PSYCH 508

Question 1

Authentic existence

Answer 1

Part of: humanistic/existential therapy
Who: Carl Rogers
What: A key part of psychological health depends on whether an individual’s self is consistent with her overall psychological experience. This is called congruence, or authentic existence. This is a humanistic concept used in existential therapy; the goal of existential therapy is to help a client develop an authentic existence (construct meaning of life in a meaningless existence - take responsibility for true self).
Clinical example: Staci likes to wear clothes and play with toys more traditionally associated with boys. Her parents push her towards more feminine choices in clothes and toys. She feels conflict between the authentic existence she wants and the pressures to conform to a less authentic (more feminine) version of herself.

Question 2

Big Five Personality Model/Traits

Answer 2

Who: McCrae and Costa (work by Allport, Cattell, and Eynseck)
What: The Big Five personality traits, also known as the five factor model, is a model based on common language descriptors of personality. These descriptors were grouped together using a statistical technique called factor analysis. This widely examined theory suggests five broad dimensions that describe the human personality and psyche. The five factors have been defined as openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism, often listed under the acronym OCEAN. Clinical example: Dylann came into therapy because he was experiencing anxiety over the fact that he was unable to pick a major. The counselor gave John the NEO-PI which is based on the big 5 personality model to determine his personality traits and work together to explore different majors and career paths.

Question 3

Client-centered/person-centered theory/therapy

Answer 3

Person-centered therapy is a humanistic approach first developed by Carl Rogers based on his theory of personality which asserts that humans have a natural tendency towards growth, learning, and change - actualization tendency.Elements of client-centered therapy include:* The therapist trusts the client.* Therapists hold attitudes toward clients of congruence, unconditional regard, and empathic understanding. (Necessary therapeutic conditions)* The therapeutic relationship is the mechanism of change.* Therapists don’t educate clients, interpret their conflicts, or identify faulty thoughts or behaviors; instead, they establish relational conditions that allow clients to engage in natural self-discovery and personal growth.* Psychopathology results from a failure to learn from experience and it continues when clients accept projected parental conditions of worth instead of modifying self concept based on day-by-day personal experiences* Potential weaknesses include: focus on self may not fit all cultures or world views; focus on emotional expression might not fit with other cultures; culturally diverse client may prefer expert advice and directive therapies.
Nondirective techniques including reflecting and summarizing.
Clinical example: Trisha is a person-centered therapist. Her sessions are wide ranging and client driven. She provides continual empathic feedback and an environment that encourages her clients to be their authentic selves. She asks questions to help her clients come to their own conclusions.

Question 4

Cognitive therapy

Answer 4

Who: Aaron Beck
What: Cognitive theory asserts that cognition (the mental processes that take place in the brain, including thinking, attention, language, learning, memory and perception) is at the core of human suffering, and that psychological problems can be mastered by correcting misconceptions and learning more adaptive attitudes. The therapist’s job is to help the client modify distress-producing thoughts.

Cognitive triad - negative views of the self, the world, the future

a form of psychotherapy based on the concept that emotional and behavioral problems in an individual are, at least in part, the result of maladaptive or faulty ways of thinking and distorted attitudes toward oneself and others. The objective of the therapy is to identify these faulty cognitions (automatic thoughts) and replace them with more adaptive ones, a process known as cognitive restructuring. The therapist takes the role of an active guide who attempts to make the client aware of these distorted thinking patterns and who helps the client correct and revise his or her perceptions and attitudes by citing evidence to the contrary or by eliciting it from the client (Socratic questioning).
Clinical example: Beth tells her cognitive therapist that whenever she makes a mistake, however small, she feels worthless. The work of therapy will be to target these automatic thoughts with alternate interpretations to ultimately change her schema.

Question 5

Common factors in psychotherapy

Answer 5

Part of: clinical practice
What: theory that proposes that there are certain factors, regardless of specific techniques or theoretical approach, at the heart of successful psychotherapy and treatment.
Rogers: WEG, therapeutic relationship
Common factors include:
1. Extratherapeutic factors: client factors such as motivation, support within environment.
2. Therapeutic alliance: rapport and positive working relationship between therapist and client. - warmth, genuineness, empathy
3. Expectation: hope for positive outcomes
Many different theorists and studies - now even ESTs on certain factors in therapy besides treatment protocols
Clinical example: Dora has worked with both a client-centered therapist and a cognitive-behavioral therapist. Though their approaches differed, she notes the positive relationship she had with each and her own willingness to change as factors that affected her outcomes.

Question 6

Conditional v. unconditional positive regard

Answer 6

Rogerian or person-centered theory maintains that therapists must show unconditional positive regard for their clients. Unconditional positive regard includes acceptance and respect. Through acceptance, therapists lead clients to self acceptance. Conditional positive regard would be when acceptance is given or withheld based on how a client (or person) is acting. Unconditional positive regard is a prerequisite for self-actualization.
Clinical example: In a session, a client expresses attitudes toward his partner that the therapist finds personally repulsive. She maintains an open and accepting posture towards her client despite her personal feelings because she believes unconditional positive regard is key to the therapeutic relationship.

Question 7

Conditions of worth

Answer 7

A term coined by Carl Rogers, conditions of worth are the standards that children and adults believe they must meet to be acceptable and worthy of love. These conditions lead individuals toward an external locus of evaluation. When conditions of worth are placed on a people, they will deny parts of their self-concept in order to meet these conditions. Conditions of worth cause incongruence between the real and ideal self and ultimately to pathology. Clinical example: Denise’s parents had very strict standards for acceptable ways of thinking and acting. Emotional support was withheld when she breached these standards. As an adult, Denise struggles to feel secure in her relationships because she expects such conditions of worth to be present.

Question 8

Countertransference

Answer 8

A term developed by Sigmund Freud and related to psychoanalytic theory, countertransference is a process that occurs in therapy when the therapist projects past feelings or attitudes about something in their own lives onto the client, thereby distorting the way they perceive and react to the client and contributing to bias. It is important for the therapist to be aware of countertransference because it can lead to confusing and/or harmful reactions in therapy. May serve as insight to patient’s effect on people.
Clinical example: Listening to a client discuss her resentment towards her mother brings up strong feelings in her therapist, who also has a troubled relationship with her own mother.

Question 9

Defense mechanisms

Answer 9

A Freudian concept (Anna Freud), defense mechanisms are automatic, unconscious, and ward of unacceptable impulses and distort reality. People use them to preserve the integrity of their self-image and keep their ego from experiencing anxiety. Defense mechanisms can also be used as coping mechanisms to protect against psychological harm/stress. Freudian psychology states that normal, healthy individuals do use defense mechanisms, which only become unhealthy when they lead to maladaptive behaviors.
Defense mechanisms include: 1. repression: forgetting an emotionally painful memory
2. denial: more forceful than repression
3. projection: pushing unacceptable thoughts and impulses on another person
3. reaction formation: expressing the opposite of an unacceptable impulse
4. displacement: shifting a sexual or aggressive impulse to a less dangerous person (kicking the dog)
5. rationalization: excessive explanation to justify behavior 6. regression: reverting to less sophisticated method of doing things
7. sublimation: sexual or aggressive energy channeled into something positive (creative tasks or hard work, house cleaning)
Clinical example: Cindy is abused by her father, but states that he is just always stressed by work. She is using rationalization as a defense mechanism.

Question 10

Existential theory/therapy

Answer 10

Who: made popular by Victor Frankl (1940s) and many other theorists/philosophers
What: Existential psychotherapy is grounded in existential philosophy - a way of thinking (why am I here? Who am i?); it focuses on self-awareness, facing the unavoidable conditions of human existence, and authentic living. Humans are in conflict with internal forces or ultimate concerns which produce anxiety. The four ultimate concerns are death, freedom, isolation, and meaninglessness. Focus on responsibility, free will, and the present/future (past does not determine future). Elements of the therapeutic process include presence, empathic mirroring, feedback and confrontation, and mindfulness. Goal is authentic existence.
Clinical example: A client with an existential therapist is encouraged to accept his fear of death and learn to live with it rather than avoiding it through denial.

Question 11

Factor analysis

Answer 11

Who: Spearman
A mathematical procedure that helps to sort test responses into relatively homogenous clusters of items that are highly correlated. (It can clarify which response patterns go together.) Help with data sets that have large number of variables that are thought to be able to be groups into fewer variables. **Exploratory **(when groups are unknown) and confirmatory (when there is some idea of what groups) factor analysis.
Clinical example: Jane comes to therapy explaining that she is worried about her personality test that her job just gave her. You explain to her that the Big 5 Personality model was researched using factor analysis and takes many different descriptions of personality and make it easier to understand in the 5 personalities.

Question 12

Fixation

Answer 12

Part of: psychoanalysis and Who: Sigmund Freud, What: fixation occurs when there is unresolved unconscious conflict (dysfunctional internal working model) at one or more of Freud’s psychosexual stages of development. Both frustration and overindulgence can cause fixation.Fixation influences one’s personality and contributes to psychopathology.Clinical example: Mary came to therapy for excessive binge eating. The therapist utilized a psychodynamic perspective and looked to Mary’s past to see if she progressed normally through Freud’s psychosexual stages, specifically the Oral stage. The therapist theorized that if her needs weren’t met at that stage, she is fixated at this stage, and this would explain the binge eating.

Question 13

Insight/Catharsis

Answer 13

Part of: Psychodynamic theoryWho: Freud and BreuerA term from psychodynamic theory and developed by Freud and Breuer. In psychodynamic therapy, the therapist guides the client towards insight and catharsis. A main goal of psychoanalytic theory is to gain insight, which is to understand intrapsychic conflicts and interpersonal relationships, understand the historical roots of current problems, then integrate them into current life and increase ego strength. Successfully achieving insight should enable the client to release or free their emotions, the experience of catharsis, providing relief from repressed emotions.
Clinical example: A client is finally able to describe in detail a painful childhood experience. She deeply feels the emotions associated with that experience after repressing them for decades. She has experienced a moment of catharsis.

Question 14

Person-behavior-environment reciprocal interaction

Answer 14

Part of: Social Learning Theory
Who: Bandura
What: AKA reciprocal determinism; the idea that an individual’s behavior both influences and is influenced by personal factors and the environment. As personality develops in someone, all three aspects - the individual, their behaviors, and their environment are interacting influencing one another. Understanding how the person, behavior and environment relationship functions in clients can help create targeted, more effective therapeutic interventions.Clinical example: You have client with social anxiety that thinks he is ugly and boring. (Personal Factor) His thoughts cause him to act awkward and be short with people at parties. (Behavior) His behavior causes the people around him to ignore him and not want to get to know him. (Environment). You explain that his personal factors, behavior, and environment are all influencing one another. You argue that by changing his cognitions in therapy, his behavior and environment might change as well

Question 15

Person-situation debate

Answer 15

A debate between personality theorists about what is most important for determining a person’s behavior - the person/traits of the person, or the situation (environment).- sparked by an influential book by Walter Mischel, arguing that traits fail to predict actual behavior- Generally, traits are superior in predicting general behavior patterns, while situations are better at predicting specific behaviors.Example: Tara is a therapist that strongly believes in the person side of the person situation debate in psychology. She believes that all traits are consistent across situations. Because of this, she administers the NEO-PI to all of her clients. Tara feels that she is better able to understand and predict her clients behavior because the assessment points out key personality traits.

Question 16

Potentially harmful treatments

Answer 16

Part of: Ethical practice and efficacy research
Who: Scott Lilienfeld
What: A treatment where harm lies in either the nature of the intervention or in the improper application of the intervention. According to Lillienfield, characteristics include documented harmful psychological or physical effects on clients or others (eg relatives). The harmful effects are enduring and do not merely reflect an exacerbation of symptoms during treatment, the harmful effects have been replicated by independent investigative teams. Examples of these txs include boot camp and scared straight for conduct disorder, critical incident stress debriefing, and even grief counseling. Impt to know about these treatment to prevent doing harm to a client. EXAMPLE: Critical incident stress debriefing has been found to increase some people’s risk for developing PTSD. It is considered a potentially harmful tx and is rarely used because of the enduring harmful effects that has been observed.

Question 17

Pleasure principle

Answer 17

A term from psychoanalytic theory developed by Freud. The pleasure principle is what drives the id (infancy and early childhood); it unconsciously seeks instant gratification for all needs, wants, and desires and aims to avoid pain- mostly biological. Countered with the reality principle and the ego - help regulate our pleasure principle and behave appropriately. Important for explaining behavior in psychodynamic terms. Clinical example: The drive to immediately eat an ice cream cone the moment see a picture of one illustrates the pleasure principle.

Question 18

Projective hypothesis-techniques

Answer 18

Part of: personality theory and psychodynamic
Who: David Rapaport
The projective hypothesis says that when people attempt to understand an ambiguous or vague stimulus, their interpretation of that stimulus reflects their needs, feelings, experiences, thought processes, etc and can reveal personality structure. The most common techniques are projective personality tests such as the Rorschach inkblot test, the TAT or the draw-a-person. This technique is not backed by research - not valid or reliable (too much interpretation for tester).
Example: A therapist asks a client to interpret a black ‘blob’ while using the Rorschach inkblot. According to the projective hypothesis, the client saying that she sees a crab in the image might be indicative of her mood at the time of testing.

Question 19

Psychodynamic theory

Answer 19

Developed by Freud (Jung, Erikson, Adler), this theory says that psychopathology arises from early childhood experiences; past focused. - Includes Freud’s 5 stages of psychosexual development. Fixations can arise from troubles in a certain stage and also contribute to psychopathology- De-emphasizes environmental and social factors- The mind is made up of the unconscious , preconscious , and conscious; bxs largely motivated by unconscious- The mind also consists of an id (governed by pleasure principle/primary process; biological desires typically outside of awareness), ego (governed by reality principle/secondary process - rational thought, in awareness; helps cope with id’s drives and make decisions), and superego (morals- desire to emulate adult standards) - Therapist viewed as expert; his/her interpretations are valued; acts as blank slate and listens for unconscious conflicts and motivations that underlie client’s patterns of behavior- Goal is to bring the unconscious into conscious awareness; primarily accomplished through therapist interpretations. Another goal is to help clients develop greater self-control over maladaptive impulses- Techniques include free association, dream analysis, resistance and transference. - In more recent years, less focus on sexual instincts as prime motivating factor, ego considered as separate from the ID with its own independent motivations (ego psychology)
Example: Jane visits a psychodynamic therapist who works on dream analysis with her. He interprets her dream about her mother to mean that she had a bad relationship with her mother in childhood, which is now subconsciously causing her depression.

Question 20

Psychosexual stages

Answer 20

In psychodynamic theory, these stages are considered to be how personality is developed. Developed by Freud, this is a sequence of stages which is controlled by libidinal energy concentrated in erogenous zones. Erogenous zones includes:
1) Oral: gratification or frustration [birth to 1]
2) Anal: retention/elimination functions inactive/active and aggressive [1-3 yr old]
3) Phallic: Oedipal and Electra complexes; boys and girls, castration anxiety and penis envy: identification w/ father/mother [3-5]
4) Latency: period of repression [5-12]
5) Genital: onset of puberty, catharsis: mature libidinal attachments- Adult personality is determined by the way we resolve conflict within each stage- Psychopathology is thought to come from a fixation in one of these stages (related to childhood experiences typically).Example: 9 month old Charlie puts everything he gets his hands on in his mouth. Freud would argue it is because he is in the oral developmental stage.

Question 21

Rational-Emotive behavior therapy

Answer 21

Part of: cognitive behavioral therapy
Who: Albert Ellis
What: based on the idea that distress is not created by events themselves but by judgments and beliefs about those events. REBT claims humans have a strong tendency to think irrationally, causing psychological distress, but also that humans have the power to alter their thinking. REBT employs cognitive restructuring to change irrational thoughts that cause psychological problems such as anxiety, depression, anger, and guilt. “There’s nothing good or bad but thinking makes it so.”- Therapist is confrontational in order to get client to think about their thinking. Therapist is the expert and infers logical errors and irrationality- Goals include changing maladaptive thoughts and instilling critical thinking Clinical example: In an REBT session, a client says she isn’t going to apply for a job she is qualified for because she fears rejection. The therapist challenges her fear repeatedly, sometimes aggressively, to help her see it differently and ultimately, overcome it.
Uses ABC model (activating event, belief, consequence), reframing, decatastrophizing, role-playing, exposure therapy, cog restructuring, humor, assertiveness training.
EXAMPLE: You are seeing a client that found a missed call from another woman on her husbands phone. She believes that he is hiding things from her and must be cheating on her. She has kicked him out of the house and is refusing to speak to him. Her therapist utilizes REBT and helps to identify her underlying irrational thought patterns and belief. She then challenges these irrational beliefs, honestly and bluntly, by saying, “Aren’t you jumping to conclusions by not speaking to him about this?”

Question 22

Resistance

Answer 22

Part of: psychodynamic theory (originally), now a more ubiquitous termWho: FreudWhat: a phenomenon often encountered in clinical practice in which clients either directly or indirectly oppose changing their behavior, or refuse to discuss, remember or even think about presumably clinically relevant experiences.- May include pauses, inability to recall, shifts in topic, avoidance behaviors, or disagreements - Initially a key concept of Freud’s, referring to patients blocking memories from consciousness and interfering with treatment requiring that these memories become available - in other treatments such as MI and Narrative Therapy, it can be seen as a natural part of the treatment process, and an opportunity to develop dissonance and create motivation for changeClinical example: Whenever Jean’s therapist asks questions about her mother, Jean changes the subject or deflects. The therapist sees this as resistance because Jean’s relationship with her mother is central to her psychological struggles.EXAMPLE: You’re providing CBT to a client with substance use disorder. She has either refused to or forgotten to do her homework the past couple of weeks. This opposition to change be indicative of tx resistance. You should consider using MI to create/elicit motivation for change.

Question 23

Schema or core belief

Answer 23

According to Beck’s cognitive theory, a schema is a set of core beliefs an individual holds about herself, others and the world. It is at a deeper level than, and to some extent a product of, automatic and intermediate thoughts. Can be positive or negative views. Use downward arrow to arrive at these schemas. Important in explaining automatic thoughts. Clinical example: Over time, Bethany has developed the core belief that she has little value in relationships.

Question 24

Reality principle

Answer 24

Part of: Pscyhodynamic theory
Who: Freud
What: According to the Freudian concept of id, ego, and superego, the ego is an individual’s conscious decision making process. It operates on the reality principle, which means it understands the limitations the real world places on impulses of the id and the ideals of the superego. The reality principle holds that it can delay gratification in order to satisfy the id’s instinct in a realistic and socially appropriate way. Opposite of pleasure principle.
Clinical example: Dylan may have the impulse to walk up to his partner and passionately kiss her in the middle of a group, but secondary processes and the reality principle would tell him to greet her in a less physical way given the circumstances.

Question 25

Self actualization

Answer 25

Part of: Maslow’s Hierarchy, Person-Centered TherapyWho: Maslow and RogersWhat: the alignment of a person’s view of themselves, their experiences, and who they want to be (self-concept). Self-actualization involves congruence and reaching one’s highest potential. -Self-actualization is achieved within the climate of unconditional positive regard that is provided during the treatment process, if not in actual life previously. Must meet basic needs first. Qualities of a self-actualized person include: - open to experience (accurately perceives one’s feelings and experiences in the world) - lives in the present - trusting their own thoughts and feelings as accurate - acknowledges one’s freedoms and takes responsibility for own actions) - creative (participating fully in the world, including contributing to the lives of others)Example: A counselor was working with Carla, a first time mom. Carla commented on how she was worried about keeping a roof over her new baby’s head as her landlord was trying to evict her. As a humanistic therapist, the counselor realized that Carla needed to work on satisfying her basic needs before they could move onto larger goals such as striving for self-actualization. The counselor worked with Carla to try and get into safe housing.

Question 26

Self-concept

Answer 26

A term utilized in various psychological theories including person-centered theory, self-concept refers to an individual’s organized set of perceptions about self and relationships. Self-concept develops as we interact with the world (experiences + introjected values). The self concept is a type of schema that helps in the process of perceiving, evaluating and regulating oneself in terms of the real self and the ideal self (who we think we should be). This is helpful in seeing how someone perceives how they will act in certain situations. (“I am shy”) Example: Client in counseling reveals that he became a lawyer because he comes from a family of lawyers. He discloses that he always felt drawn to creative writing. The counselor works with the client and helps the client come up with ways in which he can lead a life that more closely aligns with his self concept-maybe join an writing group, take the time on the weekends to write short stories.

Question 27

Self-efficacy

Answer 27

Part of: Social Learning TheoryWho: BanduraWhat: self-efficacy is a person’s belief about their ability to succeed in specific situations or accomplish certain tasks. - Related to person’s locus of control- Situation specific and not an overall trait - Determinant of behavior initiation, maintenance, and energy expenditure - Can be increased via modeling and skills therapy - Primary goal of behavior change is to increase self-efficacyImportant because higher self-efficacy is associated with positive self-talk, persistence, effort, and willingness to face obstacles.Clinical example: An overweight client came into therapy presenting with depressive symptoms. She had been overweight for years and felt that it was a worthless cause to try to lose weight. Therapist worked with her to increase her self-efficacy by building upon small tasks that she could complete, like walking around the block once a week, then increasing it to twice a week, etc.

Question 28

Self-monitoring

Answer 28

Part of: CBT
What: A type of observation or therapeutic tool in which a client monitors her own target behaviors, thoughts and/or feelings. Teaching clients to self-monitor is an easy but effective therapeutic skill. Self-monitoring, like direct observation, is subject to reactivity of monitoring in that a person may decrease an undesired behavior unconsciously when they start monitoring that behavior. So, self-monitoring as an intervention can help influence adaptive behavior change.Clinical example: Cindy is trying to quit smoking. As a first step, she is advised to keep a log of when and how many cigarettes she smokes for two weeks, and when she craves a cigarette but does not give in to the craving. By the end of the two weeks, Cindy is smoking fewer cigarettes even though she was only asked to monitor, not decrease, the behavior.

Question 29

Trait

Answer 29

Part of: Trait theory, person-situation debate, personality theory
What: enduring and consistent across contexts aspects of an individual’s personality. Traits can predict behavior, and are relatively stable/ enduring across many situations. Trait theory attempts to label and classify people but ignores situational behavior (person-situation debate). Big 5 personality traits. Helpful in therapy to know what traits a person might have but be able to work towards goals if traits are maladaptive in certain situations.
Clinical example: John comes to therapy and lets the therapist know that he has personality traits that he has discovered, like being calm. He tells the therapist that he is usually the calmest person in the room if things get heated, but he’s having a tough time staying calm with his grandmother who lives with him. You tell him about the person-situation debate and help him find coping skills to be with his grandmother.

Question 30

Warmth, empathy, genuineness (WEG)

Answer 30

Who: Rogers
What: the 3 therapist characteristics that are necessary and sufficient conditions for therapeutic change: warmth, empathy and genuineness. - Warmth: showing unconditional positive regard to the client as well as being nonjudgmental, caring and accepting of client despite possibly disagreeing with the client’s actions/beliefs. - Empathy: therapist puts themselves in the shoes of the client with accurate/sensitive entries into the client’s IFR, thinking WITH and not FOR the client. - Genuineness: the therapist is transparent with the client and stays true to themselves. The therapist maintains genuineness by being congruent and neither having a superior attitude nor using professional jargon. - When all three are presented by the therapist and perceived by the client, a strong therapeutic relationship is built.
Example: Jen has just begun therapy, and she has expressed to her therapist that she is nervous about the idea of being in therapy. The therapist ensures her that her feelings are completely normal and that it will take time to build a trusting relationship, demonstrating empathy. She also shared that she had similar concerns the first time she went to therapy- demonstrating genuineness. The therapist continues to demonstrate these core conditions along with UPR in order to gain her trust and build a healthy therapeutic relationship.

Question 31

Automatic thoughts

Answer 31

Part of: Cognitive Theory/Therapy
Who: Aaron Beck
What: thoughts that arise spontaneously or reflexively following some environmental stimuli. Beck posited that automatic thoughts arise from faulty assumptions and are rooted in core beliefs/schema. Automatic thoughts can be targets of effective cognitive therapy or hypotheses to be tested. The goal of cognitive therapy is to uncover and challenge the core belief underlying automatic thoughts. Downward arrow technique and Socratic questioning are two techniques that can help uncover the deeper root of automatic thoughts. Common cognitive distortions include arbitrary inference, overgeneralization, selective abstraction, personalization, polarized thinking, magnification, or minimization.
Example: A client says she texted a friend and asked to hang out this weekend, but hasn’t heard back. When she didn’t hear back immediately, she said she thought, “no one wants to be friends with me; I’m just a drag.” Her therapist recognizes the cognitive distortions of personalization and magnification at play. She uses Socratic questioning to uncover the core belief underlying the automatic thought: “no one wants to be friends with me.”
EXAMPLE: Your client is upset because Bob, the new co-worker, won’t talk to her. She states it is because she is worthless and no one likes her. As a therapist conducting Beck’s cognitive therapy, you would view this is an automatic thought riddled with absolute thinking and jumping to conclusions. Your next step might be utilizing the downward arrow technique to get at the deeper schema/core belief.

Question 32

Behavioral activation

Answer 32

Part of Behavioral therapy/theory
Who: Peter Lewinsohn
What: posits that changing behaviors will improve symptoms (typically of depression). Behavioral activation identifies a client’s avoidance behaviors and potential reinforcing activities. Then it sets up activation strategies to get the client to actively engage in reinforcing activities and thus decrease their avoidance behavior. Peter Lewinsohn pioneered BA as a therapy for depression in which the therapist works systematically to increase the number of constructive and pleasurable activities and events in a client’s life. Sometimes this application is called “activity scheduling”: working with depressed clients to schedule activities that increase the rate of naturally occurring positive reinforcement. Example: Lindsay is in treatment for depression. She is struggling to shower and fulfill daily activities. Her therapist works with her to schedule a shower every other day, and a short walk around the block on the other days. She instructs Lindsay to log these activities, and any accompanying feelings. As a behavioral therapist, she expects these actions to be self-reinforcing and to decrease Lindsay’s depressive symptoms.

Question 33

Cultural self-awareness

Answer 33

Cultural self-awareness is a competency of multi-cultural therapists, and entails a therapist understanding her own cultural background and biases. It’s important to know your own culture, values and biases before working with a client who might be different - don’t want to inadvertently impose your culture/values on them. Develop this self awareness by educating yourself about different cultures and see the difference between you and others.
Example: Dylan is a white male therapist who grew up in a middle class family. When he works with clients who have different cultural identities, be they racial, socioeconomic, or sexuality differences, he takes care to be aware of his own blind spots and biases based on his different cultural life experience.

Question 34

Externalizing conversations

Answer 34

Part of: Constructive therapies (narrative therapy, solution-focused therapy)
What: a therapeutic technique in which clients push their problems outside the intrapsychic realm. Through problem externalization, clients can dissociate from problems, look at them from greater distances, and develop strategies for eliminating them. This technique helps clients who are distressed because they blame themselves for the problems or pain they are experiencing.Ex: Joel is in treatment for a heroin addiction. He has been in treatment before and feels somewhat helpless in the face of the addiction. His therapist steers him towards an externalizing conversation with the question, “How long have you been working against this opiate problem?”

Question 35

Genogram

Answer 35

Part of: Family Systems Therapy
Who: Murray Bowen
What: A tool developed by Bowen for use in family therapy, a genogram is a tool for teaching family members about relationship dynamics in their system, similar to a family tree. Bowen maintains that a key to psychological health is differentiation from family members. Once family members attain differentiation, they’re emotionally and intellectually self-sufficient and able to resist the unconscious grasp of their family’s rules and roles. A genogram can help reveal some of these relationship dynamics in the family system. Used to trace recurring behavior patterns within the family; usually includes 3 generations
Example: Leo is a family systems therapist. He helps a family create a genogram exploring the behavioral and psychological trends over the past generation. The genogram makes it starkly clear to the family that issues of infidelity are a family pattern. This pattern helps the family work in therapy on some of the issues affecting them presently.

Question 36

Multicultural counseling

Answer 36

A helping role and a process that uses modalities and defines goals consistent with the life experiences and cultural values of diverse clients. A multiculturally competent therapist possesses cultural self-awareness (awareness of cultural background and biases), cultural knowledge (possession of information about specific cultures), and culture-specific expertise and skills (using techniques that fit clients’ culture). Important to practice from this role in order to prevent more harm done to a client inadvertently. Being multiculturally competent is an ongoing process.
Example: Tatiana is working with an Asian-American client. When her client discusses how entwined her life is with her family, and how much obligation she feels toward her family, Tatiana knows that this may not be an unhealthy family dynamic but simply the result of a more collectivistic culture. This is an example of a multiculturally competent counselor.

Question 37

Narrative Therapy

Answer 37

Part of: Constructive approaches to therapy
Who: Michael White
What: Narrative therapy is a client-focused, strengths-based practice that works from the fundamental position that the client is not the problem, but** “the problem is the problem.”** Based on the idea that people create a personal narrative or dominant story to understand and give meaning to their lives and to themselves; these stories are often negative or ‘problem saturated’ and the therapist works to create a new narrative, which will facilitate change in the client. therapy engages in a process of deconstructing the person’s dominant narrative to understand how that narrative influences their thoughts, feelings, behaviors and communication; it then explores whether this narrative is the story the person wants for their life (re-authors their story) and works to develop and actualize new, preferred stories for their life. There is no use of diagnoses but there is an emphasis on cultural influences and social justice.
Example: Pat is using narrative therapy to work on her depressive symptoms they’ve had ever since her husband cheated on her. The therapist encourages her to externalize her feelings and they together work on rewriting a narrative of her life that she prefers.

Question 38

Psychoeducation

Answer 38

An important component of CBT (though incorporated into other modalities as well), psychoeducation is a part of the therapy process wherein a therapist provides information about client diagnosis, treatment process, prognosis, and intervention strategies in order to help client reach a better outcome in treatment. This can be given verbally or in written form with handouts, homework, or books.
Psychoeducation may also be provided to family members, particularly in cases of severe mental illness such as schizophrenia. It’s important to not assume that clients know what we know about mental health and provide them with the information that can help them psychologically.
Example: Danielle has just diagnosed her client with depression. After sharing the diagnosis, she takes time to explain what it means, its first line treatments, and how they can work together in therapy to help ease her symptoms.

Question 39

Systems Theory

Answer 39

Systems theory was developed by Urie Bronfebrenner to explain and differentiate systemic forces that influence children’s development. Levels of influence:
1. The child: an entity that is influence by the other five factors
2. The microsystem: the setting where the child lives including parents, siblings, classmates
3. The mesosystem: the interaction between micro and exosystems ie interaction between child’s family and school administration
4. The ecosystem: Systems outside the microsystem with which the individual or microsystem interacts (parents’ employers, extended family, mass media)
5. The macrosystem: culture, laws, politics, socioeconomics
6. The chronosystem: changes occurring in the other five domains over time
: an approach that focuses not on individual components but on how entities (can be organizations or families) operate. A systems theory perspective sees individuals as part of a larger whole. When an individual has a problem, that problem usually functions to maintain the status quo and is maintained by the system. Therefore, the target of intervention is the system, not the individuals. Systems theory sees all symptoms as purposeful or functional, works to depathologize individuals.
Example: Jane comes to therapy for her anxiety. She explains that she is having a hard time in school, her mother just got diagnosed with cancer, and she cant stop worrying about politics and the current president. The therapist views her with a systems theory perspective, understanding that all of these aspects of her life are contributing to her anxiety.

Question 40

Solution-Focused Brief Therapy

Answer 40

Part of: originally developed for family/marital counseling/inner city but used on individuals as well
Who: Steve de Shazer
What: A goal-oriented and collaborative brief therapy approach that focuses on client solutions and minimizes any talk about problems. Dysfunction develops from failed attempts at problem-solving; clients can become “stuck” in their problem-solving process - Focus on the present where problems are maintained rather than searching for cause “problem talk” is negative → switch to solution-focused narrative- Client is expert, therapist leads from behind- Specific techniques include externalizing conversations, reframing, miracle questioning, expectation questions, looking for what worked in the past and focus on small goals or successes. .Example: In a first session of solution-focused brief therapy, the therapist listens for and points out any indications that change is already occurring. His client is struggling with alcohol use but mentions that she went home instead of to the bar after work with her friends that night before, and went straight to bed. “How did you manage that?” the therapist asks, directing the client to think about the positive progress she is already making .

Question 41

Neo-Freudian

Answer 41

Part of: Psychodynamic approaches
Who: Karen Horney, Alfred Adler, Erik Erikson (psychosocial development), Carl Jung
What: an approach that builds on psychodynamic theory’s and Freud’s ideas about how the past and unconscious impact functioning, but brings social and cultural factors into the framework of psychopathology (no emphasis on sexuality). Neo-Freudian approaches may be more time-limited, relational, or attachment-informed than more traditional psychoanalytic approaches.
Example: Jennifer is a neo-Freudian therapist. She strives to cultivate warmth with her clients, and considers their present relationships an important piece of their psychological health. She also asks a lot of questions about childhood, and attempts to help them make the unconscious conscious.

Question 42

HIPAA Compliance

Answer 42

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the Secretary of the U.S. Department of Health and Human Services (HHS) to develop regulations protecting the privacy and security of certain health information.It establishes national standards for the protection of certain health information. The Security Standards for the Protection of Electronic Protected Health Information (the Security Rule) establish a national set of security standards for protecting certain health information that is held or transferred in electronic form. The Security Rule operationalizes the protections contained in the Privacy Rule by addressing the technical and non-technical safeguards that organizations called “covered entities” must put in place to secure individuals’ “electronic protected health information” (e-PHI). Within HHS, the Office for Civil Rights (OCR) has responsibility for enforcing the Privacy and Security Rules with voluntary compliance activities and civil money penalties.A therapist must adhere to the HIPAA privacy and security rules in order to protect the information of the patient. (prevent HIPAA violation)
Example: Sara comes to therapy but is quite concerned that the therapist might tell other about what she has experienced in her life. The therapist reassures her that she cannot share this personal information with anyone with her written consent, per HIPAA.