Treatment/intervention Flashcards
Interventions based on behaviorism
psychopathology results from problematic learned patterns; based on classical conditioning, operant condition, and social learning theory
Interventions based on classical conditioning
involve unlearning previous problematic connections (e.g., phobias, anxiety, addictions); counter-conditioning and classical extinction
Interventions based on counter-conditioning
systematic desensitization, sensate focus, assertiveness training, aversive conditioning
Interventions based on classical extinction
flooding, implosive therapy
Systematic desensitization
based on counter-conditioning; developed by Joseph Wolpe; train client to relax, then exposure hierarchy; research indicates effective, but not as effective as flooding
Sensate focus
based on counter-conditioning; developed by Masters and Johnson; uses pleasure to counter-condition performance anxiety (body massages that are discontinued at first sign of anxiety); require couple initially to abstain from intercourse
Masters and Johnson sexual response cycle stages
excitement, plateau, orgasm, resolution
Assertiveness training
based on counter-conditioning; assertiveness response antagonistic to social anxiety
Aversive conditioning
based on counter-conditioning; used to eliminate “bad” or “deviant” behaviors; conditioned stimulus paired with new and stronger aversive stimulus; in vivo or in imagination; may have short-term benefits, but not effective in long run; high rates of recidivism
Covert sensitization
aversive conditioning done in imagination
Antabuse
response of nausea or vomiting when ingesting alcohol
Disulfiram
Antabuse; response of nausea or vomiting when ingesting alcohol
Interventions based on classical extinction
present conditioned stimulus without unconditioned stimulus until CS no longer elicits CR; techniques are flooding or implosive therapy
Flooding
based on classical extinction; in vivo or in imagination; present CS without US; prolonged exposure (about 45 min) more effective than multiple, briefer periods (can exacerbate); flooding with response prevention more effective than systematic desensitization for agoraphobia, OCD, specific phobias
Implosive therapy
based on classical extinction; developed by Stampfl; client exposed to feared object in imagination, therapist interprets psychosexual themes; research indicates gains only due to exposure component
Treatment approaches based on operant conditioning
involve reinforcement or punishment; typically involves functional assessment; behavior modification program
Treatment based on reinforcement
shaping, token economies, contingency contracting, Premack principle, differential reinforcement, self-reinforcement;
Primary reinforcers
reinforce everyone at all ages from all cultures (e.g., food
Secondary reinforces
acquire reinforcing value through training or experience (e.g., praise)
Generalized conditioned reinforcers
not inherently reinforcing but take on value because give access to other reinforcers (e.g., money, tokens)
Contingency contracting
utilized when there are problematic interactions between two or more people; helps people involved identify behaviors they most want from one another and negotiate a contract for their exchange
Premack principle
principle of reinforcer relativity; use high frequency behavior to reinforce low frequency behavior (e.g., eat vegetables before going out to play); “Grandma’s Rule”
Principle of reinforcer relativity
Premack principle; use high frequency behavior to reinforce low frequency behavior
Differential reinforcement of other behaviors (DRO)
also differential reinforcement of incompatible responses (DRI) or differential reinforcement of alternative responses (DRA); combines extinction and positive reinforcement; example: ignore off-task behavior, reinforce on-task behavior
Self-reinforcement
administering reinforcement to oneself (e.g., reward for each pound lost); one element of behavioral self-control or self-regulation procedures
Self-control procedures
self-reinforcement, self-monitoring, stimulus control
Stimulus control
self-control procedure; narrow range of stimuli that elicit particular behavior (e.g., eating only at table) and develop incompatible responses (e.g., going for walk instead of snacking)
Treatment based on aversive control of behavior
positive punishment, escape learning, avoidance learning, overcorrection
Positive punishment
adding aversive stimulus (e.g., yelling) after undesired behavior; rarely used in clinical settings; example: thought stopping; merely suppresses behavior but does not eliminate it
Maximize effectiveness of punishment
at maximum intensity the first time, certain, little delay; delivered early if sequence of undesirable behaviors; alternative routes to reinforcement should be made clear
Escape learning
aversive stimulus cannot be avoided altogether but can be stopped by desired behavior (e.g., make assailant go away by giving wallet, stop shock by pulling lever)
Avoidance learning
aversive stimulus avoided entirely by emitting desired behavior in time; typically discriminative stimulus or cue notifies time for behavior (e.g., pay before date on bill)
Overcorrection
involves restitution or reparation as well as physical guidance (e.g., require child to clean two rooms if messes up one
Treatment approaches based on social learning theory
modeling of adaptive behaviors to replace maladaptive ones; used for treatment of phobias, improve social skills, repair behavioral deficits; symbolic modeling, live or in vivo modeling, participant modeling
Symbolic modeling
filmed modeling; observing a film in which model (similar to participant) enjoys progressively more intimate interaction with a feared object or anxiety-producing setting
Live or in vivo modeling
observe live model engage in gradual interactions with feared object or anxiety-producing situation
Participant modeling
live modeling plus contact with model; model gradually guides participant in interacting with feared object/situation; particularly appropriate for children with phobias
Wolfgang Kohler
early critic of pure behavioral model of learning; known for insight studies with chimps
Edward Tolman
early critic of pure behavioral model of learning; known for studies with rats that demonstrated “latent learning”
Ellis
dissatisfied with psychoanalysis; developed rational emotive behavior therapy (REBT)
Rational emotive behavior therapy (REBT)
first cognitive-behavioral treatment approach; developed by Ellis; providing clients with an alternative philosophical system, by relying largely on persuasion and reason as the means of modifying beliefs; approaches problems in a direct and straightforward way by convincing them of their irrationally (emotional disturbances thought to stem from irrational beliefs); ABC model, proposed it is not activating event but instead one’s beliefs about event that result in consequence; DEF result of therapy; direct instruction, persuasion, and logical disputation are major procedural components; actively dispute irrational beliefs; active and confrontative; also includes modeling, homework, relaxation, and rehearsal; multimodal, integrates cognitive, affective, and behavioral
DEF (Ellis’s REBT)
result of therapy; disrupting intervention, adoption of more effective philosophy, new feelings
Cognitive therapy
developed by Beck; emphasizes hypothesis testing and Socratic questioning; more collaborative than REBT; automatic thoughts, logical errors, faulty conceptions, self-signals; keeping daily logs, activity scheduling, attempting gradual tasks to increase mastery, and encouragement of activities to check out one’s cognitions
Beck’s cognitive triad
negative view of self, world, and future; results in depression
Meichenbaum
cognitive behavior modification
Cognitive behavior modification (CBM)
self-instructional training and stress inoculation training; focus on self-statements; emphasizes collaboration and Socratic questioning
Self-instruction therapy
combines modeling and graduated practice with elements of rational emotive theory, to help children or adults that have problems with task com; empirically supported for children with ADHD; five step procedure: therapist modeling, therapist verbalization, patient verbalization, patient silently talks through task, independent task performance
Protocol analysis
Meichenbaum; used when a person is learning a task and is asked to describe aloud the steps being taken to solve the task; gain access to people’s problem-solving strategies
Stress inoculation training
Meichenbaum; guidelines for treating stressed individuals; empirically validated for treatment of PTSD; idea of “ inoculation ,” that bolstering a client’s repertoire of coping responses to milder stressors can decrease susceptibility to more severe stress; three-phase intervention approach: education and cognitive preparation (reactions depend on interpretation of events, coping abilities affect subjective stress), coping skills acquisition (relaxation, coping self-statements, imagery, and thought stopping), application of skills in imagination and in vivo
Rehm
self-control model of depression
Self-control model of depression
Rehm; integrates cognitive and behavioral models; reinforcement is important but can be self-generated (rather than only derived from external sources); views depression and its concomitant low rate of behavior (e.g., lack of involvement in activities) as a result of negative self-evaluations, lack of self-reinforcement and high rates of self-punishment
Marlatt
relapse prevention
Relapse prevention
Marlatt; attempts to minimize effects of relapses by teaching to view relapses as inevitable and something to learn from; identify the triggers for relapse (external factors, interpersonal situations, or internal states); assist to develop new skills or behaviors for dealing with triggers
Classical psychoanalysis
Freud’s view of human nature is basically deterministic, determined by irrational forces, unconscious motivations, biological and instinctual drives, and psychosexual events of the first six years of life; neurotic anxiety results when the unacceptable urges of the id become too strong to be controlled by the ego , and these impulses begin to edge their way into consciousness; cornerstone is free association; treatment process involves four steps (clarification, confrontation, interpretation, and working through)
Id
most primitive part of psyche; ruled by instincts (libido, aggression); present at birth; largely unconscious, lacks organization, and disregards reality; operates on pleasure principle
Ego
operates on reality principle; defer immediate gratification in order to obtain greater long-term gratification; “executive” controlling conscious and psychic functions; main task is to suspend or satisfy the id impulses using means that are rational, socially acceptable, and reasonably safe
Superego
conscience, moral code, and internalized parental and societal standards; forces the ego to satisfy the id in a manner that is moral and ethical; weapon is guilt; believed to evolve as the child successfully passes through the Oedipal stage
Primary process (Freud)
chief characteristic is urgent attempt at tension reduction, even at the expense of reality; includes dreams and hallucinations
Secondary process (Freud)
characterized by a focus on meeting the demands of reality and by the ability to delay gratification; includes thinking and speaking
Defense mechanism
purpose is to prevent id’s forbidden impulses from entering consciousness; work through self-deception and distortion of reality so that id’s urge is not acknowledged
Motivated forgetting
Freudian defense mechanism; repression; most common
Projection
Freudian defense mechanism; seeing one’ s unconscious urges (e.g., hostility) in another person ’s behavior; common outcome is suspicion and paranoia; (paranoid PD)
Regression
Freudian defense mechanism; (borderline PD)
Dissociation
Freudian defense mechanism; (histrionic PD)
Displacement
Freudian defense mechanism; transference of emotions from the original object to some substitute or symbolic representation (e.g., afraid of sex afraid of snakes); can be factor in phobias
Reaction formation
Freudian defense mechanism; engaging in behaviors that are the exact opposite of the id’s real urges
Intellectualization
Freudian defense mechanism; distancing oneself from one’s feelings; (schizoid PD)
Rationalization
Freudian defense mechanism; coming up with self-satisfying, yet incorrect reasons for one’ s behavior; (narcissistic PD)
Sublimination
Freudian defense mechanism; finding socially acceptable ways of discharging energy from unconscious forbidden desires (e.g., desire to smear feces becomes painter); considered normal and desirable
Theodore Millon
each personality disorder relies on one primary defense mechanism
Introjection
Freudian defense mechanism; internalize ideas or voices of other people; (dependent PD)
Acting out
Freudian defense mechanism; (antisocial PD)
Alloplastic
alloplastic reactions to stress involve trying to change the external environment or blaming the external environment; some argue people with PDs use
Autoplastic
autoplastic reactions to stress involve trying to change oneself or blaming oneself, as is typical of people with Major Depression or anxiety
Ego psychology
expands on classical analysis; focus on the ego’ s capacity for integration and adaptation; Heinz Hartmann, Anna Freud , and Erik Erikson
Heinz Hartmann
“father of ego psychology;” ego arises in parallel instead of out of id; people are not only driven by their passions, but also by their thinking; differentiated between defensive ego functions and ego autonomous functions; coined the term “conflict-free sphere”
Conflict-free sphere
coined by Heinz Hartmann; ego functions occurring and developing outside of conflict, including the functions of perception, learning, memory, and locomotion
Anna Freud
ego’s capacity for mastery by noting the ego’s inherent ability to reconcile drive conflicts with the demands of reality; along with Melanie Klein, pioneering work in applying psychoanalysis with children; interpreted words of children rather than play; attempted to form strong positive bond with clients rather than remain neutral
Erik Erikson
combined ego psychology with psychosocial lifespan theory; development occurs in response to social crises; eight stages of ego development, extend into adulthood; described human behavior as an interaction between the internal world of the psyche (ego, id, and superego) and the external social world
Object-relations theory
expands on classical psychoanalysis; deals with capacity to have mutually satisfying interpersonal relationships; inherent drive for satisfying object relationships; Early object relationships are thought to have a profound impact on personality development; therapy as opportunity to experience object relations that differ from childhood; integrating split-off parts of the self and integrating the good and bad into whole object representations to obtain object constancy; therapist plays active role (not “blank screen”); Klein, Winnicott, Mahler
Melanie Klein
described splitting as a major defense mechanism used when the infant has hostile feelings toward a loved object; splitting prevents object constancy; saw play as the child’s free association, and conducted child therapy in a manner very similar to adult analysis
Winnicott
importance of being a “good enough mother;” pathology as resulting from abandoning one’s true self and adopting a “ false self;” importance of the transitional object, which serves as a link between developing children and their mothers (e.g., a child’s favorite blanket or doll)
Margaret Mahler
six-stage theory that describes the processes of separation and individuation
Separation
process of becoming a discrete physical entity by physically distancing
Individuation
process of becoming a psychologically independent person, involves maturation of independent ego functions
Self-psychology
based on Khout; development of narcissism, earlier stages of life; focus on “ empathic attunement” with clients and prefer interpretations that are “ experience near” rather than “ experience distant” (such as those in classical psychoanalysis)
Khout
self-psychology; suggested that there was another line of development, the development of narcissism; focused on earliest stages of child’s life
Primary narcissism
proposed by Khout; healthy kind of narcissism that occurs when a baby naturally focuses on getting its own needs met
Selfobject needs
mirroring (approval and admiration of the baby), idealizing (the presence of adults worthy of idealization), and twinship (the ability to join in with and imitate adults, like a toddler pretending to shave when his father does)
Neo-freudian
expanded on classical psychoanalysis; focused on the impact of social and cultural factors in determining personality; psychological disturbance results from faulty learning and involves a characterologically maladaptive style of interacting with the environment; psychotherapy is interpersonal experience, helps client examine difficulties in relating to people; Sullivan, Horney, Fromm
Harry Stack Sullivan
known for interpersonal theory; believed that personality exists only in an emotional exchange between people; drew from Piaget’s theory of cognitive development; three modes of existence (prototaxic, parataxic, syntaxic)
Prototaxic
birth to seven months; serial sensation and a stream of sensory experiences that are isolated and uncoordinated with one another
Parataxic
8-11 months; sequential sensations, and the dominance of temporal sequence serves as the only conception of causality
Syntaxic
12 months-2 years; causal sensation, logical and analytical thinking, and ability to predict cause from knowledge of their effects
Interpersonal therapy (IPT)
based in large part on Sullivan’s work; evidence-based treatment for depression; 16-session, time-limited therapy model that connects the client’ s presenting problem to interpersonal difficulties; focused on current relationships; one of four interpersonal problem areas targeted (grief, role dispute, role transition, or interpersonal deficits); does not use traditional psychodynamic techniques
Karen Horney
neurosis is a culturally defined construct, indicating deviation from a common pattern of behavior in a given society; results from alienation, basic anxiety and basic hostility that result from the child’s discovery of helplessness in the face of all-powerful, indifferent adults; three neurotic trends (moving compliantly toward others, moving aggressively against others, and moving detachedly away from others)
Erich Fromm
viewed man’s behavior as resulting from sociocultural and economic conditions; experience of freedom frightens most people; two modes of existence: having and being (being healthier)
Alderian psychology
also individual psychology; each person strives for superiority or personal competence; we struggle not just to survive but to master life; believed humans profoundly influenced by first six years of life but primarily influenced by social (aggressive) rather than sexual urges; our happiness or success is largely related to social connectedness and our ability to transcend the self; more one’s life-style is connected to struggles for power at the expense of social interest, the more likely the person is to engage in maladaptive behavior; neurosis results from a maladaptive effort to compensate for feelings of inferiority by adopting a life-style by adopting a lifestyle that is unproductive; interpretation focuses on mistaken goals and faulty assumptions; focus on encouraging client; focus on current concerns and goals rather than past conflicts; teleological view of behavior (determined by future rather than past); pragmatic, problem-solving approach; applications to education and parenting
Individual psychology
Alderian psychology
STEP Program
Systematic Training in Effective Parenting; based on Alder; democratic approach to parenting that values and respects the child’ s contribution; democratic approach to parenting that values and respects the child’ s contribution; encourages parents to understand misbehavior as one of four mistaken goals (attention, power, revenge, giving up)
Jungian psychology
analytic psychology; psyche include conscious ego, personal unconscious, and collective unconscious; neurosis represents struggle to free oneself from interference of archetypes their progress toward personality integration and fulfillment of potential, seen as striving for maturity (individuation) rather than illness; teleological view of behavior (determined by future rather than past); utilize interpretation to help the client gain awareness of the unconscious, with a particular focus on the symbolic meaning of dreams, myths and folklore; guide client into a productive relationship with elements of unconscious and thereby liberate growth-promoting forces within personality; direct focusing of session and real relationship; more focused on adult development
Collective unconscious
Jung; transpersonal or impersonal; include archetypes
Archetypes
Jung; primordial images and ideas that have been inherited, and that are common to all members of the race from the beginning of life; examples: persona (social mask), shadow (hidden aspects), anima (female aspect), animus (male aspect)
Analytic psychology
Jungian psychology
Teleological view of behavior
determined by future rather than by past
Humanism/existentialism
emphasize client’s subjective experiences; phenomenological approach which requires therapist to enter client’s subjective world; trust client’s capacity to make positive and constructive conscious choices; emphasis on freedom, choice, autonomy, purpose, and meaning, and the focus is on the present; Client-Centered Therapy (Carl Rogers) , Gestalt Therapy (Fritz Peris), and Reality Therapy (Glasser)
Humanists
believe we move in direction of actualization if nurtured; Maslow key figure (hierarchy of needs)
Existentialists
believe we have no internal nature, world lacks intrinsic meaning, people faced with what to make of meaninglessness; influenced by philosophers; Binswanger, Boss, Victor Frankl, R. D. Laing , Rollo May and Irving Yalom
Client/person-centered therapy
Carl Rogers; premise that all people have inborn capacities for purposive, goal-directed behavior, and, if free of adverse conditions, will develop into self-accepting, kind, socialized persons; faulty learning, however, can cause people to become hateful, self-centered, ineffective and antagonistic; problems due to incongruence between self (true feelings) and experience (ability to be aware of and express these feelings); focus on correcting faulty learning by providing clients with opportunity to expand awareness of and liking for themselves; does not offer direct suggestions or make interpretations; overall focus of treatment is on clarifying feelings, without judging them or elaborating upon them; three characteristics of treatment are empathy, warmth, and genuineness
Carl Rogers
person/client-centered therapy
Phenomenal self
client/person-centered therapy; private world of experience and meaning
Empathy
client/person-centered therapy; therapist conveys to a client that he or she is being listened to and understood
Warmth
client/person-centered therapy; unconditional positive regard and acceptance
Genuineness
client/person-centered therapy; also called congruence; therapist being truthful and authentic and saying only what he or she believes, and doing only what is comfortable
Gestalt Therapy
Perls; people structure experiences as whole, integrated organisms, not in cognitive or affective fragments; healthy functioning when maintain flexible and adaptive contact with own needs and environment, otherwise personality fragmentation, limited awareness, and deficiencies in responsibility, authenticity and self-regulation; focus of therapy is becoming aware of whole personality by discovering aspects of self that are blocked from awareness, achieve integration; goal is to enhance capacity to communicate or make contact with self and others; resistances to contact or boundary disturbances (Polster & Polster) include introjection, projection, retroflection, deflection, and confluence; active and focuses on awareness, experience and affective expression, rather than on a cognitive analysis of behavior; empty chair, become different parts of dreams; focus on present
Perls
Gestalt therapy
Introjection
Gestalt therapy resistance to contact or boundary disturbance; people take information in whole, which results in problems with being overly compliant and gullible
Projection
Gestalt therapy resistance to contact or boundary disturbance; people project their feelings onto others, which results in paranoia
Retroflection
Gestalt therapy resistance to contact or boundary disturbance; turn back on self what would like to do to others; results in self-destruction
Deflection
Gestalt therapy resistance to contact or boundary disturbance; distance themselves from their feelings through distraction, humor, generalization, and asking questions rather than making statements
Confluence
Gestalt therapy resistance to contact or boundary disturbance; lack of awareness of a differentiation between the self and others, in an attempt to avoid conflicts
Reality therapy
Glasser; influenced by existentialism and REBT; key feature is responsibility; clarifying clients’ values and helping clients evaluate current behavior and plans in relation to values; end goal is client accepting responsibility; Choice Theory (Control Theory) key element; help client perceive of consequences of possible courses of action and decide on realistic solutions or goals; once plan of action is chosen, contract may be signed; use of humor, paradox, skillful questioning; used with juvenile delinquents, prison inmates
Glasser
reality therapy
Choice Theory
previously known as Control Theory; we create an inner world that satisfies our needs, one that does not necessarily reflect the real world; behavior is an attempt to control perceptions of the external world to fit internal “need-satisfying” world; all behaviors generated from within, people have choices
Schools Without Failures
based on reality therapy; used in high schools to reduce drop-out rates
Berne
transactional analysis
Transactional analysis (TA)
Berne; rooted in anti-deterministic philosophy; clients become aware of intent behind communication, eliminate deceit they can interpret their behavior accurately; looks at early decisions a person made and capacity to make new decisions; key concepts: ego state, transactions, games, strokes, life scripts; techniques include structural analysis (becoming aware of parent, adult, child), transactional analysis (looking at communication patterns), analysis of games, script analysis
Ego states (transactional analysis)
parent, adult, child; components of personality
Transactions (transactional analysis)
interactions between ego states of two persons; occur at two levels: social (overt) and psychological (covert); can be complementary (e.g., adult to adult), crossed (e.g., one person adult to adult, other responds child to parent), or ulterior (e.g., dual levels of simultaneous transaction, one overt and one covert)
Games (transactional analysis)
orderly series of ulterior transactions, commonly ends in bad feelings for both
Strokes (transactional analysis)
recognition given to a person, positive or negative
Life scripts (transactional analysis)
patterns that have developed that virtually dictate one’s life; parents give child messages (injunctions) about how to behave to receive recognition (strokes), which influence early decisions that guide adult development and behavior
Hypnotherapy
state or condition in which person is able to respond to suggestions by experiencing alterations of perceptions, memory, or mood; subjective experiential change
Levels of trance state for hypnosis
light: changes in motor activity (e.g., muscles relax, hands levitate, parasthesias); medium: decreased pain sensation and partial or complete amnesia; deep: deep anesthesia as well as induced visual and auditory experiences and capacity for post-hypnotic suggestion; regardless of state, will not follow command if it is something does not want to do
hypnosis uses
chronic pain, asthma, conversion symptoms, substance use, aid memory (but research indicates more false memories)
people who are good candidates for hypnosis
paranoid, obsessive-compulsive
Eriksonian hypnotherapy
techniques that rely on psycholinguistic nuances as well as relaxation and focus during trance; depends more on subtleties of communication; manipulative, controlling, and paradoxical at times
Biofeedback
operant conditioning of normally involuntary autonomic nervous system (ANS) functions, with the goal of alleviating symptoms; given feedback about the status of certain involuntary biological functions, and is then taught to regulate one or more of these biological states; mechanism is decreased sympathetic arousal; common include thermal biofeedback, EMG, EEG, and GSR
Thermal biofeedback
measures skin temperature; commonly used for migraine headaches and Reynaud’s disease; goal is to increase peripheral skin temperature; commonly combined with autogenic training (a specific type of relaxation training that focuses on warmth and heaviness)
Autogenic training
a specific type of relaxation training that focuses on warmth and heaviness
Electromyography (EMG)
measures surface muscle tension (jaw, lower back, forehead); commonly used for tension headaches, temporomandibular joint pain (TMJ), and back pain; goal is equalizing or reducing tension; also used for neuromuscular rehabilitation (e.g., secondary to stroke); commonly combined with progressive or passive muscle relaxation training
Electroencephalography (EEG)
a measures brain waves; used to treat people suffering from hyperactivity or seizure disorders
Galvanic skin response (GSR)
also called electrodermal response (EDR); measures skin conductivity or sweat; used in treatment of generalized anxiety (in combination with relaxation)
Evidence for biofeedback effectiveness
inconsistent; EMG biofeedback for tension headaches (most effective) and thermal biofeedback for migraine are both effective treatments
feminist therapy
promotes independence and autonomy; don’t bond with clients because don’t want to foster dependence; sexism as underlying problem, don’t focus on pathology; strive for egalitarian relationship, make appropriate self-disclosing comments, serve as role models; advocate for socio-political change
Prochaska
Transtheoretical Model of Behavior Change
Transtheoretical Model of Behavior Change
Prochaska; people progress through stages in changing their behavior; five stages of change are precontemplation, contemplation, preparation, action, and maintenance; used for addictive behaviors, eating disorders, weight management, promoting health-related behaviors
precontemplation stage
do not believe have a problem; defenses; no intention to change
contemplation stage
begin to acknowledge problem, increase awareness and knowledge of problem; ambivalence; no attempts to change or commitment to change
Preparation stage
have developed commitment to change; construct detailed plan for change; perceive greater benefits than barriers
Action stage
initiate behavior change; others recognize progress; move to maintenance after at least six months
maintenance stage
steps to prevent relapse and maintain gains
Miller & Rollnick
motivational interviewing
Costa & McCrae
utilized factor analysis on previous personality research to develop five-factor theory of personality
Five-factor theory of personality
“Big 5” model; Costa & McCrae; five basic personality traits are openness to experience (O), conscientiousness (C), extroversion (E), agreeableness (A), and neuroticism (N)
Neuroticism
a emotionally unstable, insecure, anxious, and moody; people who score low are emotionally stable, even -tempered, calm, easy-going, and relaxed
Two theoretical models for family therapy
general systems theory, cybernetics
General systems theory
system is an interaction of component parts, which seeks to attain homeostasis.
cybernetics
focuses on circular nature of feedback loops, which can be positive or. Negative
Positive feedback loops
increase deviation or change; ex: marital argument;
Negative feedback loops
decrease deviation in a system, maintain status quo; ex: thermostat, family returning to healthy functioning after disruptive event
family therapy theories
psychodynamic, structural, communications, strategic, family systems, behavioral/social learning
Psychodynamic family therapy
emphasis is on facilitating individual maturation within context of family system and freeing family members from unconscious patterns of anxiety and projection rooted in past; emphasize clarifying communication and honestly admitting feelings
Lidz
two types of marital relationships (marital schism and marital skew) which lead to impaired parenting and disrupted sex-role learning for child; psychodynamic family therapy
Marital schism
severe, chronic discord and disequilibrium; common and recurrent threats of separation; communication centers on power struggles and efforts to avoid facing schism; parents seek support from children, diminish other parent; psychodynamic family therapy
Marital skew
relationship skewed toward meeting needs of one member at expense of other; psychodynamic family therapy
Family sculpting
psychodynamic family therapy; therapist interprets family sculpture and modifies it to suggest new relationships
Object-relations family therapy
branch of psychodynamic family therapy; focuses on transferences and projections; problems are caused when members unconsciously project unwanted elements of themselves onto others in the family; as a result, experience dissatisfaction and try to change one another; help become aware of projections and address unwanted elements within each person
Framo
object-relations family therapy; family-of-origin sessions in which a troubled couple first meets with one spouse’ s entire family-of-origin and then, in a later session, meets with the other spouse’s family-of-origin
Minuchin
structural family therapy; described three chronic boundary problems (triangulation, detouring, stable coalitions)
Structural family therapy
family viewed as single, interrelated system, assessed along a variety of dimensions: hierarchy of power, clarity and firmness of boundaries, and significant alliances and splits (subsystems); pathology results from structural imbalances such as a malfunctioning hierarchical arrangement, or poor boundaries that may be too rigid or too diffuse; goal is to unbalance or reorganize family’s structure to remove dysnfunctional elements; therapist joins family and attempts to understand dynamics; strategies for unbalancing include therapist taking sides, blaming, forming coalitions; highly effective in treatment of child and adolescent problems
Triangulation
child is caught in the middle of parents’ conflict, with each parent demanding the child side with him or her; child becomes paralyzed
Detouring
parents express through one child, who becomes identified client; false sense of harmony between parents who blame child for problems or unite to protect sick child
Stable coalition
One parent unites with child against other parent; rigid, cross-generational coalition
Communications family therapists
Virginia Satir, Paul Watzlawick, Gregory Bateson, Don Jackson, and Jay Haley; MRI group (research at Mental Research Institute in Palo Alto in 1960s); focused on communication and its impact on family functioning
Double bind
maladaptive communication that typically involves at least three elements: an injunction telling the person that if they do or don’t do something they will be punished; a secondary injunction which is generally nonverbal, conflicting with the first at a more abstract level, also enforced by punishment; and a tertiary injunction prohibiting the victim from escaping the field (e.g., by not allowing the victim to point out the inconsistency); ex: hug mother, mother stiffens, mother scolds when withdraws; saw as contributing to schizophrenia (double bind theory of schizophrenia)
Communications family therapy techniques
direct (teaching, pointing out problematic patterns) and indirect (paradoxical interventions such as prescribing the symptom) techniques
Haley
strategic family therapy; influenced by Milton Erikson
Strategic family therapy
Haley; combines Minuchin’s structural approach (focus on hierarchies) and communications approach (focus on family communication and interactions); normal family functioning involves flexibility, a large behavioral repertoire for problem -solving and life-cycle passage, and clear rules governing the family’s hierarchy; pathology results from malfunctioning hierarchy; views family’s presenting problem and symptoms as communicative act within an interactional pattern; treatment focuses on resolving presenting problem only, interrupting the rigid feedback cycle and defining a clearer hierarchy
Milan group
Palazzoli, Boscolo, Cecchin, and Prata; systemic family therapy
Systemic family therapy
developed by Milan group; elements of general systems theory and cybernetics (feedback loops), as well as components of strategic theory, such as communication, reframing, and paradox; key elements are circular questioning and prescription of rituals
Circular questioning
gathering information (hypothesis formation) and at the same time introducing information into the family system; ex: each family member asked to express views; transforms families’ ways of thinking from linear and causal, to reciprocal and interdependent
Prescription of rituals
purpose is to alter family’s direction from current course; Some therapists tailor rituals to specific needs of each family; others always prescribe same ritual (may involve parental secrecy and parental outings framed as disappearances)
Bowen
family systems therapy
family systems therapy
Bowen; families have clearly differentiated family members and overall balance of intellectual and emotional forces; families with pathology function as a single organism and the identified patient is that part of the organism through which overt symptoms are expressed; goal of treatment is personal differentiation from family-of-origin; family assessed on two levels: degree of fusion vs. ability to differentiate and analysis of emotional triangles in presenting problems; therapists role is to shift hot triangle (the one that relates to the presenting problem) and to work with most psychologically available family members on achieving enough differentiation to avoid hot triangle
Family emotional system
Bowen’s family systems therapy; undifferentiated family ego mass; emotional oneness that exists and shifts about within the family in definite patterns of emotional reactivity
Multigenerational transmission process
Bowen’s family systems therapy; emotional dysfunction of individual results from emotional processes that have lasted in family over several generations
Emotional triangle
Bowen’s family systems therapy; three-party system arranged so that the closeness of two members tends to exclude a third
Genogram
originated by Bowen; historical survey of family going back several generations
Steve de Shazer
initially developed solution-focused therapy
Solution-focused therapy
has roots in MRI group, initially developed by Steve de Shazer; encourages clients to focus on strengths and identify solutions; built on assumption that expectations are powerful, therefore attempts to set up positive expectations; assumes therapist only has to cause relatively small change in client, starts process that leads to bigger changes; typically brief (3-4 sessions); known for use of specific questions (miracle question, exception question, scaling question)
Miracle question
solution-focused therapy; suppose there was a miracle and this problem was solved. How would you know? What would be different?
Exception questin
solution-focused therapy; think about times when they didn’t have the problem to discover what they were doing that was effective at that time
Scaling question
solution-focused therapy; rate their problem on a scale of 0 to 10 (ten being how they will feel the day after the miracle); helps highlight small improvements and reduce all-or-nothing thinking
Michael White
narrative therapy
Narrative therapy
Michael White; symptoms do not serve functions but rather oppress people; symptoms thought to result from clients developing stories that are “problem-saturated descriptions,” filled with a sense of powerlessness; takes directive role in helping clients to “re-story” by casting difficulties as “struggle for control” with symptom; asks questions to demonstrate “unique outcomes,” those successes that have been hidden by the focus on problems; as change occurs, new questions are asked to strengthen and solidify the success and the new identity that emerges
Behavioral family therapy model
Liberman, Patterson, Alexander; normal family functioning results when adaptive behavior is rewarded, maladaptive behavior is not reinforced, and the benefits of being a member of the family outweigh costs; in troubled families, maladaptive behavior is reinforced by family attention; treatment focuses on concrete, observable behavioral goals; key interventions include changing contingencies of social reinforcement and improving communication
Cognitive-behavioral family therapy
relationship-related cognitions are seen as underlying cause of feelings and behavior of family members; assess cognitive appraisals of each other, intervene to promote relationship-related cognitions that cause growth and adaptive functioning
Marital behavioral therapy
begins with thorough behavioral analysis of couple; positive reciprocity established to increase couple’s positive and loving behaviors; communication skills taught (“I” statements; staying in present, positive feedback); problem-solving skills improved (negotiation and contingency contracting); Richard Stuart was one of the pioneers
Richard Stuart
one of the pioneers of marital behavioral therapy; developed approach combining operant principles with social exchange theory; used contingency contracting to address; goal is to enhance positive behavioral change; caring days
Social exchange theory
behavior in relationships maintained by ratio of costs and benefits
Caring days
one day a week, spouse deliberately performs behaviors requested by partner; requests most be positive, specific, small, and not a focus of current marital conflict; increase positive reciprocity and commitment
Twelve distinct factors that contribute to group benefits
Yalom; insight, the instillation of hope, universality, imparting information, altruism, corrective recapitulation of the primary family group, development of socializing techniques, imitative behavior, interpersonal learning, group cohesiveness, catharsis, and existential factors; cohesiveness considered most critical
Yalom
twelve factors that contribute to group benefits; catharsis necessary but not sufficient for change; believes leadership style, ideological school, and confrontation do not contribute to group effectiveness; cohesiveness considered most critical component; therapists’ tasks include shaping group into therapeutic social system; process groups evolve through three stages (initial, second, third); appropriate open conflict between leaders and self-disclosure can be beneficial
Initial stage for process groups
alom; characterized by attempts of group members to get oriented; participation hesitant; content and communication style is stereotyped and restricted; discusses topics of little personal significance, searches for commonalities; typically talk to therapists rather than to one another
Second stage for process group
Yalom; conflict among group members, rebellion toward group leaders, attempts at dominance
Third stage for process group
Yalom; characterized by development of closeness, intimacy, cohesion; group members talk freely with one another
Clients most likely to fail in groups
Those with lowest skills
Ideal group composition
members who are heterogenous in terms of conflict, homogenous in terms of ego strength; ideal size is 7-8, 5-10 acceptable
Crisis theory
centers on concept of homeostatic equilibrium (psychosocial balance, person’s usual coping techniques operating sufficiently to handle daily problems
Caplan’s four stages of typical crisis situation
emotional tension and disorganization when crisis begins, attempts to manage situation using previously-learned coping; coping efforts fail, further disorganization; increased tension, further mobilization of internal and outside resources, perhaps help-seeking or change of direction/goals; if intensified efforts fail, extensive personality disorganization and emotional breakdown
Most crucial aspect of crisis intervention
rapid treatment with goal of resolving crisis and avoiding chronic symptoms
Elements of crisis treatment
establishing rapport, reviewing steps that led to crisis, helping client gain understanding of maladaptive reactions, helping client develop more adaptive ways of dealing with crisis; taught strategies to avoid hazardous situations likely to produce crisis; terminated as soon as appears crisis has been resolved and client understands steps that led to development and resolution
Community intervention
focuses on the prevention, treatment and rehabilitation of mental disorders through the use of organized community programs
1963 Community Mental Health Centers Act
community mental health centers (CMHCs) were created to provide five services: inpatient, emergency, consultation, day care (including halfway houses and outpatient treatment), and research and education
Caplan’s four categories of consultation
client-centered case consultation, consultee-centered case consultation, consultee-centered administrative consultation, program-centered administrative consultation
Consultee-centered administrative consultation
consultant focuses on the consultee’s difficulties that limit effectiveness in instituting program change; ex: increase therapist’s knowledge about type of program working within with goal of implementing goal more effectively
Advocacy consultation
consultant advocates for social change
Primary prevention
prevent the onset or occurrence of disease or disorder, reducing its incidence; often focuses on building psychological health through education and competence training (e.g., Head Start, vaccinations)
Secondary prevention
focuses on early identification and prompt treatment of illness or disorder that already exists; stop mild from becoming more serious or prolonged; prevent mild from becoming more serious or prolonged; reduce prevalence of disorder (how many cases at any given time) by shortening duration (e.g., mammogram, hotlines, screening for learning disabilities)
Tertiary prevention
reducing residual effects of chronic disability or minimizing negative consequences of established, serious disorder; (e.g., vocational rehabilitation, day treatment centers, 12-step programs)
Child abuse statistics
one million maltreated each year; 2,000-4,000 deaths caused by abuse or neglect
Physical abuse or neglect risk factors
more than half born prematurely or had low birth weight; perceived by parents as developmentally slow, different, hard to discipline; hyperactive children; poor, socially isolated homes; inappropriate expectations of children
Physical abuse perpetrator characteristics
female; 80% live in home of child; 80% in two-parent household; 90% severely abused as children; substance abuse common; typically no history of major psychiatric problems
Sexual abuse statistics
150,000-200,000 new cases each year, likely underestimate
Sexual abuse perpetrator characteristics
family member perpetrates approximately 50% of all cases; most common are fathers, step-fathers, uncles, older siblings;
Father-daughter incest characteristics
passive, weak, or otherwise incapacitated mother; daughter who takes on maternal role; father who abuses alcohol; overcrowding
Sexual abuse age
25% involves children under age of 8; peaks at ages 9-12
Domestic violence statistics
estimated 1.5 million women (25%) and over 800,000 men (7.5%); 8% of women and 2% of men report stalking, over 1 million per year;
Predictor of domestic violence
although race/ethnicity has some bearing on incidence, impact lessened when other variables controlled for
Variable that best predicts domestic violence
presence of verbally abusive partner
Characteristics of domestic violence perpetrators
tend to be immature, dependent, nonassertive, and generally feel Inferior; abusive men likely to come from violent homes, witnessed spousal abuse, may have had higher rates of being abused
Expressive spousal abuse
less deliberate, results from difficulty managing emotions; more amenable to psychological treatment; tends to become instrumental over time when left untreated
Instrumental spousal abuse
more deliberate use of violence as a means of control; less amendable to psychological treatment
Demographics of rapists
most men who rape are 14-24; alcohol involved 50% of time; about half are White, close to half African American; most commonly occurs within race
Reaction to divorce by age
3-6 year-olds feel responsible; 7-12-year-olds decreased school performance; adolescents feel they could have prevented, also hurt by and critical of parents
Recovery from divorce
typically takes children 3-5 years
Child gender and adjustment to divorce
initially girls seem to do better; girls become increasingly affected in adolescence and if mother remarries
Child age and adjustment to divorce
younger children are more anxious at time of divorce and have less realistic expectations of what caused it but adapt more quickly and have fewer bad memories
Outcomes for adult children of divorce parents
higher levels of depression and marital problems, lower levels of SES and health
Eysenck (1952) meta-analysis
reported that 2/3 of neurotics improved in two-year period regardless of whether received treatment; treated people actually seem to do worse than non-treated people; widely criticized for non-random assignment to treatment and lack of distinction between therapists administering treatment
Spontaneous improvement rate
estimated to be about 40%
Average effect size for treated vs. untreated
0.85; at end of treatment, average treated person better off than 80% of untreated sample
Meta-analysis about rate of treatment
Howard et al. (1986); 50% measurably improved by 8thsession, 75% improved by end of six months
1995 Consumer Reports study
effectiveness study; 7,000 people given questionnaires about mental health treatment; clients benefited very substantially from psychotherapy, with 90% of treated clients doing well; long-term treatments yielded better outcomes than short-term; clients also receiving medication did not benefit more; no specific modality led to better outcomes for any disorder; Psychiatrists, psychologists, and social workers did not differ in effectiveness but all did better than marriage counselors and long-term family doctoring; treatment limited by insurance or managed care did worse; limitations: absence of control group, non-random assignment, possible biased sampling, reliance on retrospective self-report; many outcomes differ from efficacy research
Client variables and therapeutic outcome
make largest contribution to therapeutic outcome; key variables are client’s ability to relate and client’s amenability to new learning
Client dropout
Sue et al. (1976) found 23% of clients starting therapy dropped out after the first session and 70% dropped out before the tenth session; individuals of lower social classes and with less education drop out earlier and more frequently than those of higher SES and with more education, but also tend to be assigned to less experienced therapists; African Americans tend to terminate earlier than Whites, but these findings are inconclusive and may relate to social class variables; social class affects duration but not outcome of treatment
Diagnoses/symptoms associated with therapy outcomes
clients with symptoms of anxiety and depression improve the most, and those with somatic complaints improve the least
Likeability/attractiveness of client
associated with positive outcomes
Aspects of therapeutic relationship associated with outcome
demonstrably effective: alliance, group cohesion, empathy, collecting feedback; probably effective: goal consensus, collaboration, positive regard; promising: congruence/genuineness, repairing alliance ruptures, managing countertransference
Rates of psychiatric disorders by age
over age of 65 lowest; 45-64 next lowest; 25-44 highest
Total Quality Management (TQM)
philosophy and set of guiding principles that focus on continuous improvement of the organization, its procedures, and the services that it provides; focuses on needs of customer, improving quality of work and finished product; based on five premises: customer focus, total involvement (whole organization), measurement, systematic support (innovative problem solving), continuous improvement; includes Deming’s problem prevention cycle: plan, do, check, act
Quality assurance (QA)
monitoring and evaluating a plan’s health care services in terms of availability or accessibility, adequacy, and appropriateness; promote continuous improvement; interventions include monitoring patterns and outcomes of care, conducting customer satisfaction surveys, reviewing targeted diagnoses and treatments, and comparing current with past performance
Utilization review (UR)
focuses on conserving costs and resources; strategies include reviews (prospective, concurrent, and retrospective), second opinions and case management; goal is to evaluate the medical necessity, appropriateness, cost-effectiveness, and quality of proposed and delivered services
Risk management
taking steps to reduce inappropriate practices, limit potential for liability or malpractice; planned programs for loss prevention and liability management
