routines of the day to day life of the family
Parent work schedule, school schedule, kid doing parental duties
Sequences and patterns lens (ebbs and flows of life)
What does the family’s life look like when it’s back to school time? Marriages? Family reunions?
Sequences and patterns lens (transgenerational)
Repeated patterns across generations
Developmental lens
Development of the family, not the individuals
When were there children, when do they get married, what do the parents do, retirement? Grandparents in the house?
Useful for step families and multicultural families
Individual’s Internal Family System Lens
How each family member views their family dynamic
Multicultural lens
Intra and inter cultural experiences
Gender lens
Something you can learn about the family based on gender roles/ power dynamics
Process lens
Noticed in the therapy room- “how” is the family interacting rather than “what” they are doing
Family therapy technique - joining
convince the family that the therapist is on their side, build trust
Family therapy technique - enactment
therapist has the family act out a problem area
Family therapy technique- reframing and insight
helping the family to understand the problems in a new way
Family therapy technique- valuing and inclusion
make sure all the family members are included, especially the ones who are normally absent
Issues with general therapy
therapist gender and culture, missing persons in the family, tensions between individual and systems approach, based on the western family model
Liddle - Family therapy
Adolescent problems are multidimensional
Problem situations provide essential info and opportunity
Therapist responsibility is emphasized
Foa Reading
Focuses on why PTSD occurs and relates it to the effectiveness of exposure therapy
Ruglass Reading
Those who went through COPE and RPT experienced a greater reduction in PTSD symptom severity compared to AMCG.
The difference between the effectiveness of COPE and RPT was not significant for the entire sample, however the data showed that there was a significant difference in the subset for only PTSD, that COPE resulted in a significantly greater diminishment of PTSD symptoms compared to RPT.
