Clinical Psychology/Intervention Flashcards

(157 cards)

1
Q

Best treatment for chronic pain

A

Comprehensive tx, focusing on teaching coping skills to alleviate pain & increasing sense of control, incorporates hypnosis

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2
Q

6 phases of classical Adlerian psychotherapy

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Support, Encouragement, Insight, Change, Challenge, MetaTherapy; there are 12 stages within these phases reflecting progressive strategies to awaken client’s underdeveloped sense of community

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3
Q

According to Ellis’ Rational Emotive Therapy, what is self indoctrination?

A

During early childhood, children internalize critical attitude of parents & perpetuate that as they grow older

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4
Q

Treatment of Specific Phobia

A

Brief In Vivo Exposure, often within 2 to 4 sessions; cognitive techniques may not improve effects substantially

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5
Q

Smith & Glass (1977)

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1st meta analysis: allows researchers to stat compare several independent studies to yield single effect size indicating magnitude of IV’s effect

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6
Q

3 Categories of Behavioral Interventions

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Based on:
Classical Conditioning
Operant Conditioning
Social Learning Theory

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7
Q

2 Broad categories of Class Cond Interventions

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Counterconditioning

Classical Extinction

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8
Q

Interventions based on counterconditioning principles

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Aversive Conditioning
Systematic Desensitization
Sensate Focus
Assertiveness Training

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9
Q

Reciprocal Inhibition

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Foundational principle of counterconditioning

Idea that 2 incompatible responses cannot be experienced at same time, so stronger will inhibit the weaker

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10
Q

Aversive Cond

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Only for deviant bxs;
CS paired w/stronger negative stim
Ex: smoking paired w/electric shock (in vivo)
Ex: smoking paired w/imagining lungs blackening (covert sensitization)
Short term benefit, high rates of recidivism

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11
Q

Theorist assoc w/Systematic Desensitization

A

Joseph Wolpe

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12
Q

Systematic Desens most commonly treats ____

A

specific phobias

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13
Q

Systematic Desensitization

A

Pt taught to relax deeply
Then create anxiety hierarchy
Teach client to relax while exposing to least to highest anxiety provoking event
*CS paired w/deep relaxation

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14
Q

True or False: Systematic Desens is the most efficacious tx for specific phobia.

A

False- prolonged & intense exposure (flooding) more effective

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15
Q

Sensate Focus

A

Masters & Johnson; reduce sexual perf anxiety by initially abstaining from intercourse, then focus on body massage until anxiety eliminated

  • Targets the arousal sex cycle
  • CS paired w/massage
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16
Q

Sexual Response Cycles (4 stages)

A
Masters & Johnson
Excitement
Plateau
Orgasm
Resolution
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17
Q

Assertiveness training

A
Social anxiety (CS) paired w/assertive bxs, leading to reduced distress & more effective coping
start w/role plays move to real life situations
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18
Q

Interventions based on Classical Extinction

A

Flooding
Implosive Therapy
*CS presented repeatedly w/o US until CS no longer elicits CR

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19
Q

Flooding

A

Often don’t know what the US was to elicit fear response to CS, but tx focused on exposure to feared situation w/o option of fleeing
*Prolonged exposure (45 min) more effective than multiple brief periods

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20
Q

Implosive Therapy

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Stampfl; imagination only, exposure to feared object & therapist interps psychosexual themes

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21
Q

2 Broad Categories of Intervention based on Operant Conditioning

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Reinforcement

Punishment (or aversive control of bx)

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22
Q

Functional Assessment of Bx

A

Performed prior to operant conditioning based tx
Define target bx
Determine antecedents & consequences
Id contingencies (reinf & punishers) that maintain the bx
*this allows for creation of bx mod program

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23
Q

3 types of reinforcers

A

Primary- reinforce everyone (food)
Secondary-acquire value thru experience (praise)
Generalized Conditioned Reinforcers-not inherently reinforcing, but all access to other reinforcers (money)

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24
Q

Interventions based on reinforcement

A
Shaping
Token Economy
Contingency Contracting
Premack Principle
Differential Reinforcement
Self Reinforcement
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25
Contingency contracting
Focuses on bx in naturalistic environ, between 2 ppl | Id bxs ppl most want from one another, then negotiate a contract for their exchange
26
Differential Reinf of other bxs
combines extinction w/pos reinf | Ex: Ignore E when she whines, respond enthusiastically when she speaks like a big girl
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Stimulus control
Narrow range of stimuli that elicit a particular bx (don't have junk food around) & develop incompatible responses (go for walk instead of snacking)
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Interventions based on punishment or aversive control of bx
Positive punishment Escape Learning Avoidance learning Overcorrection
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Escape learning
Aversive stim cannot be avoided, but can be stopped by emitting the desired bx Ex: person being mugged can make assailant go away by giving wallet
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Avoidance learning
Aversive stim can be avoided if you emit desired bx in time; there is typically a cue or discriminative stim to prompt bx Ex: pay bills on time, avoid late fee
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Overcorrection
Punishment that involves restitution of some kind & physical guidance Ex: child makes mess in living room, must clean up that room plus another
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Rational Emotive Behavior Therapy
Ellis; 1st CBT approach Coined term irrational beliefs Proposed ABC model to clarify role of cognition in bx Not the Activating event itself, but the person's beliefs about the event that dictate C D-Disputing intervention E-adoption of more effective belief F-new feelings
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Major procedural components of REBT
direct instruction persuasion logical disputation *provides alt philosophical system by relying on reason as modifying beliefs
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Beck's CBT emphasizes ___ ___ ___, where clients are taught to test the validity of their beliefs; often uses ____ ___
empirical hypothesis testing; socratic questioning
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In Beck's CBT theory, psych symptoms are the result of ___
automatic maladaptive thoughts/logical errors
36
Beck's Maladaptive Cognitive Triad
Negative view of the self Negative view of the world Negative view of the future
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Meichenbaum's Cognitive Behavior Modification: 2 programs
Self instructional training Stress Inoculation Training *Emphasized use of positive self statements
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Self instruction training has been empirically supported as a tx for ____
ADHD
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Self Instruction therapy: 5 steps
Meichenbaum 1. Therapist Modeling 2. Therapist Verbalization 3. Patient Verbalization 4. Patient silently talks through task 5. Independent task perf
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Stress Inoculation Training: Central concept
Meichenbaum: bolstering a person's repertoire of coping resp to a milder stressor decreases vulnerability to more severe stress
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3 phases of Stress Inoculation training
1. Education & cognitive prep- taught about importance of cognitive interp of a situation in dictating stress response 2. Coping skills acquisition (relaxation, coping self statements, imagery, thought stopping) 3. Application of skills in imagination & in vivo
42
Self Control Model of Depression
Rehm; views depression & low rate of bx (i.e. anhedonia, lack of involvement) as a result of: neg self evaluations lack of self reinforcement high rates of self punishment
43
Marlatt's model of Relapse Prevention
Views addiction as an overlearned habit, where relapse is inevitable, pt taught to view relapse as a setback to be learned from
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Marlatt proposed that the most common relapse trigger is _____
pt's emotional state.
45
3 parts structuring personality, according to Freud
The Id The Ego The SuperEgo
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The ID
primitive, instinctual part of psyche basic drives- libido (eros) & aggression (thanatos operates on pleasure principle
47
The Ego
Operates on reality principle-awareness of world & consequences Main task: suspend or satisfy Id impulses through socially acceptable means
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The Superego
Forces ego to satisfy id in a manner that is moral & ethical Guilt is primary weapon believed to evolve as the child successfully passes through the Oedipal stage
49
Freud: neurotic anxiety the result of ____, and leads to ____, so these forbidden impulses cannot enter consciousness
id impulses breaking through the ego; defense mechanisms
50
Freud: Repression
most common defense mech; "motivated forgetting" | **Fundamental aspect of ALL defense mechanisms (making the conscious unconscious)
51
Freud: Regression
guarding against anxiety by retreating to earlier, less demanding stage of dev
52
Freud: Projection
Seeing one's unconscious urges in another person's bx | suspicion common outcome
53
Freud: Displacement
Transference of emotions to a substitute object or symbolic representation Can play a role in phobias- ex: fear of snakes related to underlying fear of sex
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Freud:Reaction Formation
Engage in bxs exact opposite of id urges.
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Freud: Intellectualization
Distancing self from feelings
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Freud: Sublimation
finding soc acceptable ways of discharging energy from unconscious desires
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Freud: Rationalization
come up w/self satisfying yet incorrect reason's for one's bx
58
Alloplastic vs autoplastic defenses | hint: pers d/os use alloplastic & neurotics use autoplastic
alloplastic: blame ext environ autoplastic: blame self
59
Psychoanalysis involves 4 steps:
``` Clarification Confrontation Interpretation Working through *free association is cornerstone ```
60
Extensions of Psychoanalysis/Psychodynamic Theories
Ego Psych Object Relations Self Psych Neo-Freudians
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Major dynamic theorist departing from psychoanalysis
Adler (Ind Psych) | Jung (Analytical psych)
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Ego Psychology proposes that the ego ____
acts as the guide to mastery of life, not as the helpless rider of the id
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Major Ego Psychologists
Heinz Hartmann Anna Freud Erik Erikson
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Heinz Hartmann
"Father of ego psych" proposed parallel dev of id and ego; ppl not only driven by passion but also by thought differentiated btwn defensive ego fxs & ego autonomous fxs "conflict free sphere" for ego fxs that develop outside of conflict
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Anna Freud
Noted the ego's ability to reconcile drive conflicts w/demands of reality Applied psychoanalysis to children, but allowed strong positive bond and interpreted words over play
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Erik Erikson
Combined ego psych w/psychosoc life span theory: human bx result of interaction btwn internal world of the psyche & external social world Proposed dev occurs in response to social crises, series of stages
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Object Relations Theory
Focused on capacity to have mutually satisfying interpersonal relationships Object= relationship of infant to another person Proposed an inherent drive toward satisfying object relationships Therapy focused on integrating split off parts of self
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Melanie Klein
Object Relations theorist; Described splitting as major defense mech when infant has hostile feelings toward loved object, which prevents object constancy (ability to recognize the object as one person w/good and bad tendencies -Worked w/children, saw play as a form of free association
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D.W. Winnicott
Emphasized importance of being a "good enough mother Described pathology as result of abandoning true self for a false self Importance of Transitional Object to link children to mothers
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Margaret Mahler
Object Relations Theorist Proposed development through processes of separation (become distinct phys entity through distancing) & individuation (become psychologically ind thru dev of mature ego fxs)
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Self Psychology
KOHUT Focused on infantile development of narcissism-healthy/natural focus on getting needs met Appr caretaking satisfies selfobject needs (mirroring, idealizing, and twinship)
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Self psychologists focus on ____ ___ w/pts and prefer __ __ interpretations
empathic attunement | experience near
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According to Neo Freudians, pathology results from:
faulty learning | characterological maladaptive style of interacting w/environment
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In therapy, NeoFreudians:
focus on identifying & correcting misinterpretations re:the bx of others
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Major Neo-Freudian theorists
Harry Stack Sullivan Karen Horney Erich Fromm
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Harry Stack Sullivan
neo Freudian | Interpersonal theory-personality only exists in emotional exchange w/other ppl
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Sullivan's 3 modes of existence
Prototaxic-birth to 7 mos, isolated sensory exp Parataxic-8 to 11 mos, sequential sensations serves as only conception of causality Syntaxic- 12 mos to 2 yrs; causal sensation, logic, ability to predict based on knowledge
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Interpersonal Therapy (IPT): 4 commonly targeted areas
``` Based largely on Sullivan's work Focused on here & now 4 commonly targeted areas: Grief Role dispute Role Transition Interpersonal deficits ```
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Karen Horney
``` NeoFreudian Neurosis is culturally defined construct 3 neurotic trends: 1. Moving compliantly toward others 2. Moving aggressively toward others 3. Moving detachedly away from others ```
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Erich Fromm
NeoFreudian Incorp concepts from Marx & existentialism believed freedom frightened ppl 2 modes of existence: "having" and "being" healthier ppl live in "being" mode
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Alfred Adler
Asserted humans motivated by social (aggressive) rather than sexual urges Happiness related to social connectedness & ability to transcend self Pathology result of desire for belonging mistakenly channeled into power, attention, inadequacy or revenge
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Acc to Adler, a person is more likely to engage in maladaptive bx if they _____
are more focused on struggle for power at the expense of social interest
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Adler proposed that neurosis is result of compensation for natural feelings of ____by adopting unproductive lifestyle
Inadequacy
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In therapy Adlerians look for ___ and _____; focus on encouraging the pt
mistaken goals; faulty assumptions
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Adlerians emphasize a ____ view of bx, meaning that bx is seen as determined by future rather than the past
teleological
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STEP Program
Systematic Training in Effective Parenting Adler's work applied to education & parenting Democratic approach to parenting that values child's contributions Understand misbehavior as reflecting 4 mistaken goals (attention, power, revenge, giving up)
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Jungian Psychology: structure of psyche incl:
Conscious ego Personal unconscious Collective unconscious
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Collective Unconscious
Contains archetypes-primordial images/ideas that are inherited & common to all humans from beg of life
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In Jungian Psychology, neurosis is result of
struggle to free from interference of archetypes w/progress toward personality integration -we are striving toward psychological maturity, or individuation
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Humanism/Existentialism focus on entering the pt's subjective world, also known as a ______ approach
phenomenological
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Hum & Existentialism emphasize____ and focus on ___
freedom, choice, meaning, purpose, autonomy; the present
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Key figure in humanist psych, ___, believed we proceed thru hierarchy of needs toward self actualization
Maslow
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Existentialists:
believe no internal nature, no intrinsic meaning, have to make something of what is meaningless
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Client/Person Centered Therapy
Rogers Central concept: Phenomenal self, or private work of experience & meaning; therapist creates accepting atmosphere where clients grow thru the rel, form more pos vioew of self, and direct themselves toward more self actualizing patterns of bx therapist clarifies feelings, without judging or elaborating on them
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3 characteristics of Client Centered Therapy
Empathy Warmth Genuineness
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Gestalt Therapy
Perls Focus of therapy is becoming aware of whole personality by discovering those aspects blocked from awareness Perceptions based on gestalts (combos of figure-what is attended to- and ground- what is ignored) *therapy is active & focused on awareness, experience, affective expression, not cognitive analysis of bx
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Gestalt techniques
Empty chair-take both sides of conflict, pretend to speak to someone for whom client has unresolved feelings Dreams- client take on different roles in the dream, reflecting different aspects of the person
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Reality Therapy
Glasser Key feature is responsibility- clarify pt's values & help them evaluate current bx in relation to values Help clients decide on realistic solutions, use of contracts
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Choice Theory, or Control Theory
Key element of reality therapy proposes we create an inner "need satisfying world" and bx is an attempt to control our perceptions of the external world to fit the internal world
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Schools Without Failures
based on Glasser's reality therapy | used to reduce dropout rates
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Transactional Analysis (TA)
Berne looks at intent behind communication and eliminates deceit Involves structural analysis, transactional analysis, analysis of games, & script analysis concept of life scripts
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Conditions treated by hypnosis
Chronic pain-medium trance (relief) deep trance (like anesthesia) asthma conversion sxs substance use
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Common biofeedback procedures
Thermal biofeedback- treats migraines & renoads dis Electromyography (EMG)-measures surface muscle tension; treats tension headaches, TMJ, back pain Electroencephalography (EEG)-brain wave; ADHD, seizure disorders; targets alpha waves Galvanic Skin Response-sweatiness, treats GAD
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Feminist therapists
View sexism as underlying problems, don't focus on pathology Egalitarian relationship Advocate for sociopolitical change
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Transtheoretical Model of Bx Change
``` Prochaska Stages of Change Precontemplation Contemplation Preparation Action Maintenance ```
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Five Factor Theory of Personality/The Big 5 | OCEAN
Costa & McCrae Factor analysis of previous research on pers traits yielded 5 basic traits: Openness to experience Conscientiousness Extroversion Agreeableness Neuroticism-high scores are insecure, anxious, moody
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____ is the big 5 trait most consistently assoc w/job success
Conscientiousness
108
2 Major Theories influencing Family Therapy
General Systems Theory | Cybernetics
109
Cybernetics
Circular nature of feedback loops; neg feedback loops maintain status quo in the system pos feedback loops increases change
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Marital schism & marital skew
Lidz-psychodynamic family therapy 2 types of deviant marital relationships Schism- severe discord between parents, seek support from children, attempt to diminish worth of other parent Skew- skewed toward meeting needs of one family member at the expense of another *Both lack role reciprocity (common understanding & acceptance of each other's roles & values) Can use family sculpting as a technique
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Object Relations Family Therapy
Framo Family members project unwanted elements of self onto others, such that therapy is focused on increasing awareness re: what is being projected Framo known for meeting w/entire family of origin when working w/a troubled couple
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Structural Family Therapy
Minuchin Family viewed as a system, assessed along dimensions of: Hierarchy of power Clarity & firmness of boundaries Sig alliances & splits *Therapist acts as expert, diagnosing & correcting dysfunctional elements Therapist 1st joins the family, then shifts family's positions to strengthen parental hierarchy/create clear & flexible boundaries
113
Minuchin's 3 chronic boundary problems
Triangulation-child caught in middle, ultimately becomes paralyzed Detouring-false sense of harmony btwn parents, who blame one child for family difficulties Stable Coalition-parent unites w/child against other parent
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In structural family therapy, what strategies unbalance family's homeostasis
Therapist taking sides, blaming, coalitions
115
Communications Family Therapists area also called the ___ group. They coined the term ___ ___
MRI; double bind
116
3 elements of double bind communication acc to MRI group
1. injunction telling person that if they do or don't do something, they will be punished 2. second nonverbal injunction conflicting with the first at an abstract level 3. tertiary injunction prohibiting victim from escaping the field
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Communications family therapy sometimes uses paradoxical interventions, like _____
prescribing the symptom
118
Strategic Family Therapy
Haley combo of structural & comm family therapies Normal family fxing involves flexibility, repertoire for problem soliving, clear rules around hierarchy *Tx focused on resolving presenting concerns without addressing underlying conflicts and pathology
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Systemic Family Therapy
Milan group General Systems theory, cyberkinetics (feedback loops), components of strategic theory (communication, reframing, paradox)
120
Key Aspects of Systemic Family Therapy
Circular Questioning- aims at gathering info while also introducing new info into family system. ex- each family member is asked to express views on relationships & differences between other family members Prescription of Rituals- alters family's direction; typically incl secrecy, isolation, recording in notebooks, parental outings framed as disappearance
121
Family Systems Therapy
Bowen; Central concepts: Family Emotional System (oneness of emotions within family, definite patterns of reactivity) Multigenerational transmission process of pathology Originated genograms Assesses degree to which families are fused and emotional triangles
122
Goal of tx in Family Systems Therapy
Personal differentiation from family of origin Therapist works to shift the "hot triangle" & works w/most psych available family member to achieve enough differentiation to avoid triangle happening again
123
Solution Focused Therapy
Steve de Shazer; brief 3 to 4 sessions Clients encouraged to focus on strengths, id solutions Built on assumption that expectations are powerful
124
Techniques assoc w/solution focused therapy
Miracle question-if this prob was miraculously solved, how would you know? What would be different? Exception question- Think about a time you didn't have this problem, what was different in your life? Scaling question- rate problem on scale from 0 to 10, helps reduce all or nothing thinking
125
Narrative Therapy
Michael White Pathology thought to be result of ppl developing stories that "problem saturated descriptions" filled w/powerlessness Client asked to re-write story as struggle for control w/sx Ex- encopretic boy writes story about "sneaky poo" writes about time didn't give into sneaky poo. when there is success, might ask "what does this tell you about yourself?"
126
Behavioral Family Therapy
Believes pathology result of families reinforcing neg bx through attention Interventions: changing contingencies of social reinf & improving communication
127
Cog Bx Family Therapy
Therapist assesses cog appraisals family members make of each other, promotes positive relationship related cognitions
128
Marital Bx Therapy
``` Involves: Behavioral analysis of couple Positive reciprocity established Communication is taught Problem solving skills improved ```
129
Richard Stuart Marital Therapy
Incorp operant learning & social exchange theory proposes bx maintained in rel by ratio of costs to benefits, where daily bx exchanges contr to satisfaction or dissatisfaction Strategy of caring days: each day spouse performs a bx requested by spouse
130
Yalom's 12 therapeutic benefits of group treatment
``` Insight Instillation of hope Universality Imparting Info Altruism Corrective recapitulation of primary family group Dev of socializing techniques Imitative bx Interpersonal learning Group cohesiveness Catharsis Existential factor ```
131
_____ is the most critical component of group therapy success
Cohesiveness- greater acceptance & understanding, permit more conflict
132
3 stages of group tx, acc to Yalom
Initial Stage- participation hesitant, restricted, superficial interactions, members give & seek advice, mostly talk to therapists not each other Second Stage- conflict among group members, rebellion toward leaders, attempts at dominance Third Stage-only if 2nd successfully negotiated, closeness, intimacy, cohesion
133
Ideal group composition includes members who are ___ in term of ___ and ___ in terms of ego strength
Heterogeneous; conflict; homogeneous
134
Homeostatic equilibrium
Basis of crisis theory, proposes that at equil, usual coping skills are sufficient. During crisis, person faced w/obstacle insurmountable by customary problem solving
135
4 Phases of Crisis Situation (Caplan)
1. Beginning, emotional tension, disorganization, efforts to cope w/previously learned mechanisms 2. Existing coping doesn't work, further disorganization 3. Increased tension, help seeking, change of direction/goals 4. If these efforts don't work, extensive pers disorganization & emotional breakdown may occur
136
Steps of crisis tx
Estab rapport Review steps leading to crisis Help ct gain understanding of maladaptive reactions Help ct develop more adaptive ways of coping *Goal is restoration to pre-crisis level of fxing, different from therapy where goal is growth
137
Community Mental Health Centers Act (1963)
Root of community psych movement, estab comm mental health centers to provide continuum of services for early intervention
138
Goal of Community Psych
focuses on prevention, extends services beyond agencies & clinics to more natural settings (churches, schools, etc), allows for training of non professionals
139
4 Categories of Consultation (Caplan) * Client centered-focused on a client * Consultee Centered-focused on group of clients
Client centered case consultation-individual case Consultee Centered case consultation-focused on helping therapist problem solve difficulties working w/clients Consultee Centered Administrative consult-focused on targeting consultee's issues that are impeding program change Program centered admin consult-focus on development, expansion, or modification of a program
140
3 Levels of prevention in Community Psych
Primary-prevent occurrence of new cases of a disease or disorder, often focused on education & competence training Ex- Purple ribbon program, vaccinations Secondary- Early id & prompt tx of an illness or d/o that already exists Ex- academic screening throughout schooling; psychological first aid after a tragedy Tertiary- focused on reducing negative impact of an established, serious issue; ex- day treatment centers for schiz, 12 step programs
141
Expressive vs. Instrumental Spousal abuse
Expressive- less deliberate, result of emotional reactivity Instrumental- More deliberate means of control *left untreatment, expressive likely to become instrumental
142
Impact of divorce acc to age of child
3 to 6 yr old- feel responsible 7 to 12- decreased school perf Adol-feel could have prevented divorce, but hurt & critical of parents Recovery tends to take 3 to 5 years
143
Meta analysis of divorce outcomes
Adult children of divorced parents: | higher depression, marital probs, lower SES & health
144
Earliest meta analysis
Eysenck (1952)- found that ppl treated related to neuroticism did worse over 2 year period, highly criticized methods
145
Spontaneous improvement rate in psychotherapy
around 40%
146
Avg effect size of treatment
.85, so treated person better off that 80% of untreated sample
147
Client variable impacting tx response
Outcome research indicates that charac of pt account for most variability in effectiveness Pt's ability to relate & learn new skills primary factor
148
3 therapist factors accounting for 35% of treatment outcome variance
Attractiveness Trustworthiness Expertness
149
Methods for monitoring tx implementation, utilization, & quality
Total Quality Management Quality Assurance Utilization Review Risk Management
150
5 premises of Total Quality Management
1. Customer Focus 2. Total involvement (all team members aware of what other members are doing) 3. Measurement 4. Systematic Support - innovative problem solving 5. Continuous Improvement
151
Outcome research: what factors are most important for lack of improvement in psychotherapy?
Client factors (dx, motivation, severity)
152
Theme interference problems
Problems of the supervisee/consultee that impact pt progress; could be targeted with consultee-centered case consultation
153
Thomas Szasz,
whose somewhat controversial book, "The Myth of Mental Illness," argues that psychiatric diagnoses are labels devoid of significance.
154
Avg effect size for psychotherapy outcome research
.85 (treated ppl do about .85 of a standard deviation better than untreated)
155
Jungian view of transference
projection of the personal and collective unconscious.
156
M Seligman's theory of learned optimism
attributions of optimistic ppl are opposite of depressed ppl external, unstable, specific attributions for neg life events
157
Basic requirements of token economy
Target bxs Choice of reinforcer Rate of exchange