Week 2: Paradigms & Philosophies

Question 1

What are 3 ways in which therapists can define psychological problems?

Answer 1

1. Statistical or Normative approach:
   A judgment is made whether a person’s behavior conforms, generally, to the standards, expectations, or norms of a particular society or social group.
2. Subjective interpretation/Psychological pain
   Individuals themselves make judgments as to whether their own behaviors are abnormal, maladjusted, or otherwise in need of changing. ~ Even if it’s not abnormal culturally, individuals may feel personally distressed.
3. Judgments of Maladaptive Functioning
   An expert makes a judgment as to whether a person’s behavior is abnormal or maladaptive. ~ Usually based on functioning - work and interpersonal relationships.

Question 2

Is ‘abnormal’ behavior maladaptive in every single situation/context?

Answer 2

No - it’s possible that the abnormal behavior used to serve a function and that is why it was adopted. For example, a woman who cannot stand out in the workplace due to severe anxiety is maladaptive, however she also adopted the behavior to avoid standing out to avoid the abuse her sister was on the receiving end of. It became a survival mechanism.

Question 3

What can therapists look for to define mental disorders? (3)

Answer 3

1. Sign: a problem/abnormality perceived by the therapist but not necessarily the patient.
2. Symptom: an abnormality or complaint that is perceived by a patient - and also how a patient may fit into disorder criteria.
3. Syndrome: a group or set of signs and/or symptoms that, in combination, reflect a specific health-related condition. Co-occurance of these signs reflect pathology most of the time.

Question 4

Define mental illness to the best of your ability.

Answer 4

A recognized amalgamation of signs, symptoms, and behaviors that likely causes distress for the person or others and interferes with the person’s ability to behave in a healthy and adaptive fashion.

Question 5

Explain how Emotions and Emotional Regulation affect psychopathology.

Answer 5

Emotional regulation seems to be the main cause of concern in emotional disorders such as depression and anxiety.
Also, both reduced emotional expression, known as blunted or flat affect, and an absence of certain emotions, such as empathy, remorse, or guilt, are considered indicators of some psychological problem..

Question 6

Explain how Thoughts/Cognitions, Intellectual Functioning, Information Processing affect psychopathology.

Answer 6

Some psychotic disorders such as schizophrenia may include a loss of reality. Moreover, rumination is known to play a hand in depressive disorders. And lastly, difficulties with information processing and functioning may reflect brain injury or disorder too.

Question 7

Explain how Perceptions affect psychopathology.

Answer 7

Perceptual processes involve cognitive processes that give rise to perceptual experiences.
Again, in the severe range of psychopathology, perceptual difficulties, such as hallucinations are important indicators of psychopathology such as schizophrenia.
Less extreme cases of inaccurate perceptions are related to depression (negative world view) and anxiety.

Question 8

Explain how Interpersonal Processes affect psychopathology.

Answer 8

A person develops relationship schemas (object relations) in which the relationship and the individual’s view of themself are reflected - low self-esteem/self-regard, unrealistic expectations and standards are all issues in numerous types of psychopathologies.

Question 9

Explain how Regulatory or Coping Behavior affects psychopathology.

Answer 9

Everyone experiences demands, stressors, and anxiety that require adaptation and coping. An important domain that clinical psychologists focus on deals with not only whether a person can cope with life’s demands, but also the manner in which the individual does attempt to cope and whether it is effective.
Inflexible coping can have an effect on psychopathology.

Question 10

Explain how Development affects psychopathology.

Answer 10

Whether the individual has met developmental milestones and presents expectations of normal development is important. Whether it is normal child cognitive development or adult social development.

Descriptive psychopathology, views psychopathology from a developmental perspective

Question 11

Explain how the Environment affects psychopathology.

Answer 11

Plays a key role in causing and maintaining psychological difficulties, and helping the individual, couple, or family alter the environment can be a focus of treatment.

Question 12

What does Axis I of the DSM contain?

Answer 12

Axis I: Clinical disorders or other conditions that may be a focus of clinical attention (e.g., bipolar disorder, schizophrenia, depression)

Question 13

What does Axis II of the DSM contain?

Answer 13

Axis II: Personality disorders and mental retardation (e.g., avoidant personality disorder, borderline personality disorder)

Question 14

What does Axis III of the DSM contain?

Answer 14

Axis III: General medical conditions (e.g., any physical ailment present such as cerebral palsy and hypothyroidism)

Question 15

What does Axis IV of the DSM contain?

Answer 15

Axis IV: Psychosocial and environmental problems (e.g., recent stressful events and occurrences)

Question 16

What does Axis V of the DSM contain?

Answer 16

Axis V: Global assessment of functioning (e.g., highest level of functioning over the recent past)

Question 17

What are the two philosophical issues underlying clinical psychologists’ views of psychopathology. How do they influence decisions that clinical psychologists make?

Answer 17

There’s Kraeplin’s and Freud’s view; Kraeplin is symptom focused, descriptive, while Freud is cause focused. I believe that both perspectives best work together! The descriptive philosophy may be too surface level, focused on putting people into categories rather than focusing on the people themselves. The focus of treatment would be symptom focused.
While Freud’s philosophy views psychopathology or symptoms as the result of some underlying process. The underlying process is thought to cause the existence of the signs, symptoms, and syndromes, which are viewed as markers or manifestations of the underlying process, hence, the focus of treatment is on the underlying process.

Question 18

Compare and contrast the DSM-IV-TR and the PDM in terms of philosophical stance. How do they define psychological disorders?

Answer 18

1. They have differing axes; the DSM IV separates clinical (axis I) and personality (axis II) disorders whereas the PDM has an axis (axis P) focused on the personality of the individual and axis M on the mental functioning - it is more contextual in nature.
2. The PDM provides a description of a Healthy individual as well as a disordered one.
3. In its S axis the PDM provides how to ascertain the objective experience of the patient.
4. PDM starts with personality as the beginning point of thinking about psychopathology. The DSM and ICD start with the clinical syndrome as the beginning point and incorporate personality (only disordered personality) and other components of the person’s context only secondarily.

Question 19

What does P axis of the PDM contain?

Answer 19

Personality patterns and disorders: This axis, which focuses on the personality of the individual as the starting point for diagnostic work, includes two components;

1. the first is the person’s location on a continuum of healthy to disordered personality functioning,
2. and the second is the characteristic or idiosyncratic mental functioning and how the person interacts with the world.

Question 20

What does M axis of the PDM contain?

Answer 20

Mental functioning: This axis involves a more detailed description of emotional functioning including information processing, forming and maintaining relationships, expression and understanding emotion, and characteristic coping and defense strategies.

Question 21

What does S axis of the PDM contain?

Answer 21

Manifest symptoms and concerns: The third axis describes most of the clinical syndromes found in the DSM-IV-TR or ICD-10 (as well as others) and extends the descriptions to include the person’s subjective experience of the difficulties and behavioral patterns found to be associated with each of the syndromes. This allows viewing the syndromes in the context of the person’s unique personality and context.

Question 22

What are some arguments as to why psychological disorders should not be considered like pathogens or alien entities in people?

Answer 22

The main one would be that they are incredibly flexible and changing. It depends a lot on what the societal norm currently is, and also culture.

Question 23

We described two general types of diagnostic systems, one based on descriptive and the other based on theoretical characteristics. Which kind of diagnostic system do you believe is most appropriate? Why?

Answer 23

I think both should work together - I think we need both. Symptom focused treatment is just as important as cause focused treatment. I do think the theoretical approach is more holistic however, in that societal, developmental and overall human contextual information is a key aspect of not only treatment but also diagnosis.

Question 24

Describe the types of behaviors that clinical psychologists tend to be aware of when making judgments about psychopathology. Are there any others you believe might be relevant?

Answer 24

Functioning in the workplace and in interpersonal relationships is a big focus for most psychologists. I think this might be a little too productivity focused - influenced by the idea that functionality is productivity. I think self-identity and self-compassion are very relevant and should be emphasized more.

Question 25

What did Empiricists (Ancient Greek Medicine) focus on?

Answer 25

Observable signs, symptoms, syndromes. Tied treatments to findings. Hippocratic school.

Question 26

What did Theorists (Ancient Greek Medicine) focus on?

Answer 26

Theoretical underlying causes, major premises not connected to anything established firmly at the level of observation. Pythagorean school.

Question 27

Which philosophy is embraced by Managed Care in US (i.e., insurance company)?

Answer 27

Symptom based (Descriptive)

Question 28

Shedler reading points:

Answer 28

There are things we seem to not want to know - this is different from ‘repressed memories’ (of which are not very related to psychoanalysis at all).

Most psychological difficulties were once adaptive solutions life problems.

Ambivalence/Conflict: Humans can have split feelings about something (love/hate for example). Anger does not diminish one’s love for something.

We view the present through the lens of the past. Schemas form from when we’re children and this can have influence later in our lives.

KEY ASPECT OF PSYCHOANALYTIC PSYCHOTHERAPY:
Transference: the activation of preexisting expectations, fears, desires etc. in the context of the therapy relationship, WITH THE PATIENT VIEWING THE THERAPIST THROUGH THE LENSES OF EARLY IMPORTANT RELATIONSHIPS.
These reactions are not an obstacle to therapy - they are actually usually a necessary step to recovery by uncovering and processing them.

Defense: once we realize things we’d rather not know, we get defensive to avoid knowing.

‘Chemical imbalance’: promotes patients not realizing that one’s own perceptions, cognitions, experiences, etc. of which can be changeable and in their power to change are causes of their problems. This in turn helps out big pharma - they make more money!

However random symptoms may seem, it is psychodynamic therapy’s approach that there is a cause.