EPPP Clinical
Terms
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- Pros and cons of clozapine
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An atypical antipsychotic
Pros:
often effective when conventional antipsychotics are not
does not produce tardive dyskinesia
Con:
causes aganulocytosis - Diagnostic criteria for bulemia
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binge eating
inappropriate compensatory behavior to lose weight
for at least 3 months - Therapy dropout rates by ethnic group
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Highest for Afro-Americans
Lowest for Asian-Americans - Treatment for smoking cessation
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Nicotine replacement therapy AND
Behavioral intervention - When do you use a DSM disgnosis of NOS
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Not all critera are met
Symptoms meet criteria for diagnosis under study
Uncertainty about etiology
Incomplete information
(Provisional would be added to diagnosis) - What is the greatest risk factor for childhood depression?
- Parental depression
- Def: phenothiazines
- Antipsychotics
- Def: cognitive triad of depressive cognitions
- Negative beliefs about the self, expectations of the world and the future
- What is the most effective way for the police to deal with domestic violence?
- Arresting the perpetrator results in the lowest rate of recidivism
- Relationship of psychology to cancer onset and recovery
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Unrelated to onset
Positively related to recovery and quality of life - Ethnic matching of client to therapist most effects...
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Treatment length (not outcome)
Especially with Afro-Amer clients and non-Afro-Amer therapists
Ethnic matching most beneficial for Asian and Hispanic Americans - Stages of change
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Precontemplation - no change considered
Contemplation - aware of need but not committed
Preparation - clear intent to take action
Action
Maintenance - CBT approach to panic disorder
- Indentifying and modifying interpretation of attacks and associated physical symptoms
- Relationship between therapy and outcome
- Moderate overall, but stronger when the symptoms are severe
- Central development issue in BPD (Kernberg)
- Defense against child's intrapsychic aggressive impulses
- Difference between Freud and Jung
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For Freud unconscious is personal
For Jung unconscious is both personal and collective - Adlerian explanation for childhood misbehavior
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Child's effort to obtain
attention
power
revenge
or to display deficiency - Adlerian intervention for childhood misbehavior
- Identify real goals of the behavior and find better ways to obtain them
- Use: CPI (California Psychological Inventory)
- Broad personality test for non-pathologic individuals
- Def: reaction formation *
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Defense in which an anxiety provoking impulse is replaced by its opposite
Eg hatred by oversolicitude
Typical of obsessive disorders - Def: projection
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Defense attributing unacceptable wishes to another
Includes prejudice and hypervigilance: the other person carries the guilt - Def: fixation
- Defense: Return to an earlier stage of development under stress
- Def: projective identification
- Defense: projection of unwanted aspects of self onto another creating a sense of oneness
- Adler's psychology
- Psychopathology is a maladaptive attempt to compensate for inferiority
- Neo-Freudian psychology
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Horney, Sullivan, Fromm
Emphasis on cultural and social determinants of personality - Ego analysts
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Anna Freud, Heinz Hartman
Focus on ego strength - Object-relations theory /self psychology
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Mahler, Winnicott, Kernberg, Fairbairn, Melanie Klein, Kohut
Focus on internal representations of others or introjects from childhood
Psychopathology develops from damaged or weak introjects - Parataxic distortions (Sullivan)
- Dealing w others as if they were significant persons from early life (transference?)
- Kernberg's account of BPD
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Results from failure to develop appropriate introjects
As a result of parental psychopathology or abuse
Characterized by splitting, aggression and unstable self-image - Def: introjection
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Absorbing information without understanding or assimilation (Gestalt)
Incorporating aspects of other people in your self image (object relations theory) - Def: confluence (Gestalt)
- Permeable self boundary, self merging with others
- Gestalt (Fritz Perls) technique
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Focus on here and now
I statements
Dream analysis
Empty chair technique - Stress innoculation training
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Treatment of aggressive or impulsive behavior
1. education about maladaptions
2. rehearse new skills and thinking
3. apply skills to real life - Def: paradoxical intention
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Instruction to do what you fear
Goal is to circumvent anticipatory anxiety - Def: stimulus control
- Avoiding triggers for maladaptive behavior
- Goal: Bowen's extended systems therapy
- Differentiation of self
- Goal: Minuchin's structural family therapy
- Disrupt dysfunctional processes by modifying aspects of family structure (eg rules boundaries, coalitions)
- Strategies associated with Haley's strategic family therapy
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Paradoxical directives
Reframing
Circular questioning - Def: negative feedback in family systems theory
- Maintenance of homeostasis by attempting to correct deviations in status quo
- Def: positive feedback in family systems theory
- Disruption of homeostatsis by encouraging or creating deviations in the status quo
- Def: joining in Minuchin's family therapy
- Therapist blends with family using mimesis (adopting family's style and language) and tracking (identifying with family values and history)
- Def: circular questioning in Haley's strategic family therapy
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Therapist asks each family member to describe relationships and notes differences in accounts.
Eg who's the angriest? - Benefits of group therapy
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Acquiring interpersonal skills
Expression of feeling
Cohesiveness
Instillation of hope
Sharing of information
Universality
Sense of belonging - Stages of crisis intervention
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Formulation
crisis identification
Implementation
assessment of prior life
setting of short term goals
implementation of goals
Termination
progress assessment
discussion of termination and beyond - How was the MMPI developed?
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empirical criterion keying
retention of items differentiating psychiatric from non-psychiatric populations - MMPI scores
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Reported as T-scores
Mean 50, SD 10
Deviant clinical subscale T score 65
High validity scores invalidate test - MMPI Clinical scales
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HS hypochondriasis
D depression
Hy physical symptoms with psychic origin
Pd Psychopathic deviant
Mf masculinity-femininity
Pa paranoia
Pt other neurotic, eg phobia, compulsions
Sc thought disorder, bizarre behavior
Ma manic style, inability to concentrate
Si introversion/extroversion - MMPI Validity scales *
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? unanswered questions
L hyper socially correct answers
F rarely endorsed items - high F indicates real or attempted deviance
K defensiveness
TRIN consistent response patterns - Other personality inventories
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Millon Clinical Multiaxial Inventory (MCMI-III) - DSM categories
Symptom Checklist 90 (SCL-90) - used in research - Rorschach administration steps
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1. Introduction - allay anxiety
2. Instructions - say what you see
3. Response - free association, tracking verbatim, time, and unusual responses
4. Inquiry - after all cards presented; for clarification and collection of additional information - Rorschach scoring categories
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Location - inkblot areas, including whole or detail
Determinants - form(F), movement, shading or color that determined the response
Content - human (expected), animal (children)
Populars - commonness of given responses - Stroop test
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Name the color in which a different color word is printed
Left frontal lobe lesions impair performance, because response inhibition is impaired - Def: emic
- Studying culture from within
- Def: etic
- Studying culture from the outside
- Stages of the minority development model (MID)
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Conformity
Dissonance
Resistance and immersion
Introspection
Synergistic articulation and awareness - Helms' White Racial Identity Development Model *
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Contact (lack of)
Disintegration (confusing racial awareness)
Reintegration (prejudice)
Pseudo-independence (thoughtful revisiting of prejudice)
Immersion-emersion (separate and equal; racially proud but not racist)
Autonomy (integration; non-racist identity; seek interaction)
designed to help therapists understand inter-racial tensions - McLaughlin's stages of homosexual identity formation
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Isolation
Alienation and shame
Self rejection
Passing as straight
Consolidating a self identity
Acculturation
Integration of public and private self
Pride and synthesis - Berry's acculturation model
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Integration
high on minority
high on mainstream culture
Assimilation
low on minority
high on mainstream culture
Separation
high on minority
rejection of mainstream culture
Marginalization
low on minority
rejection of mainstream culture - Considerations in treating Hispanic clients
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Prefer an active goal-orientation
Stress personal contact and attention
Consider family - Considerations in treating Native American clients
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Importance of tribe and family
Approach: non-directive,
history-oriented, accepting, cooperative
Goals: happiness, wisdom, peace with nature
Therapist attitude: reserved, open, accepting, listening - Considerations in treating Asian clients
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Approach: direct, structured, short-term; address problem as academic or vocational
Education about therapy process - Purpose of defense mechanisms (Freudian)
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Prevent unconscious drives and impulses from reaching awareness
Anxiety results from imperfect defense - MMPI 1990 revision
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Updated norms
Addition of new content scales
Change of cutoff from 70 to 65
Clinical scales unchanged - Def: calibration
- Return to homeostasis engineered by the family
- Def: equifinality
- Different causes producing the same result
- Def: equipotentiality
- Single cause may produce different results
- Nigrescence theory stages (Cross) *
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Pre-encounter - mainstream world view; problems are own
Encounter - event that precipitates search for A-A identity
Immersion/emersion - denegration of mainstream and idealization of A-A culture
Internalization - conflicts resolved; move toward non-racist view
Internalization/commitment - commitment to political activism - Def: multisystems / ecostructural approach to working with Afro-American families (Boyd-Franklin)
- Target individual, immediate and extended family, nonblood relations and friends, church and other community services
- Desc: SCL-90
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Symptom CheckList is a self report measure of general psychicatric symptoms such as depression, anxiety, somatization, obsessive-compulsiveness and hostility
Question rated on a scale of 1-5 - Risk factors for adolescent suicide
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depression
use of drugs and alcohol
anti-social behavior - Kohut's explanation and treatment for narcissim
- Narcissim is caused by lack of empathy and is treated with empathy
- Def: semantic paralexia
- Dyslexic reading error in which the child responds with something semantically similar to the stimulus (eg dog in response to cat)
- Reason for continued brain growth after birth
- Increasing dendrites and mylination
- Def: state dependence
- Memory is maximized if we are in the same emotional state during learning and recall
- % of clients profiting from psychotherapy
- 75
- Relative efficacy of behavioral vs non-behavioral treatment for children and adolescents (Weisz)
- Behavioral treatments significantly more effective
- Desc Reality Therapy *
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Premise is that people have innate, powerful needs:
survival
belonoging
power
fun
freedom
goal of therapy is to discover what needs are not satisfied - Treatment of choice for agoraphobia
- Flooding, with 75% long term improvement
- For Beck, suicidal individuals are characterized by
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hopelessness
poor problem solving skills - Terms associate with Bower
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triangulation - means of reducing tension between 2 members in a family by focusing on a third
emotional divorce - Characteristics of disengaged families (Minuchin)
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Rigid boundaries
Family members isolated from one another
Conflict avoidant
Parents inattentive to children's needs - Greenson's stages of psychoanalytic treatment
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Confrontation
Clarification
Interpretation
Working through - Minuchin's boundary disturbances *
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Triangulation - parent demands child side with him/her
Detouring - parents either consistently attack or defend the child to avoid tensions between themselves
Stable coalition - child and one parent 'gang up' on other parent
Enmeshment - unclear boundaries that promote dependence - Afro-American use of mental health services
- For solving practical rather than emotional problems
- Therapy making most use of imagry techniques
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CBT
Used to help identify automatic thoughts, increase self-control, distraction or to visualize life outcomes - Freud's explanation for specific phobias
- Result of unresolved Oedipal conflict centered on the same sex parent
- Techniques in structural family therapy (Minuchin)
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Enactments
Homework
Maps of family boundaries
Joining
Here and now focus - Central objectives of Gestalt therapy
- Awareness of self, environment and the nature of the self-environment boundary
- Terms associated with Bowen
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Triangulation - means of reducing tension and conflict between two family members who refocus their attention on a third
Emotional divorce - Def: social skills training
- A behavioral technique used to replace behavioral excesses and deficits with new behaviors
- Efficacy of psychotherapy for children and adolescents compared to adults *
- Similar
- Characterize Skinner's theory
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Focus is on environmental contingencies
Did not feel innate urges were very important - Freud's theory of personality
- established by age 6
- Horney's theory
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Basic anxiety causes one to
move toward others
move away from others
move against others - Def: self control
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For example, repeating affirmative statements to yourself
Effective in treating children afraid of the dark