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Clinical Psychology


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Freudian Structural Theory (drive theory)
Id, Ego, Superego
present at birth;
pleasure principle; seeks gratification
6 months;
reality principle
positpones gratification of id until appropriate;
realistic thinking and planning;
mediate b/w id and superego
4-5 YOA
society's standards;
block id
Anxiety in psychoanalysis
alerts ego to impending threats; if ego cant rid it then use defense mechanisms
social factors
teleogical approach (future goals)
Inferiority feelings
Style of lifeSTEP; STET
Jung's Analytical Therapy
past and future
interpersonal and social influences
Horney, Sullivan
anxiety is basis of neurosis and chld interpersonal relationships
recognition of cognitive factors in personality
Prototaxic, parataxic (see relationship b/w events but unrelated), syntaxic
maladaptive bx due to parataxic distortions
Object Relations
early relationships
Maladaptive Bx due to probs during seperation-individuation
Self Psychology
early childhood factors affect dev of cohesive sense of self;
personality caused by parents ability to provide factors for child to dev cohesive sense of self;
healhty vs pathological narcissism
Brief Psychodynamic Therapy
time limited
conrete goals
symptom focused
present bx
Interpersonal Therapy IPT
brief psychdynamic therapy
for depression (due to social roles and relationships)
interpersonal functioning
Humanistic Psychotherapies
Person-Centered Therapy
self actualizing
malad bx = incongruence b/w self and experience;
unconditional positive regard;
Gestalt Therapy
integrated "whole"
self and self image
boundary disturbances = malad bx
Integration of self into whole
empty chair; "I" stmts;
transference is bad
Reality Therapy
human bx is purposeful and comes from within individual not external
success vs failure ID
find ways to satisfy needs and dev success ID
General Systems Family Therapy
"whole" is interaction of parts
open or closed
identified patient; scapegoat
Feedback loops
neg = reduce deviation; status quo
pos = simplify deviation or change and disrupts system;can help promote change
Communication/Interaction Family Therapy
MRI; link b/w double bind comm and schizo;
alter interactional patterns
Paradoxical strategies
Extended Family Systems Therapy
beyond nuclear family;
Differentiation of self (sep emotion and intellect);
Emotional Triangle;
multigenerational dysfunction
therapeutic triangle; genogram;
increase differentiation
Structural Family Therapy
alter family structure (rigid triangle; power hierarchies; boundaries)
Rigid triangles (detouring, stable, triangulation)
joining (blend with family)
enactment; reframing
Strategic Family Therapy
transactional patterns;
interpersonal comm probs
insight = bad
pradoxical interventions
Milan Systematic Family Therapy
probs when family pattern is so fixed and members not making own choices;
circular patterns of action and reaction;
therapeutic team
Behavioral Family Therapy
operant conditioning and social learning
bx learned and kept through consequences;
marital and sex tx;
Object Relations Family Therapy
intrapsychic and interpersonal factors;
projective ID;
resolve attachments to introjects;
Yalom Group Therapy

Stages of Therapy (1-3)
1 = orientation, look at leader for approval

2 = conflict, rebellion;

3 = cohesiveness
High Cohesiveness =
better attendence, less dropout, more self-disclosure, adherence to norms
Feminist Therapy
emphasis on power differences b/w M and F
power differential b/w therapist and clt;
Feminist vs Nonsexist Therapy
both recognize impact of sexism and avoid gender-biased techniques;
Fem = priority is role of sociopolitical factors on F
Nonsex = individual factors and modify personal Bx
help recover memory
can produce pseudomemories
anxiety d/o and phobias, GAD, PTSD
Crisis Intervention
reach people in acute state of stress
ID what caused crisis
restore to previous functioning
most dreq = depression, sub sbuse, suicide attempt, marital probs;
suicide rates decrease in young W, F (most caller)
Primary Prevention
reduce prevalence
decrease incidence
i.e. meals on wheels, immunization programs
Secondary Prevention
decrease prevalence by reducing duration through early detection and intervention;
provide treatment;
i.e. screening tests to ID 1st graders with disabilities to provide educational intervention
Tertiary Prevention
reduce duration and consequence of disorders;
i.e. rehab, halfway houses
Stages of Consultation
entry = ID needs; resistance

diagnosis = gathering info; define prob; goals

implementation = choose interventions; make plan; implement it

Disengagement = eval consultation
Client-centered Case Consultation
working with consultee (therapist) to make plan for consultee to work mjore effectively with client (patient); consultant = expert
Consultee-Centered case Consultation
enhance consultee's performance in delivering services to group of clients;
focus on consultee's skills
Program-Centered Administrative Consultation
working with 1 or more administrators (consultees) to resolve probs in program
Consultee-Centered Administrative Consultation
help administrative-level personnel improve functioning so can be more effective in future with program dev, eval, etc
Parallel Process
occurs when therapist (supervisee) replicates probs and symptoms with SV that are being manifested by client;

if client is anxious and therapist cant help, therapist may enter SV anxious
Eysenck's psychotherapy research
effects of therapy small or none
72% in no-therapy had iprovements within 2 years of smyptoms
66% receiving ecclectic
44% with psychoanalytic
Smith, Glass and Miller research
ave client in therapy is better off than 80% of those who need therapy but remain untreated
effect size .85
Specific therapies and research
None are the best
CBT better for anxiety
psychotherapy with children and adolescence research
effects size .71
ave treated is better off than 76% of those untreated
Bx techniqes have larger effect size
therapy same for undercontrolled probs (ADHD)and overcontrolled (Dep)
therapy better for adol than children
Dose Dependent Effect of Therapy
longer tx has better outcome; levels off at 26 sessions
3 stages related to length of treatment
Remoralization - 1st few sessions; measures of well being

Remediation - second phase; focus on symptoms; 16 sessions

Rehabilitation - 3rd phase; unlearning bad bx and learn new; eval life functioning
Transtheoretical Model of Bx Change

5 stages
Prochaska and DiClemente;

Precontemplation - little insight into need for change; no change

Contemplation - aware of need for change; change within 6 months

Preparation - cledar intent to take action within next month

Action - take steps to bring about change

Maintenance - change lasted for 6 months; relapse prevention
Psychiatric Hospitalizations
M > F
M more acting out bx
admission rates higher for never married and lowest for widowed;
other races > W
25-44 YOA
Schizo most common Dx for 18-44
65+ is organic d/o
Therapist-Client Matching

Sue and Sue
increases # of sessions
benefits for Hisp-amer
if strong commitment to culture more likely to prefer same culture therapist
Utilization of Services
Anglos, AA, NA overutilize

Asian and H-Amer underutilize
Premature Termination
minorities more likely
AA higher early dropout
usually due to mistrust in credibility and cultural mistrust
Multicultural Counseling and Therapy (MCT)
dev of racial/cultural ID is important
2 frameworks - universal and culture-specific
Cultural Encapsulation
define reality according to own cultural assumptions and stereotypes;
disregard cultural differences;
Emic vs Etic Orientation
Emic - culture specific; used to understand culture; see things through eyes of members of culture

Etic - universal (culture general); view people from different cultures as same; traditional theory
Cultural Competence
scientific mindedness (form hypotheses about symptoms of culturally different clients not assigning Dx);
i.e. seeing spirits may be common cultural
have knowledge of other cultures
Cultural vs Functional Paranoia
cultural - healthy reaction to racism; doesnt disclose to W therapist due to fear of being hurt or misunderstood

Functional - unhealthy; unwillingness to disclose to therapist regardless of race due to mistrust; pathology
Intercultural Nonparanoiac Disclosure
Low Functional Paranoia; Low Cultural Paranoia; will self disclose to AA or W therapist
Functional Paranoiac
High Functional Low Cultural Paranoia;
nondiscriminative to both AA and W therapists; nondisclosure due to pathology; choose therapsit based on competence not race
Healthy Cultural Paranoiac
Low Functional High Cultural Paranoia;
self disclose to AA but not W therapist due to apst expereinces with racism; confront meaning of paranoia
Confluent Paranoiac
High Functional, High Cultural Paranoia;
nondisclosure to AA or W due to combo of pathology and racism; therapist should be same race

degree to which a member of a culturally-diverse group accepts and adheres to values; Bx of own group and majority group;
Integration, ASsimilation, Separation, Marginalization
Berry's Integration
maintain own (minority) culture but incorporates aspects of majority culture; bicultural ID
Berry's Assimilation
accepts majority culture while giving up own culture
Berry's Separation
person withdraws from majority culture and accepts own culture
Berry's Marginalization
person doesnt ID with either culture
Racial/Cultural ID Developmental Model (MID)
5 stages that people experience as attempt to understand self in terms of own culture, dominant culture, and relaitonship between 2 cultures.

Conformity, Dissonance, Resistance and Immersion, Introspection, Integrative Awareness;

progress linear through 5 stages; may remain at 1 stage or move forward or back due to changes in interactions

in families at diff stages = conflict
MID Conformity
positive attitudes toward and preference for dominant culture; declining attiudes to own culture;

prefer therapist from majority group
MID Dissonance
confusion and conflict towards self and others of same and different groups;

prefer therapist from a racial minority group

see personal problems as being related to cultural ID issues
MID Resistance and Immersion
reject dominant society

good attitudes to self and own group

prefer same race therapist

personal problems due to oppression
MID Introspection
uncertainty about beliefs in stage 3;

conflict between loyalty to own group and personal autonomy;

prefer therapist from own group

open to therapist with same worldview
MID Integrative Awareness
self fulfillment to cultural ID

desire to eliminate oppression

multicultural perspective

therapist preference is similarity in worldview, beliefs not race
Black Racial (Nigrescence) ID Dev Model

AA ID Dev linked to racial oppression

Preencounter, Encounter, Immersion/Emersion, Internalization/Commitment
Cross' Preencounter
racial ID has low salience;

W seen as ideal

AA put down

AA prefer W therapist
Cross' Encounter
exposure to race related event leads to greater racial awareness;

increased interest in dev AA ID

AA perfer same race therapist
Cross' Immersion/Emersion
struggle between old and new ideas of race

idealizes AA

immerse self in AA culture

Put down W

new ID
Cross' Internalization/Commitment
adopts AA worldview

works to eradicate racism

healthy cultural paranoia
White Racial ID Dev Model

occurs when W person first acknowledges racism then relinquishes it and dev nonracist W persona

Contact, Disintegration, Reintegration, Pseudo-Independence, Immersion-Emersion, Autonomy
Helm's Contact
little awareness of racial ID;

racist attitudes
Helm's Disintegration
increasing contact with AA

increase awareness of being W

confusion and ambivalence

may overID with AA
Helm's Reintegration
attempts to resolve conflicts of Disintegration stage

accepts racist views of W superiority and AA inferiority
Helm's Pseudo-Independence
event causes person to question racist views

see W have responsiblity for racism
Helm's Immersion-Emersion
explores what it means to be W
Helm's Autonomy
internalizes positive (nonracist) W ID

appreciates cultural differences and similarities
W therapist stage of ID dev is likely to have impact on work with diverse clients

IF therapist in Disintegration and AA in Cross' INternalization/Commitment stage, therapist likely to experience _________________...what will occur?
experience anxiety about race related issues and interct with client with reserve

client will sense it and terminate early

W therapist ID is positively correlated with therapeutic success

Therapist in autonomy stage more effective
Therapy with AA

Therapy guidelines
group welfare > individual needs
M and F equal
healthy cultural paranoia
multisystems approach
family therapy

time ltd
prob solving
seek Tx for practical reasons
Therapy with NA

Therapy guidelines
spiritual harmony
extended family and tribe > individual
listen > talk
network therapy

NOT directive
know NV differences
traditional healers
Therapy with Asian-Amer

Therapy guidelines
group > indiviudal
hierarchical family structure
restraint of strong emotions

formalism (address members to show status)
indirect and NV comm
somatic complaints
Therapy with H-Amer

Therapy guidelines
family welfare > individual
no intimate details
control of life = GOD and external
family therapy

personalismo (no 1st names 2st session)
folk cures
diff in acculturation
see MD for psych probs
Therapy with Elderly
cognitive symptoms most common problem
ID transitions
death issues

comprehensive multimodal approach
therapist more active
Therapy with Gay and Lesbian Women

4 stages
more likely to consult with MH professional

ID Dev -
Stage 1 = sensitization, feel different
Stage 2 = self recognition, ID confusion
Stage 3 = ID assumption, may try to pass as straight
Stage 4 = commitment, ID integration
Child Physical Abuse

Abusive parent characteristics
7 and younger
B more at risk in childhood
F increases during adol

mids 20s
low SES
M = F
bad Bx internal; good external
less affectionate
Child Sexual Abuse

Characteristics of Sexual Perps
1:3 F
1:6-10 M
F usually between 10-12
oldest F usually abused by fathers

50% F and 20% M victims by family
40% by knwon person
90-95% of perps are M
F perps abuse B
disorganized homes
poor boundaries

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