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| 1. William James, Father of American Psychology First 1. First American Psychology Lab at Harvard James-Lange Theory of Emotion 1. Theory of emotion developed simultaneously as Carl Lange in 1880s 2. Emotion results from perception of bodily sensations from physiological changes 3. Contrasts common sense notion that physiological changes come from emotion 4. Thus, James argues, we feel sad because we cry, we do not cry because we are sad Book 1. Authored the "Principles of Psychology," described emotion theory |
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| Therapeutic orientation: Bxal. Process 1. Pairing of imaginary negative consequences with an undesirable bx Purpose 1. Reduce likelihood of undesirable bx Requires 1. Use of negative mental imagery and rehearsal |
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| Therapeutic Orientation: Bxal. Premise 1. Increase desirable bx by imaging others performing similar bxs with positive outcomes 2. Client imagines specific positive consequences of new bx 3. Based on simple modeling Key components 1. Capability of the client to utilize positive imagery and mental rehearsal |
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| Therapeutic orientation: Cognitive Bxal. Premise 1. Teach clients skills increasing cognitive, bxal and affective proficiencies Common uses 1. Managing anxiety-provoking situations, from situational-based stressors to chronic anxiety disorders Key components 1. Positive self-statements, positive imagery |
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| Key figure 1. Aaron Beck Definition 1. Client and therapist are equal partners working together 2. Mutual understanding 3. Communication 4. Respect Premise 1. Client is capable of objectively analyzing his/her own issues and arriving at own conclusions Approaches 1. Most common is through guided discovery a. Socratic-style questioning to help the client arrive at objective understanding b. Helping the client to develop and test hypotheses about their own beliefs |
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| Key figure 1. Aaron Beck Premise 1. Challenge unpleasant internal beliefs and assumptions to recognize and replace maladaptive cognitions with productive ones 2. Encourages cognitive flexibility 3. Affective arousal is essential to successful modification Assumption 1. Person can change their undesirable bx by changing their thoughts Opposition to 1. Bxal premise that states changes in bx stem from changing external stimuli only |
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| Therapeutic orientation: Cognitive Therapy. Definition 1. A cognitive distortion that involves using the emotional state as the evidence for rationale defending the source stimulus as the "cause" of their emotional state Cognitive distortion 1. Emotional Reasoning is counter to the Cognitive Therapy premise that our beliefs or cognitive distortions effectively change our emotional response to any situation Resistant to change 1. Given the circular nature of using one's emotions to justify the rationale of the source of one's suffering it is particularly resistant to change Amplification of other cognitive distortions |
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| Freud's perspectives on personality Topographic: conscious vs. unconscious. Dynamic: interaction of psychic forces. Genetic: stage-wise development. Economic: distribution and transformation of psychic energy. Structural: tripartite structure of the mind (id, ego, superego). Adaptive: born with ability to interact with environment. Basic personality dynamic Two primitive drives: Eros and Thanatos. The sexual and aggressive urges are in direct conflict with societal norms Personality develops through psychosexual stages Source of sexual gratification changes with development. Oral, Anal, Phallic, Latency, Genital. Unsuccessful attempts to have needs met at each stage results in fixation. Fixation can result in psychopathology (neurosis or hysteria) Psychic structure The mind is separated into id, ego, superego. Id: urges, pleasure principle, immediate gratification. Ego: reality based, develops through interaction with world. Superego: moralistic, learned through society and parents, restrictive. Defense mechanisms To control the sexual and aggressive urges of the id from reaching consciousness. Repression: hide id's impulses in the unconscious. Suppression: avoidance of thoughts/emotions. Projection: placing onto others those things one cannot accept about oneself. Reaction Formation: acting or stating feelings in direct opposition to one's true feelings because those true feelings are unacceptable to the self. Introjection: deeply identifying with an idea or object. Regression: reversion to an earlier stage of development. Denial: refusal to accept reality. Displacement: expression of thoughts or feelings to a safe target rather than the true target. Sublimation: transforming negative emotions into positive action or bxs. Rationalization: justification through faulty reasoning. Intellectualization: use of logic to rationalize a situation Unconscious Methods to infer unconscious thought or emotion. Direct observation of bx. Conscious bxs: dreams, slips of the tongue, free association. Psychic Determinism: unconscious thoughts/emotions do affect bx. Freud's therapeutic techniques. Confrontation, clarification, interpretation, working-through Psychoanalytic and psychodynamic therapies Object Relations Therapy, like psychoanalysis focus on the first years of life and interpersonal dynamics. Focus on how unconscious affects current relationships. Identify/interpret defenses, transference, and resistance; thus increasing insight. Transference: process of directing feelings of one person onto another (therapist). Therapist remains a neutral stimuli allowing for client’s natural transference. Resistance: refusal to address specific issues in therapy. Projection is root of paranoia. Working-through is the integration of therapeutic insights resulting in symptom reduction Root of psychological disorders Psychological disorders result from reaction to unconscious. Phobias: displacement of emotions from original object to new or symbolic object. Mania/Hypomania: polar opposite expression of underlying depression. Anxiety: bolstered defenses in response to id impulses spilling into the ego |
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| Neo-Freudian who established analytic psychology: Blending Freud's psychodynamic and humanistic psychology Difference from Freud: Freud believed present and future were rooted in the past Jung believed hopes and aspirations were as important as the past. Jung de-emphasized libido Focused on social an aggressive origins over sexual drives Jung de-emphasized childhood experiences Focused on adult and mid-life experiences Agreed with Freud that there is a personal unconscious. Introduced, in contrast to Freud, the Collective Unconscious (CU) Common to all people. Drew on all the thoughts and bx patterns of various cultural groups over time. Consisted of archetypes (basic categories) for conceptualizing world. Developed from work with psychotic patients who had similar delusions and hallucinations. Four main archetype categories: Self:regulation center of psyche, archetype for ego Shadow:aka mask, part of oneself that opposes the ego Anima:feminine aspect of a person Animus:masculine aspect of the person. Neuroses develop from conflicting archetypes as people strive to be more fully functioning. Transference was both personal unconscious and CU. Universal Symbolism: Universal symbols and the meaning of life are two areas of interest for Jung and the write extensively in the field. Categorical Personality Traits: Identified extroversion, introversion, orientations toward external or subjective inner worlds. Later these traits became part of the Myers-Briggs Type Indicator (MBTI) test. |
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| 1. A psychodynamic therapy examines impact of unconscious relationship to interpret defenses and transferences. 2. Assumes child's bx and interactions based on quality of relationship with mother. 3. Therapy encourages safety, security and attachment. 4. People seek objects to relate to. 5. Introjects: emotionally charged aspects of significant people are incorporated with the individual's sense of self. 6. Early attachments shape perceptions and expectations of important people in their lives 7. Early attachments shape later interpersonal relationships. Unique Object Relations Therapeutic styles and viewpoints 1. William Fairbain: Object-seeking shapes mind and personality, a basic motivation to make and keep connections with other people. Pleasure-seeking is the manner to relate to objects – opposing Freud's belief that object-related is manner to seek pleasure. 2. Melanie Klein: Internal objects are fully internalized presence in the mind or unconscious (e.g., a voice). Part internalizations are developmentally primitive (e.g., mother's breast). External objects are internalized then later projected in the external world again, creating a cycle. Satisfaction from early experiences such as breast-feeding lead to love or creativity. Dissatisfaction from early experiences such as breast feeding lead to hate or destruction. Splitting is defense for hostile feelings toward loved object. To protect the loved object from destruction, the infant splits the object into two, good and bad. Play is free association. Child therapy much like adult analysis, and was opposed by Anna Freud 3. Margaret Mahler: Focus on the emergence of individual self through separation and individuation process. First three years of life form lifelong mature object-relations. First month of life biological needs dominate. - Corresponds to Erickson's Trust vs. Mistrust phase. Second month of life recognition of mother-object, but not different from self (symbiosis). - Corresponds to Erickson's Autonomy vs. Shame & Doubt phase. 6-36 months separation-individuation phase: - Separation: physical distancing - Individuation: psychological independence - Corresponds with Erickson's Initiative vs. Guilt Successful resolution of theses phases results in permanence of emotional-object, thus the parent exists even when out of sight. |
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| About 1. One of the four schools of Psychoanalytic Theory (together with Freudian, Self, and Object-Relations) 2. Evolved from basic Freudian Theory and Psychoanalysis 3.Took shape through Sigmund and Anna Freud's contributions 4. Finalized into a distinct theory by Heinz Hartmann: "Ego Psychology and the Problem of Adaptation" (1939) 5. Other important names: Erikson, Mahler, Kris, Spitz, Lowenstein 6. Focuses on ego functions (defense, adaptation, reality-testing) in the individual's interpersonal and socio-cultural context 7. Views individuals as innately adaptive beings, who undergo a lifelong biopsychosocial development orchestrated by the ego Ego 1. The ego is an autonomous psychic entity that manages the process of adaptation and shaping to the environment; has great synthetic power 2. It operates through defenses, which ward off anxiety and affect coping effectiveness; can be adaptive or maladaptive 3. Personality is organized through interaction with the world; it is shaped by internal needs as well as outer forces (culture, religion, race, presence of physical challenges, etc.) 4. Ego deficits and person-environment fit contribute to psychosocial problems 5. Ego Functions: reality testing, judgment, sense of reality, affect and impulse regulation, primary and secondary thought processes and regression in the service of the ego 6. Mastery-Competence and Adaptation: The ability of the person to develop a "sense of competence" by mastering conflicts, internal needs, and environmental demands 7. Object (or Interpersonal) Relations: Forming a sense of self and of others, and the quality, as well as development, of the relationship to self and others 8. Long-term psycho-analytic therapy approach, explores ego adaptive processes within the individual's interpersonal and socio-cultural reality |
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| Family:Youngest daughter of Sigmund Freud. Neo-Freudians:Focus on social and cultural factors' influence and shaping of personality. Did not focus on the unconscious conflicts as much as Sigmund. Population:Anna focused on children. Stressed importance of supportive, protective, and educational attitudes toward children. Neurotic symptoms in children can have different meaning than adult neuroses. Diagnostic Profile:Anna Freud developed the first-known classification system of childhood symptoms. Reflected developmental issues. Formalized assessment procedures. Organized and integrated data from diagnostic assessments. Created a complete concept of patient's personality and developmental appropriateness. Developmental Line:Series of id-ego interactions that decrease a child's dependence on external controls and increase ego mastery of themselves and their world. Dependency to emotional self-reliance. Sucking to rational eating. Wetting and soiling to bladder and bowel control. Irresponsibility to responsibility in body management. Play to work. Egocentricity to companionship. Defenses:Anna systematized and elaborated on Sigmund's ego defenses. |
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| Adler is one of the original founders of psychoanalysis. He also developed Individual Psychology. 1. Individual Psychology is not individualistic, but social. People are viewed within their social context. People are motivated to belong. 2. Problems from a need to belong are misdirected to power, revenge, attention, or displays of inadequacy. Children's misbx stems from these misdirections: 1. Power struggle, i.e. belonging is gained through control; compliance diminishes personal value. 2. Revenge, i.e. if they cannot be in charge, then seek revenge, feeling significant only when others hurt in the same way they have been hurt. 3. Attention, i.e. feeling significant only through attention seeking/engaging in inappropriate bx. 4. Displays of inadequacy, i.e. belonging only through complete inadequacy, becoming helpless and incompetent; do not attempt tasks as failure is expected. Inferiority Complex: 1. Inferiority motivates a person's ultimate goal for perfection or develops into neurosis. 2. Neurosis develops from maladaptive efforts to compensate for inferiority and is influenced by family, friends and birth-order. 3. Adler one of the first to introduce the importance of birth-order. Goals of Therapy 1. Increase feelings of community 2. Promote feelings of equality 3. Replace egocentric self-protection, self-enhancement and self-indulgence with self-transcending, courageous, social contributions. Methods 1. Socratic questioning 2. Assessment 3. Guided imagery 4. Role-playing 5. Problem-focused problem-solving. Disagreements with Freud 1. Freud believed inner conflict is sexual in nature. 2. Adler said humans are motivated by social drives. Lifestyle and Style of Life 1. Lifestyle means integrated rules and themes of interaction that are foundational to all bx. 2. With style of life, it is not the events of life, but the interpretation of those events that have the most influence. Adler's use of the Teleological Lens 1. Investigate final causes, expected outcomes, endpoints, and purposes behind bxs. 2. This increases the therapist's ability to better understand motivations of individual bx, systemic purposes of symptoms, goals of triangulation, and the use of patterned interactions and routines, in order to reframe mistaken interactions and create a new perspective on an experience. |
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| Key Figure:Jacob L Moreno, M.D. Premise: Guided dramatic action to examine problems and develop insight, personal growth, and integrate cognitive, affective, and bxal components for an individual. Basic Elements (Operational Components): Protagonist: person represents "theme" of the drama Auxiliary Egos: represent significant others in the drama Audience: witness the drama and represent the world at large Stage: physical space to conduct the drama Director: trained psychodramatist Three Phases: Warm-up: Theme is identified and protagonist selected. Action: Dramatization occurs and protagonist explores new methods for resolution of the problem Sharing: Group expresses connection with the protagonist's work. Challenges to the benefits of psychodrama: Watchel (1997) argues that success in assertiveness training stems from the structured practice in-session and daily-life practice, which distinguishes it from psychodrama. Psychodrama may appear similar to assertiveness role-play but emphasizes insight over structured therapy to change patient's overt bxs. |
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| Premise:Examination of interactions with other people through communication and scrutiny of habitual patterns of bx/associations. Goal: Awareness of the intent behind communication (eliminate deceit) resulting in client's improved interpretation of personal bx. Intent:To be broadly applied, even outside of therapy. Theme:People are capable of making their own decisions and therefore responsible for their own fate. Focus:Enact change through bxal and cognitive means, giving the responsibility of change to the client. Therapeutic levels of analysis: Structural analysis:Individual personality analyzed Three separate ego states: Parent: Consists of traditions and values that are copied from parental and authoritarian figures (controlling, rule-making, commanding parts of personality). Child: Creativity, humor, excitement (impulsive parts of one's personality). Adult: Computer processor between the ego states and outside world (logical, reasonable, and unemotional parts of one's personality). Transactional analysis: Interpersonal personality analyzed. Interaction between the ego states of two people. Two levels: Social (overt); Psychological (covert). Types of interactions: Complementary: same ego state Crossed: mixed ego state Ulterior: dual levels of communication Racket and game analysis: Repetitive relational patterns analyzed. Life positions of OKness of self and others. Four positions: I’m okay, you’re okay. I’m okay, you’re not okay. I’m not okay, you’re okay. I’m not okay, you’re not okay. Rackets and games are used to find support for one's life position. Rackets are habitual ways of feeling. Games are seeking confirmation (strokes) regarding perspectives of self Strokes may be verbal, nonverbal, physical Script analysis: Life patterns at thematic levels analyzed. These are the patterns that virtually dictate life. Arise from parents giving their children messages, injunctions |
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| Definition: Significant release of emotion, results in awareness of unconscious material, thus reducing anxiety. Theoretical perspectives: Bxists view this as a reduction in an emotional response resulting from extinction. Emphasized by Freud's early psychoanalytic work. No longer used in current psychoanalysis. Irvin Yalom identifies catharsis as necessary for interpersonal learning in group therapy. Other therapeutic factors include: altruism, cohesion, family re-enactment, guidance, identification, instillation of hope, interpersonal input, interpersonal output, self-understanding, universality, and other existential factors. Cohesion is the necessary precondition for effective group therapy. |
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| 1. Human or animal's perception and cognitive reaction to a stimulus, not merely perception 2. Also, the focusing of one's attention 3. Provides subjective ideas about what is being experienced. Levels of Awareness 1. Partial Awareness, unconsciously aware, acutely aware of object, feeling or thought 2. All animals have capacity for Awareness 3. Regulation of attention neural systems attenuate Awareness in complex animals Awareness in Gestalt therapy 1. Goal is to achieve conscious Awareness by discovering the parts of the self that are blocked 2. Key to helping clients recognize and satisfy needs, accepting polarities within personality 3. Awareness sufficient to cause change Awareness in multiculturalism 1. Awareness of one's own values, beliefs, and stereotypes and knowledge and competency with culturally diverse clients is necessary for therapists 2. Invisible veil: Coined by Sue and Sue 3. Describes a therapist who accepts their own traditional cultural stereotypes of minority populations and lacks Awareness of their own cultural biases 4. Functions outside our level of awareness 5. Healthy cultural paranoia: Therapist should bring feelings of suspiciousness, frustration, and antipathy into awareness for the client to be addressed Awareness as a therapeutic tool 1. In Beck's cognitive therapy individuals must first become aware of their negative thinking styles before they can be challenged2. Mindfulness is a therapeutic approach that involves a non-judgmental Awareness 3. The focus of the Awareness may be sensations or cognitive/emotional events 4. Mindfulness is a component of several third wave therapies, including DBT, ACT, and MBCT |
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| Origins:1700s with Franz Mesmer (Mesmerizing), used suggestion as a cure. Definition:Deep state of relaxation in which clients experience extreme suggestibility, dissociation, and absorption (complete attention). Clients will experience changes in sensations, perceptions, thoughts, bxs. Hypnotic induction can be stopped by the client. Hypnosis in therapy: Hypnotherapist: Trained and licensed, uses hypnosis as part of general therapy. Often using as an aid to smoking cessation and weight loss. Hypnotist: unlicensed and may use hypnosis for treatment or entertainment. False Memory Controversy: Given highly suggestible state, errant hypnotists lead people to believe things later proved to be false. Particularly true with issues of childhood trauma and sexual abuse cases. Not a validated treatment for memory retrieval. If a client seeks hypnosis for this purpose, they should be educated about false or pseudo memories. Indications: No evidence hypnosis can help incurable diseases. May help pain and other body functions that can make disease more manageable. May be used for anxiety disorders, by focusing on relaxation skills and helping with a sense of control. May be used with health disorders with psychological or stress components. Pain, asthma, irritable bowel syndrome. Limits: Only as effective as someone is hypnotizable. Hypnotizablity may be a personality characteristic that is genetically determined. Disorders/issues affecting trust or needs for control (OCPD) would likely not benefit. |
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| Definition 1. A mirroring of bxs or attitudes in one relationship (therapist-client) into another relationship (therapist-supervisor). Cause 1. Associated with countertransference Example 1. Therapist has client acting in passive-aggressive manner, parallel process is when the therapist then acts this way with the supervisor. 2. Can also occur when the supervisor begins to act this way toward the therapist. Possible Sources 1. Therapist looking for similarities with the client to find best strategy (taking on the issues). 2. Therapist overidentifies with the patient and uncertain how to proceed. 3. Therapist wants supervisor to experience same feelings he or she had in the session, thus unconsciously recreating the therapeutic problem. |
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| Key Figure: Kohut Premise: Deficits in meeting child's needs of mirroring and idealizing result in unhealthy narcissism. Mirroring: Infant receiving approval and admiration from parent. Idealizing: Presence of an adult worth idealizing. Therapeutic Technique: Empathetic attunement to provide opportunities to meet admiration and idealizing needs. Does not utilize blank presentation of therapist because the person with narcissism cannot project emotions or images consistently and are too preoccupied. |
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| Interpersonal Theory & Psychotherapy |
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| Key figure 1. Harry Stack Sullivan (a neo-Freudian) Premise 1. Sullivan's interpersonal theory identified the development of personality from emotional exchanges in a social context Three modes of existence 1. Prototaxic: Serial sensations, single, unconnected experiences 2. Parataxic: Sequential sensations, temporal causations a. Hindered parataxic development root of neurosis b. Transference is a parataxic distortion 3. Syntaxic: Emerges around age 1. Logic and analytical thinking, language acquisition Interpersonal psychotherapy 1. Klerman's application of IPT to unipolar, non-psychotic depression 2. Aims: improve current interpersonal relationships to improve depression 3. Four areas addressed: grief, role disputes, role transitions, interpersonal deficits 4. Effective for relapse prevention |
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| Primary assumptions: 1. All people are inherently good 2. Without negative environmental factors, people will only show goodness 3. Humanism vs Bxism: Humanism criticizes bxism for mechanistic views and its emphasis on the similarities between humans and non-humans 4. Humanism vs Psychoanalysis: Humanism criticizes psychoanalysis for being overly pessimistic, overly focused on abnormalities, sexual motivations, and the unconscious mind 5. Humanism vs Biological Psychology: Humanism criticizes biological psychology for its similarities to physical science and deterministic perspective Self-actualization: The discovery and realization of one's own personality 1. It is the fundamental purpose 2. Emphasis: Values, intentions, and meanings 3. Experiential psychotherapy techniques Three notable Humanistic therapies 1. Client-Centered: Carl Rogers a. Unconditional positive regard, empathy, and genuineness in the client-therapist relationship b. De-emphasizes assessment/dx c. Egalitarian client-therapist relationship 2. Gestalt Therapy: Fritz Perls a. Emphasizes one's direct experiences and how these contribute to psychic distress b. Emphasizes the present and the unification of actions and feelings c. Focus is discovery/re-unification of the whole self d. Identification and awareness of split off parts of self e. Emphasizes personal accountability 3. Existential Therapy: Rollo May and Irvin Yalom a. Client's responsibility for finding/creating meaning and values in one's life b. Addresses purpose of death, life, and limitations Unifying Themes of the Humanistic Therapies 1. The study of nonhuman animals provides little knowledge about humans 2. Human bx is rooted in subjective reality 3. Knowledge gained from studying the individual, rather than groups of humans 4. Study should emphasize enriching and expanding human experiences 5. Ultimate psychological goal is to describe what it means to be human. |
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| Premise: Both a humanistic and existential modality, focuses exclusively on the present experience. People start off whole, as they grow and encounter experiences, feelings, fears, they lose parts of themselves. These splits must be reintegrated in order to live intentional and self-actualized life. Human nature: Holistic, consisting of many variables making each person unique. Reintegration Techniques: Empty-Chair and two-chair: Discuss conflicts with another person by imaging them in an empty chair; may be directed to take the other's position to respond. Helps to experience and understand feelings more fully. Useful for unfinished business for conflict resolution. Talking to parts of oneself. Noting incongruities between body language and words. Dreamwork Not interpreted by the therapist as past conflicts. Dreams as metaphor to aid understanding present-day conflicts. Pieces of dreams are utilized as projection of client's experiential work. Avoid interpretation, encourage self-discovery and insight. Key Figure: Wolfgang Kohler. Research: Insight learning with apes Buried food too far to reach, spontaneous use of tools -- sticks. Therapeutic Applications: Applied Gestalt learning to develop insight. Central Goal of Gestalt Therapy: Help clients understand and accept their needs, desires, and fears to enhance awareness of how they block themselves from satisfying their own needs and achieving their goals (discovery of whole self). Boundaries that hinder progress described by Polster and Polster: Projection: Seeing undesirable aspects of oneself resulting in suspiciousness. Introjection: Taking in what others say without analyzing it for oneself, resulting naiveté and unexamined values and beliefs. Retroflection: Directing impulses, such as anger, onto oneself -- may lead to self-harm. Deflection: Distance gained through distraction, humor or asking questions. Confluence: Seeing oneself as in-line with another, resulting in lack of awareness of conflicts. Questions by clients: Seen as problematic because they foster intellectualization and block experience. |
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| Motivational Interviewing (MI) |
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| Key Figures:William Miller and Stephen Rollnick. Premise:Therapeutic style addresses client's motivation for change by the client articulating the costs and benefits of change. Basic approach:Client-centered and directive enhances basic motivation. Explores and resolves ambivalence. Confrontational style is avoided. Elicits client's perceptions, goals and values. Collaborative. Goals: Create motivational discrepancies. Resolve ambivalence. Elicit self-motivational statements. Two Phases: Increasing motivation for change:Build rapport, recognize problems, explore various aspects of ambivalence; useful in the precontemplation stage. Strengthen commitment to the decision for change:Goal setting, making bxal plans, avoiding roadblocks to successful change attempts; useful in the contemplative stage of change. Four Principles: Empathy. Pointing out discrepancies between values/beliefs and bxs. Accepting reluctance to change as natural (not resistance as pathology). Encouraging self-efficacy |
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| Classical/Operant Conditioning |
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| Classical Conditioning: Learning from two events that are associated through repeated temporal pairings; often pairing of neutral and unconditioned stimulus, resulting in the neutral stimulus becoming the learned conditioned stimulus. Operant Conditioning: Learning through consequences of reinforcement or punishment. Reinforcement increases a bx, punishment suppresses a bx. Classical and Operant Conditioning impact on bxal and cognitive-bxal therapy: Token economies: Reinforcement of desired bxs, punishment of undesirable bxs, frequently used in schools and mental institutions. Systematic desensitization, flooding, implosion are all exposure techniques that utilize classical conditioning. Desensitization: Based on reciprocal inhibition, it is a process of replacing a previously learned association through an incompatible response -- replacing anxious response to stimuli with a relaxation response. Extinction, stimulus generalization, response cost, and other counterconditioning techniques are useful for increasing desirable bxs, decreasing undesirable bxs, extinguishing phobic responses Roots of abnormal bxs: Classical conditioning is also considered a primary source of phobias and certain conduct and anxiety disorders. Mowrer's Two-Factor Theory: Used both operant and classical conditioning to explain avoidance learning in the development and maintenance of phobias. |
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| Key Figure:B.F. Skinner Learning Theory:Describes how bxs are shaped. Contingencies:Positive and negative reinforcement and punishment. Positive Reinforcement:Component of Operant Conditioning. Increase the likelihood of a bx through the addition of a pleasant consequence. Example: Giving a dessert after eating everything on the plate increases the likelihood of eating everything on the plate in the future even if the person is already full. Premack Principle: Reinforce a low-frequency bx with a high-frequency bx (aka Grandma's rule). Negative Reinforcement:Component of Operant Conditioning. Increase the likelihood of a bx through the removal of an aversive stimulus. Example: Anxiety disorders are perpetuated by the fact that avoidance of the feared stimulus leads to relief of the anxiety (the aversive stimulus) and thus increases the likelihood of avoidance in the future. Reinforcement Schedules: Fixed-Interval:Reinforcement after a set amount of time has passed (e.g., weekly paycheck). Fixed-Ratio:Reinforcement after a fixed number of responses (e.g., pay per unit of work completed). Variable-Ratio:Reinforcement after an average number of responses (e.g., slot machines). Variable-Interval:Reinforcement after a non-specific time period has passed (e.g., bird watching). Definition of Punishment: Component of Operant Conditioning. Reduces or decreases likelihood of target bx by administration of an undersirable consequence for a target bx. Can be the addition an aversive consequence or the removal of an enjoyable consequence. Guidelines for use with humans:Verbalization of the targeted bx that is problematic, emphasizing it is not the person, but the bx that is targeted. Punishment should developmentally appropriate and match seriousness of the problematic bx. The punishment should not consistently be paired with another stimulus (e.g., only one parent) because once the stimulus is gone (that parent is not home) the bx is likely to re-emerge. Punishment should not be the only means to change bx as it only suppresses bx, which will likely re-emerge if other more appropriate bxs have not been reinforced or the individual believes they will not be caught engaging in the negative bx. Bxal Therapy:Applying reinforcement and punishment principles to change problematic bxs. Principle: Bxs shaped through learning experiences. Clients learn to identify and adjust antecedents, bxs and consequences. |
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| Purpose:Elimination of deviant bxs Process:Counterconditioning process involving the pairing of a stronger noxious stimulus with the original stimulus resulting in the stronger noxious response. Over time the original stimulus alone will elicit the noxious response and will be avoided. In vivo:in real life (e.g., antabuse) Imaginal:in imagination Applications:Paraphilias, smoking and drinking Outcomes:Short-term benefits for paraphilias do not last Disadvantages:Lack of generalization and ethical concerns |
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| Purpose:Elimination of deviant bxs Process:Counterconditioning process involving the pairing of a stronger noxious stimulus with the original stimulus resulting in the stronger noxious response. Over time the original stimulus alone will elicit the noxious response and will be avoided. In vivo:in real life (e.g., antabuse) Imaginal:in imagination Applications:Paraphilias, smoking and drinking Outcomes:Short-term benefits for paraphilias do not last Disadvantages:Lack of generalization and ethical concerns |
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| Roots of Bx Modification: Stems from bxism and uses conditioning techniques to alter maladaptive patterns that have been learned. Major Focus: Providing encouragement. Aversive techniques are difficult because they only suppress the unwanted bx. Ratio of five compliments for each criticism is most effective. Uses: Treatment of unhealthy lifestyles reduces illness and pain. Conduct disorder: When family is involved. Tourette's disorder: With awareness training, relaxation, and cognitive therapy Aggressive bx in children: Reinforce appropriate bx and mild punishment for inappropriate bxs. |
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| Roots of Bx Modification: Stems from bxism and uses conditioning techniques to alter maladaptive patterns that have been learned. Major Focus: Providing encouragement. Aversive techniques are difficult because they only suppress the unwanted bx. Ratio of five compliments for each criticism is most effective. Uses: Treatment of unhealthy lifestyles reduces illness and pain. Conduct disorder: When family is involved. Tourette's disorder: With awareness training, relaxation, and cognitive therapy Aggressive bx in children: Reinforce appropriate bx and mild punishment for inappropriate bxs. |
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| Premise: learning occurs from observation or social interaction. Observational/Vicarious Learning:Albert Bandura. Learning through observation and modeling of others. Four components: Attention, retention, motoric performance, motivation. Sources of reinforcement (part of motivation): external, vicarious, self-generated. Learning is separate from action and can occur without reinforcement. Reciprocal Determinism:cognitions, bx and environment all influence each other Social Learning Theory applications: Theory of aggression. Clinical bx modification Family Therapy:Bxal-social-exchange model. Resolve family problems with communication, reward, problem-solving. Cost-benefit analysis of communication and decision-making. Therapists as teachers/contract negotiators in active and direct treatment approach Four assumptions of the theory (based on needs): Need to establish concrete and observable goals. A need to realign with the contingencies of social reinforcement. A need to model appropriate bxs. A need to establish family contracts that seek to develop. Normal family functioning requisites: Adaptive bx is rewarded. Maladaptive bx is not reinforced. Benefits of being a family member outweigh the costs. Pathological family functioning includes: Reinforcement of maladaptive bx through attention/reward. Deficient reward exchanges. Communication deficits |
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| Beck's Theory of Depression |
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Definition
| Beck's Premise 1. Maladaptive cognitions and dysfunctional attitudes create a vulnerability (diathesis) that when combined with continued stress results in depression. Five common cognitive errors that can cause depressive symptoms 1. Overgeneralization: believing negative events from one situation will happen in similar situations 2. Selective Abstraction: focusing on one aspect of a situation, ignoring others 3. Magnification: overestimating negative aspects 4. Personalization: attributing the negative feelings of others onto oneself 5. Dichotomous Thinking: believing experiences are either all good or all bad Schemata 1. The constructs of reality from a person's thinking patterns Specificity Hypothesis 1. Different types of cognitive content develop different degrees of depressive symptoms. Cognitive Triad 1. Depression ideation, and resulting automatic maladaptive thoughts and self-verbalizations, have three themes: Negative view of self. Negative view of the world. Negative view of the future Beck's Cognitive Therapy 1. Restructuring maladaptive automatic thoughts is done through collaborative empiricism. 2. Client and therapist are "co-investigators" who examine the evidence that supports or refutes the client's thoughts, beliefs and assumptions. Beck's Depression Inventory (BDI-II) 1. A 21-term inventory assessing the presence and severity of depressive symptoms 2. Considered highly reliable. |
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Term
| Rational Emotive Bx Therapy (REBT)- Albert Ellis |
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Definition
| Psychotherapeutic Focus 1. Cognitive bxal Psychopathology 1. Bxal disorders due to self-indoctrination 2. Beliefs are internalized attitudes of parents and society 3. ABC's: Activating Events, Beliefs (rational or irrational attitudes about event), Consequences (emotional and/or bxal) 4. Irrational beliefs triggered by activating events leads to emotional disturbances Therapeutic Interventions 1. Direct persuasion disputing irrational beliefs 2. Types of irrational beliefs: musterbation, awfulizing, low frustration tolerance, and overgeneralization 3. Utilizes instruction, persuasion, and logical disputation 4. DEF's: Disputing intervention, Effective philosophy is adopted, Feelings (new feelings result) |
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Term
| Self-Control Model of Depression |
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Definition
| Key Figure: Rehm Based on: Kanfer's general model of self-regulation, which explains that some bxs persist in the absence of reinforcement. Rehm's Self-control concept: Involves a series of processes attempting to change the probabilities of one's own responses. Responses are maintained in the absence of immediate external reinforcement. Source of Depression: Deficits in each self-control process: Self-monitoring, self-evaluation, and self-reinforcement. Example: Selective monitoring of negative events, little self-reinforcement for adaptive bxs, and excessive self-punishment. Self-control processes and related deficits: Self-monitoring deficits include: Attending to only negative events to the exclusion of positive ones. Immediate, instead of long-term, outcomes of bx. Self-evaluation deficits include: Setting stringent, perfectionistic self-evaluative standards. Making inaccurate and depressive attributions for one's own bx. Self-reinforcement deficits include: Administering too few self-rewards. Excessive self-administered punishment. Treatment plan: Highly structured in-session exercises and homework assignments. Group therapy format used with series of 10 sessions, successive skill building. Self-monitoring phase: Learns monitoring their focus on negative activities and self-statements, as well as positive delayed outcome of bx. Monitor own progress, keeping daily logs of activities, self-statements, and mood. Self-evaluation phase: Clients learn how to set reasonable goals and break them into sub-goals, learn how to make effective attributions for their bx. Self-reinforcement phase: follow a difficult goal and subgoal with easy and positive activities and self-statements. Successful identifying coping skills deficits in depressive disorders. |
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Term
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Definition
| Key Figure:Meichenbaum Premise:Utilize coping self-statements as coping with stressful situation and increasing task-oriented bx. Five-step procedure:Therapist Modeling;Therapist Verbalization;Patient Verbalization;Patient Silently Talks Through;Independent Task Performance. Goals:Build adaptive cognitions in performing tasks. Indications:Effective for treatment of ADHD (inattention/impulsivity). |
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Term
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Definition
| Key Figure:Meichenbaum Purpose:Coping with stress situations. Akin to medical inoculation against disease. Initially designed to prepare students for stress-inducing real-life events. Premise: Modifying cognitions to be healthier, adaptive, and practical will increase more functional emotions and bxs. Three Phases:1) Conceptualization: Providing adaptive perspective and understanding of negative reactions to stressful events. 2) Skills acquisition and rehearsal: Teaching patients specific coping skills, practice alternative problem-solving strategies (including deep muscle relaxation, coping self-statements, imagery, thought stoppping). 3) Application and follow-through: Practice new skills. Begin with low-stress imagery, then role-play, then "homework" assignments in gradually more stressful situations. |
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Term
| Personal Construct Therapy |
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Definition
| Key figure:George Kelly, one the first cognitive theorists. Premise:People develop constructs, which are hypotheses based on the interpretations of events that affect them. Individuals then develop a way to interact with their world, which becomes their personality. Fundamental Postulate:A person's processes are psychologically channeled by the ways in which he anticipates events (i.e., we interact with the world in a manner congruent with our expectations of the world). Eleven Corollaries:Choice corollary, commonality corollary, construction corollary, dichotomy corollary, experience corollary, fragmentation corollary, individuality corollary, modulation corollary, organization corollary, range corollary, sociality corollary. Explain how we interpret information, why we see the world differently and how we influence the perceptions of others. Criticized for being confusing and overly simplistic, but still well utilized. Person-as-scientist: Human capacity for meaning-making, agency and revision of personal systems of knowing. Incipient scientists who creatively formulate own constructs (hypotheses) about own life to make life meaningful and predictable. These systems of meaning are continually revised, extended, and refined. Core constructs:Nonverbalizable meanings, but are critical to one's construct systems and embody basic values, sense of self, and social embeddedness. Core constructs find validation in relational, family and cultural contexts. |
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Definition
| Figure: William Glasser Premise: Rooted in choice theory, imposes a sense of personal accountability in choice and change. Content in therapy is only focused on what the client can control; no sense in talking about what the client can't control Components: Irresponsible fulfillment of needs results in "failure identity." Needs: Survival, power, belonging, freedom and fun. No value placed on transference, medication, or diagnosing Primary goal: Replace failure identity with success identity discovering responsible and effective means to satisfy needs. Techniques: Evaluate patient's actions, values, current bxs/plans and help client accept responsibility for their actions. Phrases to remember: "How's that working for you?" "Commit to the pain," and "you're not depressed; you're depressing." Present focused. Requisites: Comfortable relationship between therapist and client. Client ability/willingness to openly evaluate life to identify changes. |
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Term
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Definition
| 1.Learning control of generally involuntary responses, such as muscle activity, brain waves, heart rate, skin temperature, blood pressure and other bodily functions Mechanism of action 1.Affects the parasympathetic nervous system, increasing the rest, relaxation and recuperation response Operant Conditioning 1. Visual and/or auditory feedback on autonomic nervous system functions to learn regulation of those functions Purpose 1. To reduce the actions of the sympathetic nervous system (flight or fight response) that is involved in anxiety disorder Types 1.EMG (electromyogram):Electrodes measure muscle tension to teach relaxation and release of muscle tension associated with backaches, headaches, neck pain and teeth grinding a. Applied to treating illnesses affected by stress, such as asthma and ulcers b. Skin temperature: To address certain circulatory disorders c. Galvanic skin response: Measure perspiration in the skin which is related to anxiety d. Often used in the treatment of phobias, anxiety and stuttering 2.EEG (electroencephalogram):Measures brain wave activity for meditation or treatment of attention disorders a. Used less frequently than others because of cost and availability of EEG machine Controversy 1. The expense involved in biofeedback is large compared to similar treatments that increase relaxation such as relaxation training, meditation and self-hypnosis a. Relaxation training may do more good than biofeedback for hypertension |
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Term
| Electroconvulsive Therapy |
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Definition
| Indications:Treatment resistant depression and/or depression with psychotic symptoms. Procedures:Electrodes on the forehead produce a current through the brain, eliciting seizure activity. Conducted over 6-12 sessions. Original uses:Thought to cure schizophrenia in the 1930s, which lead to greater research and development of electrical induction techniques. Side effect management and residual problems:Administration of muscle relaxants and anesthetics during procedure reduces most side effects. Lasting memory problems continue to be reported by some patients and is likely dose dependent. Memory effects may be mitigated by antidepressants. |
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Term
| Eye Movement Desensitization and Reprocessing |
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Definition
| Key Figure: Francine Shapiro Premise: Moving eyes side to side in saccadic movements while bringing up distressing traumatic images. Use: Usually for the treatment of PTSD. Before treatment begins, client learns self-relaxation techniques. Multiple Phases in one given session: First Phase: Intake, Client history and treatment plan. Client identifies traumatic memories. Second Phase: Preparation for procedure and introduction to what EMDR is. Client is asked to pick most distressing memory and negative cognition related to it. Client is asked to give a Subjective Units of Distress Scale (SUDS) rating SUDS Scale: Instrument often used to assess client's level of distress during various exposure techniques for anxiety treatment. Client rates memory using SUDS: 0-10 (0 is no distress and 10 is highest distress possible) 1-100 (1 is lowest distress and 100 is highest) Third Phase: Installation. Client replaces negative cognitions with positive ones. Positive cognitions are then associated with original memory. Fourth and Final Phase: Client returned to emotional equilibrium, whether or not desensitization is completed. Homework: Logging distressing images and thoughts; practice relaxation. Support/Criticisms: Critics: EMDR effects are due to the exposure part, not to the eye movements. Little empirical research to support treatment. Supports: Exposure techniques and EMDR equally effective. Given evidence, more empirical validation warranted. |
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Term
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Definition
| Goal:Help client become more self-defining and encompass more than just a woman's view of the self. Focus:Mutual education and psychoeducation, egalitarian relationship, thus acknowledging inherent power differential and seeking to minimize it in the client-therapist relationship. Key Issues:Social context and oppression Changes are framed within a socio-political context Techniques: Egalitarian:Self-disclosure of one's own personal experiences Pluralism:Teaching the client multiple ways to view the world External emphasis:Stressing the oppressive aspects of reality Use of community resources Active counseling:May join client as an advocate, but encourages independence. Information giving. Personal validation Self-in-relation Feminist Theory: Considers impact of same versus opposite gender in caregiver-infant relationships on the development of self. Proposes women are fundamentally different than men in attachment, separation, intimacy, and connection. Personality structures evolve from early experiences with mother, who fosters male and female orientation to self and others. Empathy, nurturing, and caring develop through early mother-daughter relationship. Difficulty with: Separating, dealing with loss, developing a differentiated sense of self, impaired ability to care for self also arise from early mother-daughter relationships. Psychoanalytic Feminist Therapy: Key figure: Nancy Chodorow Premise: Freud's assertion that the individual is born bisexual and mother is first sexual object. Combines feminist perspective to object-relations by proposing the child forms its ego in reaction to the dominating figure of the mother. Sons form independence easily because identify with father. Only struggle with dyadic love experience. Daughters identify more with mothers; mothers identify more with daughters. Daughter attempts for independence by making father new love object and developing her ego; the intense bond with her mother may thwart her -- libidinal triangle: love for mother, love for father, concern for the parents' relationship. Dyadic versus triangle love experiences explain socially constructed gender roles and perpetuates women's issues. Intervention: Male-female co-education may solve gender-specific structuralization of society. |
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Term
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Definition
| Definition:Nonsexist therapy is therapeutic practice in an unbiased way that does not treat the client in accordance with stereotypical sex roles. Sexism: prejudice and/or discrimination based on gender. Sexism's influence on psychotherapy:May lead to unfair judgements, negative or narrow beliefs, differential treatment based on gender. Early therapies were criticized for gender-stereotyped treatment of clients. Sex differences:Males and females are biologically complementary. Personal and professional differences due to differential treatment, expectation or opportunities. Homophobia:Nonsexist therapy also applies to issues of traditional gender roles and providing non-homophobic therapy. Homophobia is an imprecise term according to Herek. Three distinct issues: Sexual stigma:Shared society’s negative regard any non-heterosexual bx, identity, relationship, or community. Heterosexism:Societal beliefs and systems that encourage/perpetuate violence, hatred, and antipathy against sexual minorities. Sexual prejudice:Negative attitudes and beliefs based on sexual orientation or romantic affiliation. Sexual prejudice highest among: heterosexual males, older individuals, lower-education populations, Southern or Midwestern, and/or rural regions, those with limited interactions with homosexualism, conservative political views, higher authoritarianism, membership with fundamental religious groups. |
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Term
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Definition
| Format:Empirically validated psychotherapy protocols outlining session-by-session treatment goals and techniques. Theoretical Orientation, Goals & Modalities:Commonly CBT focused approaches; most focus on development of effective coping strategies for anger, anxiety, assertiveness, substance abuse, and trauma. Treatment Length:6-8 sessions up to 7-8 months Notable Benefits:Provision of guidelines for most effective treatments and standardization permits outcomes studies across therapists, clients and situations. |
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Term
| Transtheoretical Model (TTM) of Bx Change |
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Definition
| Key Figures: Prochaska and DiClemente. Basis of development of the model: High rates of relapse with smoking cessation studies. Premise: Bx change is not singular, nor linear. Original model proposed five stages of change that dynamically interacting cycles that result in sustained bx change. Termination stage later added as the sixth stage. Precontemplation: Denial, no recognized intention for change, unaware of the problem, defensive when confronted. Contemplation: Acknowledges the existence of a problem, but ambivalent toward change; thus, thinking about change, but not committing to do so. Debates pros and cons of change. Preparation: Decision is made for change, getting ready for change in next month. Action: Typically lasts 3-6 months; development of plans, rewards, help, and support. Maintenance: After bx has been sustained for at least six months. Aware that the change has been worthwhile and meaningful, must work on relapse prevention. Termination: Ultimate goal of bx change. No longer sees relapse or return to old bxs as possible. Interventions: Most-effective interventions match stage of change. Precontemplation: Psychoeducation Action or maintenance: Learning new strategies for bx change. Model Updates: In addition to the sixth stage of change, Prochaska, Norcross, and DiClemente updated the stages of change to include 10 processes that help people move through the stages: Increasing awareness, emotional arousal, social reappraisal, environmental opportunities, self-evaluation, stimulus control, supportive relationships, substituting, rewarding, and self-liberation or commitment. |
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Term
| Multitheoretical Psychotherapy (MTP) |
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Definition
| Key Figure:Jeff Brooks-Harris Premise:Integrate training and treatment, with the premise that thoughts, feelings and actions interact and are shaped by biological, systemic, interpersonal, and cultural contexts. Integrates cognitive, bxal, biopsychosocial, psychodynamic, systemic, and multicultural treatment approaches to address psychopathology. Integration:Working interactively with thoughts, feelings, and actions. Strategies to promote functional thoughts. Bxal skills to encourage effective actions. Experiential interventions to shape adaptive feelings. Biopsychosocial model with focus on biology and more adaptive health practices. Psychodynamic-Interpersonal Skills for interpersonal patterns and promotion of undistorted perceptions. Systemic-Constructivist interventions look at social systems and support personal narratives. Multicultural-Feminist interventions explore cultural contexts and encourage identity development. Eclecticism and Integration:Eclecticism has gained favor since the 1980s. Eclecticism takes strategies from many different modalities and borrows them. Integration melds the strategies together. |
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Term
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Definition
| Therapeutic orientation 1. Cognitive-Bxal Therapy Process 1. Client records thoughts, feelings, and bxs 2. Often assigned as homework in therapy to further engage the client Purpose 1. To facilitate change and self-regulation 2. Both an assessment tool and intervention 3. Provides therapist with detailed records 4. Observing one's undesirable bx can decrease its occurrence |
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Term
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Definition
| Key figure 1. Julian Rotter Definition 1. Cognitive construct that categorizes people's perceptions of their control over the environment Internal Locus of Control 1. Events in life influenced by the self 2. More likely to experience feelings of autonomy and self-determination External Locus of Control 1. Events in life due to factors outside of one's control 2. More likely to experience feelings of victimization, depression and stress Beck's Theory of Depression 1. People with depression place external Locus of Control contrasted with an internal sense of responsibility Beck's Cognitive Triad 1. Negative view of self, world, and future |
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Term
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Definition
| Descriptors 1. Therapeutic Orientation: Bxal 2. Premise: Replace undesirable bx with desirable bx by rewarding use of the desirable bx in place of the undesirable one Key Components1. Identify target bx to reduce 2. Identify target bx to increase 3. Identify reinforcement schedule 4. Identify source of providing reinforcement 5. Identify content of the reinforcement Common Uses 1. Treatment settings such as halfway houses or inpatient programs 2. Often occurs in form of token economy: Client receives intermediate token (voucher) that can be redeemed for rewards |
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Term
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Definition
| 1. Aims to modify problematic patterns of bx and improve family functioning by targeting presenting symptoms 2. Premise: bx is controlled by reinforcers and punishers; hence, it is maintained by consequences; it can be modified by altering these consequences. 3. Views problematic bxs as acquired learned responses, maintained through reciprocal reinforcement (e.g. a child throwing tantrum and a parent giving it attention) 4. States that the use of aversive control to change unwanted bx often obtains the opposite effect 5. Is based on social learning theory (Bandura), and on Thibaut and Kelley's theory of social exchange (people strive to minimize costs and maximize rewards) 6. Requires a therapist to assess and record progress on an ongoing basis, empirically evaluating the treatment's outcomes 7. Has a limited number of sessions 8. General goal: decrease aversive control, increase rewarding exchanges, and improve communication and problem-solving in the family Two main components of BFT 1. Bxal Parent Training (BPT) trains parents to respond to a child's bxs with operant conditioning techniques (including social and tangible reinforcers, contingency contracting, shaping, token economies, and time-outs. 2. Bxal Couple Therapy (BCT) assesses the strengths and weaknesses of parents' interaction and teaches communication and problem-solving skills. Techniques include bx exchange procedures (partners are taught to verbalize their needs clearly to the each other) and contingency contracting ("if you do this for me, I will do that for you") NB: The effectiveness of both BPT and BCT depends on detailed bxal assessment of baseline functioning Additional therapies listed in Division 53 of the APA which are bxally oriented, evidence-based family interventions, for the treatment of children and adolescents 1. Functional Family Therapy 2. Brief Strategic Family Therapy 3. Multisystemic Therapy 4. Multidimensional Family Therapy |
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Term
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Definition
| Sex therapy is a specific form of marital therapy. Stuart's Operant-Interpersonal Approach is a bxal marital therapy. Assumptions of Marital Therapy: Individuals in family/marriage are interdependent, thus treatment must occur within this context. Family systems struggle to maintain balance. Marital problems can occur at any stage of marriage. Early stage problems are often related to adaptation to lifestyle changes. Individual therapy should not be adopted by the same psychologist who conducted marital therapy for that person. Sex Therapy: Treatment of diminished interest in sex, difficulty with arousal/climax, or pain during intercourse. Sexual dysfunction and the relationship may be interrelated (e.g., hypoactive sex drive may be related to problems in communication, expectations, problem-solving, or emotional intimacy). Caution must be taken to throroughly assess the potential for medical and physical sources or contributions of sexual dysfunction. |
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Term
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Definition
| Key Figures:Masters and Johnson Sexual Response Phases:Excitement (initial arousal), plateau, orgasmic, resolution Sensate Focus Therapy: Indicated for difficulty with sexual phase advancement (erectile or orgasmic dysfunction). Introduced at the excitement phase of arousal. Counter-conditioning technique. Non-demand pleasuring (no demands or intercourse or orgasm) |
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Term
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Definition
| Premise: Family therapy where the family is viewed as a system of interacting parts. Therapeutic change from altering systems of interaction between family members. Identify solutions to family system problems rather than identifying singular cause of dysfunction. Homeostasis: When a disruption (crisis) occurs in the family status, the members will attempt to regain homeostasis, decrease stress, and restore balance through family-learned mechanisms. Feedback provides consequences to the family system. Negative Feedback: restore equilibrium, minimize deviation, maintain status quo. Positive Feedback: disrupt dysfunctional transactional patterns, help members reassess their methods of engaging, alter rules of family system Circular Questioning: Helps family members identify similarities and differences in perceptions of events or relationships. Circular questions gather information and introduce information to the family system. Gathering information provides basis for formulating and testing hypotheses in family dynamic. Transmission of information may alter individual's/family's knowledge. Reframing: Help clients view experiences/events from another perspective. Alters client's/family's internal models of the world. May be used in a paradoxical manner. Other Factors/Approaches: Minuchin's structural approach: Focus on the family interrelated system, assesses/changes hierarchies, boundaries, alliances/splits. Haley's strategic approach: Emphasis on family unit, assess/change hierarchies, communication, and interaction to address/resolve presenting problem. Triangulation/Coalition: One individual colludes with another family member against a third. Alliances/coalitions are when groups of family members are against another member or other part of the family. Enmeshment: Undifferentiated ego mass, which is defined by an overdependence among family members, addressed in Bowenian family systems therapy. Extended family systems therapy: Incorporation of multiple generations and intergenerational issues. Creation of therapeutic triangle with the therapist and two family members. Clinician highlights family fusions. |
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Term
| Structural Family Therapy |
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Definition
| Key Figure: Salvador Minuchin Family Structure: Single and interrelated Assessed along three dimensions: Hierarchy of power, clarity and firmness of boundaries, and significant alliance/splits (subsystems). Dysfunctional families: Impaired boundaries (enmeshed or diffuse), inappropriate coalitions, and power imbalances. Triangulation: Two-person conflict involves a third party (often child) to stabilize conflict. Detouring: Distress expressed through third party (often child), blaming them for negativity or uniting for the sick child. Cross-generational coalitions: Associated with psychosomatic families; involve one parent uniting with one child, with enmeshment and a lack of boundaries. Therapeutic Goals and Techniques: Goals: Altering perceptions of the problem (reframe) and enhancing adaptive patterns. Techniques: Joining: Acceptance of the therapist by the family for diagnostic and restructuring purposes; creates unbalance in the dysfunctional system through taking sides, blaming, forming coalitions in order to adapt to or accommodate the systems of the family. Family Maps: Identification of boundaries, coalitions, and alignments. Enactments/Role-plays: Create boundaries that force parents to unite, demoting child from authority. |
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Term
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Definition
| Key figure 1. Jay Haley Premise 1. Directive problem-focused approach to reduce dysfunctional, symptomatic problems in the family Source of family problems 1. Misguided solutions that create chronic problems resulting in positive feedback in the family system 2. Structural problems with incongruous hierarchies (power and control) 3. Functional problems with members of the system covertly protecting and maintaining symptoms in the family Double Bind: communication with mixed messages. Two contradicting messages are given, leaving the receiver in a no-win situation Functional families 1. Flexible problem-solving approaches 2. Larger repertoire of problem-solving abilities 3. Maintain hierarchy within family Therapeutic goals 1. Therapists track improvements and actively direct reduction in symptoms 2. Focus on the presenting problem only (not underlying causes) 3. Bxally defined objectives and criteria Techniques 1. Focused on changing the family repetitive interaction sequences 2. Directives, disruption of feedback cycles, clarification of hierarchies, and paradoxical interventions, like "prescribing the problem" |
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Term
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Definition
| Definition:Two family members create a coalition against a third. Bowenian triangles:Two family members recruit a third member to alleviate stress. The two members may be enmeshed and emotionally cut off. Detriangulation: Help the client recognize emotional enmeshment and learn greater neutrality in responding. Also have cross-generational coalitions. Structural family therapy triangulation:Occurs when each parent demands that the child take their side against the other parent. Strategic family therapy triangulation:Cross-generational coalitions in which a member of one generation colludes with a member of another generation against a third member (usually a parent). |
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Term
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Definition
| Development 1. Psychoanalytic-based theory from work with schizophrenic patients and their families Premise 1. Three-generation perspective--a multigenerational transmission process to describe anxiety passed down from generation to generation that results in the psychopathology of family members. 2. Problems in one's current family situation cannot be changed until unhealthy relationships and interactions in one's family of origin are acknowledged and changed. 3. Family is viewed as an emotional unit--understanding one's individual problems can best be done in relation to seeing the family as an emotional unit. Goal 1. Increase differentiation/individuation of family members Core concepts 1. Differentiation: how individuals view themselves objectively in the midst of intense family emotion; increasing individuation of the most differentiated member may motivate individuation of other family members 2. Fusion: lack of maturity where emotionality overpowers objective reasoning and the individual lacks individuality; it results in undifferentiated family ego mass--overdependence or enmeshment among family members 3. Triangulation: two-against-one. In a conflicted dyad one member recruits a third person. This may represent an attempt to reduce stress or conflict; it may result in covering-up or defusing the conflict. A multigenerational process occurs when the triangulation develops across generations. This can lead to severe psychopathology. 4. Emotional cutoff: denying and isolating one's problems from the rest of family. It is used to help people cope with unresolved attachments to their families of origin. 5. Family projection process: a procedure in which parents come together for the sake of the child and his/her problems. The child will likely develop the problematic symptoms of his or her family. Therapeutic interventions 1. Shifting the hot triangle 2. Working with the most available family members to achieve differentiation 3. De-triangulating 4. Repairing emotional cut-offs |
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Term
| Complementary Communication |
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Definition
| Etiology 1. Articulated by Watzlawick, Beavin, Jackson 2. Pragmatics of Human Communication (1967) fifth axiom Key theory 1. Communication/Interaction Family Therapy: Seeks to understand how faulty communication patterns impact family dysfunction 2. Complementary Communication: One person leads the other person 3. Symmetrical Communication: Leadership is equal and either person takes the lead 4. Psychopathology can result from either complementary or symmetrical communication (parent treating 5-year-old as an adult may prevent adequate development and growth of a child) |
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Term
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Definition
| Definition:Tailoring an intervention to disrupt bxal patterns that support client's presenting problem. Utilization:Therapeutic strategy in family therapy. Useful with resistant families and specific bxal problems. Can produce extreme bxs. Requires training, consultation, supervision. Should not be used with patients with severe psychopathology. Technique:encourage symptom presentation (a problem bx) in a way that the patient cannot continue to utilize it. Encourage continuation of bx as is. Encourage increasing the frequency or duration of the bx. Encourage enacting the bx in different settings. |
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Term
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Definition
| Key figure:Steve de Shazer Premise:Clients want change and have the capacity to solve their problems by focusing on patterns that work, on strengths and solutions that have worked in the past. Techniques:Miracle Question:If a miracle occurred how would the client see the problem resolved? How would their life be different? This question encourages viewing the future and seeing the ultimate goals to work toward. Exception Question:Consider times in past when the problem has not occurred. This question encourages the client to recognize past skills or situations that helped with this problem. Formula task:Encourages the identification of strengths and using these to address the presenting problems. |
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Term
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Definition
| 1. A legendary pioneer of Family Therapy 2. Director of training early in her career at Mental Research Institute 3. Premise is humanistic; her work belongs to both the experiential and communications traditions 4. Clinical style ("clinical artistry") warm, genuine, lively and direct 5. Added "feeling dimension" to the developing school of family therapy 6. Straightforward approach sought to elicit changes in the family by exposing hidden family rules 7. Encouraged family members to speak for themselves 8. Pointed out nonverbal communication channels 9. Clarified questions, modeled openness, authenticity, clear speaking and communication Key assumptions 1. Presenting problem is rarely the actual problem 2. The real problem is how one copes with problems 3. Change is possible 4. Responsibility for both bxs and internal experiences 5. Familiarity is a driving factor in making choices for many people Family-of-origin focus 1. Genograms (family maps) to facilitate therapeutic change a. Factual present and perceptual past 2. Survival Stance 3. Not a personality trait 4. A coping strategy 5. Four coping/survival stances: Placating, blaming, super-reasonable, irrelevant 6. A preferred coping stance is used when under stress 7. May utilize any of the four depending on the situation and interpersonal dynamics 8. Contact with inner self and others a sacred event 9. Highly valued the "I-Though" encounter 10. Emphasized one's uniqueness, as well connectedness with the other members of the family 11. Constantly mindful of the self-other-context reality 12. Focus on family's positive dynamics and solutions, rather than complaints 13. Emphasized congruent vs. incongruent communication, genuine expression of feelings and thoughts 14. Famous for use of touch and modeling of affection with children 15. Used psychodrama (Moreno) and body sculpting (Kantor and Duhl) to elicit and work with affective experiences 16. Developed the "Family Reconstruction" technique for work on transgenerational issues 17. Believed in empathizing with parents, as well as in resolving past issues to in order to live more freely and fully in the present |
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Term
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Definition
| 1. Symbolic representation of family system a. Geometric figures and lines depict individuals and relationships b. Basic Genograms include biological and adoptive relationships of family tree c. Also include emotional state of relationship 2. Original information and symbols was not standardized a. Genograms in Family Assessment book first widely used 3. Originated in Family Therapy 4. Now utilized in variety of settings a. Counseling, individual, and couples b. Medical history c. Genetic counseling Uses in psychotherapy 1. Individual's problems affect family 2. Family affects the individual's problems 3. Individual's problems arise from family problems 4. Focus of therapy is personal growth 5. Communication, patterns of relating, strengths/weakness of system |
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Term
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Definition
| 1. Developed by Michael White and David Epston 2. Premise: Structure of self provides meaning and organization 3. Personal narrative: Meaning attached to events, relationships, and thoughts a. Constructed through social discourse (language is cultural and contextual) b. Other terms to describe personal narrative: narrative metaphor, identifying systems theory, cybernetics, and alternative metaphors c. Affects one's self view and ultimately bx Therapeutic process 1. Goal: Re-author distressing or unhelpful narratives, changing bx 2. Role of the therapist: Minimize expertise, client is agent of change and can interpret meaning of the narrative 3. Externalization of the problem 4. Recognition of formative process of narrative through influential social environments and people 5. Strengths based 6. Deconstruction of original narrative a. Questioning assumptions and errors b. Mapping identifies impact of narrative on life 7. Re-authoring of new narrative a. Questioning, "Miracle Question"8. Re-remembering a. Final stage b. Sharing new narrative with supportive others c. Sharing can be with living, deceased, in vivo or imaginal Meta-narratives 1. Societal narratives that impact social justice, rights, oppression, marginalization, and self-concept |
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Term
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Definition
| 1. Psychotherapy involving multiple clients in a group setting Source of support 1. Therapist and other group members Curative components (as purported by Yalom) 1. Altruism 2. Group cohesiveness 3. Universality 4. Interpersonal learning-input 5. Interpersonal learning-output 6. Guidance 7. Catharsis 8. Identification 9. Family re-enactment 10. Self-understanding 11. Instillation of hope 12. Existential factors Most important factors 1. Group cohesiveness: Sense of belonging and acceptance that moves the group into the working stage promoting deep and meaningful personal sharing; this is considered THE most important factor, as it parallels the rapport developed in individual therapy 2. Interpersonal learning: Improving ability to relate to others 3. Catharsis: Release of emotional energy and feelings 4. Self-understanding: Growth in self-awareness Stages of Group Therapy 1. Forming: Early stage, attempting to determine structure and purpose of the group and develop social relationships in the group; guidance, answers, approval and acceptance are primarily sought through the group leader 2. Storming: Conflict and rebellion with group members challenging tasks, rules and therapists; advice giving replaced by criticism, judgment, and hostility 3. Norming: Group cohesiveness with more intimacy, trust, disclosure and concern for other members 4. Performing: Open discussion and resolution of conflicts, working together supporting and encouraging emotional growth and therapeutic change 5. Adjourning: Included as a stage by some researchers and therapists; includes separation and conclusion of group Theoretical approaches 1. Interpersonal, psychodynamic, social systems, cognitive-bxal, psychodrama, redecision therapy, existential therapy Common/important procedures/norms/phenomena 1. Importance of maintenance of group's procedural norms, allowing turn-taking in self-disclosure 2. Self-disclosure of other members improves when another member has disclosed 3. Resistance, more likely during the storming phase, should be discussed with the group 4. Co-therapists should discuss disagreements openly in front of the group to model conflict management 5. Premature termination often due to unrealistic expectations/unfavorable attitudes toward group processes -- reduce likelihood through prescreening and framing, training, and information for realistic expectations 6. Polarization: Group may make more extreme decisions than individual group members 7. Social facilitation: Improved performance on task with presence of others 8. Fundamental attribution bias: Making dispositional rather than situational-based attributions of others' actions Issues of concurrent individual therapy 1. Cons: Clients in concurrent individual and Group Therapy may save their self-disclosure of individual therapy; Group Therapy not for times of crisis, requiring individual attention 2. Pros: Individual therapy may help clients work on issues interfering with Group Therapy; Group Therapy may reduce resistance in individual therapy; clients with certain diagnoses (Borderline and Narcissistic Personality Disorders) benefit most from concurrent individual and Group Therapy |
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Definition
| Premise:Orienting intervention assisting clients in developing more effective coping. Confidence is generated, greater coping for responses for future use. Cognitive-bxal approaches primarily used. In cases dealing with bereavement, grief work is employed. Focus:Help client view situation more accurately, make better choices and decisions, act and behave more constructively, overcome the crisis, bring individual back to normal level of functioning. Means to prevent long-term problems from developing. Crises may include natural disasters, injuries, accidents, victimization, abuse, harm to others, self-harm. Suicidal Intervention:Crisis intervention has been useful for SI with crisis hotlines, suicide education, and walk-in appointments. These are mostly utilized by young Caucasian women. More research needed to verify effectiveness of the suicide prevention centers. Psychological Debriefing: Encouraging victims of traumatic events to talk about their situation, feelings and reactions. Primarily used for people who haven't fully developed symptoms related to their crisis; intended to prevent further distress. Counselors help the person remit/relive experience, validate the normalcy of their feelings and reactions to the crisis, offer stress management, refer them out for outpatient psychotherapy. 1991, Disaster Response Network, one of the largest mobilization programs was developed by the American Psychological Association and the American Red Cross; Disaster Response Network provides free emergency mental health services to disaster sites Criticisms:Effectiveness and cultural competence have been called into question. |
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Term
| Critical Incident Stress Debriefing |
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Definition
| Premise:Following a large-scale disasters it is a provision of emergency mental health help Four stage approach:1) normalization of trauma response symptoms 2) encourage expression of feelings 3) teach self-help for stress management, etc. 4) provide appropriate referrals Popularity is growing, but debate about effectiveness remains |
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Definition
| Premise:Consultative approach that emphasizes social interventions. Pursues changes in policies and institutions for perceived benefit of all whom they might serve. Social and legal reform to improve well-being of disenfranchised group. All in the organization may benefit, but primarily the disenfranchised. Goal:Promote social change Approaches:Equalizing power differentials and focus on social system rather than individual change. Multidimensional and multifaceted interventions. Controversial because of its political and confrontational nature Skills:Requires a wide range of skills and activities of the consultants. Organizational/political/legal. Negotiation. Public relations. Tolerance for frustration, ambiguity and conflict |
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Term
| Mental Health Consultation |
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Definition
| Key Figure: Gerald Caplan Premise: More clients can benefit from mental health care through indirect services that address client issues, consultee issues, and issues in the work environment. Consulting Strategies:Vary by content (case or administrative consultation). Vary by focus (client/program centered or consultee-centered). Four resulting categories: Client-centered case consultation: Expert assessment of a client's problems and suggests ways to handle it. Consultee-centered administrative consultation: Focus on how consultee's knowledge, attitudes, or bxs affect the program. Consultee-centered case consultation: Consultant works with consultee and indirectly assists the client through the consultee. Program-centered administrative consultation: Direct assistance to the program. Primary strategies regardless of focus: Observation, listen to, question, and watch the dynamics of the client-consultee relationship. Make inferences on the forces that may be influencing client functioning. Explain the problem and offer plausible solutions or interventions. Theme Interference: Past or present unresolved personal problems that are unconsciously projected onto work tasks. Results in temporary ineffectiveness and emotional instability. Characterized by repeated difficulty with specific problem, confusion, anxiety, emotional reactions and unpredictable or inappropriate responses. Consultant role: Reduce theme interference by discussing alternative outcomes with consultee, using parables to demonstrate themes outside current context, remaining calm, or mimicking the relationship between consultee and client to invalidate the consequences the consultee expects. |
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Term
| Primary, Secondary, and Tertiary Prevention |
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Definition
| Purpose of prevention:To reduce the development, incidence, and chronicity of mental disorders. Very important in community psychology. Component of three types of prevention identified by Caplan:primary,secondary,tertiary. Cowen's two types of primary prevention: Programs that prevent people from developing psychological disorders. Programs that foster healthy lifestyles. Cowen's components of primary prevention: Offered to groups, not individuals. Applied before symptoms of maladjustment arise in targeted population. Intended to strengthen psychological adjustment. Empirically demonstrated effectiveness. Primary prevention techniques: Encourage secure attachments. Teach cognitive and social skills. Changing environments. Enhancing stress-coping skills. Promoting empowerment. Best known example of primary prevention: Head Start. Definition of secondary prevention: Secondary prevention works on early identification of problems to prevent them from getting worse, like an early warning system. May include post-crisis intervention to prevent problems from worsening. Targets specific individuals. Detection:Requires effective assessment. Difficulty arises with false positives: Identified as being at-risk, when not. Education to identify problems often resides with community mental health. Example of secondary prevention: Primary Mental Health Project. Started by Cowen 1957 in New York Schools. Identified at risk students for mental health disorders, provided programs to reduce or prevent the problems. Definition of tertiary prevention: Intervening when the mental illness is severe, a clear dx has been made. To reduce chronicity, severity or prevent relapse. |
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Definition
| 1. FP is the application of psychological science to issues related to criminal and civil law 2. Provides professional psychological expertise to the judicial system 3. Three main areas, criminal, civil, correctional 4. Re-specialization not necessary, but forensic training and experience highly advised 5. Forensic psychologists rely on APA's Ethics Code as well as on the "Specialty Guidelines for Forensic Psychologists" (APA Division 41, 2010) 6. American Academy of Forensic Psychology provides CE training in FP Forensic psychologists in criminal law 1. Assess defendants' competency to stand trial 2. Assess defendants' mental state at the time of the offense 3. Serve as expert witnesses 4. Evaluate potential jurors Forensic psychologists in civil law 1. Child custody evaluations 2. Sexual harassment suits 3. Immigration issues 4. Employment discrimination, malpractice, mental disability 5. Product liability and personal injury 6. Mediation and conflict resolution Correctional forensic psychologists 1. Provide assessments 2. Dx and treatment in correctional institutions and psychiatric hospitals 3. Consultation on parole hearings Frequent ethical violations 1. Lack of specialized knowledge 2. Failing to maintain neutrality in assessments/recommendations 3. Failure to maintain professional boundaries with the hiring attorney 4. Multiple relationships 5. Ignorance of privilege and confidentiality specific to legal setting 6. Poor recordkeeping |
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Term
| Sue's (1978) Minority Worldview |
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Definition
| Premise:Refers to one's individual or group attitudes, beliefs or values 2x2 Grid: Locus of Control vs Locus of Responsibility. Internal Locus of Control (IC): Reinforcement contingent on their own actions. External Locus of Control (EC): Events occur independently of their actions (due to luck). Internal Locus of Responsibility (IR): Feel basic responsibility for their actions and effects on others. External Locus of Responsibility (ER): feel that other people and external events are to blame Four combinations:EC-IR, IC-ER, EC-ER, IC-IR. IC-IR: Dominant cultural view of the United States, most minority groups assume other three. Characteristically white, middle-class. Emphasis on uniqueness, individuality, independence, self-reliance. EC-ER: Poor conditions attributed to an exploitive system and inability to change it themselves (learned helplessness). May adopt "placater" attitude: going along with the system to avoid reprisal. Passivity is a form of defense. In African-American clients manifested as "Uncle Tom Syndrome," concealing feelings that are considered unacceptable to Caucasians. Therapist should help their clients develop new coping and experience success more fully. EC-IR: Responsibility for one's conditions, helpless to change it. Marginalization and non-belonging may lead to self-hatred largely because they feel inferior to majority and feel responsible for that position. Therapist can help client understand view and delineate positive acculturation versus rejection of one's own feelings. IC-ER: More likely to be demonstrated by minority groups that become aware of their own cultural identity and impact of racism on their individual lives. |
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Term
| Cross's Ethnic Identity Development Model |
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Definition
| Aka: Black Racial Identity Model Premise:Identity development of African-Americans from self-hatred to self-acceptance, termed nigrescence (process of being Black) Original (1971) model includes 5 stages: Pre-encounter: Believe world operates as being non-Black, anti-Black or opposite of Black. Devaluing of Black identity/idealization of Whiteness. Internalized negative stereotypes leads to low self-esteem. Denial of racial oppression. Prefer White therapists. Encounter: Challenge to prior frame from startling personal/social event. Receptive to new frame of reference/interpretation of identity. Increased racial/cultural awareness lead to development of Black identity. Prefer same-race therapist Immersion-Emersion: Race/racial identity highly salient Immersion substage People idealize Blackness. Immerse self in Black culture. Rejection of non-Black values. Rage toward Whites. Guilt regarding previous lack of racial awareness Emersion substage. Anger and anxiety fade. Internalize a black identity. Internalization: Internalize elements of immersion experience. Inner security. Satisfaction and confidence in Black identity. Increased comfort with acceptance of other cultures. Internalization-Commitment: Confidence develops into commitment. Oriented toward change for community. Adopt one of three identities. Black nationalist identity (pro-Black, non-racist). Biculturalist identity (integration of Black and White/other identity). Multiculutralist identity (integration of Black with multiple other). Acceptance of diverse backgrounds 1991 Revisions: Stages 4 and 5 combined into one stage "Internalization". Stage 1 pre-encounter subdivided into:. Pre-encounter anti-Black with being Black extremely negative. Pre-encounter assimilation with a "pro-American" or mainstream identity with a low salience of race as part of one's identity. 2001 Revisions:. Expanded model during creation of Cross-Racial Identity Scale (CRIS). Stage 3 was supplemented with two types: Intense Black Involvement: Love for all things Black, rage at White society, guilt and rage toward oneself Anti-White:Naïve attitudes through daydreams and fantasies about hurting White people. Stage 1 (Pre-encounter) also includes assimilation, miseducation, and self-hatred identities. Stage 4/5 added multiculturalist racial and multiculturalist inclusive identities. Racial Identity Attitude Scale (RIAS): Developed by Parham and Helms based Cross's model. People do not progress through stages linearly, but cycle back and forth. Supported 3 of 4; only the Encounter stage was not included. Stages are more a progression of pride and positive identification with one's racial group rather than self-actualization of psychological functioning. Criticisms:Assumes homogeneity of African-American experience. Relies too much on concepts of racism and oppression. Regardless of these criticisms remains influential theory. |
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Term
| Minority Identity Development (MID) Model |
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Definition
| Key Figures:Atkinson, Morten, and Sue (1994) Basic Model: Curvilinear Five-stage process with fluid boundaries including attitudes towards oneself, one’s same culture, other minority cultures, and the dominant culture at each stage The five stages: Conformity:Self-deprecating, group deprecating to others of same minority group, discriminatory to others in different minority group, and group- appreciating of dominant group. Dissonance:Individual feels a conflict between himself and all of the other groups (same minority, other minority, dominant group). Resistance and Immersion:Self-and same-group appreciating, conflict between feelings of empathy for other minority experiences and of personal problems as a result of oppression, dominant group depreciating. Introspection:Concerned with basis of self-deprecation, concerned with the nature of unequivocal appreciation for the same minority group, concerned with ethnocentric basis for judging others and concerned with the basis of dominant group depreciation. Integrative Awareness(prior name - Synergetic articulation and Awareness): Self- and all-group-appreciating, with selective appreciation for the dominant group. Goal: Recognition that all cultures have both positive and negative attributes. Original Term: Minority Identity Development (MID). Current Term:Atkinson, Morten & Sue's model -- Racial/Culural Identity Development Model (R/MID). |
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Term
| White Racial Identity Development Model |
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Definition
| Key Figure: Janet Helms Premise: Development of healthy racial identity depends on the racism in society. Model structure: Two phases, each with three distinct statuses. Each status is associated with a specific Information Processing Strategy (IPS), which reduced racially related discomfort. Phase One: Abandonment of racism. Contact Status: Uncomfortable and unsophisticated relationships with people of other races or ethnicities. Often show stereotypical racist bxs and attitudes. Lack awareness of racism (or of own racial identity). IPS: Denial and obliviousness. Disintegration Status: Acknowledge "whiteness" and question long-held beliefs. May experience anxiety, guilt, shame, dissonance between expressed values and reality of racial discrimination. Overly paternalistic toward minority group. May over-identify with minority group members. May withdraw further from white society. IPS: Suppression of information and ambivalence. Reintegration Status: Retreat from dissonance of prior status and consciously choose racism. Avoid people of other races. Embrace only like-minded Caucasians. Believe whites experience "reverse discrimination." Blame minority members for their problems. IPS: Selective perception of negative out-group distortion. Phase Two: establishment of a non-racist white identity. Pseudo-independence Status: Results from personally jarring event; questioning of previous definitions of whiteness and justifiability of racism. Acknowledge that whites played a role in perpetuating and promoting racism. Missionary zeal to help other people from different ethnicities. Understanding of racism is purely intellectual. IPS: Selective perception and reshaping reality. Immersion-emersion: Movement away from paternalistic efforts to help other groups toward internalized desire to change oneself in a positive way. Emotional sorting of previously repressed, denied, or avoided issues. Recognize as whites we have intentionally or unintentionally benefited from societal racism. Increased experiential/emotional awareness and understanding of racism and oppression. IPS: Hypervigilance and reshaping. Autonomy Status: Emotionally and intellectually internalize a new, non-racist white identity including an appreciation and respect for cultural/racial differences/similarities. Make connections between racism and other forms of inequality/dominance such as sexism, heterosexism, classism, and ageism. Drive to abandon white entitlement while being aware of one's whiteness. Actively seek out interactions with culturally and racially diverse others. IPS: Flexibility and complexity. Therapists who have reached autonomy status are most effective with multicultural counseling. Interaction Counseling: Four possible relationships when clients and therapists are at different stages of development and from different racial or ethnic backgrounds. Parallel relationship: Share same racial attitudes, may lead to mutual respect or difficulty if the client and therapist are at less-advanced stages of development. Crossed relationship: Opposing racial attitudes, highly contentious, poor therapeutic outcomes. Progressive relationship: Therapist is at least one stage ahead of the client in racial identity. Helms argues this produces the most effective therapeutic outcomes. Regressive relationship: Therapist's stage is at least one stage lower than the client's, marked by conflict, early termination. |
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Term
| Gay and Lesbian Identity Development Models |
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Definition
| Models:There are several models explaining gay and lesbian identity development. All models stress eventual achievement of self-acceptance and self-definition in the face of oppression. Most important stressor faced: Isolation. Homosexual individuals seek out mental health care, possibly at a higher rate than heterosexuals. Cass's 1979 Model:First non-pathologizing model. Six stages of identity development for gay and lesbian individuals: Confusion: Questions assumptions about sexual orientation, experiences turmoil, bx is perceived as correct/acceptable, correct/undesirable, or incorrect/undesirable, may adopt strong anti-homosexual stance. Identity Comparison: Accepts the possibility that one may be gay; isolation from both gay and heterosexual people. Identity Tolerance: Accepts that they are gay and seek out gay and lesbian people; with positive experiences, feelings of isolation and self-hatred will decrease. Identity Acceptance: Selectively reveals his or her sexual orientation; increasing interaction with other gays and lesbians is important. Identity Pride: Experiences incongruence between own acceptance of identity and society's rejection, pride in gay culture may be present or disclosure of one's sexual orientation made as a demonstration of pride. Identity Synthesis: Gay or lesbian matures into an overall view of self, more positive contact with members of socially dominant group develops. Critics of Cass's model argue she did not account for socio-cultural factors that impact identity development (stigma and stigma practices). Critics also argue that the linear model suggests that one is not a well-adjusted homosexual if they did not go through all of the stages. Sophie's Model:First sexual identity model exclusively for lesbians. Four-stage model: (1)First Awareness (2)Testing and Exploration (3)Identity Acceptance;(4)Identity Integration Troiden's Model:Following Cass, a model of gay and lesbian identity development. Four stages: Sensitization: Consider self heterosexual but have experiences that cause them to feel different or marginalized. Identity Confusion: Consider the possibility that they may be gay or lesbian. Identity Assumption: Coming-out process. Identity Commitment or Integration: Individual obtains a certain level of comfort with and commitment to homosexual self-discovery. Early processes for males: Stage 2 expected at 17 for male, 18 for females; stages 3 and 4 expected at 19-21 for males and 21-24 for females. Meyer's Minority Stress Model:Argues that gay individuals face chronic stress due to stigmatization like other minority groups. Distal Sources of Stress: External events like exposure to prejudicial events of discrimination and/or violence. Proximal Sources of Stress: Individual's perception of events and conditions, expectations of rejection, concealment of sexual orientation, internalized homophobia; these predict mental health distress for lesbian, gay and bisexual individuals. Internalized Homophobia: Degree to which a gay or lesbian person internalizes the antigay sentiments of the larger heterosexual community; represents an internal source of stress. Expectations of Stigma: Include the anticipation of rejection and discrimination based on one's sexual identity. Experience with Prejudicial Events: contributes to minority stress and leads to a sense of personal vulnerability and perception of the world as an insecure place. |
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Term
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Definition
| Key Figures of Multicultural Counseling Theory 1. Sue, Ivey & Pederson Six considerations for multicultural counseling 1. Each Western/non-Western theory has a unique worldview. 2. Therapy should include counseling context and client-counselor experiences. 3. Cultural identity of both client and counselor influence approaches to problem-solving and goals. 4. Therapists should aim to increase repertoire of helping skills and tools. 5. Conventional counseling one of many helping roles available to help the client. 6. Recognition of personal, family, group, and organizational consciousness and context. Relativistic1. Individual bx and psychological experiences influenced by cultural context. Two basic processes important to consider when working with ethnic minority 1. Credibility: Client perceives therapist as trustworthy and effective. Strongly related to degree the therapist intervenes in culturally consistent manner. 2. Giving: Client's perception that something was received from therapy.Nonverbal communication 1. Seven universal facial expressions: anger, contempt, disgust, fear, happiness, sadness, surprise. 2. Social rules or cultural display rules vary regarding appropriate use of the expressions. 3. Therapists should familiarize themselves with the culturally appropriate displays of emotion and other nonverbals (eye gaze and visual bx) to limit misattributions and misunderstandings. Paralinguistic communication 1. Nonverbal elements of communication that convey meaning 2. Vocal tone, volume, rate of speech or body of language 3. High-context communication relies more on nonverbal or paralinguistics Often associated with African-Americans and other ethnic minorities 4. Low-context communication tends to rely more on the content of the words Often associated Caucasian Americans Other factors 1. Client's racial or cultural identification. 2. Potential preference for counselor of same ethnicity. 3. Length of treatment: Some minority clients tend to terminate therapy prematurely. 4. Cultural views of gender and sex roles may vary. African-Americans tend to have an egalitarian sex role cultural view. Traditional Hispanic-American tend to be hierarchical and patriarchal. Asian-American families often lineal, with clear lines of authority, traditionally male-dominant. Caucasian families tend to be male-dominant. 5. Men are often seen as more competent by both men and women. Success of males attributed to ability regardless of task. Success of females attributed to ability only on traditionally female tasks and attributed to luck on traditionally male tasks. |
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Term
| Bicultural Identification |
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Definition
| Developmental relevance:Particularly relevant during adolescence as part of identity formation that involves two cultures. Adolescents are aware of the different roles, differing demands and the differences in cultures. Possible conflicts in frame of reference. Facing reality of discrimination and minority status. Coping with two cultures:Studies by Phinney & Devich-Navarro (1997). How adolescents deal with being part of two cultures. Surveyed Mexican-Americans and African-Americans. Three patterns: Blended biculturals:View two cultures as non-conflicting and integrated. Alternating biculturals:Acknowledge American heritage, but are more influenced by their ethnic background. Separated:Distance self from their ethnic background and are more invested in developing American identity. Thus, bicultural identification is multidimensional |
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Term
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Definition
| Mental health outcomes from discrimination: Members of groups facing discrimination are more likely to receive psychiatric diagnoses. Women have 2x higher rates of depressive and anxiety diagnoses than men. African-American men associated with high rates of anxiety diagnoses. African-American women associated with high rates of anxiety and depressive diagnoses. Hispanic men have higher rates of alcoholism. Racial and sexual prejudice contributes to: Abnormal tension patterns. Unhappiness. Low self-esteem. Escape bxs. Perceived Discrimination: Related to anxiety, depression and other mental health. Affects African-American and Caucasian individuals |
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Term
| Alloplastic & Autoplastic |
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Definition
| Key Figure 1. J.G. Draguns Definition of autoplastic intervention 1. Changing oneself (beliefs or bxs that are contributing to distress). 2. Sources of distress come from oneself. Definition of alloplastic intervention 1. Changing the environments that are contributing to the distress. 2. Sources of distress come from the environment. The larger theoretical framework for barriers to psychotherapy across cultures 1. Etic vs. emic perspectives 2. Relationship vs. techniques as a key focus of therapy 3. Bilaterality of the client-counselor relationship 4. Futuristic thinking 5. Alloplastic vs. autoplastic dilemmas |
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Definition
| Mental Health/Health Care Disparities/Barriers to Care: African-Americans at same risk for mental illness as Caucasians, but rates of receiving treatment are significantly less. No difference in treatment outcomes of African-Americans and Caucasians.vLargest variation in treatment outcomes due to individual differences in motivation to change. 25 percent of African-Americans are medically uninsured. More likely to sue emergency or primary care specialists than other minority groups. Twice as likely than non-Hispanic Caucasians to be diagnosed with schizophrenia. African-Americans are overrepresented in public inpatient mental health institutions. African-Americans are underrepresented in outpatient mental health services. Stereotypes on the part of white therapists may be a barrier to care. Most important factor in therapeutic retention is the relationship. Therapists should accept that almost all African-Americans encounter prejudice and racism. May wrestle with rage at majority culture for insensitivities/unappreciative of emotional consequences of growing up a member of a feared and hated minority. Culturally competent therapist should include focus on African-American experience; discussions of race should also occur early in therapy. Self-Disclosure: Key Figures: C.R. Ridley and Nancy Boyd-Franklin. Four primary presentations of self-disclosure. Intercultural non-paranoia: fairly high levels of self-disclosure. Functional paranoia: med levels of self-disclosure. Healthy cultural paranoia (paranorm): med levels of self-disclosure. Confluent paranoia: Both cultural and pathological paranoia, present with high levels of cultural mistrust and low levels of self-disclosure as well as suspiciousness and uncooperativeness, will prefer to work with someone from same cultural background. Therapists may address elements of cultural paranoia by: Helping clients gain awareness of feelings. Helping clarify self-disclosure appropriateness and inappropriateness. Discussing contributing issues such as frustration, suspiciousness and antipathy toward Caucasians. Caution must be taken in interpreting mistrust and paranoia on personality testing, because it may be adaptive and non-pathological. Families: Key Figure: Boyd-Franklin Families respond to problem-solving/time-limited familial approaches. Suggests a multisystemic approach (ecostructural approach). Reaches out to individual, family, friends, church, community. Overthrow the myth of the African-American superhuman woman. Family structure is not matriarchal, but more egalitarian. Developed African-American specific defense mechanisms: Playing it cool: Hiding one's true feelings. Uncle Tom Syndrome: Placating and passive-aggressive attitude in relating to European-American authority figures. Split-Self Syndrome: All-good or all-bad thinking. Splits off part of self representing "African me" as it is devalued in European-American system. Blended bicultural bx patterns emerge with equally American and ethnic or as more American. |
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Definition
| Management of Emotional Distress:Emotional distress viewed as a personal struggle of willpower, not something to seek psychotherapy for. Thus, Asian-Americans are less likely to seek mental health care compared to other minority groups. Strategies for improving psychotherapeutic outcomes with Asian-Americans: Therapist should discuss his/her educational background as a way of establishing rapport and trust. Wait on client's timing for disclosures; hesitancy in sharing is shame-based. Support positive, dependent relationships with parents: not pathological. Confront rationality gently, yet firmly. Use abstract and subtle approaches rather than concreteness, which can be offputting. Cultural oppression is an often-presenting theme. Sex and marital relationships are taboo and unlikely to be discussed. Traditional Asian-American clients may prefer a directive approach, may not respect the counselor otherwise. Thus, psychodynamic therapy is contraindicated especially as emotional expression and individual needs are signs of immaturity. Interpersonal relationships: Respect, structure, and formality are important features in interpersonal relationships, and useful for the therapist to utilize. Due to the respect and formality, the client may not disagree with the therapist openly, but rather simply fails to show up at the next session. Idioms of distress:Indirect ways of expressing emotional difficulties. Asian-Americans typically express distress through physical problems and seek medical, not mental health, care. Successes are attributed to fear of failure rather than talent. Due to the high expression through somatic distress, they are more likely to receive a dx of Somatoform Disorder; however, this incidence is a misdx due to cultural habits not truly meeting criteria. Asian-Americans do not have fewer psychological problems. Asian-Americans do not have less access to medical services. Differences in nonverbal communication from American culture: Avoidance of eye contact and not verbally expressing feelings and opinions are signs of respect. Smiling may convey embarrassment, confusion or discomfort -- not happiness. |
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Definition
| Ethnicity:Differ from other ethnic minorities in that more defined by culture than biology. Latino-American are not a race, but an ethnicity. Comprised of numerous particular cultural groups (ex. Mexican, Chicanos, Huichol Indians). Deep spiritual and religious roots:Cultural commonality Often identify with Catholicism. African roots in Caribbean. Spiritual heritage from South American Indian tribes. Spirituality integrated in daily life. Spiritual advisers often sought more than psychologists. Primacy of the Family:Cultural commonality. Family commitments take precedence. Parent-child bonds are firm. Strongest familial bond is mother-son. Father-son also especially close. Preference toward traditional family arrangement; parent-child cohesion, parental authority. Traditional roles: working father, homemaker mother, equality of decision-making. Dysfunctional families: Present with more male-dominance, oppressive/abusive expressions of power. Mother/wife prioritizes family over self leading to vulnerability for abuse. Women often silently sacrifice self for family, result of socialization not co-dependence. Machismo:Less rigid and less exaggerated in reality than believed by dominant culture High-Context Culture:Subtleties and nuances of culture are expressed indirectly. More extensive and expressive vocal tones. May experience American speech styles as unemotional or flat. Humor a large part of daily life. Group Emphasis:The group is emphasized over individual. Logistic and Cultural Considerations in Therapy: "Being" view of time and little expectation that previously agreed upon or specified meetings times will hold up. Somatize rather than psychologize, integrating mind-body experiences and expressing them through spiritual or physical means. Better outcomes with informal, multi-modal approaches, here-and-now perspectives, view interdependency with family as normal. Highest positive outcomes in therapy than other minority groups. Improve outcomes with incorporating elements of Latino culture in therapy, increasing and emphasizing access to mental health services. Select treatments that best fit Latino culture. |
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Term
| Native American Psychology |
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Definition
| Focus:Unique cultural characteristic of indigenous Americans Psychological or Personality Outcomes:There are no uniform personality or psychological characteristics that apply universally to Native Americans. Cultural influences:Emphasis on tribe/clan over individual. Functional clan systems incorporate extended family in all rituals and responsibilities. Families are typified by values of sharing and caring for extended family. Families and individual members are differentially affected by acculturation. Political, social, and environmental factors have adversely affected Native American family structures. Alcoholism:Most commonly researched topic in Native American psychology. Related to spousal abuse, child abuse, sexual abuse, aggression. Rates of alcohol abuse similar among other demographic groups, however, when alcohol abuse does occur in the Native American population it appears to be heavier and paired with socially reinforced risky bxs. Chronicity is related to recreation and anxiety. Primary reason for incarceration of a Native American: Related to crimes of burglary, sexual assault, first-degree assault and murder. Treatment programs that do not incorporate social and spiritual beliefs are ineffective and resisted. Successful programs are tailored to specific tribal customs, history and culture. One successful intervention is the bicultural competence approach. Teaches Native American youths social and communication skills. Blends Native American and popular American culture. Native American youths who participate engage in less substance abuse. |
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Term
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Definition
| Descriptors Clients between the ages of 12 and 18. Difficulty to engage and retain in treatment. High therapy dropout rates Common Disorders Affecting Adolescents Anxiety Disorders. Major Depression. Eating Disorders. Drug Abuse. Alcohol abuse and dependence. Outcomes Adolescents may require longer treatment episodes than adults to achieve same results. Experience higher incidence of positive outcomes than children. Adolescent females experience more positive outcomes than adolescent males. Few studies on adolescents in residential drug treatment programs. CBT most widely used approach with this population. Self-control, social interaction, deep muscle relaxation, scheduling activities, modifying negative unrealistic cognitions. For anxiety disorders: Systematic desensitization, modeling and observational learning. |
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Definition
| Definition:Form of child maltreatment that involves fondling, sexual intercourse, sexual comments, or other types of sexual exploitation. Perpetrators:Usually male and member of the child's family. Finds children sexually arousing, has irrational impulses that he cannot control, rationalize that the child wants sex. Comorbidities:Substance Abuse Disorders, Borderline Personality Disorder, sexual dysfunction, prior victimization by another. Victims:Usually female, often described as compliant, physically weak, socially isolated. Often occurs in poverty or marital break-up situations. Children often have depression, low self-esteem, phobia, sleep difficulties, loss of appetite and repressed memories. May develop PTSD and attempt suicide. 200,000 cases of child sexual abuse each year. Treatment of Victim:Therapy recommended for child and family. May involve use of anatomically correct dolls for low verbal or highly embarrassed children to describe events that happened. Best treatment is prevention. Teaching people to look for signs of inappropriate sexual bx can be useful. Effects appear less severe when perpetrator is a stranger versus a family member. Effect of Memories: Disagreement about how memory of child sexual abuse affects individuals. McNally et al. (2000): Women with repressed or recovered memories demonstrated higher levels of absorption and dissociation than did women with continuous memories and women without abuse history; women with repressed memories had higher levels of distress than did women with continuous memories or women without history of abuse. McNally et al. (2006): Similar levels of anxiety, depression, dissociation, and absorption among individuals with repressed, recovered, and continuous memories. |
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Definition
| Common Diagnoses in the Geriatric Population: 1. Depression 2. Paranoia 3. Dementia Depression 1. Most frequently diagnosed 2. Women report more symptoms than men 3. Highest suicide rates among 65 + 4. Higher suicide rates for men 5. Antidepressants, CBT, ECT, are effective Paranoia 1. Relatively rare 2. Symptoms usually are suspicion, persecutory ideation, and paranoid delusions 3. Anti-psychotics (neuroleptics) with therapy are effective Dementia 1. Primarily a disorder of old age 2. It is distinguished by multiple cognitive impairments: memory impairment + 1 (aphasia, apraxia, or disturbances of abstract thinking or complex bxs) 3. Alzheimer's dementia is the most common 4. Vascular dementia is the second most common 5. Risk is reduced through diet, exercise, non-smoking, and hypertension treatment 6. Aspirin and anti-coagulants reduce the risk of future CVAs 7. CVA: Cerebral Vascular Accident, stroke Other Diagnoses in the Geriatric Population: 1. Anxiety, which generally presents as fears 2. Alcoholism, but it is less likely in those over 60 due to increased death rates in younger age groups from alcohol that did not live to be in this cohort. 3. Drug abuse, which is largely prescription and over-the-counter Medications 1. Geriatric patients are 13% of population but take 30% of all prescriptions 2. There is a higher risk of hospitalization due to medication-related problems such as non-compliance. Or, 3. Poly-pharmacy, the taking more than one medication at the same time. Or, 4. Changes in sensitivities to drugs such as changes in absorption, metabolism, excretion. 5. And, because metabolism changes with age, the half life of certain medications may be extended, increasing the risk of toxicity. Thus, physicians usually start with low doses and go slow with dosage increases Psychotherapy and the Geriatric Population 1. They are underserved 2. There are fewer instances of mental illness in elderly than other age groups 3. Psychotherapy is just as effective as in other age groups, but may take longer 4. Greater variability exists in physical health, cognitive skills, etc., and should be recognized by the therapist Socioemotional Selectivity Theory (Carstensen) 1. A process by which social contact is motivated by many goals, including information seeking, self-concept, and emotional regulation. 2. As people age, goals for social contact become more focused on emotional needs rather than on gaining knowledge or other motives for seeking social contact. Living Situations 1. Informal caregiving is often provided by spouses and daughters |
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Term
| Alcohol Relapse and Prevention Model |
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Definition
| Components of addiction 1. Physiological 2. Psychological 3. Genetic Most effective treatment 1. A combination of pharmacology and psychological interventions Three common pharmacotherapy treatments 1. Acamprosate (calcium acetyl-homotaurine), restores the glutaminergic neurons to normal activity level, increases treatment completion and associated with higher abstinence rates 2. Naltrexone, often used in relapse prevention, improves coping with cravings and reduce use of alcohol 3. Disfulfiram, is a deterrent medication that involves aversive symptoms like flushing, headaches, nausea, decreased blood pressure, and constriction in airways when the person consumes alcohol. Non-compliance with this medication is common. Non-pharmacological treatments 1. Peer support, such as AA and other 12-step programs 2. Rehabilitation programs 3. Intensive out-patient programs 4. Counseling 5. Brief intervention Relapse 1. Relapse is the return to prior levels of alcohol consumption 2. Relapse is not an isolated event, also known as a slip 3. The risk is very high in recovery 4. Conger's Tension Reduction Hypothesis (1956) states that alcohol reduces stress and therefore is reinforcing; high stress times increase likelihood of relapse 5. A relapse linked to strong negative emotions: anger, depressed mood, and/or intense anxiety Relapse Prevention 1. Relapse is common event in recovery 2. Increase awareness of high-risk situations 3. Build appropriate coping skills 4. Minimize negative outcomes from a relapse 5. Reinforce view of relapse as learning opportunity to reduce stigma/shame and encourage resumption of treatment/abstinence 6. Focus on relapse as a learning event, not evidence of treatment failure Relapse Prevention Model (Marlatt & Gordon, 1985) 1. Employ after standard treatment of abuse or dependency 2. Cognitive-Bxal orientation 3. 75% of relapses are associated with negative affective states, interpersonal conflict, or social pressure 4. The detailed classification of factors/situations precipitating relapse episodes fall into two categories: a. Immediate determinants: high-risk situations, coping skills, outcome expectancies, abstinence violation effect b. Covert antecedents: lifestyle imbalances, urges, and cravings Network therapy 1. This is similar to the relapse prevention model, but it engages members of the client's social support network to support abstinence. |
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Definition
| Symptoms 1. Continued use of substances despite negative consequences related to work, family, and/or friends 2. Actual use of substance consistently exceeds intended use 3. Unsuccessful attempts to reduce or quite usage of the substance 4. Preoccupation with obtaining and/or using the substance 5. Tolerance: Increased need of larger doses for same effect (or reduced effect from same amount) 6. Withdrawal: Unwanted physical or psychological effects when the substance is reduced or stopped 7. Substance-induced disorders 8. Reinforcing effect of dopamine Considered a brain disease with bxal maintenance 1. Overlearned habit with series of positive and negative reinforcers 2. Maintained by user as he or she continues to take the drug to avoid the negative feelings associated with stopping 3. Both operantly and classically reinforced (release of dopoamine reinforces) 4. Highly resistant to treatment |
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| Tension Reduction Hypothesis |
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Definition
| Premise1. Motivation is based on hedonic (pleasure) theories that states people work to alleviate internal states of distress or discomfort. Central Postulates1. Consuming substances reduced internal discomfort, providing relief and pleasure (negative reinforcement). This pattern can result in abuse of substances. Treatment of Substance Abuse1. Cognitive-bxal therapy is one therapy for reducing substance abuse. 2. Marlatt's relapse prevention therapy: Not abstinence-based Minimize effects of relapse (negative self-talk/decreased self-efficacy). Learn from relapse, identify factors and develop effective coping Critiques 1. Fails to consider other motivations for drug use 2. Fails to recognize the varied effects from drugs 3. Fails to consider situational context in which substances are used |
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| Definition:Progressive disease characterized by memory loss related to the deterioration of brain tissue. Stages of Symptom Progression: Stage 1: No Impairment Stage 2: Very mild cognitive decline (difficult to distinguish from normal aging related changes) Stage 3: Mild cognitive decline (early-stage AD). Family, friends, and co-workers notice changes. May be measurable with detailed clinical interview. Stage 4: Moderate cognitive decline (mild or early-stage AD). Declines evident in clinical interview. Deficits in memory for recent events, complex tasks. Stage 5: Moderately severe cognitive decline (moderate or mid-stage AD). Some assistance with ADLs required. Memory loss for personal details (phone number, address). Confusion related to time and place. Difficulty with personal history. Stage 6: Severe cognitive decline (Moderately severe or mid-stage AD). Personality changes. Distorted personal history. Not recognize close family members, spouse or primary care-giver. Wandering is problematic. Stage 7: Very severe cognitive decline (Severe or late-stage AD). Loss of responsiveness to environment. General incontinence. Abnormal reflexes. Swallowing impaired. Mortality:Death usually occurs within 12 years of onset. In 2000 it was the seventh leading cause of death in men and women over 65. Neurobiological correlates:Plaques and neurofibrillary tanges through cerebral cortex and hippocampus in acetylocholinergic (ACh) neurons. Causes death to ACh neurons ACh is biggest part in AD in earliest stages. Serotonin, norepinephrine, and glutamate play larger part in later stages. Medications aimed at increasing levels of ACh in the brain. Medications:Acetylcholinesterase inhibitors interfere with the breakdown of ACh. Including: donepezil hydrochloride (Aricept); tacrine hydrochloride (Cognex); .galantamine (Reminyl). These meds appear to reduce memory loss compared to placebo trials. Meds may be supplemented with Namenda (mematine), which affect aspartate receptors and is believed to be involved in memory. No treatments reverse AD. |
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Definition
| Medical cancer treatment: Surgery, radiation and chemotherapy Rationale for psychology in cancer treatment: Depression and hopelessness can impede cancer recovery and decrease immune system. Psychotherapy can improve these emotional disturbances. Psychotherapy can improve chances of cancer recovery. Breast cancer patients with positive, upbeat attitudes display better outcomes than those who are stressed or anxious. Targeted therapies for psychotherapy in cancer treatment: Social support, practicing relaxation strategies, eating healthier, learning stress management and modification of expectations improve cancer recovery and the immune system. These also help side effects of chemo, including nausea, vomiting, dry mouth, and sweating. Assisting with anticipatory side effects from conditioned associations is helpful. Psychotherapy related to improved quality of life, reduction of emotional distress, learning more effective coping skills. Coping with death and dying: Psychotherapy can assist in acceptance with death and dying, helping families with bereavement concerns. Medical treatment risks and children: Children are at greater risk of developing learning disabilities from chemo and radiation. Attributed to damage to tiny blood vessels in the brain. |
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Term
| Human Immunodeficiency Virus (HIV) |
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Definition
| Definition: AIDS is a disease in which the body's immune system is compromised by HIV, putting the person at risk for opportunistic and fatal diseases Opportunistic Disease: By weakening the immune systems, other diseases (lymph cancer, fungal, viral and bacterial infections) become fatal Demographics: Anyone can get HIV/AIDS Women account for half of all cases worldwide. HIV rates of women of color in the USA are much higher than among men or white women. Rates of HIV and deaths due to HIV/AIDS among Caucasians have decreased. Rates of HIV and deaths due to HIV/AIDS among African-Americans and Latinos have increased. Racial differences attributable to socioeconomic factors. Reduced access to treatment. Reduced access to prevention programs. Research required related to prevention, adherence and stigma with the virus. Policy barriers exist with care of HIV regarding gender inequality and homophobia. HIV and Aging: HIV in the elderly often causes dementia. Commonly misdiagnosed as Alzheimer's dementia because of failure to recognize sexual activity among elderly patients. HIV proceeds to AIDS twice as fast among older adults than younger adults; thus early detection imperative in this population. Role of clinical and counseling psychologists regarding HIV Work with related affective disorders, dementia, addiction and personality disorders associated with HIV. Psycho-education regarding health status, safety. Group therapy for support |
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Definition
| Characteristics of Conduct Disorder: Bxs that violate societal norms and/or the basic rights of others. Most bxs are also illegal. Severity beyond pranks and mischief. May include aggression and cruelty toward people or animals, damage to property, stealing. Often marked by vicious lack of remorse. 40 percent go on to develop adult antisocial personality disorder. Lower SES. Parent Management Training (PMT): Developed by Gerald Patterson. Promising bxal program. Teaches parents to reinforce prosocial bxs and uses time-outs and loss of privileges for aggressive or antisocial bxs. Alters parent-child interactions, which decreases antisocial/aggressive bxs. Improves siblings bx, reduces depression in mothers of participating families. Like family therapy, PMT reduces rates of criminal offense, PMT is faster. Multisystemic Treatment (MST): Intensive and comprehensive treatment in the community. Shows reduction in arrests four years later. Targeting adolescents, their family, their school and their peer group. Treatment delivered at home, school, or local rec centers. Strategies include bxal, cognitive, family-systems, case-management. May include teaching children cognitive skills to control anger to reduce aggressive bx. Emphasizes individual and family strengths. Identifies context for conduct problems. Uses interventions that require daily and weekly efforts by family members. Individual Therapy: Since both PMT and MST are time-consuming, some do individual therapy. Usually a cognitive therapy. Teach distraction techniques (like humming a tune or saying calming things when being verbally attacked, to reduce aggressive responding). These techniques are rarely implemented in daily life. May improve a child's function, but family treatments are the most effective overall. |
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| Types Diagnostic Uncertainty: Occurs when a client presents with features of a disorder that could be explained by a number of different diagnostic possibilities (differential dx). Diagnostic Overshadowing: Clinican overlooks other mental health problems of mentally challenged patients or attributes problems to intellectual disability a. Example: Poor social skills and depressive symptoms erroneously attributed to intellectual disability rather than to a separate psychological problem b. Vulnerable Populations: Occurs with individuals with mental retardation, 1. Autism Spectrum disorder, or Attention-Deficit Hyperactivity Disorder 2. Intellectual Distortion: Client mislabeling an emotion or other experience due to underdeveloped communication skills 3. Psychosocial Masking: Atypical bxs due to poor social skills or life experiences that misrepresent another disorder 4. Baseline Exaggeration: High levels of unusual bxs exhibited prior to onset of disorder increases difficulty in accurate dx |
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Definition
| Symptoms 1. 2+ motor tics, 1+ vocal tic, minimum of 1 year, onset prior to age 18 2. Most cases are mild 3. Affects 4x more males than females 4. Exacerbated by stress Tic definition 1. Involuntary motor or vocal expressions 2. Simple motor tic examples: eye blinks, nose scrunches, eye rolling, neck thrusts 3. Complex motor tic examples: body twists, hopping up and down, raising an arm 4. Vocal tic examples: sniffling, throat clearing, barking, saying words 5. Coprolalia: involuntary vocalization of obscenities 6. Echolalia: repetitions of the vocalizations of another person Comorbid symptoms and syndromes 1. Inattention, hyperactivity, impulsivity, repetitive thoughts and bxs 2. ADHD: 50 percent of people with Tourette's have ADHD 3. OCD: 40 percent of people with Tourette's have OCD 4. Learning disorders are commonly comorbid 5. Oppositional defiant disorder is commonly comorbid 6. Intellectual ability is usually average to above average with general awareness of their uncontrollable tics and resulting embarrassment Neurological findings 1. Reduced caudate nucleus volume, possible damage to caudate nucleus and putamen (structures of the basal ganglia) 2. Overactivitvation of dopamine, particularly D2 receptors. appears responsible for exaggerated, isolated or random activation of the putamen and resulting involuntary vocalizations Treatment 1. Psychotherapy, school treatment and pharmacotherapy 2. Medication actions: Dopamine antagonists, blocking D2 receptor sites 3. Medications: pimozide, haloperidol, and Clonidine reduce and control tics 4. Complications: Since Tourette's is treated with dopamine antagonists and ADHD is treated with dopamine agonists, comorbid management is difficult 5. Dopamine agonist in ADHD medications may worsen tics 6. Dopamine Antagonists may worsen inattention and impulsivity in ADHD 7. Some SSRIs can help with OCD that accompanies Tourette's disorder 8. Less effective on the tics than haloperidol, but helpful in the compulsions in OCD |
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Definition
| Definition 1. Major depression is a mood state with changes in cognitive, physical, and bxal domains leaving a person bereft of positive thoughts regarding oneself or the future. Comorbidity1. The most commonly occurring disorders are the anxiety disorders. Symptoms 1. sadness or numbness 2. lack of interest in previously favored activities 3. irritability 4. bleak outlook on life 5. excessive self-criticism 6. changes in weight 7. disruptions in eating and sleeping habits8. physical pain 9. social withdrawal 10. difficulty concentrating 11. tendency toward self-absorption 12. suicidal ideation13. less spontaneous movement 14. lack of motivation to achieve basic hygiene. Common treatments 1. Cognitive-bxal therapy: 16-20 sessions over 12-16 weeks, directive, addresses negative views of self, world, and future. 2. Structured-learning therapy: Group therapy teaching mastery of everyday social skills utilizing modeling, role-plays, social reinforcement, and transfer training. Outcomes research 1. CBT as effective as antidepressant medications and interpersonal therapy. 2. Combination of CBT and medication is the most effective. 3. When therapies and medications are insufficient or there is serious concern of suicide, electroconvulsive shock therapy (ECT) may be used. ECT is especially useful for mood disorders with psychotic features. |
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Definition
| Definition:Intense elation or irritability, a cycle alternating with depression in bipolar disorders. Associated symptoms:Rapid speech, racing thoughts, decreased need for sleep, hypersexuality, increased goal-directed activity, euphoria, grandiosity. Socially: May be intrusive and oblivious to potentially disastrous consequences of bx. Onset/Duration of acute symptoms: Onset is rapid. Duration is a minimum of one week or any length of time if hospitalization is required. Psychodynamic theory:Argue that the cause of mania is repressed depression. Hypomania:Less intense form of mania with fewer symptoms. Severe manic episodes:Feature grandiose delusions or hallucinations. Acute mania treatment:Mood stabilizers and antipsychotic medications. Long-term stabilization:Management of mood cycles through combination of psychotherapy and pharmacotherapy. Medications:Lithium is a classic mood stabilizer, high risks of toxicity. Anticonvulsants, such as valprioc acid and carbamazepine. Also provide mood stabilization with fewer risks of toxicity. |
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| 1. A disruptive fear of an object or situation is out of proportion to the real danger posed, is intensely avoided, and interferes with a person's social and/or occupational functioning Types of Phobias 1. Specific Phobia 2. Social Phobia Etiological theories 1. Psychoanalytic: Does not distinguish social or specific phobia; anxiety is a result of repressed id impulses a. Symbol of a psychosexual stage fixation that is displaced or transferred onto a different symbol 2. Biological theory: Genes and autonomic nervous system lability cause phobias 3. Cognitive theory: Misattributions and faulty automatic processes 4. Bxal theory: Specific Phobias arise from classical conditioning (pairing of neutral and fear producing stimuli) and maintained through operant conditioning (negative reinforcement) 5. Social Phobias arise from both cognitive and bxal factors making them more difficult to treat 6. Includes negative self-evaluations, high standards of performance, unrealistic negative beliefs about consequences of social bx, high self-monitoring, and harsh judgments of how others may be thinking about him or herself Interventions 1. Systematic desensitization: First widely used bxal treatment. Utilizes relaxation as an incompatible response to the exposure to progressively more fearful stimuli in a process known as reciprocal inhibition 2. Reinforced practice: Similar to systematic desensitization that involves gradual exposures. Also engages client in other bxal activities to overcome the fear 3. Interoceptive Exposure: Exposure to internal cues that resemble panic-like symptoms 4. Flooding: Exposure to phobic stimulus at full intensity until the fear subsides (based on classical extinction) Outcomes 1. Cognitive interventions not as effective as exposure interventions, except for Phobias and fears in children (particularly self-control techniques) 2. Medications alone lead to worse outcomes than exposure treatment alone 3. Medications: Benzodiazepines, antidepressants and other anxiolytics are helpful in the treatment of phobic symptoms 4. Paroxetine (Paxil) and Gabapentin (Neurontin) are indicated for social Phobia |
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| 1. Disturbances of thought, emotion and bx 2. Ideas not logically related 3. Visual and auditory hallucinations 4. Movement and bx disturbances Etiology 1. Genetic transmission in form of predisposition is evident Gender differences 1. Men and women get Schizophrenia equally 2. Men develop it earlier (age of onset mid-20s); women develop it later (age of onset late-20s) 3. Women have better premorbid functioning and better prognosis, display more affective symptoms, paranoid delusions, and hallucinations 4. Men have worse premorbid functioning and worse prognosis, displaying more negative symptoms Good prognostic indicators 1. Paranoid type; positive symptoms Neurotransmitter disturbances 1. Dopamine Theory: prefrontal damage causes dopamine neurons to be underactive 2. Leads to negative symptoms or causes the release of mesolimbic dopamine neurons from inhibitory control, leading to positive symptoms 3. Other transmitters involved: Serotonin, glutamate, and GABA Brain Structure Theories 1. The brains of some Schizophrenia patients have enlarged ventricles and problems with the prefrontal cortex a. Possibly developed from late pregnancy viral illness b. Not specific to Schizophrenia; also evident in bipolar disorder with psychotic features c. Some MRI studies show reduced prefrontal gray matter Hypofrontality hypothesis 1. Inconsistent data 2. Links Schizophrenia with lower metabolic activity in the brain's frontal regions during attention tasks -- not well supported 3. Some research documents decreased blood flow during specific cognitive tasks Schizophrenia and SES 1. Schizophrenia is frequently diagnosed in people of the lowest socioeconomic status 2. Arguments indicate downward social mobility created by the disorder 3. Arguments indicate traumas associated with growing up in poverty could trigger a person who is predisposed Communication patterns 1. Families with higher incidence of and relapse of Schizophrenia also tend to have high Expressed Emotion (critical, hostile, and emotionally over-involved communication styles in families) 2. Double-bind messages may also be present: these are messages with covert meanings that contradict the overt message Treatment 1. Gold-standard: Neuroleptics (antipsychotic medications) 2. Non-pharmaceutical treatments: a. Family therapies to reduce high levels of expressed emotion are valuable for preventing relapse b. Social skills training and CBT: Manage family and community stresses c. Some therapies to address thinking styles shows promise 3. Most promising approaches combine medication with psychosocial intervention |
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| Definition:Misinterpretation of external stimuli that appear perceptually different than reality. Commonly confused terms: Hallucination:Sensory perception in the absence of external stimulus. Delusion:Deeply held beliefs not based in facts or real events. |
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| Definition:Physical, emotional or mental exhaustion, typically related to work Common results from Burnout:Decreased motivation, negative attitudes, depleted energy, reduced immune functioning, increased absenteeism, reduced performance. Cause:High level stress/tension until overburdening takes physical, emotional or mental toll. Three components: Emotional exhaustion: Feeling emotionally drained by work demands Depersonalization and cynicism:Treating others as objects Low personal accomplishment or ineffectiveness:Powerless, difficulty coping, difficulty understanding others' problems. Five stages: Honeymoon:Job appears wonderful, full of energy and enthusiasm. Awakening:Early realization that the initial impressions/expectations are unrealistic, no longer satisfies all of one's needs. Brownout:Chronic fatigue and irritability set in, changes in eating, sleep, escapism bxs (sex, drinking, drugs, shopping). Despair:Overwhelming sense of failure and loss of self-esteem/self-confidence, with onset of depression life appears pointless and pessimism grows about the future. Hitting the wall:Career and life are threatened at this stage, may include suicide, stroke, or heart attacks. Risk factors:Service-oriented careers with chronic high levels of stress, counselors working with individuals coping with trauma, athletes with high stress and low recovery time, young employees overwhelmed with new job demands, women, helping professionals, unmarried individuals, chronically demanding jobs, uncontrollable noise, intense work pace, intense workload, and too many hours worked. |
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Definition
| Therapeutic Orientation 1. Cognitive Theory Definition 1. Feeling that one will never experience positive emotions, never have anything good in life, never be happy, never see improvement in their suffering 2. A factor in depression, according to Beck 3. When combined with dichotomous thinking, Hopelessness can result in suicide Beck Hopelessness Scale 1. 20-item scale developed by Beck 2. High BHS scores and High BDI-II have very high risk of suicidal ideation |
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| Definition 1. A cognitive distortion involving polarized thinking, also known as black-and-white thinking or all-or-none thinking Distortion 1. Does not evaluate possibilities other than extremes Problematic 1. When coupled with hopelessness, often a risk factor for depression and suicide Changeable 1. One of the distortions to address, challenge, and replace in CBT |
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| Definition 1. Instantaneous, habitual self-statements, reflexive, knee-jerk responses to certain situations Universal 1. Everyone has automatic thoughts, provide efficient processing Negative self-statements 1. Can lead to anxiety, depression, phobias, other disorders 2. Beck views these as arising from specific situations and resulting in emotional reactions 3. Less accessible than voluntary thoughts, more stable and resistant to change Intervention 1. Building awareness of the presence and impact of automatic thoughts followed by challenging/changing these thoughts with more positive self-statements is the primary process of Cognitive Therapy |
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Term
| Empirically Supported Treatments |
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Definition
| About Empirically Established Treatments (EST) 1. Treatment interventions that are supported by empirical evidence, as shown by having met basic scientific standards for efficacy 2. These standards were met for "efficacy" rather than for "effectiveness" 3. Strong evidence is referred to as "well established" and modest evidence as "probably efficacious" 4. A treatment is considered EST when it has been found efficacious in randomized controlled trials (RCTs) or their logical equivalents. This is because these types of studies afford casual inference of treatments' benefits 5. An EST usually has the following four basic characteristics: a. Clearly established treatment goals b. An agreement between therapist and patient on how to evaluate progress toward the set goals c. An attentive monitoring of progress d. Implementation of changes in the treatment plan if progress is not seen 6. Treatments are described in detail in specific treatment manuals 7. A manual is written in such a fashion as to provide sufficient detail to allow a trained clinician to replicate the treatment with their clients 8. Solid theoretical grounding and supervised training is needed along with the manual 9. Other factors, including empathy and the quality of therapeutic rapport, are important in the use of EST 10. The lists of EST and their manuals are available through APA 11. APA's Society of Clinical Psychology, Division 12, lists ESTs for adults 12. APA's Society for Clinical and Adolescent Psychology, Division 53, directs the user to the Association for Bxal and Cognitive Therapy's website, which lists EST for children and adolescents 13. The lists of EST and relative manuals is inclusive, rather than exclusive (hence, it includes well-established as well as probably efficacious treatments) 14. The children and adolescent's EST list also includes "possibly efficacious" treatments 15. Ongoing controversy surrounds the EST issue, including how the list was developed, the methodology used to devise it, and the lists' biases against other types of psychotherapies (for example, psychoanalytic approaches) |
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| Psychiatry and Psychology |
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Definition
| Numerous clinical perspectives: Two include Psychology and Psychiatry 1. Psychology: Ph.D. or Psy.D., primarily psychotherapy and assessment, some with prescription privileges 2. Psychiatry: M.D., primarily medication management, historically more psychotherapy (primarily psychoanalytic), now some still offer psychotherapy 3. Greater differences exist within professional groups (psychology, marital therapy, social work, psychiatry) than between professional groups 4. Shifts in the role of psychiatrists and others providing psychotherapy occurred after WWII Medical model 1. Prior to 1950s psychoanalytic view dominated 2. With effective psychotropic meds came increased respect for biological perspective (somatogenic) |
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| Premise: People are born as a blank slate (tabula rasa). All knowledge is learned Knowledge Acquisition: Accidental associations from interactions with the physical world Primary and Secondary Qualities: Primary Qualities are sensations that correspond to physical attributes (shape, mobility, solidity, extension). Secondary Qualities are sensations with no physical attribute, but are perceived and organized by the person, such as color, smell, and taste. |
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