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Flashcards in Clinical Psychology 5 Deck (48):

What defines a crisis?

when a person's normal ways of adapting and coping are insufficient to respond effectively to a particular stressor


What are some of the goals of crisis intervention?

- help client learn more effective coping
* current crisis
* future events
- symptom reduction
- restoration of previous functioning
- prevention of further breakdown/dysfunction
- resolve issues as quickly as possible with the least suffering


What are some typical strategies in crisis management?

- active listening
- grief work
- open emotional expression
- understanding of crisis
- acceptance
- exploring coping
- linkage to social support
- decision counseling
- reinforcement of new coping behaviors


What are the assumptions typically made by crisis counselors?

- people are basically strong, competent, and adaptable
- presenting problems represent a need for additional support
- intervention facilitates current efforts, not long-term cure
- need for ongoing assessment
- small, short-term changes lead to big, long-term ones


What are Golan's three Stages of Crisis Intervention?

- formulation; identification of crisis and reactions
- implementation; assessment of pre-crisis situation, short-term goals and steps to achieve them
- termination; assessment of progress toward goals, termination, and post-termination issues


What are the stages in Roberts' Seven-Stage Crisis Intervention Model?

- plan and conduct assessment
- establish rapport & relationship
- identify major problems
- deal with emotions
- explore alternatives
- formulate action plan
- follow-up


What do the various forms of brief psychotherapy have in common in their treatment philosophy?

- goals:
* to reduce client's most severe symptoms quickly and restore them to previous function
* to aid in understanding and skills to support better coping in the future
- time-limited work, e.g., 25 sessions or less
- emphasis on therapeutic alliance
- problem-focus
- active role for therapist
- flexibility in intervention
- limited client population:
* acute symptom onset
* previous satisfactory functioning
* high initial motivation
* relate well with others


What distinguishes Shazer & Berg's Solution-Focused Brief Therapy (SFBT)?

- clients possess necessary resources for solution
- minimum intervention from therapist
- six sessions or less for treatment
- assumption that clients want to change; rejection of intervention is directive for therapist to take different tack
- change is inevitable


What are some techniques used in Shazer and Berg's Solution-Focused Brief Therapy (SFBT)?

- prescriptions for change (formula tasks)
- compliments
- attempts to "unlock" solutions without focusing on the problem (skeleton keys)
- considering time when problem did not exist (exception question)
- rating problem (scaling question)
- imagining life without problem (miracle question)
- narratives, with therapist injecting alternative view


With what populations has Shazer and Berg's Solution-Focused Brief Therapy (SFBT) been found to be effective?

- juvenile offenders
- substance abuse treatment
- at-risk students in school settings


List the four main types of psychotherapy integration.

- common factors
- assimilative (starting from one orientation and incorporating others)
- theoretical (full theoretical integration of multiple orientations)
- technical eclecticism (application of a range of techniques based on experience and knowledge rather than theoretical structure)


Define eclectic psychotherapy.

application of specific techniques for specific conditions, across orientations, to enhance overall efficiency


What are some examples of eclectic psychotherapy?

- Prochaska & DiClemente's Transtheoretical Approach (stages of change)
- Lazarus' Multimodal Therapy (MMT) (psychoeducational approach)
- Howard, Nance, and Myers' Adaptive Counseling and Therapy (ACT), based on client "level of readiness" (willingness, ability, and confidence)


List the seven areas of a client's life (BASIC ID) addressed in Lazarus' Multimodal Therapy (MMT).

Affect (affective responses)
Interpersonal relationships
need for Drugs, exercise, nutrition, or other bio functioning


Describe the three key elements of Norcross & Beutler's Prescriptive Eclectic Therapy.

- synergy of awareness and action (both treatment approaches facilitate each other)
- complementary nature of psychotherapy systems (diversity instead of contradiction)
- identification of empirical markers for therapy selection (all empirically supported psychotherapies are useful)


Describe some of the guidelines for psychotherapy choice in Norcross & Beutler's Prescriptive Eclectic Therapy.

- disorder
- treatment goal
- motivation
- stage of change
- level of change


Describe some of the guidelines for therapeutic relationship choice in Norcross & Beutler's Prescriptive Eclectic Therapy.

- patient expectancies
- reactance level
- stage of change
- anaclytic-introjective continuum


What are the six stages of change in Prochaska & DiClemente's Transtheoretical Model?

1. Precontemplation (denial of, resistance to change)
2. Contemplation (ambivalence, plans to change w/in 6 months)
3. Preparation (clear intent to change, w/in 30 days)
4. Action (active engagement in change)
5. Maintenance (active change maintained at least 6 months)
6. Termination (zero temptation for relapse and 100% self-efficacy; not necessary for model)


Describe Interpersonal Psychotherapy (IPT).

A present-oriented, short-term, manualized therapy integrating biological and psychosocial components. It emphasizes interpersonal issues in four areas: role transitions, conflicts, interpersonal deficits, and grief.


Describe the three forms of somatic therapy:

- psychopharmacology: any application of psychoactive drugs; the most common somatic therapy
- electroconvulsive shock therapy (ECT): the passing of an electric current through the non-dominant brain hemisphere; a treatment of last resort for depression and suicidality
- psychosurgery: lobotomy (removal of brain tissue) or leucotomy (severing brain connections); used only for acute, severe, chronic depression, anxiety, or obsession disorders


Define "emic" (as opposed to "etic") in cross-cultural psychology.

"of, relating to, or involving analysis of cultural phenomena from the perspective of one who participates in the culture being studied" (MW)
- think em- is like en- or "inside of"
- in clinical work, therapists are encouraged to consider the client's particular cultural frame of reference (emic), rather than viewing his/her culture from the viewpoint of one's own culture (etic)


Define "etic" (as opposed to "emic") in cross-cultural psychology.

"of, relating to, or involving analysis of cultural phenomena from the perspective of one who does not participate in the culture being studied" (MW)
- think et- is like ex- or "out of"
- in clinical work, therapists are encouraged to consider the client's particular cultural frame of reference (emic), rather than viewing his/her culture from the viewpoint of one's own culture (etic)


Define universality, as it is used in cross-cultural psychology.

the erroneous perspective that all people share the same reality, regardless of race, culture, ethnicity, or gender


Describe some class-bound values in Western psychotherapy.

- valuing time boundaries, adherence to time schedules
- ambiguous and unstructured approach to problem solving
- emphasis on long-range goals and solutions


Describe some culture-bound values in Western psychotherapy.

- emphasis on individualism vs. collectivism
- cause and effect relationships for problems
- emphasis on emotional/verbal expressivness
- active participation in and openness to discussing intimate details
- separation of physical and mental wellness


Describe some important language variables in Western psychotherapy.

- emphasis on standard English
- emphasis on verbal communication


Describe the four modes of Berry's acculturation model.

- integration: high retention of minority culture, high maintenance of mainstream culture
- assimilation: low retention of minority culture, high maintenance of mainstream culture
- separation: high retention of minority culture and rejection of the mainstream culture
- marginalization: low retention of minority culture and low maintenance of mainstream culture


What stress levels are associated with each of the four modes of Berry's acculturation model?

- integration: low
- assimilation: moderate
- separation and marginalization: high


What are some of the factors that affect stress associated with assimilation?

- acculturation mode
- nature of mainstream society (e.g., pluralistic or monistic)
- characteristics of assimilating individual (e.g., social support, cognitive style, values)


What is the outcome research on therapist-client racial/ethnic similarity?

Mixed. Some evidence that similarity is preferred by most African-American and Hispanic clients and may be more effective. Other research has not supported this conclusion. Consensus is closest on the idea that similarity alone is not related to therapy outcome, although it may reduce premature termination.


What are some cross-culturally-related variables that impact the therapeutic relationship?

- attitude similarity (as opposed to racial similarity)
- therapist sensitivity (cultural awareness)
- racial/cultural identification (on client's part)
- presenting problem


Describe the five stages of the Minority Identity Development model.

- conformity (preference for dominant culture over one's own)
- dissonance (active questioning of dominant culture)
- resistance and immersion (rejection of dominant culture, immersion in minority culture; focus on combating racism)
- introspection (questioning unequivocal loyalty to minority culture)
- synergistic articulation and awareness (sense of individual autonomy and choice of values from each/both cultures; desire to eliminate all forms of oppression)


How might one's stage in Minority Identity Development model affect preference for a racially/ethnically similar therapist?

- conformity: likely to prefer mainstream therapist
- dissonance, resistance/immersion, introspection: likely to prefer similar therapist
- synergistic articulation and awareness: therapist probably chosen based more on values and attitudes than race/ethnicity


Describe the six stages of Helms' White Racial Identity Development model.

- contact: ignorance and disregard of racial differences
- disintegration: confusion arising from increased awareness of racial inequalities
- reintegration: adoption of position of white superiority
- pseudo-independence: dissatisfaction with reintegration, re-examination of beliefs about inequalities
- immersion-emersion: attempt to embrace of whiteness without rejecting minority races
- autonomy: internalization of nonracist white identity, realistic understanding of strengths & weaknesses of white culture, valuing and seeking cross-racial interactions


Describe the five stages of Cross' Model of Psychological Nigrescence.

- pre-encounter: unconscious deferment to European-American values and determinants
- encounter: catharsis precipitating search for African-American identity
- immersion-emersion: destruction of old (European-American) identity and clarification of the new (African-American); associated with racist attitudes
- internalization: process of resolution of conflicts of previous stage; movement toward non-racist perspective
- internalization-commitment: initiative to pro-African-American activism


True or false: research indicates that communication style correlates highly with race, ethnicity, and culture.

True (Sue & Sue, 1990). This is important to bear in mind in cross-cultural counseling, as differences in prosody, body language, affect, and other factors can easily be misconstrued by persons not of the communicator's background.


Define the difference between Hall's concepts of high-context versus low-context communication styles.

high-context: words and sentences are shortened without loss of meaning
low-context: communication is direct, overt, elaborate


Describe the assertion regarding differential perceptions of others between low-status/power persons and high-status/power persons.

Persons of low-status/power are more likely to be better at reading/perceiving persons of high-status/power than the other way around. For example, minority clients are more likely to be familiar with the culture and life experiences of majority therapists than vice versa.


Define "healthy cultural paranoia."

A non-pathological suspicion of majority culture on the part of minority cultural members, e.g., the sense of an African-American client that disclosure to a European-American therapist might get him/her in trouble.


Describe four aspects of a culturally encapsulated counselor.

- reality is defined according to one set of cultural assumptions
- is insensitive to cultural variations in others
- disregards evidence contradicting her/his assumptions
- relies on rigid techniques and strategies, judging clients' progress on counselor's cultural assumptions


Define cultural overgeneralization and describe why it is important.

The tendency to assume that all of a client's presenting problems are directly culturally related. Hall (1997) argues that this contributes to premature dropout and underutilization of services by racial and ethnic minorities.


Define diagnostic overshadowing.

The tendency to attribute all a client's problems to a diagnosis or pathology, rather than observe and consider alternative explanations or comorbidity.


What are some of the differences among racial and ethnic groups in psychological service utilization.

- Asian-Americans and Mexican-Americans tend to be underrepresented in outpatient
- African-Americans tend to be overrepresented but have fewer positive outcomes and terminate more quickly than Asian-, Mexican-, and European-Americans
- ethnic minorities tend to be overrepresented in inpatient care and underrepresented in outpatient care


What are some general cultural factors to consider when working with African-American clients?

African-Americans are a heterogeneous group but tend to have a strong sense of collective ethnic pride. Relative to European-Americans, they tend to:
- be more non-verbal
- be more emotional
- be more concrete
- respond best to practical (problem-solving oriented) therapies
- be more connected to and affected by family (immediate and extended) and social networks


What are some general cultural factors to consider when working with Hispanic clients?

Hispanic clients are a heterogeneous group, with many different cultures and national origins. Relative to (non-Hispanic) European-Americans, they tend to:
- have patriarchal family structures
- have more rigid sex roles and family roles
- prefer personal contact in attention in therapy
- be cautious about seeking help outside the family
- respond best to active, goal-oriented therapy that considers family and is mindful of level of acculturation


Describe Cuento Therapy.

"Cuento" means folktale. Cuentos are read aloud and discussed in groups, focusing on characters' behavior and the tales' morals. Can be told in original form to emphasize role models or retold to reflect majority culture to assist with coping with a change in cultural context.


What are some general cultural factors to consider when working with Native American clients?

Native Americans are a heterogeneous group, with many different styles of living and tribal identities. Relative to European-Americans, they tend to prefer therapy that is:
- non-directive
- history-oriented
- accepting
- cooperative
...and therapists who are
- reserved
- open
- accepting
- willing to listen


What are some general cultural factors to consider when working with Asian-American clients?

Asian-Americans come from a wide range of countries and lifestyles, but, relative to European-Americans:
- social roles tend to be determined by family, age, and sex
- families tend to be traditional, patriarchal, respectful of elders
- family and cultural roles tend to be clearly defined and rigid
- problems tend to be addressed within family structure
- tend to be reserved and inhibited
They tend to prefer therapy that:
- is direct
- is structured
- is short-term
- places the problem in an academic or vocational context
- explains at the outset what to expect, the need for verbal disclosure, therapist and client roles, and addresses misconceptions about treatment