Multiple Choice/EPPP Flashcards
Animals in Research
Standard 8.09 requires psychologists to ‘acquire, care for, use, and dispose of animals in compliance with current federal, state, and local laws and regulations, and with professional standards’ and ‘to make reasonable efforts to minimize the discomfort, infection, illness, and pain of animal subjects.’ It also states that, ‘when it is appropriate that an animal’s life be terminated, psychologists proceed rapidly, with an effort to minimize the pain and in accordance with accepted procedures.
Collection Agencies
Standard 6.04 states that ‘if the recipient of services does not pay for services as agreed, and if psychologists intend to use collection agencies or legal measures to collect the fees, psychologists first inform the person that such measures will be taken and provide that person an opportunity to make prompt payment.’
Education and Supervision
Standards 7.01 through 7.06 address education and supervision and require psychologists to act competently and responsibly when teaching, supervising, and designing education and training programs and to avoid misrepresenting themselves or their work when performing these functions.
Informed Consent and Assent
Standard 3.10 states that ‘when psychologists conduct research or provide assessment, therapy, counseling, or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons.’ It also states that ‘for persons who are legally incapable of giving informed consent, psychologists nevertheless (1) provide an appropriate explanation, (2) seek the individual’s assent, (3) consider such persons’ preferences and best interests, and (4) obtain appropriate permission from a legally authorized person.’
Personal Problems
Standard 2.06 states: ‘(a) Psychologists refrain from initiating an activity when they known or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner…[and] (b) When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation, or assistance, and determine whether they should limit, suspend, or terminate their work-related duties.’
Sexual Misconduct by Psychotherapists
Research on sexual misconduct has found that male therapists engage in sexual and other dual relationships with clients much more often than female therapists. The data also show that male therapists who engage in sexual misconduct are usually older than the female clients they become involved with, with the average therapist being between 42 and 44 and the client being between 30 and 33. No consistent relationship has been found between risk for sexual misconduct and theoretical orientation, professional experience, or education (Pope et al., 1993).
Avoiding Bias in Language
The Publication Manual of the American Psychological Association provides guidelines for avoiding bias in language related to race/ethnicity, gender, age, and sexual orientation. For example, it recommends putting ‘people first’ (e.g., ‘clients with a disability’, rather than “disabled clients’); being specific when referring to race and avoiding using Whites as a comparison group; and using emotionally neutral terms (e.g., “people with a disease’ rather than ‘people afflicted by a disease’).
Competence
Standard 2.01 requires psychologists to ‘provide services, teach, and conduct research within populations and in areas only within the boundaries of their competence based on their education, training, supervised experience, consultation, study, or professional experience’.
EPPP
The EPPP (Examination for Professional Practice in Psychology) is a requirement for licensure in the United States and Canada. It is prepared by the Association of State and Provincial Psychology Boards (ASPPB) and is designed to assist the boards ‘in their evaluation of the qualifications of applicants for licensure and certification’ by assessing ‘the knowledge that the most recent practice analysis has determined as foundational to the competent practice of psychology’ (ASPPB, 2010).
Informed Consent for Research
Standard 8.02 states: ‘(a) When obtaining informed consent…, psychologists inform participants about (1) the purpose of the research, expected duration, and procedures; (2) their right to decline to participate and to withdraw from the research once participation has begun; (3) the foreseeable consequences of declining or withdrawing; (4) reasonably foreseeable factors that may be expected to influence their willingness to participate such as potential risks, discomfort, or adverse effects; (5) any prospective research benefits; (6) limits of confidentiality; (7) incentives for participation; and (8) whom to contact for questions about the research and research participants’ rights’.
Privilege and Holder of the Privilege
Privilege is a legal concept that protects a client’s confidentiality in the context of legal proceedings. Most jurisdictions have laws that establish privilege for communications between licensed mental health practitioners and their clients. The client is ordinarily the ‘holder of the privilege’, but a psychologist can claim the privilege on behalf of a client, and there are legally defined exceptions to privilege.
Sexual Relations with Students and Supervisees
Standard 7.07 states that ‘psychologists do not engage in sexual relationships with students or supervisees who are in their department, agency, or training center or over whom psychologists have or are likely to have evaluative authority’.
Client Access to Records
Client access to records is determined by law but, in general, the psychologist is the owner of the physical record while the client has the right to inspect the contents of the record.
Confidentiality
Confidentiality refers to the obligation of psychologists to protect clients from unauthorized disclosure of information revealed in the context of the professional relationship. Confidentiality is an ethical principle and, in some situations, a legal requirement.
General Guidelines for Providers of Psychological Services
The General Guidelines were adopted ‘as a means of self-regulation in the public interest’, and its provisions are general and aspirational. It delineates basic guiding principles for all providers of psychological services (except for those who teach psychology, conduct research, or write and edit scientific manuscripts), and its goal is to ‘improve the quality, effectiveness, and accessibility of psychological services.’
Interruption and Termination of Therapy
Standard 10.10 requires psychologists to ‘terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service’ and, when doing so, to ‘provide pre termination counseling and suggest alternative service providers as appropriate.’ An exception to this general rule is provided in Standard 10.10(b), which states that pre termination counseling or referral is not necessary when a psychologist is terminating therapy with a client because the client or a person the client has a relationship with poses a threat to the psychologist.
Referral Fees
Standard 6.07 states: ‘When psychologists pay, receive payment from, or divide fees with another professional, other than in an employer-employee relationship, they payment to each is based on the services provided (clinical, consultative, administrative, or other) and is not based on the referral itself.’
Tarasoff Decision
The original Tarasoff decision established a ‘duty to warn’ an intended victim of a therapy client; however, in a rehearing of the case, this was changed to a ‘duty to protect’ and intended victim by warning them, notifying the police, or taking other steps. In most jurisdictions, the duty to warn/protect applies only when a client poses a clear and imminent danger to an identifiable victim or victims (although, in some jurisdictions, the duty has been expanded to include an identifiable ‘class of victims’).
Client Testimonials
Standard 5.05 states that ‘psychologists do not solicit testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence.’
Consultation
Standard 4.06 states that ‘when consulting with colleagues, (1) psychologists do not disclose confidential information that reasonably could lead to the identification of a client/patient, research participant, or other person or organization with whom they have a confidential relationship unless they have obtained the prior consent of the person or organization or the disclosure cannot be avoided, and (2) they disclose information only to the extent necessary to achieve the purposes of the consultation’.
Guidelines for Child Custody Evaluations in Family Law Proceedings
The goal of the Guidelines for Child Custody Evaluations is ‘to promote proficiency’ in the conduct of child custody evaluations, and it provides aspirational guidelines that are intended to ‘facilitate the continued systematic development of the profession and help facilitate a high level of practice by psychologists.’ It states that determining the ‘psychologist best interests’ of the child is the primary purpose of a child custody evaluation and that the child’s welfare is always of paramount importance.
Malpractice
For a client or other person to bring a claim of malpractice against a psychologist, four conditions must be met: (1) The psychologist must have had a professional relationships with the person that established a legal duty of care. (2) There must be a demonstrable standard of care that the psychologist has breached. (3) The person suffered harm or injury. (4) The psychologist’s breach of duty within the context of the standard of care was the proximate cause of the person’s harm or injury.
Responding to a Subpoena
(1) The first step is to determine if the subpoena is a legally valid demand. (2) If the subpoena is valid, a formal response is required, but the psychologist should first contact the client to discuss the implications of providing the requested information. (3) If the client consents to disclosure and there is no valid reason for withholding the information, the psychologist should provide the requested information. If the client does not consent, the psychologist or their attorney can attempt to negotiate with the party who issued the subpoena. (4) If the client does not consent and the requesting party continues to demand that the information be provided, the psychologist can seek guidance from the court informally through a letter or have their attorney file a motion to quash the subpoena or a motion for a protective order.
Test Data and Materials
Standard 9.04 defines test data as ‘raw and scaled scores, client/patient responses to test questions or stimuli, and psychologists’ notes and recordings concerning client/patient statements and behavior during an examination.’ It also states that ‘pursuant to a client/patient release, psychologists provide test data to the client/patient or other persons identified in the release’. Standard 9.11 requires psychologists to ‘make reasonable efforts’ to protect the integrity and security of test materials, which include ‘manuals, instruments, protocols, and test questions or stimuli.’
Barter
Standard 6.05 states that ‘psychologists may engage in barter for their services only when (1) it is not clinically contraindicated, and (2) the resulting arrangement is not exploitative.’
Competence to Stand Trial
Laws related to competence to stand trial were derived from the standard set forth in Dusky v. United States (1960), which defines a defendant as incompetent if, as the result of mental defect or illness, the defendant lacks ‘sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding, and … a rational as well as a factual understanding of the proceedings against him.’
Ethical Violations by Colleagues
Standard 1.04 encourages psychologists to handle ethical violations informally by discussing the matter with the offender when an ‘informal resolution appears appropriate’, while Standard 1.05 states that psychologists make a formal report to the Ethics Committee, state licensing board, or other appropriate authority when the problem involves ‘substantial harm’ and is not appropriate for an informal resolution or has not been resolved satisfactorily by an attempt at an informal resolution. These Standards also require that, before psychologists take any action, they must consider the issue of client confidentiality.
Informed Consent for Therapy
Standard 10.01 states: ‘(a) When obtaining informed consent to therapy…, psychologists inform clients/patients are early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers’.
Pro Bono Services
Although the term pro bono is not used in the Ethics Code, General Principle B (Fidelity and Responsibility) states that ‘psychologists strive to contribute a portion of their professional time for little or no compensation or personal advantage.’ Because pro bono services are addressed in the Ethics Code’s aspirational General Principles rather than in its mandatory Ethical Standards, this means that pro bono services are recommended by the Code but are not required.
Sliding Fee Scale
A sliding fee scale is not explicitly addressed by the Ethics Code but is generally considered acceptable as long as the scale is fair and serves the best interests of the client.
Child Abuse Reporting
Although the specific laws vary from jurisdiction to jurisdiction, all jurisdictions require psychologists to report known or suspected cases of child abuse to the appropriate authorities.
Complainants and Respondents
Standard 1.08 states that ‘psychologists do not deny persons employment, advancement, admissions to academic or other programs, tenure, or promotion, based solely upon their having made or their being the subject of an ethics complaint. This does not preclude taking action based upon the outcome of such proceedings or considering other appropriate information.’
Fact versus Expert Witness
A fact witness is a person ‘who testifies as to what they have seen, heard, or otherwise observed regarding a circumstance, event, or occurrence as it actually took place…Fact witnesses are generally not allowed to offer an opinion, address issues that they do not have personal knowledge of or respond to hypothetical situations’ (APA, 1998, p. 7). An expert witness is a person ‘who by reason of education or specialized experience possesses superior knowledge respecting a subject about which persons having no particular training are incapable of forming an accurate opinion or deducing correct conclusions’ (Nolan & Nolan-Haley, 1990, p. 578). A person who has been qualified as an expert witness by the court is allowed to offer opinions and provide testimony based on hypothetical scenarios.
Insanity
Insanity is a legal concept and most definitions reflect the rule set forth by the American Law Institute, which states that a person is not guilty by reason of insanity when, because of a mental disease or defect, ‘that person lacks substantial capacity to appreciate the wrongfulness of the act or lacks substantial capacity to behave according to the requirements of the law’ (Gutheil, 1995, p. 2764).
Publication Credit
Standard 8.12 states: ‘(a) Psychologists take responsibility and credit, including authorship credit, only for work they have actually performed or to which they have substantially contributed…[and] (b) Principal authorship and other publication credits accurately reflect the relative scientific or professional contributions of the individuals involved, regardless or their relative status.’
Speciality Guidelines for Forensic Psychology
The goals of the Specialty Guidelines for Forensic Psychology ‘are to improve the quality of forensic psychological services; enhance the practice and facilitate the systematic development of forensics psychology; encourage a high level of quality in professional practice; and encourage forensic practitioners to acknowledge and respect the rights of those they serve.’ It provides guidelines on several issues encountered by practitioners of ‘forensic psychology’ (e.g., multiple relationships, fees, informed consent, and confidentiality), which it defines as ‘professional practice by any psychologist working within any sub-discipline of psychology (e.g., clinical, developmental, social, cognitive) when applying the scientific, technical, or specialized knowledge of psychology to the law to assist in addressing legal, contractual, and administrative matters.’
Client Welfare
Standard 3.04 addresses client welfare in a general way and states that psychologists ‘take reasonable steps’ to avoid and minimize harm to clients, students, research participants, and others with whom they work.
Cost Analysis
Cost analysis refers to techniques that are used to assess the costs of an intervention in order to facilitate decision-making about the intervention. Methods of cost analysis include cost-benefit, cost-effectiveness, cost-utility, cost-feasibility, cost-minimization analysis, and cost-offset analysis.
Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations
The Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations presents aspirational principles and guidelines for psychologists working with members of ethnic, linguistic, and culturally diverse populations. It emphasizes the importance of competence and presents recommendations for incorporating cultural issues and knowledge into practice.
Multiple Relationships
Standard 3.05 states that ‘a psychologist refrains from entering into a multiple relationship if it could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing their functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.’
Sexual Harassment
Standard 3.02 prohibits psychologists from engaging in sexual harassment, which it defines as ‘sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature, that occurs in connection with the psychologist’s activities or roles as a psychologist, and that either (1) is unwelcome, is offensive, or creates a hostile workplace or educational environment, and the psychologist knows or is told this or (2) is sufficiently severe or intense to be abusive to a reasonable person in the context.’
Test Scoring and Interpretation Services
Standard 9.09 states: ‘(a) Psychologists who offer assessment or scoring services to other professionals accurately describe the purpose, norms, validity, reliability, and applications of the procedures and any special qualifications applicable to their use… [and] (c) Psychologists retain responsibility for the appropriate application, interpretation, and use of assessment instruments, whether they score and interpret such tests themselves or use automated or other services.’
Deception in Research
Standard 8.07 states that deception is acceptable only when the following conditions are met: (a) The use of deception is justified by the study’s significant prospective scientific, educational, or applied value and…effective non deceptive alternative procedures are not feasible’; (b) prospective participants are not deceived about conditions that can be ‘reasonably expected to cause physical pain or severe emotional distress’; and (c) participants will be debriefed ‘preferably at the conclusion of their participation, but no later than at the conclusion of the data collection.’
In-Person Solicitation
Standard 5.06 states that ‘psychologists do no engage, directly or through agents, in uninvited in-person solicitation of business from actual or potential therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence.’ It also identifies two exceptions to this prohibition-I.e., making ‘collateral contacts for the purpose of benefiting an already engaged therapy client/patient… [and] providing disaster or community outreach services.’
Obsolete Tests
Standard 9.08 states that psychologists ‘do not base their assessment or intervention decisions or recommendations on data or test results that are outdated for the current purpose…[and] do not base such decisions or recommendations on tests and measures that are obsolete and not useful for the current purpose.’
Clients Receiving Services From Another Professional
Standard 10.04 states that ‘in deciding whether to offer or provide services to those already receiving mental health services elsewhere, psychologists carefully consider the treatment issues and the potential client’s/patient’s welfare. Psychologists discuss these issues with the client/patient…and proceed with caution.’
Sexual Intimacies with Clients and Former Clients
Standard 10.05 explicitly prohibits psychologists from having sexual relationships with current clients, while 10.08 forbids a psychologist from having a sexual relationship with a former client for at least two years after cessation of therapy. The latter Standard also states that, even after the two-year limit has passed, a relationship may be acceptable only in the ‘most unusual circumstances.’ Standard 10.07 prohibits psychologists from providing therapy to people with whom they have had sexual relationships in the past.
Vicarious Liability
Under certain circumstances, supervisors and employers may be legally responsible for the actions of their supervisees and employees. This is referred to as vicarious liability (respondeat superior).
Communication/Interaction Family Therapy (Symmetrical vs. Complementary Communication)
The communication/interaction approach is associated with Jackson, Satir, Haley, and others and focuses on the impact of communication on family and individual functioning. It distinguishes between two communication patterns: Symmetrical communication occurs between equals but may escalate into a competitive one-upsmanship game, and complementary communication occurs between individuals who are unequal and emphasizes their differences.
Emic vs. Etic Orientation
Emic and etic refer to different oritentations to understanding and describing cultures. An Emic orientation is culture-specific and involves understanding the culture from the perspective of members of that culture. An etic orientation is culture-general and assumes that universal principles can be applied to all cultures.
Group Therapy (Formative Stages, Cohesiveness, Premature Termination)
According to Yalom, therapy groups typically pass through three formative stages- (1) orientation, participation, search for meaning, and dependency; (2) conflict, dominance, and rebellion; and (3) development of cohesiveness. Yalom describes cohesiveness as the most important curative factor provided by group therapy and the group therapy analog for the therapist-client relationship in individual therapy. He proposes that prescreening of potential group members and post-selection preparation can reduce premature termination from group therapy and enhance therapy outcomes.
Prevention (Primary, Secondary, Tertiary)
Methods of prevention are classified as primary, secondary, or tertiary: Primary preventions make an intervention available to all members of a target group or population in order to keep them from developing a disorder. Secondary preventions identify at-risk individuals who are showing early signs of a disorder and offer them appropriate interventions. Tertiary preventions are designed to reduce the duration and consequences of an illness that has already occurred.
Mental Health Consultation (Caplan)
Caplan distinguished between four types of mental health consultation: (1) Client-centered case consultation focuses on helping the consultee work more effectively with a particular client. (2) Consultee-centered case consultation focuses on enhancing the consultee’s ability to deliver services to a particular group or population of clients. (3) Program-centered administrative consultation involves working with one or more administrators (consultees) to resolve problems related to a particular program. (4) Consultee-centered administrative consultation involves enhancing the ability of administrators to develop, implement, and evaluate programs.
Healthcare Systems
Healthcare systems are the collaborative effort between institutions and professionals to provide serves to the public.
Cultural Competence
Sue and Sue (2003) describe cultural competence as involving three competencies: the therapist’s awareness of their cultural assumptions, values and beliefs; knowledge about the worldviews of culturally diverse clients; and skills that enable them to provide interventions that are appropriate and effective for culturally different clients.
Existential Therapy
The existential therapies are derived from existential philosophy and share an emphasis on personal choice and responsibility for developing a meaningful life. They describe maladaptive behavior as the result of an inability to cope authentically with the ultimate concerns of existence-I.e, death, freedom, existential isolation, and meaninglessness.
Health Belief Model
The health belief model proposes that health behaviors are influenced by (1) the person’s readiness to take a particular action, which is related to their perceived susceptibility to the illness and perceived severity of its consequences; (2) the person’s evaluation of the benefits and costs of making a particular response; and (3) the internal and external ‘cues to action’ that trigger the response.
Motivational Interviewing (Oars)
Motivational interviewing was developed specifically for clients who are ambivalent about changing their behavior and combines the trans theoretical (stages of change) model with client-centered therapy and the concept of self-efficacy. The specific techniques of motivational interviewing are open-ended questions, affirmations, reflective listening, and summaries (OARS).
Psychiatric Inpatients (Demographic Characteristics)
Research on the utilization rates of mental health services has provided the following information about the demographic characteristics of psychiatric inpatients: (1) For both men and women, admission rates into psychiatric hospitals are lowest among the widowed, intermediate for those who are married or divorced/separated, and highest for the never married. (2) Although Whites represent the largest number of psychiatric inpatients, when population proportions are taken into account, patients from other races are overrepresented. (3) For both men and women, the largest proportion of admissions is in the 25 to 44 age range.
Strategic Family Therapy (Paradoxical Interventions)
Haley’s strategic family therapy focuses on transactional patterns and view symptoms as interpersonal events that serve to control relationships. Therapy focuses on symptom relief (rather than insight); and involves the use of specific strategies, especially paradoxical interventions (e.g., ordeals, prescribing the symptom, reframing) that are designed to alter the behavior of family members by helping them see a symptom in an alternative way or recognize they have control over their behavior or by using their resistance in a constructive way.
Solution-Focused Therapy (Questions)
Solution-focused therapists focus on solutions to problems rather than on the problems themselves. In therapy, the client is viewed as the ‘expert’ while the therapist acts as a consultant/collaborator who poses questions designed to assist the client in recognizing and using their strengths and resources to achieve specific goals (e.g., the miracle question, exception questions, scaling questions).
Evidence-Based Treatments (EBTs)
The integration of the best available research within clinical expertise in the context of patient characteristics, culture, and preferences (APA Policy Statement on Evidence-Based Practice in Psychology, 2005).
Acculturation (Berry)
According to Berry, a person’s level of acculturation can be described in terms of four categories that reflect the person’s adoption of their own culture and the culture of the dominant group-I.e., integration (adopt cultural norms of dominant group while maintaining their culture of origin), assimilation (adopt cultural norms of dominant group over their original culture), separation (reject the cultural norms of dominant group in favor of their original culture), or marginalization (reject both culture of origin and dominant group culture).
Cybernetics (Positive and Negative Feedback Loops)
Cybernetics is concerned with communication and processes and distinguishes between negative and positive feedback loops. A negative feedback loop reduces deviation and helps a system maintain the status quo, while a positive feedback loop amplifies deviation or change and thereby disrupts the system.
Feminist Therapy (Nonsexist Therapy, Self-in-Relation Theory)
Feminist therapy is based on the premise that ‘the personal is political’. It focuses on empowerment and social change and acknowledges and minimizes the power differential inherent in the client-therapist relationship. Self-in-relation theory applies feminism to object relations theory and proposes that many gender differences can be traced to differences in the early mother-daughter and mother-son relationship. Feminist therapy must be distinguished from nonsexist therapy, which focuses more on the personal causes of behavior and personal change.
Howard and Colleagues (Dose Dependent Effect; Phase Model)
Howard et al., (1996) identified a dose dependent effect of psychotherapy-I.e, about 75% of patients show measurable improvement at 26 sessions and that this number increases to only about 85% at 52 sessions. They also identified a phase model, which predicts that the effects of psychotherapy are related to the number of sessions and distinguishes between three phases: remoralization, remediation, and rehabilitation.
Object-Relations Family Therapy (Projective Identification, Multiple Transferences)
For object relations family therapists, maladaptive behavior is the result of both intrapsychic and interpersonal factors. A primary source of dysfunction is projective identification, which occurs when a family member projects old introjects onto another family member and then reaches to that person as though they actually have the projected characteristics or provokes the person to act in ways consistent with those characteristics. The primary goal of therapy is to resolve each family member’s attachment to family introjects and involves addressing multiple transferences (I.e, transferences of one family member to another, transferences of each member to the therapist, and transferences of the family as a whole to the therapist).
Separation-Individuation (Mahler’s)
Mahler’s version of object relations theory focuses on the processes by which an infant assumes their own physical and psychological identity, and her model of early development involves several phases. The development of object relations occurs during the separation-individuation phase, which begins at four to five months of age. According to Mahler, adult psychopathology can be traced to problems that occurred during separation-individuation.
Transtheoretical Model (Stages of Change)
Prochaska and DiClemente’s (1992) transtheoretical model of behavior change proposes that the change process involves six stages (precontemplation, contemplation, preparation, action, maintenance, termination) and that interventions are most effective when they match the person’s stage of change-e.g., consciousness raising, dramatic relief, and environmental reevaluation are useful for helping clients transition from the precontemplation to the contemplation stage.
Triangular Model
A form of supervision that emphasizes providing service to clients that includes organizational policies, professional knowledge, and the supervisory relationship.
Adler’s Individual Psychology
Adler’s personality theory and approach to therapy stress the unity of the individual and the belief that behavior is purposeful and goal-directed. Key concepts are inferiority feelings, striving for superiority, and style of life (which unifies the various aspects of an individual’s personality). Maladaptive behavior represents a mistaken style of life that reflects inadequate social interest. Adler’s teleological approach regards behavior as being largely motivated by a person’s future goals rather than determined by past events.
Diagnostic Overshadowing
Diagnostic overshadowing was originally used to describe the tendency of health professionals to attribute all of a person’s psychiatric symptoms to their intellectual disabilities. Subsequent research found that diagnostic overshadowing applies to other conditions and diagnoses.
Freudian Psychoanalysis
According to Freud,, when the ego is unable to ward off danger (anxiety) through rational, realistic means, it may resort to one of its defense mechanisms (e.g., repression, reaction formation) which share two characteristics: They operate on an unconscious level and they serve to deny or distort reality. In psychoanalysis, the analysis of free associations, dreams, resistances, and transferences consists of a combination of confrontation, clarification, interpretation, and working through.
Hypnosis (Repressed Memories)
Orne and Dinges propose that hypnosis involves experiencing alterations of memory, perception, and mood in response to suggestions and characterize its essential features as ‘subjective experiential change’ (1989, p. 1503). Although hypnosis has been used to help people recover repressed memories, the research suggests that it does not seem to enhance the accuracy of memories, may produce more pseudomemories (inaccurate or confabulated memories) than accurate memories, and may exaggerate a person’s confidence in the validity of uncertain memories, especially for those that are inaccurate.
Parallel Process
Parallel process occurs in clinical supervision when the therapist (supervisee) behaves toward their supervisor in ways that mirror how the client is behaving toward the therapist.
Sexual Minorities (Internalized homophobia, coming out)
Issues faced by lesbian, gay, bisexual, and transsexual (LGBT) individuals include internalized homophobia and coming out: Internalized homophobia occurs when LGBT individuals accept negative stereotypes about sexual minorities and incorporate them into their self-concept. Consequences include low self-esteem, self-doubt, and self-destructive behavior. Coming out (disclosing one’s sexual orientation) to family members, friends, and others is associated with rejection and other negative consequences as well as with higher levels of self-esteem and positive affectivity, lower levels of anxiety, and other positive consequences. Research suggests that the age of coming out is about the same for gay males and lesbians.
Treatment Manuals
Treatment manuals were originally developed to standardize psychotherapeutic treatments so their effects could be empirically evaluated and to provide guidelines for training therapists. They specify the theoretical underpinnings of the treatment along with treatment goals and specific therapeutic guidelines and strategies. A potential limitation of treatment manuals is that they may oversimplify the therapeutic process.
Telepsychology
The use of the telephone, text, e-mail, chats, interactive tele-video conferencing technologies, or virtual reality for mental health assessment and treatment.
Cultural Encapsulation (Wrenn)
Culturally encapsulated counselors interpret everyone’s reality through their own cultural assumptions and stereotypes and disregard cultural differences and their own cultural biases.
Extended Family Systems Therapy (Differentiation, Emotional Triangle, Genogram)
Bowen’s approach to family therapy extends general systems theory beyond the nuclear family. Key terms include differentiation of self and emotional triangles: Differentiation refers to a person’s ability to separate their intellectual and emotional functioning, which helps keep the person from becoming ‘fused’ with the emotions that dominate the family. An emotional triangle develops when a two-person system attempts to reduce instability or stress by recruiting a third person into the system. Therapy often begins with the construction of a genogram, which depicts the relationships between family members, the dates of significant life events, and other important information. The therapist often sees two members of the family (spouses) and forms a therapeutic triangle in which the therapist comes into emotional contact with the family members but avoids becoming emotionally triangled. The goal is to increase the differentiation of all family members.
High vs. Low Context Communication
Members of many culturally diverse groups in America exhibit high-context communication, which relies on shared cultural understanding and nonverbal cues. It helps unify a culture and is slow to change. In contrast, Anglos are more likely to exhibit low-context communication, which relies primarily on the verbal message, is less unifying than high-context communication, and can change rapidly and easily. Differences in communication style can lead to misunderstandings in cross-cultural therapy.
Multisystems Model (Boyd—Franklin)
Boyd-Franklin’s multisystems model is an eco structural approach for African American families that addresses multiple systems, intervenes at multiple levels, and empowers the family by utilizing its strengths. Systems that may be incorporated into treatment include the extended family and non blood kin, the church and other community resources, and social service agencies.
Racial/Cultural Identity Development Model
The RacialCultural Identity Development Model (Atkinson, Morten, & Sue, 1993) distinguishes between five stages that people experience as they attempt to understand themselves in terms of their own minority culture, the dominant culture, and the oppressive relationship between the two cultures. The five stages are conformity (positive attitudes for the dominant group), dissonance (confusion and conflict over contradictory attitudes), resistance and immersion (active rejection of the dominant group), introspection (uncertainty about the rigidity of Stage 3 beliefs), and integrative awareness (adoption of a multicultural perspective).
Structural Family Therapy (Boundaries, Rigid Triads, Joining)
Minuchin’s structural family therapy emphasizes altering the family’s structure in order to change the behavior patterns of family members. Boundaries (rules that determine the amount of contact that is allowed between family members) are one element of the family structure: When boundaries are overly rigid, family members are disengaged and when they are too diffuse or permeable, family members are enmeshed. Minuchin distinguished between three chronic boundary problems, or rigid triads: detouring, stable coalition, and triangulation.
Resilience
Resilience is the psychological capacity to cope with socio-environmental challenges.
Cultural vs. Functional Paranoia
Ridley described non disclosure by African American therapy clients as being due to two types of paranoia: A client is exhibiting cultural paranoia (which is a healthy reaction to racism) when they do not disclose to a white therapist due to a fear of being hurt or misunderstood. A client is exhibiting functional paranoia (which is due to pathology) when they are unwilling to disclose to any therapist, regardless of race or ethnicity, as a result of mistrust and suspicion.
Eysenck
Eysenck was a British psychologist known for his factor analysis of personality traits, contributions to behavior therapy, and 1952 review of psychotherapy outcome studies in which he found that 72% of untreated neurotic individuals improved without therapy, while 66% of patients receiving eclectic psychotherapy and 44% receiving psychoanalytic psychotherapy showed a substantial decrease in symptoms. Based on these findings, Eysenck concluded that any apparent benefit of therapy is due to spontaneous remission.
Homosexual (Gay/Lesbian) Identity Development Model
Troiden’s (1988) model of homosexual identity development distinguishes between four stages-sensitization/feeling different, self-recognition/identity confusion, identity assumption, and commitment/identity commitment.
Network Therapy
Network therapy has been identified as an effective intervention for American Indian clients and is often used as a treatment for alcohol and drug abuse. It is a multimodal treatment that incorporates family and community members into the treatment process and situates an individual’s problems within the context of their family, workplace, community, and other social systems.
Reality Therapy
Glasser’s reality therapy is based on choice theory, which assumes that people are responsible for the choices they make and focuses on how people make choices that affect the course of their lives. It proposes that people have five basic innate needs (survival, love and belonging, power, freedom, and fun) and that a person adopts a success (versus failure) identity when they fulfill these needs in a responsible way.
Therapist-Client Matching
Research on therapist-client matching in terms of race, ethnicity, or culture has produced inconsistent results. However, matching may reduce premature termination for members of some groups (e.g, Asian and Hispanic/Latino). Some research suggests that other factors (e.g., similarity in values and worldview) are more important than similarity in terms of race, ethnicity, or culture.
Health Promotion
Health promotion involves several different methods of encouraging healthy behaviors, such as advertising and increased education.
Alloplastic vs. Autoplastic Interventions
In the context of psychotherapy, alloplastic and autoplastic refer to the focus of an intervention with regard to the environment. The goal of an alloplastic intervention is to make changes in the environment so it better accommodates the individual, while the goal of an autoplastic intervention is to change the individual so that they are better able to function effectively in their environment.
Double-Bind Communication
As originally defined by Bateson, Jackson, Haley, and Weakland (1956), double-bind communication is an etiological factor for schizophrenia and involves conflicting negative interjunctions-e.g., ‘do that and you’ll be punished’ and ‘don’t do that and you’ll be punished’-with one injunction often being expressed verbally and the other non verbally. In addition, the recipient of the contradictory injunctions is not allowed to comment on them or seek help from someone else.
General Systems Theory
General systems theory defines a system as an entity that is maintained by the mutual interactions of its components and assumes that the actions of interactions are best understood by studying them in their context. Consistent with general systems theory, family therapists view the family as primarily an open system that continuously receives input from and discharges output to the environment and is adaptable to change. The influence of general systems theory on family therapy is evident in the concept of homeostasis, which is the tendency for a family to act in ways that maintain the family’s equilibrium or status quo.
Interpersonal Therapy (Primary Problem Areas)
Interpersonal therapy (IPT) is a brief manual-based therapy that was originally developed as a treatment for depression, but it has since been applied to a number of other conditions. IPT focuses on symptom reduction and resolving one or more primary areas of interpersonal functioning-unresolved grief, interpersonal role disputes, role transitions, and interpersonal deficits.
Person-Centered Therapy (Facilitative Conditions)
Rogers’ person-centered therapy is based on the assumptions that people possess an inherent ability for growth and self-actualization and that maladaptive behavior occurs when ‘incongruence between self and experience’ disrupts this natural tendency. The therapist’s role is to provide the client with three facilitative conditions (empathy, genuineness, and unconditional positive regard) that enable the client to return to their natural tendency for self-actualization.
Sexual Stigma, Heterosexism, and Sexual Prejudice (Herek)
Herek (2004) argues that the term homophobia is ambiguous and imprecise and proposes that it be replaced with sexual stigma, heterosexism, and sexual prejudice. Sexual stigma refers to ‘the shared knowledge of society’s negative regard for any nonheterosexual behavior, identity, relationship, or community’ (p. 15). Heterosexism refers to cultural ideologies, which are ‘systems that provide the rationale and operating instructions’ (p. 15) that promote and perpetrate antipathy, hostility, and violence against homosexuals. Sexual prejudice refers to negative attitudes that are based on sexual orientation, whether the target is homosexual, bisexual, or heterosexual. Herek found higher levels of sexual prejudice among heterosexual men (versus heterosexual women) and among individuals who are older, have lower levels of education, live in Southern or Midwestern states or in rural areas, or have limited personal contact with homosexuals.
White Racial Identity Development Model
According to Helms (1990), White racial identity development involves two phases: abandoning racism (statuses 1-3) and developing a non racist white identity (statuses 4-6). Her White Racial Identity Development Model involves six statuses (stages): contact (little awareness of racism), disintegration (increasing awareness of race and racism which leads to confusion and conflict), reintegration (idealization of White society and denigration of members of minority groups), pseudo-independence (questioning of racist views), immersion-emersion (confrontation of own biases), and autonomy (internalization of a non racist White identity).
Black Racial (Nigrescence) Identity Development Model
Cross’s Black Racial Identity Development Model consists of four stages: During the pre-encounter stage, race and racial identity have low salience. In the encounter stage, the person has greater racial/cultural awareness and is interested in developing a Black identity. In the immersion/emersion stage, race and racial identity have high salience and the person moves from intense Black involvement (immersion) to strong anti-White attitudes (emersion). Finally, during the internalization stage, race continues to have high salience and the person adopts an Afrocentric, biculturist, or multiculturist orientation.
Gestalt Therapy (Boundary Disturbance, Transference, Awareness)
Gestalt therapy views ‘awareness’ (a full understanding of one’s thoughts, feelings, and actions in the here-and-now) as the primary curative factor and defines neurosis as a ‘growth disorder’ that is often attributable to a boundary disturbance (e.g., introjection) that leads to an abandonment of the self for the self image. Gestaltians regard a client’s transference to be counterproductive and respond to it by helping the client recognize the difference between their ‘transference fantasy’ and reality.
Jung’s Analytical Psychotherapy
Analytical psychotherapy views behavior as being determined by both conscious and unconscious factors, including the collective unconscious which is the repository of latent memory traces that have been passed down from one generation to the next. Included in the collective unconscious are archetypes (primordial images) that cause people to experience certain phenomena in universal ways. Therapeutic strategies include the interpretation of dreams and transferences (which reflects projections of both the personal and collective unconscious). A key concept in Jung’s personality theory is individuation, which refers to an integration of the conscious and unconscious aspects of the psyche that occurs in the later years and leads to a unique identity and the development of wisdom.
Efficacy vs. Effectiveness Research
An ongoing debate on psychotherapy outcome research is over the best way to evaluate the effects of psychotherapy. On one side of the argument are experts who support efficacy studies (clinical trials); on the other are those who prefer effectiveness studies, which are correlational or quasi-experimental in nature.
Personal Construct Therapy
George Kelly’s personal construct therapy focuses on how the client experiences the world. It assumes that a person’s psychological processes are determined by the way they ‘construe’ (perceives, interprets, and predicts) events, with construing involving the use of personal constructs, which are bipolar dimensions of meaning (e.g., happy/sad, competent/incompetent) that begin to develop in infancy and may operate on an unconscious or conscious level. The goal of therapy is to help the client identify and revise or replace maladaptive personal constructs so that the client is better able to ‘make sense’ of their experiences.
Smith, Glass, and Miller (Meta-Analysis/Effect Size)
Smith et al. used meta-analysis to combine the results of the psychotherapy outcome studies and found, contrary to Eysenck, that psychotherapy does have substantial benefits. In one study, they obtained an average effect size of .85, which indicates that the typical therapy client is better off than 80% of individuals who need therapy but are untreated.
Worldview (Sue)
As defined by Sue (1978), a person’s worldview is affected by their cultural background and is determined by two factors-locus of control and locus of responsibility. Differences in worldview can affect the therapeutic process. For example, White middle-class therapists typically have an internal locus of control and internal locus of responsibility (IC-IR) and are likely to have problems working with an African-American client with an internal locus of control and external locus of responsibility (IC-ER) who may challenge the therapist’s authority and trustworthiness and be reluctant to self-disclose.
Bipolar I Disorder
A diagnosis of Bipolar I Disorder requires at least one manic episode that lasts for at least one week, is present most of the day nearly every day, and includes at least three characteristic symptoms-e.g., inflated self-esteem or grandiosity; decreased need for sleep; flight of ideas. Symptoms must cause marked impairment in social or occupational functioning, require hospitalization to avoid harm to self or others, or include psychotic features. This disorder may include one or more episodes of hypomania or major depression. Treatment usually includes lithium or an anti-seizure medication and cognitive-behavior therapy or other form of therapy.
Cyclothymic Disorder
Cyclothymis Disorder is characterized by multiple periods of hypomanic symptoms that do not meet the criteria for a hypomanic episode and multiple episodes of depressive symptoms that do not meet the criteria for a major depressive episode. Symptoms must last for at least two years in adults and one year in children and adolescents.
Alcohol-Induced Disorders (Withdrawal, Korsakoff Syndrome, Sleep Disorder)
Alcohol Withdrawal is diagnosed in the presence of at least two characteristic symptoms within several hours to a few days following cessation or reduction of alcohol consumption; autonomic hyperactivity; hand tremor; insomnia; nausea or vomiting; transient illusions or hallucinations; anxiety; psychomotor agitation; generalized tonic-clonic seizures. The DSM-5 distinguishes between two types of Alcohol-Induced Major Neurocogntive Disorder-nonamnestic-confabulatory type and amnestic-confabulatory type. The amnestic-confabulatory type is also known as Korsakoff Syndrome, and it is characterized by anterograde and retrograde amnesia and confabulation and has been linked to a thiamine deficiency. Alcohol-Induced Sleep Disorder is usually of the insomnia type and can be the result of either Intoxication or Withdrawal.
Dopamine Hypothesis
The dopamine hypothesis attributes Schizophrenia to elevated levels of or oversensitivity to dopamine.
Genito-Pelvic Pain/Penetration Disorder
This disorder is diagnosed in the presence of persistent difficulties involving at least one of the following: vaginal penetration during intercourse; Genito-pelvic pain during intercourse or penetration attempts; anxiety about Genito-pelvic pain before, during, or as a result of vaginal penetration; tensing of pelvic floor muscles during attempted vaginal penetration.
Major Depressive Disorder with Seasonal Pattern
The seasonal pattern specifier is applied to Major Depressive Bipolar I disorder, and Bipolar II Disorder when there is a temporal relationship between the onset of a mood episode and a particular time of the year. This condition is also known as Seasonal Affective Disorder (SAD) and, in the Northern Hemisphere, most commonly occurs during the winter months. People with SAD usually experience hypersomnia, increased appetite and weigh gain, and a craving for carbohydrates.
Obsessive-Compulsive Personality Disorder
Obsessive-Compulsive Personality Disorder is characterized by a persistent preoccupation with orderliness, perfectionism, and mental and interpersonal control that severely limits the individual’s flexibility, openness, and efficiency. At least four characteristic symptoms must be present-e.g., exhibits perfectionism that interferes with task completion; is excessively devoted to work and productivity to the exclusion of leisure activities and friendships; is reluctant to delegate work to others unless they are willing to do it their way; adopts a miserly spending style toward self and others.
Posttraumatic Stress Disorder (PTSD)
The diagnosis of PTSD requires exposure to actual or threatened death, serious injury, or sexual violence; presence of at least one intrusion symptom related to the event; persistent avoidance of stimuli associated with the event; negative changes in cognition or mood associated with the event; and marked change in arousal and reactivity associated with the event. Symptoms must have a duration of more than one month and must cause clinically significant distress or impaired functioning. The treatment-of-choice is a comprehensive cognitive-behavioral intervention that incorporates exposure, cognitive restructuring, and anxiety management or similar techniques.
Schizotypal Personality Disorder
Schizotypal Personality Disorder is diagnosed in the presence of (a) pervasive social and interpersonal deficits involving acute discomfort with and reduced capacity for close relationships and (b) eccentricities in cognition, perception, and behavior as manifested by the presence of at least five symptoms-e.g., ideas of reference; odd beliefs or magical thinking that influence behavior; bodily illusions and other unusual perceptions; is suspicious or has paranoid ideation; inappropriate or constricted affect; lacks close friends or confidants other than first-degree relatives; excessive social anxiety.
Tobacco Withdrawal
Tobacco Withdrawal is characterized by the development of at least four characteristic symptoms within 24 hours of abrupt cessation or reduction in the use of tobacco-i.e., irritability or anger, anxiety, impaired concentration, increased appetite, restlessness, depressed mood, insomnia.
Anorexia Nervosa
The essential features of Anorexia Nervosa are (a) a restriction of energy intake that leads to a significantly low body weight; (b) an intense fear of gaining weight or becoming fat or behavior that interferes with weight gain; (c) a disturbance in the way the person experiences their body weight or shape or a persistent lack of recognition of the seriousness of their low body weight.
Bipolar II Disorder
A diagnosis of Bipolar II Disorder requires at least one hypomanic episode and at least one major depressive episode. A hypomanic episode lasts for at least four consecutive days and involves at least three symptoms that are also associated with a manic episode but are not severe enough to cause marked impairment in functioning or require hospitalization. A major depressive episode lasts for at least two weeks and involves at least five characteristics symptoms, at least one of which must be a depressed mood or a loss of interest or pleasure.
Delirium
A diagnosis of Delirium requires (a) a disturbance in attention and awareness that develops over a short period of time, represents a change from baseline functioning, and tends to fluctuate in severity over the course of a day and (b) an additional disturbance in cognition (e.g., impaired memory, disorientation, impaired language, deficits in visuospatial ability, perceptual distortions). Symptoms must not be due to another Neurocognitive Disorder and must not occur during a severely reduced level of arousal (e.g., during a coma), and there must be evidence that symptoms are the direct physiological consequence of a medical condition, substance intoxication or withdrawal, and/or exposure to a toxin.
DSM-5
The DSM-5 utilizes a categorical approach that divides the mental disorders into types that are defined by a set of diagnostic criteria and requires the clinician to determine whether or not a client meets the minimum criteria for a given diagnosis. To allow for individual differences, it includes a polythetic criteria set for most disorders that requires a client to present with only a subset of characteristics from a larger list. It provides a nonaxial assessment system in which all mental and medical diagnoses are listed together with the primary diagnoses listed first.
Histrionic Personality Disorder
Histrionic Personality Disorder is characterized by a pervasive pattern of emotionality and attention-seeking as manifested by at least five characteristic symptoms-e.g., discomfort when not the center of attention; inappropriately sexually seductive or provocative; rapidly shifting and shallow emotions; consistent use of physical appearance to gain attention; considers relationships to be more intimate than they are.
Malingering
Malingering is included in the DSM-5 with Other Conditions that May Be a Focus of Clinical Attention. It involves the intentional production, faking, or gross exaggeration of physical or psychological symptoms to obtain an external reward (e.g., to avoid criminal prosecution or obtain financial compensation).
Opioid Withdrawal
Opioid Withdrawal occurs following cessation or reduction in the use of an opioid following prolonged or heavy use or administration of an opioid antagonist following a period of opioid use. The diagnosis requires at least three characteristic symptoms: dysphoric mood; nausea or vomiting; muscle aches; lacrimation or rhinorrhea; pupillary dilation; piloerection, or sweating; diarrhea; yawning; fever; insomnia.
Premature Ejaculation
Premature Ejaculation is diagnosed in the presence of a persistent or recurrent pattern of ejaculation during partnered sexual activity within about one minute of vaginal penetration or before the person desires it. The disturbance must have been present for at least six months, be experienced on all or almost all occasions of sexual activity, and cause clinically significant distress. Treatment often includes use of the start-stop or squeeze technique.
Separation Anxiety Disorder
Separation Anxiety Disorder involves developmentally inappropriate and excessive fear or anxiety related to separation from home or attachment figures as evidenced by at least three symptoms-e.g., recurrent excessive distress when anticipating or experiencing separation from home or major attachment figures; persistent excessive fear of being alone; repeated complaints of physical symptoms when separation from an attachment figure occurs or is anticipated. The disturbance must last at least four weeks in children and adolescents or six months in adults and must cause clinically significant distress or impaired functioning.
Tourette’s Disorder
Tourette’s Disorder is characterized by the presence of at least one vocal tic and multiple motor tics that may appear simultaneously or at least different times, may wax and wane in frequency, have persisted for more than one year, and began prior to age 18.
Acupuncture
Acupuncture is a traditional Asian method for restoring health and involves stimulating specific anatomical points on the body, usually with a thin metallic needle. The traditional explanation for its effects is that illness is due to a blockage of qi (vital life energy) and that acupuncture unblocks the flow of qi along the pathways through which it circulates in the body. Research suggests that its benefits may be due to the release of pain-suppressing substances or to an alteration in blood flow in areas around the needle or in certain regions of the brain.
Autism Spectrum Disorder
For a diagnosis of Autism Spectrum Disorder, the individual must exhibit (a) persistent deficits in social communication and interaction across multiple contexts as manifested by deficits in social-emotional reciprocity, nonverbal communication, and the development, maintenance, and understanding of relationships; (b) restricted, repetitive patterns of behavior, interests, and activities as manifested by at least two characteristic symptoms (e.g., stereotyped or repetitive motor movements, use of objects, or speech; inflexible adherence to routines, or ritualized patterns of behavior); (c) the presence of symptoms during the early developmental period; and (d) impaired functioning as the result of symptoms. The best outcomes are associated with an ability to communicate by age 5 or 6, an IQ over 70, and a later onset of symptoms.
Bulimia Nervosa
Bulimia Nervosa is characterized by (a) recurrent episodes of binge eating that are accompanied by a sense of a lack of control; (b) inappropriate compensatory behavior to prevent weight gain (e.g., self-induced vomiting, excessive exercise); and (c) self-evaluation that is unduly influenced by body shape and weight.
Depressive Cognitive Triad
According to Beck, the cognitive profile for depression involves a cognitive triad-i.e., negative beliefs about oneself, the world (situation), and the future.
Expressed Emotion and Schizophrenia
A high level of expressed emotion by family members toward the member of Schizophrenia is associated with a high risk for relapse and rehospitalization. High expressed emotion is characterized by open criticism and hostility toward the patient or, alternatively, overprotectiveness and emotional over involvement.
Learned Helplessness Model
Seligman’s learned helplessness model proposes that depression is due to exposure to uncontrollable negative events and internal, stable, and global attributions for those events. A reformulation of the theory by Abramson, Metalsky, and Alloy emphasizes the role of hopelessness.
Narcolepsy
Narcolepsy is characterized by attacks of an irrepressible need to sleep with lapses into sleep or daytime naps that occur at least three times per week and have been present for at least three months. The diagnosis also requires episodes of cataplexy, a hypocretin deficiency, or a rapid eye movement latency less than or equal to 15 minutes.
Panic Disorder
Panic Disorder is characterized by recurrent unexpected panic attacks with at least one attack being followed by one month of persistent concern about having additional attacks or about their consequences and/or involving a significant maladaptive change in behavior related to the attack. Cognitive behavioral interventions that incorporate exposure are the treatment-of-choice for this disorder.
Risk Factors for Suicide
High risk for suicide is associated with a warning; previous attempts; a plan (especially one involving a lethal weapon); male gender; being divorced, separate, or widowed; and feelings of hopelessness. For most age groups, the rates are highest for Whites; an exception is for American-Indian/Alaskan Native individuals ages 15 to 34 who have a rate 2.5 times higher than the national average for this age group. Of the mental disorders, the highest risk is associated with Major Depression and Bipolar Disorder. Suicide attempters (vs. completers) are most likely to be female.
Specific Phobia
Specific Phobia is characterized by intense fear of or anxiety about a specific object or situation, with the individual either avoiding the object or situation or enduring it with marked distress. The fear or anxiety is not proportional to the danger posed by the object or situation, is persistent (typically lasting for at least 6 months), and causes clinically significant. distress or impaired functioning. The treatment-of-choice is exposure with response prevention (especially in vivo exposure).
Acute Stress Disorder
The diagnosis of Acute Stress Disorder requires the development of at least nine symptoms following exposure to actual or threatened death, severe injury, or sexual violation in at least one of four ways (direct experience of the event; witnessing the event in person as it happened to others; learning that the event occurred to a close family member or friend; repeated or extreme exposure to aversive details of the event). Symptoms can be from any of five categories (intrusion, negative mood, dissociative symptoms, avoidance symptoms, arousal symptoms), have a duration of three days to one month, and cause clinically significant distress or impaired functioning.
Avoidant Personality Disorder
Avoidant Personality Disorder is characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, as indicated by at least four characteristic symptoms-e.g., avoids work activities involving interpersonal contact due to a fear of criticism, rejection, or disapproval; is unwilling to get involved with people unless certain of being liked; is preoccupied with concerns about being criticized or rejected; views self as socially inept, inferior, or unappealing to others.
Concordance Rates for Schizophrenia
The rates of schizophrenia are higher among individuals with genetic similarity, and, the greater the similarity, the higher the concordance rates: For example, for biological siblings, the rate is 10%; and, for identical (monozygotic) twins, the rate is 48%.
Diagnostic Uncertainty
When using the DSM-5, diagnostic uncertainty about a client’s diagnosis is indicated by coding one of the following: Other specified disorder is coded when the clinician wants to indicate the reason why the client’s symptoms do not meet the criteria for a specific diagnosis, while unspecified disorder is coded when the clinician does not want to indicate the reason why the client’s symptoms do not meet the criteria for a specific diagnosis.
Factitious Disorder
Individuals with Factitious Disorder imposed on Self falsify physical or psychological symptoms that are associated with their deception, present themselves to others as being ill or impaired, and engage in the deceptive behavior even in the absence of an obvious external reward for doing so. Individuals with Factitious Disorder imposed on Another falsify physical or psychological symptoms in another person, present that person to others as being ill or impaired, and engage in the deceptive behavior even in the absence of an external reward. For both types of Factitious Disorder, falsification of symptoms can involve feigning, exaggeration, simulation, or induction (e.g., by ingestion of a substance or self-injury).
Major and Mild Neurocognitive Disorder
Major Neurocognitive Disorder (formerly Dementia) is diagnosed when there is evidence of significant decline from a previous level of functioning in one or more cognitive domains that interferes with the individual’s independence in everyday activities and does not occur only in the context of Delirium. Mild Neurocognitive Disorder (formerly Cognitive Disorder NOS) is the appropriate diagnosis when there is evidence of a modest decline from a previous level of functioning in one or more cognitive domains that does not interfere with the individual’s independence in everyday activities and does not occur only in the context of Delirium. Subtypes are based on etiology and include Major and Mild Neurocognitive Disorder Due to Alzheimer’s disease, Vascular Disease, Traumatic Brain Injury, HIV infection, Parkinson’s disease, and Huntington’s Disease.
Neurocognitive Disorder Due to Alzheimer’s Disease
This disorder is diagnosed when the criteria for Major or Mild Neurocognitive Disorder are met, there is an insidious onset and gradual progression of impairment in one or more cognitive domains (or at least two domains for Major Neurocognitive Disorder), and the criteria for probably or possible Alzheimer’s disease are met. It involves a slow, progressive decline in cognitive functioning that can be described in terms of the following stages: Stage 1 (1 to 3 years) involves anterograde amnesia (especially for declarative memories); deficits in visuospatial skills (wandering); indifference, irritability, and sadness; and anomia. Stage 2 (2 to 10 years) is characterized by increasing retrograde amnesia; flat or labile mood; restlessness and agitation; delusions; fluent aphasia; acalculia; and ideomotor apraxia (inabilities to translate an idea into movement). Stage 3 (8 to 12 years) entails severely deteriorated intellectual functioning; apathy; limb rigidity; and urinary and fecal incontinence.
Paranoid Personality Disorder
Paranoid Personality Disorder involves a pervasive pattern of distrust and suspiciousness that entails interpreting the motives of others as malevolent. The diagnosis requires the presence of at least four characteristic symptoms-e.g., suspects that others are exploiting, harming, or deceiving them without a sufficient basis for doing so; reads demeaning content into benign remarks or events; persistently bears grudges; is persistently suspicious about the fidelity of their spouse or sexual partner without justification.
Schizoid Personality Disorder
Schizoid Personality Disorder involves a pervasive pattern of detachment from interpersonal relationships and a restricted range of emotional expression in social settings with at least four characteristic symptoms-doesn’t desire or enjoy close relationships; almost always chooses solitary activities; has little interest in sexual relationships; takes pleasure in few activities; lacks close friends or confidants other than first-degree relatives; seems indifferent to praise or criticism; exhibits emotional coldness or detachment.
Substance Use Disorders
The Substance Use Disorders are characterized by a ‘cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems’ (APA, 2013, p. 483) as manifested by at least two symptoms during a 12-month period-e.g., substance used in larger amounts or for a longer period of time than intended; persistent desire or unsuccessful efforts to cut down or control use; craving for the substance; recurrent substance use despite persistent social problems caused or worsened by substance use; recurrent substance use in situations in which it is physically dangerous to do so; tolerance; withdrawal.
Antisocial Personality Disorder
Antisocial Personality Disorder is characterized by a pattern of disregard for an violation of the rights of others that has occurred since age 15 and involves at least three characteristic symptoms-e.g., failure to conform to social norms with respect to lawful behavior; deceitfulness; impulsivity; reckless disregard for the safety of self and others; lack of remorse. The person must be at least 18 years old and have a history of Conduct Disorder before 15 years of age.
Borderline Personality Disorder
The essential feature of Borderline Personality Disorder is a pervasive pattern of instability in interpersonal relationships, self-image, and affect, and marked impulsivity. At least five characteristic symptoms must be present-e.g., frantic efforts to avoid abandonment; pattern of unstable, intense interpersonal relationships that are marked by fluctuations between idealization and devaluation; an identity disturbance involving a persistent instability in self-image or sense of self; recurrent suicide threats or gestures; transient stress-related paranoid ideation or severe dissociative symptoms.
Delusional Disorder
Delusional Disorder involves one or more delusions that last at least one month. Overall psychosocial functioning is not markedly impaired, and any impairment is directly related to the delusions. The DSM-5 distinguishes between the following subtypes: erotomanic, grandiose, jealous, persecutory, somatic, mixed, and unspecified.
Enuresis
Enuresis involves repeated voiding of urine into the bed or clothes at least twice a week for three or more consecutive months. Urination is usually involuntary but can be intentional and is not due to substance use or a medical condition. Enuresis is diagnosed only when the individual is at least five years old or the equivalent developmental level. The bell-and-pad (urine alarm) is the most common treatment.
Insomnia Disorder
Insomnia Disorder is characterized by dissatisfaction with sleep quality or quantity that is associated with at least one characteristic symptom-difficulty initiating sleep; difficulty maintaining sleep; early morning awakening with an inability to return to sleep. The sleep disturbance occurs at least three nights each week, has been present for at least three months, occurs despite sufficient opportunities for sleep, and causes significant distress or impaired functioning.
Marlatt and Gordon/Relapse Prevention Therapy
Marlatt and Gordon view addiction as an ‘overlearned maladaptive habit pattern’, and their relapse prevention therapy focuses on identifying circumstances that increase the risk for relapse and implementing cognitive and behavioral strategies that help the client prevent and cope effectively with lapses.
Oppositional Defiant Disorder
Oppositional Defiant Disorder involves a recurrent pattern of an angry/irritable mood, argumentative/defiant behavior, or vindictiveness as evidence by at least four characteristic symptoms that are exhibited during interactions with at least one person who is not a sibling-e.g., often loses temper; often argues with authority figures; often actively refuses to comply with requests from authority figures or with rules; often blames others for their mistakes.
Prognosis for Schizophrenia
A better prognosis for schizophrenia is associated with good premorbid adjustment, an acute and late onset, female gender, the presence of a precipitating event, a brief duration of active-phase symptoms, insight into the illness, a family history of a mood disorder, and no family history of schizophrenia.
Social Anxiety Disorder
Social Anxiety Disorder involves intense fear or anxiety about one or more social situations in which the individual may be exposed to scrutiny by others. The individual fears that they will exhibit anxiety symptoms in these situations that will be negatively evaluated; they avoid the situations or endure them with intense fear or anxiety; and their fear or anxiety is not proportional to the threat pose by the situations. The fear, anxiety, and avoidance are persistent and cause clinically significant distress or impaired functioning. Exposure with response prevention is an effective treatment, and its benefits may be enhanced when it is combined with social skills training or cognitive restructuring and other cognitive techniques.
Uncomplicated Bereavement
Uncomplicated Bereavement is included in the DSM-5 with Other Conditions that May Be a Focus of Treatment and is described as ‘a normal reaction to the death of a loved on’ (APA, 2013, p. 716). Uncomplicated bereavement may include symptoms of a major depressive episode, but the individual usually experiences the symptoms as normal and may be seeking treatment for insomnia, anorexia, or other associated symptoms.
Attention-Deficit/Hyperactivity Disorder
ADHD is the appropriate diagnosis when the individual has at least six symptoms of inattention and/or six symptoms of hyperactivity-impulsivity and symptoms had an onset prior to 12 years of age, are present in at least two settings (e.g., home and school), and interfere with social, academic, or occupational functioning. About 15% of children with ADHD continue to meet the full diagnostic criteria for the disorder as young adults and another 60% meet the criteria for ADHD in partial remission. In adults, inattention predominates the symptom profile.
Brief Psychotic Disorder
Brief Psychotic Disorder is characterized by the presence of one or more of four characteristic symptoms (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior) with at least one symptom being delusions, hallucinations, or disorganized speech. Symptoms are present for at least one day but less than one month with an eventual return to full premorbid functioning.
Dependent Personality Disorder
Dependent Personality Disorder involves a pervasive and excessive need to be taken care of, which leads to submissive, clinging behavior and a fear of separation as manifested by at least five symptoms-e.g., has difficulty making decisions without advice and reassurance from others; fears disagreeing with others because it might lead to a loss of support; has difficulty initiating projects on their own; goes to great lengths to gain nurturance and support from others; is unrealistically preoccupied with fears of being left to care for themselves.
Erectile Disorder
A diagnosis of Erectile Disorder requires the presence of at least one of three symptoms (marked difficulty in obtaining an erection during sexual activity, marked difficulty in maintaining an erection until completion of sexual activity, marked decrease in erectile rigidity) on all or almost all occasions of sexual activity.
Intellectual Disability
Intellectual Disability is diagnosed in the presence of (a) deficits in intellectual functions (e.g., reasoning, problem solving, abstract thinking); (b) deficits in adaptive functioning that result in a failure to meet community standards of personal independence and social responsibility and impair functioning across multiple environments in one or more activities of daily life; and (c) an onset of intellectual and adaptive functioning deficits during teh developmental period. Four degrees of severity (mild, moderate, severe, and profound) are based on adaptive functioning in conceptual, social, and practical domains.
Narcissistic Personality Disorder
Narcissistic Personality Disorder involves a pervasive pattern of grandiosity, need for admiration, and lack of empathy as indicated by at least five characteristic symptoms-e.g., has a grandiose sense of self-importance; is preoccupied with fantasies of unlimited success, power, beauty, love; believes they are unique and can be understood only by other high-status people; requires excessive admiration; has a sense of entitlement; lacks empathy; is often envious of others or believes others are envious of them.
Outline for Cultural Formulation
The DSM-5’s Outline for Cultural Formulation provides guidelines for assessing four factors: the client’s cultural identity; the client’s cultural conceptualization of distress; the psychosocial stressors and cultural factors that impact the client’s vulnerability and resilience; and cultural factors relevant to the relationship between the client and therapist.
Reactive Attachment Disorder
Reactive Attachment Disorder is characterized by a pattern of inhibited and emotionally withdrawn behavior toward adult caregivers as manifested by a lack of seeking or responding to comfort when distressed and a persistent social and emotional disturbance. The diagnosis requires evidence that the child has experienced extreme insufficient care that is believed to be the cause of the disturbed behavior. Symptoms must be apparent before the child is five years of age, and the child must have a developmental age of at least nine months.
Specific Learning Disorder
Specific Learning Disorder is diagnosed when a person exhibits difficulties related to academic skills as indicated by the presence of at least one characteristic symptom that persists for at least six months despite the provision of interventions targeting those difficulties. The diagnosis requires that the individual’s academic skills are substantially below those expected for their age, interfere with academic or occupational performance or activities of daily living, began during the school-age years, and are not better accounted for by another condition or disorder or other factor such as uncorrected visual or auditory impairment or psychosocial adversity.
Vascular Neurocognitive Disorder
Vascular Neurocognitive Disorder is diagnosed when the criteria for Major or Mild Neurocognitive Disorder are met, the clinical features are consistent with a vascular etiology, and there is evidence of cerebrovascular disease from the individual’s history, a physical examination, and/or neuroimaging that is considered sufficient to account for their symptoms. This disorder often has a stepwise, fluctuating course with a patchy pattern of symptoms that is determined by the location of the brain damage.
Adjustment Disorders
The Adjustment Disorders involve the development of emotional or behavioral symptoms in response to one or more identifiable psychosocial stressors within three months of the onset of the stressor(s). Symptoms must be clinically significant as evidenced by the presence of marked distress that is not proportional to the severity of the stressor and/or significant impairment in functioning, and they must remit within 6 months after termination of the stressor or its consequences.
Behavioral Pediatrics (Hospitalization, Compliance)
Hospitalized children are at increased risk for emotional and behavioral problems, and children ages one to four tend to have the most negative reactions to hospitalization. Children and adolescents with chronic medical conditions have higher rates of school-related problems (e.g., CNS irradiation and intrathecal chemotherapy for leukemia have been linked to impaired neurocognitive functioning and learning disabilities). Compliance with medical regimens is a particular problem for adolescents.
Conduct Disorder
The diagnosis of Conduct Disorder requires a persistent pattern of behavior that violates the basic rights of others and/or age-appropriate social norms or rules as evidenced by the presence of at least three characteristic symptoms during the past 12 months and at least one symptom in the past six months. Symptoms are divided into four categories: aggression to the people and animals; destruction of property; deceitfulness or theft; and serious violation of rules. Symptoms must cause significant impairment in functioning, and the disorder cannot be assigned to individuals over age 18 who meet the criteria for Antisocial Personality Disorder.
Dialectical Behavior Therapy
Linehan’s (1987) Dialectical Behavior Therapy (DBT) was designed as a treatment for Borderline Personality Disorder and incorporates three strategies: (a) group skills training to help clients regulate their emotions and improve their social and coping skills; (b) individual outpatient therapy to strengthen clients’ motivation and newly-acquired skills; and (c) telephone consultations to provide additional support and between-sessions coaching. Research has confirmed that it reduces premature termination from therapy, psychiatric hospitalizations, and parasuicidal behaviors.
Gender Dysphoria
For Gender Dysphoria in Children, the diagnostic criteria are a marked incongruence between assigned gender at birth and experienced or expressed gender as evidenced by a strong desire to be the opposite sex and at least five symptoms-e.g., strong preference for wearing clothes of the other gender; strong preference for cross-gender roles during play; strong preference for toys and activities typically used or engaged in by the other gender; strong preference for playmates of the opposite gender; strong desire for primary and/or secondary sex characteristics of one’s experience gender. For Gender Dysphoria in Adolescents and Adults, the marked incongruence between assigned gender and experienced or expressed gender must be manifested by at least two symptoms-e.g., marked incongruence between one’s primary and/or secondary sex characteristics and one’s experienced or expressed gender; strong desire for the primary and/or secondary sex characteristics of the opposite gender; strong desire to be of the opposite gender; strong conviction that one has the feelings and reactions that are characteristic of the opposite gender. For both disorders, symptoms must have a duration of at least six months and cause clinically significant distress or impaired functioning.
Major Depressive Disorder
A diagnosis of Major Depressive Disorder requires the presence of at least five symptoms of a major depressive episode nearly everyday for at least two weeks, with at least one symptoms being depressed mood or loss of interest or pleasure. Symptoms are depressed mood (or, in children and adolescents, a depressed or irritable mood); markedly diminished interest or pleasure in most or all activities; significant weight loss when not dieting or weight gain or a decrease or increase in appetite; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings or worthless or excessive guilt; diminished ability to think or concentrate; recurrent thoughts of death, recurrent suicidal ideation, and a suicide attempt. Symptoms cause clinically significant distress or impaired functioning. Treatment usually includes cognitive-behavioral therapy and an SSRI or other antidepressant.
Non-Rapid Eye Movement Sleep Arousal Disorders
This disorder involves recurrent episodes of incomplete awakening that usually occur during the first third of the major sleep episode and are accompanied by sleepwalking (getting out of bed during sleep and walking around) and/or sleep terror (an abrupt arousal from sleep that often begins with a panicky scream and is accompanied by intense fear and signs of autonomic arousal). The individual has limited or no recall of an episode upon awakening, and the disturbance causes significant distress or impaired functioning.
Paraphilic Disorders
The Paraphilic Disorders include Voyeuristic, Exhibitionistic, Frotteuristic, Sexual Sadism, Pedophilic, Fetishistic, and Tranvestic Disorders. These disorders are characterized by an ‘intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners… [that] is currently causing distress or impairment to the individual or … has entailed personal harm, or risk of harm, to others’ (APA, 2013, pp. 685-686).
Schizophrenia
A diagnosis of schizophrenia requires the presence of at least two active phase symptoms-i.e., delusions, hallucinations, disorganized speech, grossly disorganized behavior, negative symptoms-for at least one month with at least one symptom being delusions, hallucination, or disorganized speech. There must be continuous signs of the disorder for at least six months, and symptoms must cause significant impairment in functioning. Treatment usually includes an antipsychotic drug, cognitive-behavioral therapy, psychoeducation, social skills training, supported employment, and other interventions for the individual with schizophrenia and psychosocial interventions for their family.
Substance-Induced Disorders
The Substance-Induced Disorders include Substance Intoxication, Substance Withdrawal, and Substance/Medication-Induced Mental Disorders. The latter ‘are potentially severe, usually temporary, but sometimes persisting central nervous system (CNS) syndromes that develop in the context of the effects of substances of abuse, medications, or toxins (APA, 2013, p. 487) and include Substance/Medication-Induced Psychotic Disorder, Substance/Medication-Induced Depressive Disorder, and Substance/Medication-Induced Neurocognitive Disorders.
Agoraphobia
A diagnosis of Agoraphobia requires the presence of marked fear of or anxiety about at least two of five situations (using public transportation, being in open spaces, being in enclosed spaces, standing in line or being part of a crowd, and being outside the home alone). The individual fears or avoids these situations due to a concern that escape might be difficult or help will be unavailable in case they develops incapacitating or embarrassing symptoms; and the situations nearly always provoke fear or anxiety and are actively avoided, require the presence of a companion, or are enduring with intense fear or anxiety. The fear or anxiety is persistent, is not proportional to the threat posed by the situations, and causes clinically significant distress or impaired functioning.
Behavioral Theory of Depression (Lewinsohn)
Lewinsohn’s behavioral theory attributes depression to a low rate of response-contingent reinforcement.
Conversion Disorder
The symptoms of Conversion Disorder involve disturbances in voluntary motor or sensory functioning and suggest a serious neurological or other medical condition (e.g, paralysis, seizures, blindness, loss of pain sensation) with evidence of an incompatibility between the symptom and recognized neurological or other medical conditions.
Dissociative Amnesia
A diagnosis of Dissociative Amnesia requires an inability to recall important personal information that cannot be attributed to ordinary forgetfulness and causes clinically significant distress or impaired functioning. It is often related to exposure to one or more traumatic events. The most common forms of amnesia are localized and selective.
Generalized Anxiety Disorder
GAD involves excessive anxiety and worry about multiple events or activities, which are relatively constant for at least six months, the person finds difficult to control, and cause clinically significant distress or impaired functioning. Anxiety and worry must include at least three characteristic symptoms (or at least one symptom for children)-restlessness or feeling keyed up or on edge; being easily fatigued; difficulty concentrating; irritability; muscle tension; sleep disturbance. Treatment usually involves cognitive-behavioral therapy or a combination of cognitive-behavioral therapy and pharmacotherapy.
Major Depressive Disorder with Peripartum Onset
The peripartum onset specifier is applied to Major Depressive Disorder, Bipolar I Disorder, and Bipolar II Disorder when the onset of symptoms is during pregnancy or within four weeks postpartum. Symptoms may include anxiety and a preoccupation with the infant’s well-being or, in extreme cases, delusional thoughts about the infant.
Obsessive-Compulsive Disorder
OCD is characterized by recurrent obsessions and/or compulsions that are time-consuming or cause clinically significant distress or impairment in functioning. Obsessions are persistent thoughts, impulses, or images that the person experiences as intrusive and unwanted and that they attempt to ignore or suppress, and compulsions are repetitious and deliberate behaviors or mental acts that the person feels driven to perform either in response to an obsession or according to rigid rules. A combination of exposure with response prevention and the tricyclic clomipramine or an SSRI is usually the treatment of choice for OCD.
Persistent Depressive Disorder
Persistent Depressive Disorder is characterized by a depressed mood (or in children and adolescents, a depressed or irritable mood) on most days for at least two years in adults or one year in children and adolescents as indicated by the presence of at least two characteristic symptoms-poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness. During the two- or one-year period, the individual has not been symptom-free for more than two months, and symptoms cause clinically significant distress or impaired functioning.
Schizophreniform Disorder
The diagnostic criteria for schizophreniform disorder are identical to those for schizophrenia except that the disturbance is present for at least one month but less than six months and impaired social or occupational functioning may occur but is not required.
Tobacco Use Disorder/Smoking Cessation Interventions
Interventions for Tobacco Use Disorder are most likely to lead to long-term abstinence when they include three elements: (a) nicotine replacement therapy; (b) multicomponent behavior therapy that includes, for example, skills training, relapse prevention, stimulus control, and/or rapid smoking; and (c) support and assistance from a clinician.
Adolescent Egocentrism (Elkind)
Adolescent egocentrism appears at the beginning of the formal operational stage. As defined by Elkind, its characteristics include the personal fable and the imaginary audience.
Childhood (Infantile) Amnesia
Studies investigating episodic (autobiographical) memory have found that adults are usually able to recall very few of the events they experienced prior to age three or four. This is referred to as childhood or infantile amnesia.
Early Reflexes
Reflexes are unlearned responses to particular stimuli in the environment. Early reflexes include the Babinski reflex (toes fan out and upward when soles of the feet are tickled) and the Moro reflex (flings arms and legs outward and then towards the body in response to a loud noise or sudden loss of physical support).
Gay and Lesbian Parents
The research on gay and lesbian parenting suggests that the nature of the parent-child relationship is more important than a parent’s sexual orientation. Overall, children of gay and lesbian parents are similar to children of heterosexual parents in terms of social relations, psychological adjustment, cognitive functioning, gender identity development, and sexual orientation.
Internal Working Model (Bowlby)
Bowlby distinguished between four stages of attachment development that occur during the first two years of life-preattachment, attachment-in-the-making, clearcut attachment, and the formation of reciprocal relationships. According to Bowlby, as a result of experiences during these stages, a child develops an internal working model, which is a mental representation of self and others that influences the child’s future relationships.
Niche Picking
Niche-picking is also known as active genotype-environment correlation and occurs when individuals deliberately seek environments that are consistent with their genetic make-up
Piaget’s Stages of Cognitive Development
According to Piaget, cognitive development involves four universal and invariant stages: During the sensorimotor stage (birth to two years), the child learns about objects and other people through the sensory information they provide and the actions that can be performed on them. A key accomplishment of the preoperational stage (ages 2 to 7) is the development of the symbolic (semiotic) function, which is an extension of representational thought and permits the child to learn through the use of language, mental images, and other symbols. Limitations of this stage include pre causal reasoning and egocentrism. Children in the concrete operational stage (ages 7 to 11) are capable of mental operations, which are logical rules for transforming and manipulating information. As a result, they are able to classify in more sophisticated ways, seriate, understand part-whole relationships in relational terms, and conserve. Finally, a person in the formal operational stage (age 11+) is able to think abstractly and is capable of hypothetico-deductive reasoning.
Sexual Activity in Late Adulthood
The research has generally confirmed that sexual activity in mid-life and earlier is a good predictor of sexual activity in late adulthood. For example, Landau et al. (2007) found that sexually active adults 57 to 85 years of age reported a frequency of sexual activity similar to the frequency reported in an earlier study of adults ages 18 to 59. However, their survey results also indicated that the number of older adults identifying themselves as “sexually active” decreased with increasing age.
Turner Syndrome
Turner syndrome occurs in females and is caused by the presence of a single X chromosome. Females with Turner syndrome are short in stature, have characteristic physical features (e.g., drooping eyelids, webbed neck), have delayed or absent development of the secondary sex characteristics, and may exhibit certain cognitive deficits.
Adult Attachment Interview
Adult Attachment Interview (AAI0 has confirmed a relationship between parents’ own attachment experiences and the attachment patterns of their children. For example, children of adults classified as dismissing on the AAI often exhibit an avoidant attachment pattern in the Strange Situation.
Coercive Family Interaction Model (Patterson)
Patterson et al’s coercive family interaction model proposes that children initially learn aggressive behaviors from their parents who rarely reinforce prosocial behaviors, rely on harsh discipline to control their children’s behavior, and reward their children’s aggressiveness with approval and attention and that, over time, aggressive parent-child interactions escalate. They developed the Oregon model of parent management training (PMTO) to help stop this coercive cycle by teaching parents effective parenting skills and providing parents with therapy to help them cope more effectively with stress.
Effects of Age on Memory
Several aspects of memory show age-related declines, especially recent long-term (secondary) memory. Deficits in secondary memory are believed to be due primarily to a reduced spontaneous use of effective encoding strategies.The working memory aspect of short-term memory also exhibits substantial age-related decline.
Gender Identity (Kohlberg, Bem)
According to Kohlberg’s cognitive-developmental theory, the development of a gender-role identity involves a sequence of stages that parallels cognitive development: By age 2 or 3, children acquire a gender identity; that is, they recognize that they are either male or female. Soon thereafter, they realize that gender identity is stable over time (gender stability). By age 6 or 7, children understand that gender is constant over situation and know that people cannot change by superficially altering their external appearance or behavior (gender constancy). Bem’s gender schema theory attributes the acquisition of a gender-role identity to a combination of social learning and cognitive development. According to Bem, children develop schemas of masculinity and femininity as the result of their sociocultural experiences. These schemas then organize how the individual perceives and thinks about the world.
Klinefelter Syndrome
Klinefelter syndrome occurs in males and is due to the presence of two or more X chromosomes along with a single Y chromosome. A male with this disorder has a small penis and testes, develops breasts during puberty, has limited interest in sexual activity, is often sterile, and may have learning disabilities.
Object Permanence
According to Piaget, an important accomplishment of the sensorimotor stage is the development of object permanence (the “object concept”), which allows the child to recognize that objects and people continue to exist when they are out of sight.
Precausal Reasoning (Magical Thinking/Animism)
As described by Piaget, the preoperational stage of cognitive development is characterized by precausal (transductive) reasoning, which reflects an incomplete understanding of cause and effect. One manifestation of precausal reasoning is magical thinking (the belief that thinking about something will cause it to occur); another manifestation is animism (the tendency to attribute human characteristics to inanimate objects).
Sibling Relationships
Most interactions between young siblings involve pro social, play-oriented behaviors. However, middle-childhood is usually marked by a paradoxical combination of closeness/conflict and cooperation/competition. During this period, sibling rivalry increases and is most intense among same-gender siblings who are 1-1/2 to 3 years apart in age and whose parents provide inconsistent discipline. In adolescence, siblings spend less time together, their relationship becomes less emotionally intense and more distant, and the friction between them usually declines as they begin to view one another as equals.
Under extension/Overextension
During the course of language development, children exhibit a number of errors including underextension and overextension. Underextension occurs when a child applies a word too narrowly to objects or situations, while overextension occurs when a child applies a word to a wider collection of objects or events than is appropriate.
Bilingualism and Bilingual Education
Bilingualism has been linked with several benefits including higher scores on measures of cognitive flexibility, cognitive complexity, analytical reasoning, and meta linguistic awareness. There is some evidence, however, that these benefits are temporary and that, by adolescence, bilingual and monolingual speakers are indistinguishable in terms of these characteristics.
Contact Comfort (Harlow)
Research by Harlow with rhesus monkeys indicated that an infant’s attachment to their mother is due, in part, to contact comfort, or the pleasant tactile sensation that is provided by a soft, cuddly parent.
Empty Nest Syndrome
Contrary to what is commonly believed, adults do not usually experience distress and a sense of loss (i.e., the ‘empty nest syndrome’) when all of their children come of age and leave home. Instead, the studies suggest that they usually experience an increase in marital satisfaction and other positive changes.
Heteronomous versus Autonomous Morality (Piaget)
Piaget distinguished between two stages of moral development. The stage of heteronomous morality (or morality of constraint) extends from about age 7 through age 10. During this stage, children believe that rules are set by authority figures and are unalterable. When judging whether an act is “right” or “wrong”, they consider whether a rule has been violated and what the consequences of the act are. Beginning at about age 11, children enter the stage of autonomous morality (or morality of cooperation). Children in this stage view rules as being arbitrary and alterable when the people who are governed by them agree to change them. When judging an act, they focus more on the intention of the actor than on the act’s consequences.
Maternal Depression
Children of depressed mothers are at higher risk for emotional and behavioral problems, although the exact nature and severity of the problems depend on several factors including genetic predisposition and the quality of early mother-child interactions. There is evidence that the physiological signs of distress in children associated with maternal depression (e.g., elevated heart rate, greater right frontal lobe asymmetry) are apparent by the time the child is three months of age. In addition, studies of toddlers have linked maternal depression (especially chronic, severe depression) to passive noncompliance and higher than normal rates of aggressiveness when interacting with peers.
Perception in Newborns (Vision, Pain)
Of the senses, vision is least well developed at birth. At birth, the newborn sees at 20 feet what normal adults see at about 200 to 400 feet; but, by about six months, the infant’s visual acuity is probably very close to that of a normal adult. With regard to specific types of visual stimuli, newborns prefer to look at high-contrast patterns (e.g., a bold black-and-white checkerboard), and their preference for more complex patterns increases with increasing age. The research has confirmed that newborns are sensitive to pain. For example, male newborns who are circumcised without anesthesia often reach with a loud cry, a facial grimace, and an increase in heart rate, blood pressure, and muscle tension. There is evidence that exposure to severe pain as a newborn can impact later reactions (e.g., in some cases, can increase sensitivity to pain).
Remarriage (Child’s Age, Stepfathers)
Although there is evidence that, when compared to children in intact biological families, children in stepfamilies have more adjustment problems, the differences between the two groups of children are generally small. Problems are often most severe when remarriage occurs when children are in early adolescence, and this is particularly true for girls residing with a biological mother and stepfather. In terms of parenting style, the typical stepfather tends to be distant and disengaged from his stepchild.
Socioemotional Selectivity Theory (Carstensen)
An assumption underlying socioemotional selectivity theory is that social goals have two primary functions-the acquisition of knowledge and the regulation of emotion-and it predicts that social goals correspond to perceptions of time left in life as being limited or unlimited. According to this theory, older adults perceive time as limited and, consequently tend to prefer emotionally close partners.
Brain Development (Cerebral Cortex)
The cerebral cortex is largely underdeveloped at birth but shows dramatic growth during the first two years of life as the result of an increase in the size of existing neurons, more extensive dendritic branching, and increasing myelinization. The frontal lobes continue to mature into adolescence and the early 20s.
Critical and Sensitive Periods
A critical period is a time during which an organism is especially susceptible to positive and negative environmental influences. A sensitive period is more flexible than a critical period and is not limited to a specific chronological age. Some aspects of human development may depend on critical periods, but, for many human characteristics and behaviors, sensitive periods are probably more applicable.
Erikson’s Stages of Psychosocial Development
Erikson’s theory of personality development proposes that the individual faces different psychosocial crises at different points throughout the lifespan. These are: trust vs. mistrust; autonomy vs. shame and doubt; initiative vs. guilt; industry vs. inferiority; identity vs. role confusion; intimacy vs. isolation; generativity vs. stagnation; and integrity vs. despair.
Horizontal Decalage
As described by Piaget, horizontal decalage refers to the gradual development of an ability (e.g., conservation) within a particular stage of development.
Memory Strategies of Children
Preschoolers sometimes use non-deliberate memory strategies but do so in an ineffective way, while children in the early elementary school years use somewhat more effective techniques but are often distracted by irrelevant information. In addition, when taught rehearsal or other memory strategies, young children may apply them to the immediate situation but do not subsequently use them in new situations. By age nine or ten, children begin to regularly use rehearsal, elaboration, and organization, and in adolescence, these strategies are “fine-tuned” and used more deliberately and selectively.
Phenylketonuria (PKU)
PKU is caused by a pair of recessive genes and produces mental retardation unless the infant is placed on a diet low in phenylalanine soon after birth.
Rutter’s Indicators
Rutter argued that the greater the number of risk factors a baby is exposed to, the greater the risk for negative outcomes. He concluded that the following 6 family risk factors are particularly accurate predictors of child psychopathology: severe marital discord, low socioeconomic status, overcrowding or large family size, parental criminality, maternal psychopathology, and the placement of a child outside the home.
Stages of Grief (Kubler-Ross)
Kubler-Ross (1969) concluded that people progress through the following five stages of grief when facing their own death or other important loss: (a) denial and isolation (this isn’t happening to me), (b) anger (why me), (c) bargaining (not until my grandchild is born), (d) depression (yes, me), and (e) acceptance (my time is close and that’s alright).
