EPPP - Clinical Psychology Part 1

Id - Devel at Birth, 1st; Pleasure

Ego - Devel. 6 months, 2nd; Reality Principle

Superego - Devel. age 4-5; Morality

Sexual or agressive instincts/drives are the primary motivators of behavior

Personality is shaped by unconscious conflict related to these drives that occur in the early years of life

Animal instinct; Devil

Present at Birth & consists of life/death instinct - the source of all psychic energy

Operates on basis of pleasure & seeks immediate gratification

Basic bio. drives

Mediator

Devel. 6 Months BC Id unable to gratify all needs

Operates on Reality principle

Employes Realistic, ratioonal, logical, ordered, thinking & planning

Primary task mediate the conflicting demands btwn Id & reality

Morality, Angel

Devel. 4-5 yrs

Conscience

Internalization of societal values & standard as conveyed by parental punishment & rewards

Attempts to block Id’s socially unacceptable impulses

Consequence of successful passage thru Oedipal stage

Id’s libido is focused on diff. parts of the body (Orangutangs Always Play w/Little Gorillas).

1. Oral (birth - 1yr.) Focus on Mouth/Breastfeeding (Erogenous Zone); Primary conflict = Weaning

2. Anal (1-3 yrs) Focus on Bowel/Bladder (Elimination); Primary conflict = Potty Training

Phallic (3-6 yrs) Focus on genitals; Primary conflict = Resolution of Oedipal/Electra Complex, success Id w/same sex parent & devel superego

Latency (6-12 yrs.) Dormant sexual feelings, libidinal energy diffuse rather than focused; Primary conflict = Devel. social skills vs. achieve sexual gratification (Fixation)

Genital (12 yrs. +) Libido center on genitals; Primary conflict - Sexual desire blended w/affection to produce mature sexual relationship

He belived the personality is well-established by 5-6 yrs.

(Freud) Used when the ego is unable to ward off anxiety (danger) resulting from:

Conflict btwn Id impulses & demands of superego or reality.

When unable to ward of anxiety thru rational, realistic means, it may resort to one of its defense mechanisms:

Repression

Displacement

Projection

​Reaction Formation - involves transforming an ID impulse into its opposite (Ex: sub love for hate)

Sublimation - involves channeling and ID impulse into a more acceptable activity.

Rationalization

Denial

Compensation

Regression

They operate on 2 characterisitics:

an unconscious level and

serve to deny or distort reality and adaptive Fx.

Lead to maladaptive behavior when they become the habitual way of dealing w/conflict

(Most Basic, underlies other defense mechanisms)

Unconscious blocking of unacceptable thoughts, feelings & impulses (reject conscious painful/shameful experiences)

Aim of psychoanalysis is to bring conflicts out of repression

Defense Mechanism

Redirecting unacceptable impulses toward an object to a more acceptable safer object. (Transferring emotion from orignial object to a safer one)

Ex: Bad day at work go home and kick dog

Defense Mechanism (Pass on)

Misattribution of a person’s undesired thoughts, feelings or impulses onto another person who does not have those thoughts, feelings or impulses. (placing unacceptable wishes on another)

Ex: you are cheap but claim that your friend is cheap; project onto an external source (includes severe prejudice, hypervigilance to external danger)

Defense Mechanism

Act in a manner opposite of one’s inclination

involves transforming an undesierable impulse into a desireable one (its opposite)

Ex: Defend against hostility/anger toward a co-worker by being overly kind & nice; Instead of binge drinking go to AA meeting.

Defense Mechanism

Involves channeling of unacceptable impulses (Sexual/aggressive) into a more acceptable activity.

Ex: Channel hostility & agression into art; instead of binge drinking go skiing

Defense Mechanism

Make excuses for behavior

Ex: I didn’t make the team bc the coach doesn’t like me; excuse for not being good at a sport

Defense Mechanism

Refusal to recognize reality

Ex: My dughter would never use drugs

Defense Mechanism

Cover a weakness by overgratifying oneself in another area

Ex: Sexual Dysfunction so become a great golfer

Defense Mechanism

Using an immature response or reverting to an earlier stage of devel.

Ex: Baby talk

Defense Mechanism

Satifying frustrated desires through imaginary events.

Ppl seek gratification for desires that are prevented in reality thru imaginary scenarios

Ex: daydreamin about getting revenge on someone

Defense Mechanism

Blame others for own problems or attribute own unacceptable impulses to others

Ex:An abusive indiv. often blames victims by saying “You made me hurt you by what you did.”

Defense Mechanism

Separating conflicting attitudes or emotions from hurtful events into individual mental compartments so that they are not thought about at the same time or in relationship to each other to eliminate inner conflict.

Defense Mechanism

Depositing unwanted aspects of self & boost self-worth by identifying self w/another person, grp, or institution, with exemplary status.

Defense Mechanism

Giving a socially-acceptable reason to explain unacceptable behavior/thoughts

Psychopathology stems from an unconscious unresolved conflict that occured during childhood. Such as:

Phobias - An externalization of a forbidden impulse that resullts in displacement of anxiety onto an object/event symbolic of the object/event in unresloved conflict. Neurotic anxiety aroused by a perception of danger from instincts

Depression - Due to an object loss combined w/anger toward object turned inward

Mania - Represents a defense against libidinal/agressive urges that threaten to overwhelm ego.

Primary Goal: Reduce maladaptive behaviors (Sx’s) by bringing unconscious material into conscious awareness & integrating that material into the personality.

Pychic Determinism

Analysis consists of 4 processes:

clarification,

confrontation,

interpretation, and

working through.

Techniques:

free associations,

dreams,

resistances, and

transferences

Freud

Belief that all behaviors are meaningful & serve a psychological Fx

Analysis consists of 4 processes:

Confrontation: Entails making statements/asking questions that help the client see his/her behavior in a new way thru:

Free associtions

Dreams

Resistances

Transferences

Clarification: Involves clarifying the CT’s feelings & restating the CT’s remarks in clearer terms

Interpretation: Used to explicitly connect current behavior to unconscious processes & bring a CT’s unconscious material into conscious awareness. Improvment attributed to:

​Catharsis - Emotional release resulting from recall of unconscious material & paves the way for..

​Insight - The CT’s insight into the relationship btwn current behavior & unconscious processes

Working Through: (Longest) Involves an assimilation of new insights into the personality

As defined by Freud:

Transference - An unconscious process in which the CT projects an earlier relationship onto the therapist

Contemporary approaches consider it to be not only a repitition of the past but a reflection of the present relationship btwn the therapist & CT

Countertransference - The therapist's projections of unconscious feelings onto the CT that reflect the theraists personal Hx & counterproductive in therapy.

Contemporary approaches consider it to be a joint product of the therapist & CT & a potential source of info. about the CT & how other ppl may respond to the CT.

Alfred Adler (Neo-Freudian)

Personality theory & approach to therapy stress:

the unity of the indiv. &

the belief that behavior is purposeful & goal-directed.

Emphasis on Social Factors (Social Interest)

Maladaptive behavior represents a mistaken style of life that reflects inadequate social interest.

Ex: Pampered child doesn't devel. social feelings

Neglected child dominated by need for revenge

Mental D/O's represent a unhealthy/mistaken SOL, characterized by maladaptive attempts to compensate for feeling of inferiority

Regards behavior as being largely motivated by a person's future goals rather than determined by past events

Primary goals: overcoming feelings of inferiority & discouragment

Tx Techniques:

Est. collaborative rel. w/CT

Help CT ID & understand SOL & irs consequences. To Id a SOL a:

"Lifestyle Investigation" - is used to provide info. about:

CT's family constellation

Fictional (hidden) goals

"Basic Mistakes" (Distorted beliefs & attitudes)

Re-orient Ct's beliefs & goals to support a more adaptive lifestyle

Ppl are motivated primarily by an innate social interest & the goal in life is to act in ways that fulfill social responsibilities.

There are 3 major life tasks:

Friendship

Occupation

Love

All involve social interactions (Socail factors)

Alfred Adler

Based on Adler's approach & assumes all behavior is goal directed & purposeful.

Used w/ Indiv., Grps, famly, parent ED & teacher-student rel.

Ex: Misbehavior of a young child viewed as having 4 goals:

Attention

Power

Revenge

To Display deficiency

Each goal reflects a desire to belong & faulty beliefs about what is needed to meet goal (belong).

►Attention seeking behavior stems from mistaken belief that "I belong only when I am being noticed"

Analytical psychotherapy views behavior as being determined by both:

Conscious: Orient toward external world, governed by ego & rep. indiv. thoughts, ideas, feelings, sensory perceptions & memories.

Unconscious (has 2 parts):

Personal: Stores unique personal exp. & memories not currently avalible to conscious awareness.

Collective: (Deeper layer) stores latent memories & tendencies passed from one generation to the next, known as:

Archetypes (Primordial Images)

Described personality as consisting of 2 attitudes (Extroversion & Introversion) & 4 basic psychological Fx's:

Thinking

Feeling

Sensing

Intuiting

All 4 Fx's operate in unconscious, but 1 Fx predominates in consciousness

The Unconscious is made up of 2 compnents:

1. Personal & 2. Collective U*nconscious: * stores latent memories & tendencies passed from one generation to the next, known as:

Archetypes (primordial images): that cause people to experience certain phenomena in universal ways. Includes 3 diff.types important to personality devel.:

The Self: Rep. striving for a unity of diff. parts of personality

The Persona: (Public Mask) PArt of personality shown to the world

The Shadow "Dark Side" of personality (Part we hide from others & ourself) 2 parts:

The Anima - Feminine side of male personality

The Animus - Masculine side of a female's personality

A key concept in Jung's theory is personality devel. throughout the lifespan especially in the 2nd half of life.

Mid & late adulthood involves increasing:

Individuation: which refers to an integration of the conscious & unconscious aspects of the psyche that occurs in the last years and leads to devel. a unique identity (whole) and the development of wisdom.

The ego becomes more focused on the self vs. the outside world

Maladaptive behaviors: Sx's are "uncosncious messages" that something is awry (& presents) the indiv. w/a task that demands to be filled.

Goals: To re-bridge the gap btwn the conscious & personal & collective unconscious factors.

Therapeutic strategies include:

Interpretation of dreams (dreamwork): To help CT become aware of inner world, since the collective unconscious is expressed symbollically (Dreams rep. symbolic message to indiv. from unconscious)

Transferences: Which reflects projections of both the personal & collective unconscious & analysis of transferencea crucial part of therapy.

Focus on here & now, w/info. from past only sought when it will help the CT understand the present.

Focus more on conscious motivations vs. unconscious ones

More emphasis/importance on self (ego) vs. Id

Concerned w/influences of life experiences throughout life

Place more importance on roles of social needs and interpersonal relationships

Theorists:

Carl Jung

Alfred Adler

Karen Horney

Anna Freud

Share 2 assumptions: 1. Ppl have an innate need for satisfying relationships w/objects (other ppl) 2. Personality & behaavior are largely determined by early internalized representations of the self & objects (introjects) "Psychological birth" around age 2-3. "Splitting" representations of others: all good or all bad. Consider object seeking to be a basic inborn drive Theorists: Klein, Fairbairn, Mahler, Kernberg, Kohut, * Winnicott.

Mahler's version of object relations theory focuses on the processes by which an infant assumes his/her own physical & psychological identity, This model of early devel. involves several phases & sub-phases: * Normal Infantile Autism (1st few weeks-1 mo.): Infant is self-absorbed & oblivious to external env. * Normal Symbiotic Phase (1mo.-4/5 mos): The child is aware of mother but unable to differentiate btwn "me" & "not me." * Separation-Individuation Phase (4-5 mos., devel. of object rel.) 4 overlapping subphases: * Differentiation: (6-9mos) Infant able to differentiate self from mom, increased alertness, interest in outside world & use mom as point of orientation. * Practicing: (9-16mos) Due to ability to crawl/walk, begin to actively explore & be more distant from mom. * Re-Approachment: (15-24mos) Followed by a period of conflict btwn independence & dependence manifested as separation anxiety. * Object Constancy: (3yrs) Child devel.a perm. sense of self & object & is able to percieve others as both separate & related. Adult psychopathology can be traced to problems that occurred during separation-individuation & in infancy a natural tendency toward splitting into good/bad & inadequate resolution causes maladaptive behavior. Goal: Bring maladaptive unconscious rel. dynamics into consciousness so internalized dysfx object can be replaced w/more approp. ones

Proposes that gender differences in personality can be traced to differences in mother-son & mother-daughter parenting practices. Mothers encourage thier son's to separate from them & Male ID is defined by separation Mothers encourage thier daughters to stay attached & Female ID is defined by relations w/others. * Mother's cause differences since they tend to be primary caretakers & determines social gender roles.

1. Phenomenologial approach - Views each person as unique & to understand and indiv. you must see the world thru his/her eyes. 2. Focus on here-and-now, recognize influence of past. 3. Aswsume ppl have innate capacity for positive growth/self-actualization 4. Stress importance of devel. awareness of one's own thoughts, feelings & behaviors 5. Rejects traditional techniques & Dx labels.

Carl Roger's person-centered therapy (Rogerian Therapy/CTCentered) Based on the assumptions that all ppl have an inherent ability for: * Growth (growth potential) released in a caring, non-judgemental rel. w/therapist (egalitarian) * Self-actualization: Yet to do so the self must remain unified, organized & whole (Reach full potential) * innate self-actualizing tendency serves as a source of motivation & guides indiv. toward positive healthy growth.

Notion of the self-concept or the perception of the rel. btwn "I" or "Me" to others (part of the exp. that s/he percieves as "I" or "Me"). 2 Components:

Ideal Self: How the person would like to be or thinks s/he ought to be.

Real Self: Who the person actually is

To continue to grow toward self-actualization the self-concept must remain unified, organized & whole.

The self-concept becomes disorganized when the person feels incongruence btwn self & experience, which can occur when person experiences conditions of worth (blocked potential).

Incongruence causes anxiety (neurosis & psychosis) that the indiv. may attempt to alleviate thru distortion/denial of the self or exp., which interferes w/ the indiv. growth & self-actualizing potential.

Ex: Child finds out + regard from parents is conditional (not unconditional) & learns they will only recieve attention & affection when behave in a certain way:

Child feels incongruence btwn her sense of self (how she acts) & her experience in the world (how her parents want her to act)

Incongruence feels like anxiety & is a signal the unified self is being threatened. To alleviate anxiety thru defensive manuvers or distortion/denial (temp. fix)is counter to self-actualization.

Primary Goal: Help the CT achieve:

congruence btwn self & experience to become more fully functioning, self-actualized person.

Facilitate CT's self-awareness & trust

To achieve this goal the therapist's role is to provide 3 facilitative conditions:

Unconditional Positive Regard (Respect): Accept the CT w/out evaluation or judgement (judgement = conditions of self-worth, not theraputic)

Genuineness (Congruence): Therapists genuine, authentic &non-defensive in therapy; if lack genuiness (Incongruence btwn therapist word & behavior) will undermine the CT's trust.

Empathy (Understanding): Therapists ability to see world as CT does & convey understanding "reflection of feelings" - MOST IMPORTANT is CT's PERCEPTION of THERAPISTS EMPATHY

(Fritz Perls) Assumes that each person is capable of assuming personal responsibility (understanding) for:

thier own thoughts, feelings, actions in the here-and-now (Awareness) &

living as an unique, independent integrated "whole." 2 parts of personality:

Self: Creative part that promotes inherent tendency for actualization, growth, self-awareness & live as an integrated whole; "wants"

Self-image: "darker side" that hinders & imposes external standards on the self and impairs growth & self-actualization; "shoulds"

The part of the personality that dominates depends on the persons early interactions w/the env.

Ex: In early childhood parents must provide support & opportunities to overcome frustration for the self to devel. If a child is only given support in the form of approval &/or shielded from all frustration prevents the devel.of self & facilitates devel of self-image.

Therapists encourage CT's to exp. current feelings & behaviors when feelings are vague, CT's are asked to exaggerate them in order to make them clearer since doing so will help them resolve unfinished business & emotional impasses.

Maladaptive Behavior (neurosis) considered a "Growth D/O" that involves:

Abandonment of the self for the self-image resulting in a lack of integration.

This develops when a Boundary Disturbance (Btwn self & external env.) that interferes w/the indiv. ability to satisfy needs & maintain a state of homeostasis (equilibrium).

​The primary motivator of human behavior an innate striving for homeostasis. To maintain homeostasis:

​ppl interact w/env. by selecting objects, ppl, or events that satisfy thier needs.

The point of contact btwn a person & env. is a Contact Boundary.

Types of Boundary Disturbances:

Introjection: (Swallow whole concepts w/o understanding)

Projection: (disown parts of self)

Retroflection: (Doing to oneself what one wants to do to others)

Confluence: (No Boundary)

Types of Boundary Disturbances:

Introjection: (Swallow whole concepts w/o understanding) Person passively accepts values, attitudes & beliefs of others w/out truly understanding them or assimilating them. Prevents person from devel. unique personality; very compliant.

Projection: (disown parts of self)Involves disowning aspects of the self (thoughts, feelings & attitudes) & assigning them to other ppl; Extreme = paranoia)

Retroflection: (Doing to oneself what one wants to do to others) Involves directing feelings toward others inward; self-sufficency)

Confluence: (No Boundary)A complete absence of a boundary btwn self, others & env. that results in an inability to percieve oneself as a separate person & inability to tolerate diff. btwn self & others; underlies feelings of guilt & resentment.​

BD's become pathological when they exist outside the person's awareness & are maladaptive.

When layers of maladaptive behaviors removed revel genuine self

Goal: Help CT achieve integration of the various aspects of the self in order to become a unified whole (restore ability to self-regulate).

Multiple strategies used to increase CT's "awareness" (a full understanding of one's thoughts, feelings, & actions in the here and now) of how s/he Fx in the env. & help CT integrate & assume responsibility for satisfying own needs.

View Hx events as important only when it impact's CT's Fx & sees the CT's desire to talk about the past as a way to avoid coming to terms w/the present.

Primary Curative Factor (Focus on present reality; here-and-now awareness; Avoid Dx labels):

Empty chair technique: Used to help CT's stay in the here-and-now so they can experience & understand thier feelings fully that may have been disowned/denied.

Games of Dialogue (Same Goal as above)

Guided Fantasy (Imagery): Help CT visualize an event in here-and-now to exp. & unserstand feelings.

Dream work: "Royal road to integration" Elements of a dream represent different parts of the self (disowned) & involve having the CT role-play elements as if it was happening to integrate parts of personality they represent.

Gestaltians regard a client's transference to be counterproductive and respond to it by helping the client recognize the difference between his/her "transference fantasy" and reality

(Frankl, 1959; aka Logotherapy)

The existential therapies are derived from existential philosophy & share an emphasis on:

Personal choice & responsibility for developing a meaningful life.

Assume ppl are not static but are constantly evolving

Maladaptive behavior described anxiety as the result of an inability to cope authentically w/the ultimate concern of existence (i.e. death, non-being, freedom, existential isolation, & meaninglessness). Distinguish btwn 2 types of anxiety:

Normal (existential) anxiety: Considered a normal response to ultimate concerns & can serve as a source of motivation to change & grow.

Neurotic anxiety: Frequently the result of an attempt to avoid existential anxiety that is out of proportion to the situation that caused it, outside conscious awareness & can be immobilizing.

Goal: Help CT live in more committed, self-aware, authentic & meaningful ways to recognize thier freedom to choose own destinies & accept responsibility for changing own lives.

Tx Techniques: Therapist-client rel. considered the most important theraputic tool w/use of some specific interventions.

Ex: Paradoxical intervention used to reduce a CT's fear & req. the CT to focus in an exaggerated & humorous way to the feared situation.

(William Glasser) Based on choice theory, which assumes ppl are responsible for the choices they make & focuses on how ppl make choices that affect the course of their lives.

Personality Theory: Ppl have 5 basic innate needs that serve as primary source of motivation:

Survival

Love & belonging: Most important need since rel. w/others are necessary to fulfill all other needs.

Power

Freedom

Fun

The person adopts a:

Success Identity (Indiv. meets needs responsibly) way thru a conscious/realistic way that does not infringe on rights of others.

Failure Identity (needs met in an irresponsible manner; underlies most forms of mental/emotional disturbances)

Maladaptive Behavior: Key assumption is that mental illness the result of an indiv. choice.

Ex: Indiv. not Dep. bc of unplesant childhood exp. or chemical imbalance in brain but bc chosen to "depress themselves;" do this bc believe it will help them obtain attention from others or avoid unplesant activities.

Goals:

Reject medical model for mental illness

Focus on current behavior & beliefs

View transference as detrimental to Tx progress

Stress conscious processes,

Help CT ID responsible, effective & realistic ways to satisfy needs without harming self or others, taking responsibility for actions

Emphasize value judgements, the CT's ability to judge right & wrong in daily life & devel. a success ID.

Accomplished thru use of questioning, encouragement & other strategies to help CT explore needs & perceptions, eval. behaviors, devel. & commit to a realistic plan of action.

During Tx pay attention to CT's total behavior which consists of actions & thoughts (primary emphasis, most easily controlled by CT), emotions & physiology.

(George Kelly, 1955; aka Constructivist Therapy)

Focuses on how the CT experiences the world & assumes that:

Ppls psychological processes are determined by the way they "construe" (percieves, interprets & predicts) events

Construing involves use of personal constructs

which are bipolar dimensions of meaning (e.g. happy/sad, competent/incompetent, friendly/unfriendly)

begins to devel. in infancy & may operate on an unconscious or conscious level.

View of Maladaptive behavior: (rejects medical model) Uses descriptions of anxiety, hostility, & other forms of maladaptive behavior as the result of inadequate personal constructs:

Anxiety: Result of "recognition that the events w/which one is confronted lie outside the range of one's construct system."

​Ex: Indiv. exp. anxiety after devel. stroke related paralysis bc doesn't have constructs that help determine how to behave in various situations as a person w/a disability.

Hostility: Occurs when a person cont. to rely on constructs despit invalidating evidence & tries to force ppl, objects or events to fit those constructs.

Goals: Help the CT ID & revise or replace maladaptive personal constructs so that the CT is better able to "make sense" of his/her experiences. Therapist & CT considered mutual experts & co-experiementers that work together to derive tasks that will help the CT change.

Tx: Therapist uses a variety of assess techniques to ID the content & process of the CT's construing with:

Repertory Grid: Involves having the CT ID ppl who have various roles in thier life & the ways those ppl are simmilar & diff.

Self-Characterization Sketch: The CT describes themselves from the perspective of someone who knows them well.

Tx method:

Fixed-Role Therapy: Help CT "try on" & adopt alt. personal constructs & involves having the CT experiment w/other ways of experiencing life by acting out in thier daily life the roles of fictional character who is psychologically diff. from CT.

(Klerman & Weisman, 1984) A brief manual-based therapy originally devel. as a Tx for depression but has since been used for a number of other conditions (Bi-polar, bulimia, & sub. abuse).

Focus on here-and-now

Based on a medical model & views Depression & other D/O's as illnesses; in Tx encorages the CT to adopt the sick role.

Focuses on aspects of CT's interpersonal rel. that have contributed to current Sx's:

Sx Reduction: Achieved thru ed. about the D/O, instilation of hope & when needed pharmacotherapy.

Improved Interpersonal Fx: Resolve 1 + primary areas of interpersonal Fx of 4 prob. areas:

Unresolved grief,

interpersonal role disputes,

Role transitions,

Interpersonal deficits

View of Maladaptive Behavior: Related to problesm in social roles & interpersonal relationships that are traceable to a lack of strong attachements early in life.

3 Stages of Therapy:

Therapist conducts assess. to figure out:

CT's Dx,

interpersonal contexts where Sx's occur &

prob. areas to be the focus of Tx.

Uses specific strategies to address problem areas which may include:

Encouragement of Affect

Communication & Decision Analysis

Model/Role-play new ways of interacting

Last few sessions therapist reviews the CT's progress & discusses termination & relapse prevention.

(De Shazar, 1985) Based on assumption:

"you get more of what you talk about" &

focuses on solutions to CT's problems, than the probs. themselves.

Focus on present & future

View of Maladaptive Behavior: Understanding the etiology of the problem (Maladaptive behavior) is irrelevant & focus on solutions to prob.

Goals & Techniques: The CT is viewed as the "expert" while the therapist acts as a consultant/collaborator who poses diff. questions designed to assist the client in recognizing & using his/her strengths & resources to achieve specific goals. These Q's include:

Miracle "Suppose when you go to sleep tonight, a miracle happens & your problem is solved. When you wake up in the morning, how will you know that a miracle has occured?" "What will be different?"

Exception Questions:"Can you think of a time in the past week when you did not have the problem (or the problem was not as troublesome)?"

Scaling Questions: "On a scale from 1-10, how did you feel last week?" "On a scale from 1-10, how motivated are you?"

Therapy is structured around several strategies:

Inital session:

The CT ID's specific therapy goals,

Responds to miracle Q,

ID's exceptions, & instances of success

Rates his/her current status w/regard to the problem on a scale of 1-10.

End of Session:* Therapist verbally reinforces CT's successes & gives CT tasks to complete before next session

Susequent sessions*: Begin w/the question "What's better since the last time we met" & the strategies of the inital session ae repeated.

(Prochaska & DiClement's, 1992) Transtheoretical model of behavior change based on the assumption that the focus of therapy should be on change:

Proposes that the change process is esentially the same regardless of the target behavior

To be effective, an intervention must match the CT's current stage of change

The goal of any intervention to help the CT move to the next stage of change.

Proposes that the change process involves 6 stages:

Precontemplation (No change next 6 mos.)

Contemplation (Plan to change next 6mos./ambivalent)

Preparation (Take action in next month)

Action (Made some changes past 6 mos.)

Maintenance (Working to prevent relapse)

Termination (Maintained change for min 5 yrs)

Interventions are most effective when they match the person's stage of change.

The progression thru the stages is not always lineat & ppl may recycle thru some or all of the stages several times ( e.g. consciousness raising, dramatic relief, and environmental reevaluation are useful for helping clients transition from the precontemplation to the contemplation stage).

Proposes that the change process involves 6 stages:

→Model ID's 3 mediating variables that affect motivation at diff stages:

Precontemplation (No intention of changing in next 6 mos.) - Indiv not planning to change in the foreseeable future. Unaware of effects of behavior & in denial about prob. or demoralized by unsuccesful past attempts at change; little insight into need for change. →High Temptation (Hightest=Precontemplation to Lowest=Maintenance)

Contemplation (Plan to change next 6mos., but ambivalent about change) - Aware of need for change, but not committed to change & can remain stuck in this stage for an extended period of time. →Decisional Balance: Indiv. aware of pros & cons which refers to indiv. strength prob. behaviors; most important determinant of motivation in this stage

Preparation (Plan to take action in next month) - Realistic plan of action to modify behavior. →Self-Efficacy: Indiv. has confidence they will be able to cope w/high risk situations w/out relapsing; important factor to move to next stage.

Action (Made some changes in past 6 mos.) - Started new behavior patterns, committing a significant amount of time to change behavior; public committment to change. →Self-Efficacy Cont.

Maintenance (Working to prevent relapse) - Indiv. has maintained a change in behavior for at least 6 mos., taking steps to prevent relapse, & increasingly confident in changes made. →Low Temptation

Termination (Maintained behavior change for min. 5 yrs.) - Indiv. feels they can resist temptation & confident no risk for relapse.

→3 mediating variables that affect motivation at diff stages:

•Decisional Balance: Strength of percieved pros & cons of prob. behavior & plays a role in all stages; most important determinant of motivation in Contemplation stage.

​•Self-Efficacy: Indiv. has confidence they will be able to cope w/high risk situations w/out relapsing; important factor to move to next stage.

• Temptation: The intensity of urges to engage in prob. behaviors & inversely related to self-efficacy; high during inital stages but lower dring later stages.

(Miller & Rollnick) Devel. specifically for CT's who are ambivalent about changing their behavior & combines the transtheoretical (stages of change) model w/client-centered therapy & the concept of self-efficacy.

Goal: Increase the CT's intrinsic motivation to change by overcoming his/her resistance & ambivalence.

View of Maladaptive Behavior: Doesn't focus on Etiology but on factors that impede an indiv. ability to change the behavior.

4 Principal Techniques (OARS):

Open-ended questions: Help CT clarify thoughts & feelings; cant be answered with yes/no or brief replies.

Affirmations: Provides CT's w/positive feedback; reinforcement. Express empathy & understanding.

Reflective listening: Useful for building trust & rapport. Involves repeating/pharaphrasing what the CT said or reflection of feelings.

Summaries: Type of reflexive listening that is useful for facilitating transitions & ending conversations

Defines a system as an entity that is maintained by the mutual interactions of its components & assumes that the actions of interacting components are best understood by studying them in their context.

The family is a system consisting of inerrelated components

A change in 1 component (family member) affects the entire family, the focus of therapy is on the entire family system.

Family therapists view the family as primarily an:

Open system continuously receives input from & discharges output to the environment & is adaptable to change.

The influence of systems theory on family therapy is evident in the concept of:

Homeostasis refers to the tendency for a family to act in ways that maintain the family's equilibrium or status quo.

As a result of homeostasis, family members may resist change, including a therapists efforts to modify the behavior of one family member.

Described by mathmetician (1940) & then applied it to family communication processes.

Cybernetics is concerned w/communication processes & distinguishes btwn 2 types of feedback loops:

Negative feedback loop reduces deviation & helps a system maintain the status quo; stability.

Positive feedback loop amplifies deviation or change from a steady state & thereby disrupts the systems current status.

This can lead to brakdowns (Runaways) & in some situations has benefical effects. Promotes approp. change in dysfx family system.

As originally defined by Bateson, Jackson, Haley, & Weakland (1956)

Double bind communication is an etiological factor for schizophrenia & involves conflicting negative injunctions

Ex: "do that and you'll be punished" and

"don't do that and you'll be punished"

w/one injunction often being expressed verbally & the other nonverbally.

2 contradictory messages w/the condition that the recipient is in not allowed to comment on the inconsistency or seek help from someone else.

Grew from Research at Mental Research Institute (MRI) in Palo Alto in 1960's by Jackson, Satir, Haley, Riskin & others

Focuses on the impact of communication & other interactions on family and individual functioning.

Describes Double-Bind Communication: as involoving 2 contradictory messages w/the condition that the recipient cannot comment on the inconsistency.

Distinguishes btwn 2 communication patterns:

Symmetrical Interaction: communication occurs btwn 2ppl that mirror each other's behaviors; reflect equality btwn communicators. Can become competitive & escalate into one-upsmanship game.

Complementary Interaction: communication occurs btwn 1 person's behavior that complements the other person's behavior. Reflects inequality & emphasizes their differences.

Goal: Modify dysfx interactions that are maintaining the families current problems (Sx's)

Tx Techniques include:

Focusing on the present

Adopting a prob. solving approach

Using a combo of techniques including:

Direct: Point out pob. interactions when occur in Tx

Paradoxical: such as perscribing the Sx's & reframing

(Murray Bowen) Extends General Systems Theory beyonf the nuclear family & describes Family Fx in terms of several inter-related concepts:

Differentiation of Self:* *Indiv. ability to separate intelectual & emotional Fx. Allows family members to stay emotionally seprate from one another & from becoming "fused" w/emotions that dominate the family.

High degree of differentiation is optimal

Low degree are at mercy of emotions & fuse w/other family members.

Emotional Triangle: develops when a 2-person system attempts to reduce stability or stress by recruiting a 3rd person into the system.

Multigenerational Transmission Process (Family Projection Process) Parental conflict & emotional maturity transmitted to child & causes child to be less differentiated than parents.

View of Maladaptive Behavior: Behavioral D/o's are the result of a multigenerational transmission process in which progressively lower levels of differentiation are transmitted from one generation to the next.

Goal: Increase the differentiation of all family members.

Tx:

The therapist often sees 2 members of the family (Ex: spouses) & forms a therapeutic triangle in which the therapist comes into emotional contact with the family members but avoids becoming emotionally triangled.

Involves staying uninvolved in couples conflict & having each member talk to the therapist instead of each other.

Alt. they see the most differentiated family member, the person most likely to change & will have a benefical effect on other family members.

In either case the therapist adopts the role of active coach/trainer & rely on rational processes to help a family member achieve a higher level of differentiation.

Therapy often begins with the construction of a:

Genogram which depicts the relationships btwn family members & is used as an assess tool to obtain info about family Fx, the dates of significant life events, and other important information across generations.

Minuchin's emphasizes altering the family's structure in order to change the behavior patterns of family members.

Family Structure Elements are:

Power Hierarchies (How members join forces during conflict)

Family Subsystems (Parents, sibs, parent-child)

Boundaries: The rules that determine the amt. of contact allowed btwn family members.

Overly Rigid/Inflexible - Family members are disengaged/isolated from one another.

Overly Diffuse/Permeable - Family members are enmeshed/overly dependent/close.

Minuchin distinguished between 3 chronic boundary problems (rigid triads):

Detouring: Occurs when parents focus on a child by overprotecting them or blaming them for the family problems (scapegoating)

Triangulation: Occurs when each parent demands that the child side w/him or her against other.

Stable Coalition: Occurs when a parent & child consistently "gang up" against the other parent (cross generational)

(Minuchin) Primary Goal: Emphasizes altering the family's structure in order to change the behavior patterns of family members:

Restructure the family so it's better avle to adapt to stress caused by factors insode or outside the family such as illness, job loss, disaster.

Based on premise that action precedes understanding & uses techniques designed to deliberatley unbalance the family & alter structure.

View of Maladaptive Behaviors: Family Dysfx is the result of an inflexible family structure that prohibits the family from adapting to maturational & situational stressors in a healthy way.

3 Tx Techniques:

Joining: Therapist's 1st task is to devel. a therapeutic system by joining the family in a position of leadership which involves:

"blending" w/the family & includes:

Tracking (identifying & using the family's values, life themes, & significant life events in conversation)

Mimesis (adopting the family's affective & communication style).

​​​This is done to understand the family structure & communicate w/family members.

Enactment: Involves having family members role-play a problematic interaction vs. talk about it & therapist can make changes.

A Family Map: Used to clarify the family structure so that approp. interventions can be ID.

(Jay Haley; Communication patterns) Focuses on transactional patterns & views Sx's as interpersonal events that serve to control relationships.

Communication is a source of power, which refers to the ability to control a rel. w/another person.

In families, power is often determined by hierarchies; Effecitve family Fx req. a clear generational hierarchy where parents have more power.

View of Maladaptive Behavior: Struggles for control are considered inherent in any rel., but they become pathological when 1 or both parties denies the intent to control the other person thru communication. It becomes problematic when the purpose is unacknowledged/denied, & prod. symptomatic behavior.

Goal: Resolve the family's presenting probs. (Sx's) by altering faulty communication patterns.

Specific goals related to the presenting probs. are ID at the outset of therapy & a variety of strategies used to achieve goals, such as:

Direct Directives: Straightforward instructions to family members.

Paradoxical interventions (Directives): designed to alter the behavior of family members by helping them see Sx's in an alternative way

Ordeals

Restraining

Positioning

Re-Framing

Perscribing the Sx's:

Tx:

Focuses on Sx relief (vs. insight),

Therapist assumes an active, take charge role

Assumes that change does not req. understanding but occurs when family members carry out the therapist's directives.

Direct Directives: Straightforward instructions to family members & involves the use of specific strategies, especially:

Paradoxical interventions (Directives): designed to help family members alter thier behavior & see Sx's in an alt. way, recognize they have control over their behaviors or using resistance in a constructive way.

Ordeals: Unplesant tasks a CT must perform when Sx's occur (Ex: Give mom-in-law gift when fight w/her).

Restraining: Creates resistance & encourage family to "go slow" bc are not ready for change or to avoid negative consequences of changing too quickly (not to change).

Positioning: Exaggerate severity of a Sx.

Re-Framing: Re-label Sx's to help family members see it in an alt. way, as reasonable & understandable & give a more positive meaning.

Perscribing the Sx's: Instructing a family member to deliberately engage in Sx's (Ex: tell to fight for 2 hrs. a night).

In family systems there are circular patterns of action & reaction. Maladaptive behavior results when family patterns become fixed that family members can't act creatively or make new choices about thier lives.

Goal: Help family members see choices & assist them in exercising thier perogative in choosing.

The therapist helps family members understand thier rel. & probs. in an alt. way which paves way to see new solutions & choices.

Tx:

Use a theraputic team 1-2 members in session & rest of team behind a 1-way mirror (AFS).

Circular Q's: Asked of each family member to help them recognize diff & similarities in perception. Help define & clarify confused ideas, behaviors & intro. new info. to family members.

Based on the principles of operant conditioning & social learning.

Emphasizes the impact of parents & other behaviors on internal, vicarious &/or external consequences of behavior.

View of Maladaptive Behavior: Family interactions are influenced by the external events that precede & follow a family members behavior (that are learned & maintained by it's antecedents & consequences) but

also focuses on contributions of maladaptive cognitions (dysfx schemas, negative automatic thoughts, cognitive distortions) to problematic interactions.

Goals: Alter the environmental factors (antecedents &consequences) that are maintaining problem behaviors.

Tx: Focus on observable behaviors & assess to ID target behaviors, then increase/decrease target behaviros thru contingent reinforcement & improving communication & prob.solving skills.

Maladaptive behavior is the result of both intrapsychic & interpersonal factors.

A primary source of dysfunction is:

Projective Identification: occurs when a family member projects old introjects onto another family member & then reacts to that person as though he/she actually has the projected characteristics or provokes the person to act in ways consistent with those characteristics.

Primary goal: Resolve each family member's attachment to family introjects & involves addressing Multiple Transferences:

Transferences of one family member to another

Transferences of each member to the therapist

Transferences of the family as a whole to the therapist.

According to Yalom, therapy groups typically pass through 3 formative stages-

Inital Stage (orientation, participation, search for meaning, & dependency) - Grp members engage in limited communication that's restricted primarily to seeking & giving advice. →Tend to talk directly to therapist & look to therapist for direction & approval

Transition Stage (conflict, dominance, & rebellion) - Advice giving is replaced by criticism & other negative comments. →Express hostility toward therapist due to resisteance & sharing attention

Working Stage (development of cohesiveness=Theraputic alliance, curative factor) - Characterized by a high degree of trust & cohesion among grp members, increasing self-disclosure & concern when grp members absent.

Therapist acts as a technical expert & participant model & viewed the grp as an opportunity for the therapist to model behaviors diff. from grp members behaviors.

Concurrent grp & indiv. therapies should be provided only in cirtain circumstance (Ex when a grp member is experiencing a crisis) & be avoided in most cases to ensure dont drop out of grp prematurley.

Yalom describes cohesiveness as the most important curative factor provided by group therapy & the group therapy analog for the therapist-client relationship in individual therapy. Res. on curative factors showed that grp members rate these as most important: Interpersonal input Catharsis Self-understanding Cohesivness Cohessivness creates conditions for other facilitative conditions. Yalom views grp therapy as a social microcosm that provides opportunities to work thru probs. in a new more adaptive way.

Yalom proposes that prescreening of potential group members & post-selection preparation can reduce premature termination from group therapy & enhance therapy outcomes when it covers goals &processes.

Attribute early termination to unrealistic expectations

Res shows 10-35% of grp members drop out of therapy during 1st 12-20 sessions.

Contraindications for grp therapy include certain Sx's/Dx's:

Severe Depression

Withdrawl

Paranoia

Acute Psychosis

Brain Damage

Sociopathy

Inability to tolerate grp setting

Based on the premise that "the personal is political."

It focuses on:

ID & integrate Male & female aspects of woman's personality

Avoid label aspects of personality as male & female

empowerment & social change &

Acknowledges & minimizes the power differential inherent in the client-therapist relationship.

Goal: ID & alter the oppresive forces in society that have affected the CT's life.

Help the CT understand & appropriately respond to env. forces that impact the CT's life. Recognized the impact of sexism & avoid the use of gender based techniques.

Feminist therapy must be distinguished from nonsexist therapy, which focuses more on the personal causes of behavior and personal change.

Applies feminism to object relations theory & proposes that many gender differences can be traced to differences in the early mother-daughter & mother-son relationship.

Proposes that gender differences in personality can be traced to differences in mother-son & mother-daughter parenting practices.

Mothers encourage thier son's to separate from them & Male ID is defined by separation

Mothers encourage thier daughters to stay attached & Female ID is defined by relations w/others.

Mother's cause differences since they tend to be primary caretakers & determines social gender roles.

(Orne & Dinges) Propose that hypnosis involves experiencing alterations of memory, perception, & mood in response to suggestions and characterize its essential features as a "subjective experiential change".

Although hypnosis has been used to help ppl recover repressed memories, the research suggests that it does not seem to enhance the accuracy of memories & may produce more:

Pseudomemories (inaccurate or confabulated memories) than accurate memories, and

may exaggerate a person's confidence in the validity of uncertain memories, especially for those that are inaccurate.

Acupuncture is a traditional Asian method for restoring health & involves stimulating specific anatomical points on the body, usually with a thin metallic needle.

The traditional explanation for its effects is that illness is due to a blockage of qi (vital life energy) & that acupuncture unblocks the flow of qi along the pathways through which it circulates in the body.

Research suggests that its benefits may be due to the release of pain-suppressing substances or to an alteration in blood flow in areas around the needle or in certain regions of the brain.

Methods of prevention are classified as:

Primary Preventions: Designed to prevent the devel. of MH probs by making an intervention available to all members of a target group/population in order to keep them from developing a disorder.

Secondary Prevention: Designed to reduce the prevalence of MH probs. & are aimed at identifing at-risk individuals who are showing early signs of a disorder & offer them appropriate interventions.

Tertiary Preventions: Aimed at ppl who already have a MH prob. & is designed to reduce the duration & consequences of an illness that has already occurred to reduce risk of relapse or chronicity

(Becker, 1974) Proposes that health behaviors are influenced by:

Indiv. Knowledge: The person's readiness to take a particular action, which is related to his/her perceived susceptibility to the illness & perceived severity of its consequences;

Motivation: The person's evaluation of the benefits & costs of making a particular response; consequences of illness.

Self-Efficacy Beliefs: The internal & external "cues to action" that trigger the response; benefits of & barriers to taking appropriate action.

(Lau & Ware, 1982) Alternative theory to HBM proposes that health-related behaviors reflect locus of control beliefs:

Ppl may believe they have the ability to control thier health or health depends on luck or other uncontrollable factors.

Implications are that practitioners can enhance a CT's healthy behaviors by promoting the CT's sense of:

Personal Responsibility &

Control

Caplan distinguished between 4 types of mental health consultation:

In the first 2 of the 4 types, the 3 enteties are the consultant, consultee, & particular CT/Type of CT:

Client-centered case consultation: Focuses on behavior change in a particular client whom the consultee is having trouble working with. (Helping the consultee work more effectively with a particular client).

Consultee-centered case consultation: Focuses on enhancing the consultee's knowledge, skills,or objectivity so they can work more effectively w/a paarticular type of CT in the future. (Devel. the ability to deliver services to a particular group or population of CT's); Theme Interference.

For the last 2 types, the 3 entities are the consultant, 1+ program administrators/managers, & a particular program/type of program.

Program-centered administrative consultation: Help Administrators improve the effectivness of a program they are having trouble with. Involves working with 1+ administrators (consultees) to resolve probs. related to a particular program.

Consultee-centered administrative consultation: Improve the knowledge or skills of administrators so they're better able to devel., run, or eval. programs in the future. involves enhancing the ability of administrators to develop, implement, and evaluate programs.

A type of transference that occurs when a consultee's unresolved conflict related to a particular type of CT/situation interferes w/his/her objectivity when working w/similar CT's or in similar situations.

Limit's a consultee's objectivity.

Occurs in clinical supervision when the therapist (supervisee) behaves toward his/her supervisor in ways that mirror how the client is behaving toward the therapist.

A British psychologist known for his factor analysis of personality traits, contributions to behavior therapy, & 1952 review of psychotherapy outcome studies in which he found that 72% of untreated neurotic indiv. improved w/out therapy.

Answer: Found ppl who recieved no therapy are "better off" than those w/similar probs. who recieved eclectic (66%) or psychoanalytic psychotherapy (44%).

He concluded that ny apparent benefit of therapy is due to spontaneous remission.

Hid research was cirticized on methodological grounds.

They used meta-analysis to combine the results of the psychotherapy outcome studies & found, contrary to Eysenck, that psychotherapy does have substantial benefits.

1980 meta-analysis found an average effect size of .85 for a variety of therapies & D/O's, which indicates that the typical CT is better off than 80% of indivs. who need therapy but are untreated.

Howard et. al (1996) results identified:

Dose-Dependent Effect: Found that 75% of therapy CT's show measurable improvements in Sx's after 26 therapy sessions; & at 52 sessions this number only increases to about 85%

Phase Model: which predicts that the benefits of therapy vary, depending on the number of sessions & can be described in 3 phases related to Tx length:

Remoralization: (1st few sessions) Improvment due ti increased hopefulness.

Remediation: (1st few to 16th session) Improvments due to Sx relief.

Rehabilitation: (Remaining sessions) Improvments in overall Fx & long lasting behavior changes occur.

An ongoing debate on psychotherapy outcome research is over the best way to evaluate the effects of psychotherapy.

Efficacy Studies: (clinical trials) More useful for est. whether or not Tx has an effect.

Effectivness Studies: (correlational/quasi-experiements in nature) Best for assess clinical utility - determin a Tx's generalizability, feasability & cost effectivness.

Research in terms of race, ethnicity, or culture has produced inconsistent results.

Sue et. al ('91) found that ethnic matching may reduce premature termination rates for members of some grps (Asian & hispanic/lation)

Originally devel. to standardize psychotheraputic Tx so their efects could be empirically evaluated & to provide guidelines for training therapists.

They specify the theoretical underpinnings of the Tx along w/Tx goals & specific theraputic guidelines & strategies.

A potential limitation of Tx manuals is that they may oversimplify the theraputic process.

Originally used to describe the tendency of health professionals to attribute all behavioral, social & emotional probs. to mental retardation in indiv. w/this Dx.

Subsequent research found that diagnostic overshadowing also applies to other Dx's & Situations.

Refers to the focus of an intervention w/regard to the env.:

Alloplastic Intervention: Goal is to make changes in the env. to better accomodate the the indiv.

Autoplastic Intervention: Goal is to change the indiv. so that he/she is better able to Fx effectively in his/her env.

Research on the utilization rates of Mental HEalth services provided the following info. about the demographic charateristics of psychiatric inpatients:

Marital Status: For both men & women admission rates are:

lowest for widowed,

intermediate for married or divorced/separated &

highest for never married.

Race/Ethnicity: Whites rep. the largest number of inpatients, when population proportions are taken into account other races are overrepresented.

Age: For both men & women largest proportion of admissions is in the 25-44 age range.

(Boyd-Franklin) An ecostructural approach for African American families that addresses multiple systems, intervenes at multiple levels, and empowers the family by utilizing its strengths.

Systems that may be incorporated into Tx include:

Extended family & non-blood kin

The church & other community resources

Social service agencies.

Identified as an effective intervention for American Indian CT's & is often used as a Tx fro alcohol & drug abuse.

Multimodal Tx that incorporates family & community members into the Tx process & situates an indivs. probs. w/in the context of his/her family, workplace, community, & other social systems

(Martin & Hetrick, 1988) Found social & emotional isolation was the primary presenting problem for a sample of gay & lesbian adolescents seeking assistance.

LGBT individuals face issues including:

Internalized Homophobia: Occurs when LGBT indiv. accept negative sterotypes about sexual minorities & incorporate them into thier self-conccept.

Consequences include:

Low self-esteem

Self Doubt

Self-destructive behaviors

Coming Out: to family members, friends & others is assoc. w/rejection & other negative consequences as well as higher levels of self-esteem & positive affectivity, lower levels of anxiety & other positive consequences

Research suggests that the age of coming out is about the same for gay males & lesbians

Sue & Sue (2003) describe cultural competence as involving 3 competencies:

Awareness: (Therapits awareness & acceptance of cultural differences) Refers to the therapists understanding of how his/her own cultural values & biases affect the theraputic process.

Knowledge: (Knowledge about the worldviews of culturally diverse CT's)Refers to the therapists familiarity w/HX, experiences, & worldviews of members of different cultural grps & how it might affect CT's mental health & course of Tx.

Skill: Refers to the therapists ability to ID & effectively use modalities & strategies that are approp. for CT's cultural background; don't automatically use same approach & modify for diff. CT's.

Sue & Zane proposed that credibility & giving are especially critical when working w/culturally diverse CT's at higher risk for premature termination.

• Credibility: Refers to the CT's perception that the therapist is effective & trustworthy & is affected by the therapist's status:

  • Ascribed Status: The therapist's position or role, credentials, age, gender, racte, etc.

  • Achieved Status: Determined by the CT's perception of the therapists skill, which is enhanced when the therapist demonstrates accurate knowledge of the CT's cultural background.

• Giving: Refers to the CT's perception that he/she has recieved some benefit from therapy.