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EPPP Clinical Psychology 2


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Freud: Repression
Rejection from consciousness of painful or shameful experiences. Prevents unacceptable impulses or desires from reaching consciousness. It is an unconscious process.
Freud: Reaction Formation
Replaces urges that are unacceptable to the ego with their opposites. Typical of obsessive disorders.
Freud: Projection
Attributing unacceptable wishes to another.
Freud: Displacement
Transferring an emotion from the original idea or object to a more acceptable (i.e., safer) one. People with phobias displace their fears onto other objects.
Freud: Sublimation
Transformation of libidinal urges into socially acceptable interests and activities. Mature DM.
Four steps of psychoanalysis
Working Through
Important terms: Carl Jung
Analytic Psychology
Individual (personal) Unconscious
Collective Unconscious
Extroversion vs. Introversion
Carl Jung: Archetypes
Predispositions to perception and emotion shared by all people
Important terms: Alfred Adler
Individual Psychology
Inferiority complex
Compensatory patterns of behavior
Style of Life
STEP training based on whose theoretical approach?
Alfred Adler
Examples of Neo-Freudians
Karen Horney
Harry Stack Sullivan
Erich Fromm
Important concepts: Neo-Freudians
Importance of instinctual forces downplayed
Focus on social and cultural determinants of personality
Key concepts: Karen Horney
Parental behaviors can cause basic anxiety.
Modes of relating to others (e.g., movement toward others, movement against others).
Key concepts: Harry Stack Sullivan
Role of cognitive experience in personality development.
Prototaxic, parataxic, and syntaxic modes.
Neurotic behavior often caused by parataxic distortions.
Key concepts: Erich Fromm
Role of societal factors in personality development.
Five character styles: receptive, exploitative, hoarding, marketing, productive.
Key concepts: Ego-Analysts
Anna Freud, David Rappoport, Heinz Hartmann.
Emphasis on Ego's role in personality development.
Ego-defensive vs. Ego-autonomous functions.
Psychopathology related to ego losing autonomy from id.
Opportunities for "re-parenting".
Key concepts: Object-relations Theory
Klein, Fairbairn, Mahler, Kernberg, Kohut, Winnicott.
Object introjects
"Psychological birth" around age 2-3.
"Splitting" representations of others: all good or all bad.
Type of "re-parenting"
Key concepts: Heinz Kohut
Developer of Self-Psychology
Work on Narcissism
Key concepts: Client-Centered Therapy
Carl Rogers

Self-actualizing tendency

Incongruence: Conflict between self-concept and the person's experience

Three characteristics of therapy: Empathetic Understanding, Unconditional Positive Regard, Congruence (honesty, genuineness) (research hasn't supported notion that these three conditions are related to positive outcomes)
Key concepts: Existential Therapy
Struggle between individual and "ultimate concerns" of existence (death, meaninglessness, etc.)

Two types of anxiety: normal (existential) anxiety and neurotic anxiety
Key concepts: Gestalt Therapy
Fritz Perls

Assuming responsibility and living fully as a whole, integrated person.

Self (promotes actualization, growth, awareness; "wants") and Self-image (imposes external standards on the self and impairs growth; "shoulds")

Boundary disturbances: Introjection, Projection, Retroflection, Deflection, Confluence, Isolation. BD's become pathological when they exist outside the person's awareness and are maladaptive.

Awareness is everything: need to become aware of needs, organize behavior to meet needs. Awareness allows accurate interpretation of the environment.

Focus on present reality; here-and-now awareness

Empty chair technique
Key Concepts: Reality Therapy
William Glasser

Focus the client on present behavior, be realistic in fulfilling needs without harming self or others, taking responsibility for actions

Five basic needs: Survival, Power, Belonging, Freedom, Fun

"Success Identity" (individual meets needs responsibly) vs. "Failure Identity" (needs met in an irresponsible manner)

Schools Without Failure (SWF) program: application in educational settings
Key concepts: Transactional Analysis
Eric Berne

Ego States: child, parent, adult. Interactions (transactions) are primarily between ego states.

Strokes: positive or negative recognition from others

Scripts: person's life plan, characteristic pattern of giving and receiving strokes.

4 Life Positions: 1) I'm OK - You're OK; 2) I'm OK - You're not OK, etc. All children begin in 1st life position, then modified by parenting.

Transactions: Complementary, Crossed (adult:child), Ulterior (dual message)

Games: Ulterior transactions ("Now I've Got You, You SOB")

Goal: Alter maladaptive life positions and life scripts and integrate three ego states.
Key concepts: Feminist Therapy
Assumption that social roles and socialization are important determinants of behavior.

Social role conflicts: give rise to psychological conflicts.

Focus on sexism and oppression of women.

Goals: Empowerment; show clients alternative social roles and options. Therapist acts as model.

Doctor-patient relationship is "demystified." Equalization of power.

Non-Sexist Therapy: removing sexist biases from treatment. Less political than feminist therapy.

Feminist Object-Relations Theory (e.g., Nancy Chodorow): incorporation of psychodynamic principles; focus on gender-related differences in mother-child relationship; men and women should be equally responsible for child-rearing.

Self-in-Relation Theory: sense of self depends on connections with others; progression from infantile dependency to mature interdependency; relational self develops through internalization of caretaker's empathetic attitude; psychopathology considered inevitable outcome of disconnection with others; goal of therapy: increase interpersonal connections (particularly mother-daughter relationship)
Key concepts: Beck's Cognitive Therapy
Collaborative process of empirical investigation, reality testing, and problem-solving between therapist and patient. Patient's maladaptive interpretations and conclusions are treated as testable hypotheses.

Automatic thoughts: individual's appraisals that arise spontaneously in response to specific stimuli or situations.

Schemas (or Core Beliefs, Underlying Assumptions): internal models of self and world that develop through experience; facilitate information processing

Cognitive Distortions: Systematic errors in reasoning that link dysfunctional schemas and automatic thoughts; information often distorted to fit relevant schema, resulting in dysfunctional automatic thoughts.

Cognitive Triad: negative views of the self, the future, and the world
Examples of cognitive distortions:
Arbitrary Inference

Selective Abstraction


Magnification and Minimization


Dichotomous Thinking
Key concepts: Rational Emotive Therapy
Albert Ellis

"ABC" theory of human disturbance: A - experience of undesirable events, B - rational and irrational beliefs about these events, and C - creation of appropriate consequences with rational beliefs, or creation of inappropriate and dysfunctional consequences with irrational beliefs.

Goal: modify irrational beliefs about life events

Irrational beliefs stems from "musts".

Direct confrontation of irrational beliefs, contingency contracting, in-vivo desensitization, response prevention, psychoeducational methods.
Major differences between Beck's CT and Ellis' RET
RET: irrational thoughts lead to maladaptive behavior; CT: thoughts dysfunctional when they interfere with normal cog processing, not necessarily bc they are irrational.

RET: more heavily behavioral.

RET: therapist more likely to challenge patient's dysfunctional beliefs; CT: patient usually encouraged to test these beliefs on his or her own.
Key concepts: Self-Control Techniques
Self-Monitoring: (minor and short-term effects)

Stimulus Control: modifying existing S-R relationship, or creating a new one; examples: narrowing, cue strengthening, competing responses. Most useful when implemented at the beginning of a response chain.
Three steps of Stress Innoculation Training
1) cognitive preparation (education)

2) Skills aquisition

3) Practice (application)

(good for aggression and impulsive anger problems)
Key concepts: Hypnotherapy
Three factors involved: 1) absorption, 2) dissociation, 3) suggestibility.

Individuals have greater confidence in memories retrieved under hypnosis, but memories are likely to be distorted.

Used for: dissociative disorders, PTSD, habit or self control disorders (smoking, overeating, substance use), phobias, and generalized anxiety.

Contraindicated for: psychotic disorders, paranoid and suspicious patients, OCD traits. Also, severely depressed and manic patients are hard to hypnotize.

Few studies comparing with other treatments.
Key concepts: Biofeedback
Used for psychophysiological disorders (e.g., hypertension, headaches, ulcers).

For many problems, not much more effective than relaxation training.

However, it's the treatment of choice for fecal incontinence and Raynaud's disease.

EMG biofeedback for tension headaches.

Skin Temperature biofeedback for migraines.
Other CBT techniques: Paradoxical Intention
Instructing clients to do or wish for the things they fear. Prescribing the symptom.

Purpose is to circumvent anticipatory anxiety.

Most commonly used to treat insomnia. Results are mixed.
Purposes of guided imagery techniques
1) help identify automatic thoughts

2) increase self-control

3) distraction technique

4) visualize desired life outcomes
Stages in Prochaska and DeClemente's Transtheoretical Model of Change
1) Precontemplation: little insight of need for change

2) Contemplation: considering change (in the next 6 months) but not committed to it.

3) Preparation: clear intent to take action within the next month; may have begun taking small steps.

4) Action: considerable time and energy devoted to change; obvious to others

5) Maintenance: change has lasted 6 months, person consolidating change and taking steps to prevent relapse. May last as long as a lifetime.
Motivational Interviewing
Miller and Rollnick

Based on Prochaska and DeClemente's Transtheoretical Model of Change

Goal: help individuals move from precontemplation stage through contemplation, toward committment to change.

Five basic principles: express empathy, develop discrepancy, avoid argumentation and direct confrontation, roll with resistance, support self-efficacy for change.
Key Concepts: Systems Theory
family as an "open system" (able to receive energy by interacting with the environment) vs a "closed system" (resistant to change due to rigid or impermeable boundaries)

Properties of the family system:

Wholeness: parts are interrelated

Non-summativity: whole greater than sum of parts

Equifinality: patterns of behavior more important than specific controversies

Equipotentiality: One cause can lead to different results (multifinality)


Negative Feedback: maintenance of homeostasis by correcting deviations in the status quo.

Positive feedback: disruption of homeostasis by encourgaging or creating deviations in the status quo.
Communication/Interaction Therapy
All behavior is a form of communication

1960s research at Mental Research Institute in Palo Alto

Double-Bind Communication: two aspects of the same communication contradict each other.

Metacommunication: two levels of communication: "report" (intended verbal statement) and "command" (implicit non-verbal message; metacommunication)

Symmetrical communications: equality between communicators

Complementary communications: inequality in communicators; reciprocal nature; parent/child or therapist/client
Extended Family Systems Therapy
Murray Bowen

Family dysfunction as part of an intergenerational process.

Theoretical constructs: Differentiation of Self (vs. "fused" with other family members' emotions and problems), Triangulation, Nuclear Family Emotional System (mechanisms used to deal with tension and instability), Family Projective Process (projection of parental a family dysfunction onto children), Emotional Cutoff (methods used by children to remove themselves from emotional ties to parents), Multigenerational Transmission Process (escalation of dysfunction through the generations), Sibling Position (birth order), Societal Regression (impact of societal stress on family system)

Goals and Techniques: differentiation of self, use of genograms, Triangulation (therapist as third family member)

Tx typically with just husband and wife
Structural Family Therapy
Salvador Minuchin

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