Treatment/Intervention Flashcards
What are the Categories of Intervention?
Behaviorism
Cognitive-Behaviorism
Classic Psychoanalysis
Extensions of PsychoAn
Humanistic/Existentialism
Family
Group
Crisis Intervention
Community Interventions*
Miscellaneous*
‘Behavioral’ Treatment(s)?
generated and maintained by external; pathology from problematic learned behavior
Classical Conditioning (recip inhib)
* systematic desensitization [Wolpe]
* sensate focus [Masters, Johnson]
* assertive training
* aversive counterconditioning
* classic exctinction (in vivo exp, exp in imagination)
Operant Conditioning
* Reinforcement (primary, secondary, generalized)
* strategies of reinforcement (shaping, token, contingency, premack, differential, self-reinforcement)
* self procedures (self-monitoring, stimulus control)
- Aversive control of behavior
- positive punishement (“pain”)
- escape learning (can’t get out of it fully)
- avoidance learning (avoid by emitting desired behavior)
- overcorrection (do that and more)
Social Learning Theory
* symbolic modeling
* live or in-vivo modeling
* participant modeling
the above can also be utilized for/in other domains, but in this case for symptom/behavior removal/reduction/change
TIPS X Learning Theory
- counterconditioning | aversive, assertiveness, sensate focus
- flooding or exposure w/ response prevention
- exposure often “most/more” effective than systematic desensitization
- classic extinction for sexual behavior — remove conditioned sitmulus (fetish ex.) | or aversive conditioning
- classic extinction for other ‘conditioned responses’ — remove unconditioned (“universal”) stimulus
Catharsis | flooding w/o unconditioned stimulus, until no more fear/anx — decrease in affect response by extinction
^showed up within ‘treatment/intervention/prevention’
Cognitive-Behavioral Treatment(s)?
learning (emotion+behavior) is due to internal processes that must be understood; Kohler (insight), Tolman (latent learning)
Ellis [Rational Emotive Behavioral Theory|REBT]
* Convincing of ‘irrational thoughts’
* ABC <> DEF
Beck [Cognitive Therapy|CT]
* Change existing beliefs, test them, Socratic
* More ollaborative than REBT
* Pathology = auto thoughts (maladaptive), out of conscious awareness
* Maladaptive Cog Triad (neg view of self, world, future)
Meichenbaum [Cog Behavior Mod|CBM]
* Self-Instruction Therapy (levels/steps) | parallel w/ protocol analysis | used for those w/ hyperactivity/impulsivity (ADHD, etc)
* Stress Inoculation Training (SIT) (3 stages)
Rehm [Self-Control Mod of Depression]
* Reinforcement can be self-generated
* Dep = low reinforcement, high neg talk
Marlatt [Relapse Prevention]
* failure inevitable, motivation, identify trig
Linehan [DBT]
* agree to 4 conditions: therapy for spec period, reduce SI, reduce therapy interfering bx, skills train
* primary modes | individual therapy, tele contact, skills training (mindfulness, Emotion regulation, interersonal effectiveness, distress tolerance)
* therapist consultation
* MINDFULNESS – focus on here/now, non-judgemental obs of self and surroundings | mindful breathing, body scan, awareness of unproductive/neg thoughts/judgements
Acceptance & Committment [ACT]
* Core processes |acceptance, cognitive defusion, being present, self-as-context, values, committed action
Classic PsychoAnalysis Approach
Freud; human nature deterministic - irrational forces, uncoscious motiv, bio instinctual drive, psychosexual events 0-6yrs
Personality in 3 Parts
* Id (primitive), ego (reality), superego (moral manager)
Mental Fxn (2 kinds)
* Primary (dreams, halluc) | urgent tension red @ expense of reality
* Secondary (thinking, speech) | demands of reality, delay gratification
Anxiety & Defense Mechanisms
* id works thorugh self-decept, distortion
* Repression (borderline), Regression, Projection (paranoid), Displacement (ex. phobia), Reaction Formation, Intellectualization (schizoid), Rationalization (narc), Sublimation.
* Dissociation (histrionic), Introjection (dependent), Acting Out (Antisocial)
PD(s) | as “alloplastic” (other)
Neurotic | as “autoplastic” (self)
Treatment & Techniques
* unconscious > conscious, repression of id’s impulses by ego (conflict)
* free association (fundamental rule) | clarification, confrontation, interpretation, working through
* transference - seen as resistance to work through
* countertransference - seen as detrimental
Catharsis | purging of emotions
PsychoAnalysis/Dynamic
Pt. 1
Ego Psych (ego guides), Object Relations (capacity to have mutually satisfying relationships)
Ego Psychology
* Heinz Hart | ego/id parallel, thinking+passion, defensive vs. autonomous ego is the ‘conflict free sphere’ (fxn of percept, learn, memory, locomotion)
* Anna Freud | ego reconciles reality demands, fuller pic of id/superego | interpreted child’s words not play, strong positive bond not neutrality (unlike Klein)
* E. Erikson | ego + psychosocial, development in response to social crisis, all the stages birth till older age
Object Relations
* object-related from birth, profound impact on personality | internalized representation of early interpersonal experiences
* clear sense of self, balanced/realistic attitude towards others
* Melanie Klein | “splitting” (either good/bad not both) = no object constancy
* Winnicott | “good enough mother”, abandon true self, adopt “false self” | ‘transitional object’
* Mahler | separation (phys) + individuation (psych) |6 stages (infantile autism, symbiosis, differentiation, practicing, rapproachment, constancy)
PsychoAnalysis/Dynamic
Pt. 2
Self-Psych (dev of narcissism), Neo-Freudians (social/cultural factors that determine personality, pathology b/c of faulty learning, maladaptive style of interacting w/ environment)
Kohut | Self Psychology
* development of narcissism instead of libidinal
* ‘primary’ (healthy) narcissism - getting own needs met | done by appropriate caretaking satisfying ‘selfobject’ needs
* Selfobject needs = mirroring (admiration), idealizing (adults worthy of), twinship (ability to join in/imitate adults)
* Clinically - “empathetic attunement”, interpretations of “experience near” vs “experience distant”
Neo-Freudians
* Harry Sullivan |interpersonal theory, personality exists only an emotional exchange b/w people, not a “possession” but a reflection of responding to others’ POV | 3 modes of existence (prototaxic, parataxic, syntaxic)
* ^Interpersonal Therapy (IPT)
* Karen Horney |Neurosis due to alienation, basic anx, basic host after discovery of helplessness; results in rigid persuit of safety, familitarity, security; trends of compliance, aggressively, or detaching from others.
* Erich Fromm |human bx sociocultural/economic conditions; fear of freedom; existing as in “having” or “being” (healthier) mode
PsychoAnalysis/Dynamic Pt.3
departed from Freud; Adler (individual psych); Jung (analytic psych)
Adlerian | Individual
Jungian | Analytic
* personal + collective unconscious
* that which is projected = transference
* archetypes
Human/Exist Approaches
*emphasizing of client’s subjective experiences; entrance into client’s subjective worlds
*innate capacity to health/growth
Rogers | Client-Centered Therapy
Perls | Gestalt Therapy
* Goal to reintegrate parts that have been ‘blocked’ from ‘awareness’
* Introjections | adopting identity of another | result in naivete (awareness blockers)
Glasser | Reality Therapy (Choice/Control Theory)
Phenomenological | subjective experiences
The 2 ‘Theoretical Models’ of Family Therapy?
*have influenced
General Systems Theory | GST
* interaction of component parts
* aims to ATTAIN homeostatis
Cybernetics
* Circular nature of feedback loops
* Negative Feedback Loop - maintain/sustain
* Positive Feedback Loop - shift/change
Types of Family Therapy Pt. 2?
Psychodynamic Fam Therapy
Object Relations Fam Therapy
Communications Fam Therapy
Minuchin | Structural
Haley | Strategic
Milan Group | Systemic
Bowen | Family Systems
Types of Family Therapy Pt. 3?
Behavioral Cognitive Fam Therapy
Marital Behavioral Therapy
Solution-Focused Therapy (idk why)
Narrative Therapy (idk why)
Yalom’s Group Therapy?
*come back for more
12 distinct factors:
* insight
* hope [critical #1]
* universality [critical #2]
* imparting information
* altruism
* corrective recapitulation of primary fam group
* development of socializing techniques
* imitative behaviors
* interpersonal learning
* goup cohesion [most critical]
* catharsis [needed, but not sufficient enought for change]
* existential factors
Factors that do not contribute to group therapy’s effective:
* leadership style, ideological school, confrontation
Therapists’ tasks - shaping group into social system.
Group norms created as a result of implicit direction from leaders/more influencial group members.
3 stages –
* Initial | getting oriented
* Second | conflict among members, rebellion towards leaders, attempts at dominance.
* Third | dev of closeness, intimacy, cohesison, free talk
Community Int?
- Prevention, treatment, rehab of mental disorders through use of Organized Community Programs
- CMHCs (as of 1963) to provide 5 services | inpatient, emergency, consultation, day care, research + education
- Extends to natural settings (churches, schools, storefronts)
- Comm Psy emphasizes mental health consultation/training of NONprofessionals – expands services
What does Crisis Intervention Refer to?
Crisis Theory - centers on concept of homeostatic equilibrium | crisis = imbalanced
Caplan’s 4 Phases
1) Crisis begins | emotional tension, disorg, tries to manage w/ previous coping mechanisms
2) Coping efforts fail to resolve, further disorg
3) Greatly increased tension, further mobilization of internal/external resources
4) If #3 fails to resolve crisis | extensive personality disorg + emotional breakdown may occur
Treatment
* Goal: rapid, resolve crisis, avoid dev of chronic sx
* rapidly establishing rapport
* reveiw steps have led to crisis
* gain understanding of maladaptive reactions
* develop more adaptive way of dealing w/
* taught strategies to avoid situations likely to produce future crisis
* terminated as soon as resolution, etc.
Intervention vs. Short-Term Therapy
* crisis itself, restoring pre-crisis levels
* short-term for attaining higher level
optimize healing post school shooting – all except trauma debriefing
resulting from person’s inability to cope w/ events experienced.
What are the Miscellaneous Approaches*?
Berne | Transactional Analysis (TA)
Hypnotherapy
* used for chronic pain
Feminist Therapy
Biofeedback
* Impacts Sympathetic Nervous System
* INvoluntary
Electroconvulsive Therapy (ECT)
* Most commonly for MDD, severe, psychosis
* Can be used for Schiz, but much less frequent
Motivational Interviewing [come back]
Prochaska’s | Transtheoretical Model
* Precontemplation
* Contemplation
* Preparation
* Action
* Maintenance
Five-Factor Theory of Personality (Big 5|OCEAN)
*Openness to Experience
*Conscientiousness
*Extroversion
*Agreeableness
*Neuroticism
General Therapy Issues*?
*come back to FOR SURE
Child Abuse
Domestic Violence
* single predictor of DV in male-female = verbal abuse by male partner
* within lifetime, W|M 25%|7.5%
Rape
Divorce
Psychotherapy Outcome Research
General Outcomes
* Meta-analysis studies to look at therapy outcomes
* Individual studies utilized by effect size
- Eysenck | Earliest comp study, 2/3 neurotics improved in 2 yrs whether or not treated; AND treated seemed to do worse
- ^non-random assignment, attention on non-treated which could account for improvement, lack of distinction b/w therapists
- Since Eysneck | improvement rate 40%; avg effect size of .85/treated better off than 80% of untreated
- Howard | meta-analysis; 50% improved by 8th session, 75% by end of 6m
- Luborsky | treatment outcomes similar for all types of treatment
Treatment Manuals
* Standardized protocols to treat specific disorders
* Facilitate research b/c minimize differences in treatment that may occur when used by different therapists/if tailored to needs of specific client
* ^increases likelihood of statistical significance
- Facilitate dissemination to gen comm of mental health practictioners
- Criticisms | a) many treatments not good for short-term, b) prevent pracs from tailoring treatment to spec needs/strengths
EBT [def need to come back]
Client Variables
* ‘Lack of improvement’ — most responsible are client factors
* key factors inc. ability to relate + amenability to new learning
* 23% dropout after 1st session
* 70% dropout before 10th
* Lower SES, lower ed – dropout earlier, more frequently
* ^also assigned to less experienced therapists
- AfA term earlier than White (inconclusive, may be due to social)
- Social class affects duration NOT outcome as much.
- Sex/Age unrelated
- Mood sx improve most; Somatic least
- Likeability/Attractiveness correlated w/ positive outcome
Therapist Variables
* Being facilitated by female OR therapist of same gender
- Little difference when client/therapist ethnically matched
- Clients still prefer therapists of own ethnicity | leads to more participation | less premature term
- 35% therapist’s attractiveness, trustworthiness, expertness
- Competence some impact | more experience = less dropout
The Therapy Relationship
* sometimes more important than method
* APA 2011 – several aspectes “demonstrably effective”
* ^inc. – alliance in ind./couples, cohesion in groups, empathy, collecting client feedback
* ‘Empathy’ biggest contributer to successful therapy outcome.
- “probably effective” – goal consensus, collab, positive regard
- “promising but insufficient to judge” – congruence/genuineness, repairing ruptures, managing countertranference
Some Gen Findings
* Well whether individual or group
- 65+ lowest rates psychiatrich | most common dementia
- 45-64 2nd lowest rates
- 25-44 highest rates
- College < non-college
- Suburban/Rural < Inner-city
- W > M to seek help/treatment
- Married W/M < divorced/single w/ regards to freq of treatment + psychopathology
Monitoring Treatment?
- Total Quality Management (TQM)
- Quality Assurance (QA)
- Utilization Review (UR)
- Risk Management
TIPS X I/O
Fiedler’s LPC Theory
* High LPC - moderate, relationship oriented
* Low LPC - highly favorable OR unfavorable
Caplan’s Consultation
* Client-Centered Case | helps ‘consultee’ with their ‘client’
* Consultee-Centered Case | helps ‘consultee’ with their difficulties that effect 2+ clients
* Consultee-Centered Admin | helps ‘consultee’ with difficulties ‘instituting program change’
* Program-Centered Admin | helps a ‘group/consultees’ with developing/expanding/modifying a program
- ‘theme-interference’ | superviSEE problems
Decision Making
H. Simon | ‘bounded rationality’
* limited time and cognitive abilities = not thinking rationally
* ‘Satisfice’
^showed up within ‘treatment/intervention/prevention’
