Treatment/Intervention

Question 1

Classical Conditioning: Counterconditioning

Answer 1

-systematic desensitization
-sensate focus
-assertiveness training
-aversive counterconditioning

Question 2

Classical Conditioning: Classical Extinction

Answer 2

-in-vivo exposure
-imaginal exposure

Question 3

Operant Conditioning: Reinforcement

Answer 3

-primary, secondary, and generalized conditioned reinforcers

Question 4

Operant Conditioning: Strategies that Involve Reinforcement

Answer 4

-shaping
-token economies
-contingency contracting
-premack principle
-differential reinforcement
-self-reinforcement

Question 5

Operant Conditioning:
Aversive Control of Behaviour

Answer 5

-positive punishment
-escape learning
-avoidance learning
-overcorrection

Question 6

Social Learning Theory Treatment Approaches

Answer 6

-symbolic modelling
-live or in-vivo modelling
-participant modelling

Question 7

Cognitive-Behaviourism

Answer 7

-Ellis: Rational Emotive Behaviour Therapy
-Beck: Cognitive Therapy
-Meichenbaum: Cognitive Bahaviour Modification (CBM)
-Rehm: Self-Control Model of Depression
-Marlatt: Relapse Prevention
-Linehan: DBT

Question 8

Classical Psychoanalysis: Personality Structure and Functioning

Answer 8

-Id, ego, superego (primary and secondary process)
-Anxiety and defense mechanisms (repression, regression, projection, displacement, reaction formation, intellectualization, rationalization, sublimation)

Question 9

Ego Psychology

Answer 9

-emphasis is on the ego
-ego, here, has a critical component in one’s ability to master life

-Heinz Hartmann - father of ego psychology - ego and id develop in parallel and people are thus driven by their passions AND their thinking - conflict-free sphere
-Anna Freud - ego’s capacity for mastery - applied psychoanalysis with children. interpreted their words not their play. Tried to form a positive bond and not remain neutral
-Erik Erikson - development occurs in response to social crises. Epigenetic sequences. First five stages of Erikson’s stages map onto Freud’s psychosexual stages

Question 10

Object Relations Theory

Answer 10

-deals with the capacity to have mutually satisfying interpersonal relationships
-says that infant’s interest in mom is not getting oral needs met but is the inherent need to have relationships as well
-therapy is an opportunity to experience object relations that differ from those experienced as a child
-integrating split-off parts - good and bad into whole object representations

Melanie Klein - splitting as a major defense mechanism used when infant has hostile feelings toward a loved object. Splitting prevents object constancy. Play was seen as child’s free association

Winnicott - good enough mother; transitional object

Margaret Mahler - processes of separation (physical separate being) and individuation (psychologically independent)

Question 11

Self-Psychology

Answer 11

Kohut
-development of narcissism
-focused on earliest stages of a child’s life (pre-oedipal)
-primary narcissism - healthy narcissism that occurs when a baby naturally focuses on getting own needs met
-selfobject needs - mirroring, idealizing, twinship
-self-psychologists focus on empathic attunement

Question 12

Neo-Freudians

Answer 12

-focused on the impact of social and cultural factors in determining personality
-believed that psychological disturbance results from faulty learning and involves a characterologically maladaptive style of interacting with the environment

Harry Stack Sullivan
-interpersonal theory - personality exists only in an emotional exchange between people
-prototaxic, parataxic, syntaxic
-IPT - interpersonal therapy - social factors, relationships, short-term, time-limited, here and now, interpersonal deficits - one of 4: grief, role dispute, role transition, interpersonal deficits

Karen Horney

Erich Fromm

Question 13

Adlerian Psychology (Individual Psychology)

Answer 13

-we inherently strive for superiority, to feel confident
-believed our happiness or success is largely related to social connectedness and our ability to transcend the self
-the more one’s lifestyle is connected to struggles for power at the expense of social interest, the more likely the person is to engage in maladaptive behaviours
-interpretation is a significant therapeutic tool - mistaken goals and faulty assumptions
-teleological view = behaviour seen as determined by the future
-work has been widely applied in university and parenting work - STEP

Question 14

Jungian Psychology (Analytic Psychology)

Answer 14

psyche = conscious ego, personal unconscious, collective unconscious

-within the collective unconscious are archetypes including persona (social mask), shadow (one’s hidden aspects), anima (female aspect), animus (male aspect)
-the self is the transcendant part of the psyche that encompasses all archetypes and components

-neurosis is our attempt to free ourselves from the interference of the archetypes
-they interfere with our capacity to integrate ourselves and fulfill our potential

-teleological approach

-gain awareness of unconscious, focus on symbolic meaning of dreams myths and folklore

-treatment methods - direct focus of the session
-transference = projection of the personal and/or collective unconscious

Question 15

Humanism/Existentialism

Answer 15

-emphasize the client’s subjective experiences
-phenomenological approach: requires the therapist to enter the client’s subjective world
-trust in the client’s ability to make positive and constructive conscious choices
-emphases on freedom, choice, autonomy, purpose, meaning
-focus is on the present

Rogers: Client/Person-Centered Therapy
-all people have inborn capacities for purposive, goal-directed behaviour, and if free of adverse conditions will develop into self-accepting, kind, socialized persons
-pathology is due to incongruence between the self and experience
-therapy focus = providing clients with opportunity to expand their awareness and liking of themselves
-no direct suggestions or interpretations
-accepting non-threatening atmosphere
-empathy, warmth, genuineness

Perls: Gestalt Therapy
-perceptions consist of gestalts which are combinations of figure (what is seen) and ground (what is ignored)
-healthy functioning results with maintaining flexible and adaptive contact with one’s needs and environment
-focus of therapy is client becoming aware of the whole personality by discovering aspects of the self that are blocked from awareness. By re-owning disowned parts, client achieves integration
-resistance to contact or boundary disturbances:
1) introjection
2) projection
3) retroflection
4) deflection
5) confluence
-experiential therapy
-empty chair technique, dreams, active challenging transference

Glasser: Reality Therapy
-key feature is responsibility- end goal is to get clients to accept responsibility
-key focus clarifying helping evaluate current behaviour
-key element = choice theory: we create an inner world that satisfies out needs but does not reflect the real world. our behaviour is an attempt to control our perceptions of the real world to align with our internal world. People have choices in what they do.
-therapy- helping person see consequences of possible actions and decide on realistic solutions. sign a contract.
-widely implemented with juvenile populations, prison inmates
-Schools Without Failures

Question 16

Transactional Analysis: Berne

Answer 16

-antideterministic philosophy
-goal is to become aware of intent behind their communication and eliminate deceit so they can interpret their behaviour accurately
-looks at early decisions and the capacity to make new decisions
-key concepts:
1) ego states
2) transactions
3) games
4) strokes
5) life scripts
-includes structural analysis, transactional analysis, analysis of games, script analysis

Question 17

Hypnotherapy

Answer 17

-essential feature = subjective experiential change
-altered state of consciousness
-in a light trance changes in motor activity can occur
-medium trance - decreased pain sensation and partial or complete amnesia
-deep trance - deep anesthesia and visual and auditory experiences can be induced, post-hypnotic suggestion
-treats chronic pain, asthma, conversion symptoms, substance use
-used to aid memory, but not good for this
-Ericksonian hypnotherapy

Question 18

Biofeedback

Answer 18

-operant conditioning of normally involuntary ANS functions with the goal of alleviating symptoms
-through visual and auditory displays, client is given feedback about certain involuntary biological functions and is then taught to regulate one or more of these biological states
-decreased sympathetic arousal - mechanism of action
-commonly used in conjunction with relaxation training
-specific type of biofeedback and relaxation training depends on the nature of the problem
-commonly used biofeedback procedures:
1) thermal biofeedback - migraines and Reynaud’s disease (circulatory disorder)
2) electromyography (EMG) - tension headaches, TMJ, back pain
3) electroenchephalography (EEG) - hyperactivity or seizure disorders
4) galvanic skin response (GSR) - generalized anxiety

Question 19

Feminist Therapy

Answer 19

-promotes independence and autonomy
-do not attempt to bond with clients to avoid fostering dependence
-view sexism as an underlying cause of problems and don’t focus on pathology
-egalitarian relationship and appropriate self-disclosure
-advocate for socio-political change

Question 20

Prochaska’s Transtheoretical Model of Behaviour Change

Answer 20

-people progress through a series of stages when making changes in their behaviour
-5 stages of change
1) precontemplation
2) contemplation
3) preparation
4) action (at least 6 months)
5) maintenance

Question 21

Motivational Interviewing

Answer 21

-helps clients resolve ambivalence about change
-emphasis on enhancing internal motivational processes
-applications including Motivational Enhancement Therapy - validated for use with substance abuse, health-promotion behaviours, medication adherence, mental health issues

Question 22

Five-Factor Theory of Personality (Big 5 Model)

Answer 22

-5 basic personality traits (OCEAN)
-Costa and McCrae
1) openness to experience
2) conscientiousness
3) extroversion
4) agreeableness
5) neuroticism

Question 23

Family Therapies

Answer 23

-two theoretical models have influenced family therapists:

1) General Systems Theory
-the system is an interaction of component parts which seeks to attain homeostasis

2) Cybernetics
-focuses on the circular nature of feedback loops
-negative feedback loop: decreases deviation in the system and ends up with the status quo
-positive feedback loop: increases deviation or change e.g., marital argument that increases level of distress

Question 24

Family Therapies: Psychodynamic Family Therapy

Answer 24

-focuses on facilitating individual maturation in the context of family systems
-emphasizes helping family members clarify communication and honestly admit feelings
-two deviant types of marital relationships that lead to impaired parenting and disrupted sex-role learning for the child
1) marital schism - power struggles, threats of separation, seek support from children
2) marital skew - relationship skewed toward meeting the needs of one member at the expense of the needs of others
-family sculpting - therapist interprets and modifies the sculpture in ways to suggest new relationships

Question 25

Family Therapies: Object Relations Family Therapy

Answer 25

-branch of psychodynamic family therapy
-focuses on transference and projections between couples or family members
-problems are caused when members unconsciously project unwanted elements of themselves onto others in the family. Members then experience dissatisfaction and try to change one another
-therapy focuses on helping each member become aware of what is being projected and addressing these unwanted elements
-Framo - family of origin sessions - couple meets with one spouse’s entire family of origin, then later with the other

Question 26

Family Therapies: Munchin: Structural Family Therapy

Answer 26

-family is an interrelated system that is addressed on various dimensions
1) hierarchy of power
2) clarity and firmness of boundaries
3) significant alliances and splits (subsystems)

-healthy family = hierarchy with strong parental coalition at the top. boundaries are clear and firm yet there is flexibility allowing for growth. adaptive restructuring in response to changing developmental and environmental demands
-rigid boundaries result in disengaged relationships
-diffuse boundaries result in enmeshed relationships

-three chronic boundary problems:
1) triangulation - child is caught in the middle of parents’ conflict with parents demanding child select a side
2) detouring - parents express their distress through one child, who becomes the identified client
3) stable coalition - one parent unites with the child against the other parent

-goal is to unbalance or reorganize structure such that dysfunctional elements are removed
-therapist is the expert outlining dysfunction and a plan to change it
-at the start of therapy, the therapist “joins” the family and attempts to understand the family’s dynamic by adopting its style of interaction
-then, therapy focuses on shifting members’ positions to strengthen parental hierarchy
-specific strategies for unbalancing homeostasis: therapist taking sides, blaming, forming coalitions

Question 27

Family Therapies: Communications Family Therapy

Answer 27

-MRI group - various therapists - because of their work done at the Mental Research Institute in Palo Alto
-focused on communication and its impact on family functioning
-coined the term “double bind” - a maladaptive communication that typically involves at least three elements:
1) an injunction telling the person that if they do or don’t do something they’ll be punished
2) a secondary injunction that is generally nonverbal, conflicting with the first at a more abstract level and also enforced by punishment
3) a tertiary injunction prohibiting the victim from escaping the field (e.g., by not allowing the victim to point out the inconsistency)

-double bind theory of schizophrenia - saw double binds as contributing to schizophrenia - has not been empirically supported

-this therapy uses both direct and indirect techniques to address communication problems
-direct = teaching, pointing out problematic communication patterns
-indirect = paradoxical interventions such as prescribing the symptoms e.g., telling a couple with marital problems to fight at least 3 hrs per day

Question 28

Family Therapies: Haley: Strategic Family Therapy

Answer 28

-combination of Minuchin’s structural family therapy and communications family therapy
-pathology results from a malfunctioning hierarchy, or triangles and coalitions across the hierarchy
-family’s presenting problems and symptoms are viewed as a communicative act within an interactional pattern
-treatment focuses on resolving the presenting problem only, which is defined by behavioural objectives and criteria
-underlying conflicts and pathology are not addressed
-focus is on interrupting the rigid feedback cycle and defining a clearer hierarchy
-techniques such as paradoxical interventions

Question 29

Family Therapies: Milan Group: Systemic Family Therapy

Answer 29

-elements of general systems theory and cybernetics as well as components of strategic theory
-key aspects:
1) circular questioning - technique that aims at gathering information (hypothesis formation) and at the same time introducing information into the family system. Transforms families’ ways of thinking from linear and causal to reciprocal and interdependent
2) prescription of rituals - purpose of this is to altar the family’s direction from its current course. sometimes tailored to the family, other times not (e.g., parental secrecy and parental outings framed as disappearances)

Question 30

Family Therapies: Bowen: Family Systems Therapy

Answer 30

-Bowen: healthy families have clearly differentiated family members there is an 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
-family emotional system (undifferentiated family ego mass) - the emotional oneness that exists and shifts about within the family in definite patterns of emotional reactivity
-multigenerational transmission process - emotion dysfunction of an individual results from emotional processes that have lasted in the family over several generations

-essential goal of treatment is personal differentiation from the family-of-origin - ability to be one’s true self in the face of familial or other pressures that threaten loss of love or social position
-family presenting for treatment is assessed on two levels:
1) degree of fusion or emotional cutoff versus ability to differentiate
2) analysis of emotional triangles in presenting problems
-emotional triangle = a three-party system arranged so that the closeness of two members tends to exclude a third

-therapist’s role is two-fold:
1) shift the hot triangle that relates to the presenting problem
2) work with the most psychologically available family members, individually if necessary, on achieving enough personal differentiation so that the hot triangle doesn’t recur
-de-triangling and repairing emotional cutoffs

-Bowen originated the genogram

Question 31

Family Therapies: Solution-Focused Therapy

Answer 31

-encourages clients to focus on their strengths and to identify solutions, either ones that have already worked in the past or ones that might work in the future
-built on assumption that expectations are very powerful
-set up positive expectations in the client and therapist
-assumes therapist only need to cause a small change in the client because this will lead to bigger changes
-brief - 3-4 sessions

-several types of questions:
1) miracle question
2) exception question
3) scaling question

Question 32

Family Therapies: Narrative Therapy

Answer 32

-moves away from systems view of problems
-symptoms do not serve functions - they oppress people
-symptoms result from clients developing stories that are “problem-saturated descriptions” filled with a sense of powerlessness

-helping clients “re-story” by casting their difficulties as a “struggle for control” with a symptom:
1) symptom is externalized
2) ask questions to demonstrate “unique outcomes”
3) as change occurs, ask new questions to strengthen and solidify the success and the new identity that emerges

Question 33

Family Therapies: Behavioural and Cognitive-Behavioural Family Therapy

Answer 33

Behavioural Family Therapy Model
-normal family functioning = reinforce adaptive behaviour, not reinforce maladaptive behaviour, benefits of being a fam member outweigh the costs
-maladaptive behaviour is reinforced by fam attention and there are insufficient rewards in troubled families
-treatment focuses on concrete observable behavioural goals
-key interventions: changing contingencies of social reinforcement and improving communicaton

Cognitive-Behavioural Family Therapy
-relationship-related cognitions seen as the underlying cause of feelings and behaviours of family members
-therapist assesses cognitive appraisals and intervenes to promote positive relationship-related cognitions

Question 34

Family Therapies: Marital Behavioural Therapy

Answer 34

-most marital behavioural therapies share goals and techniques:
1) thorough behavioural analysis of a couple
2) establish positive reciprocity, which increases the couple’s positive and loving behaviours toward each other
3) teach communication skills including “I” statements, staying in the present, positive feedback
4) improving problem-solving skills including negotiation and contingency contracting

-approach that combines operant learning with social exchange theory - Richard Stuart
-social exchange model - behaviour in relationships is maintained by its ratio of costs and benefits
-dynamic is addressed directly in therapy through contingency contracting - each person agrees to do things - quid pro quo
-aim is to enhance positive behavioural change
-technique of caring days: one day of the week the spouse deliberately performs behaviours that have been requested by the other spouse
-requests must be positive, specific and small, and not a focus of current marital conflict

Question 35

Group Therapy

Answer 35

Yalom-12 factors that contribute to therapeutic group benefits
1) insight
2) instillation of hope
3) universality
4) imparting information
5) altruism
6) corrective recapitulation of the primary family group
7) development of socializing techniques
8) imitative behaviour
9) interpersonal learning
10) group cohesiveness
11) catharsis
12) existential factors
-catharsis is a necessary but not sufficient condition for therapeutic change

-factors that Yalom believes DO NOT contribute to group therapy’s effectiveness
1) leadership style
2) ideological school
3) confrontation

-most critical component = cohesiveness
-cohesive groups show greater acceptance, intimacy and understanding, and permit greater expression of hostility conflict among members and towards leaders

-therapist tasks: shaping the group into therapeutic social system; group norms indicated through implicit and explicit direction

-process groups evolve through 3 stages:
1) attempts of group members to get oriented
2) conflict among group members, rebellion toward group leaders, attempts at dominance
3) development of closeness and cohesion (if second stage is successfully negotiated) - group members talk freely with one another

-appropriate open conflict or disagreement between leaders is healthy and can be a positive model for group members
-self-disclosure by group leaders is frequently beneficial

-selection of members for process-oriented groups: exclude folks with brain damage, hypochondriasis, sociopaths, acute psychosis, active substance use

-group composition: heterogeneous re: conflict; homogeneous re: ego strength
-ideal group size: 7-8, acceptable range 5-10

Question 36

Crisis Intervention

Answer 36

-crisis theory - centers on concept of homeostatic equilibrium
-at equilibrium- psychosocial balance, coping techniques are sufficient

-phases of a typical crisis situation:
1) start of crisis- emotional tension and disorganization; attempts to manage situation through previously learned coping mechanisms
2) coping efforts fail to resolve the problem and further disorganization occurs
3) greatly increased tension level; further mobilization of internal and outside resources e.g., seeking help and/or changing of direction and goals
4) if intensified efforts don’t resolve crisis, extensive personality disorganization and emotional breakdown may occur

-most crucial aspect of crisis intervention = rapid treatment
-goal = resolving crisis and avoiding development of chronic symptoms
-specific elements: rapidly establishing rapport; reviewing steps that led to crisis; helping uncover maladaptive reactions; helping develop more adaptive ways of coping
-taught strategies to avoid hazardous situations
-crisis intervention terminated as soon as crisis has been resolved and client understands steps that ;ed to its development and resolution

Question 37

Community Interventions

Answer 37

-community mental health centres act (CMHCA), in which community mental health centres (CMHCs) were created to provide five services:
1) inpatient
2) emergency
3) consultation
4) day care (including halfway houses and outpatient treatment)
5) research and education
-community psych extends beyond this to natural settings (e.g., churches, schools, inner-city storefronts)

Question 38

Community Interventions: Consultation

Answer 38

-indirect service
-Caplan: four categories of consultation
1) client-centered case consultation
-consultant helps the consultee with an individual client
2) consultee-centered case consultation
-consultant helps the consultee with difficulties they are having in working with clients, whether problems stem from inexperience, lack of skill, or difficulties with objectivity
3) consultee-centered administrative consultation
-consultant focuses on the consultee’s difficulties that limit effectiveness in instituting program change
4) program-centered administrative consultation
-consultant focuses on developing, expanding, or modifying a program

Advocacy Consultation
-consultant advocates for social change

Question 39

Community Interventions: Prevention

Answer 39

Primary Prevention
-attempts to prevent the onset or occurrence of a disorder, and thereby reduce its incidence (or the number of new cases)
-often focuses on building psychological health through education and competence training
-e.g., alcohol and drug education, Head Start, vaccinations

Secondary Prevention
-focuses on early identification and prompt treatment of an illness or disorder that already exists
-goal is to stop relatively mild disorders from becoming more serious and prolonged
-reduces the prevalence (the number of cases of the disorder present at any given time) by shortening its duration

Tertiary Prevention
-focuses on reducing the residual effects of a chronic disability or minimizing further negative consequences of an established, serious disorder