Clinical Psychology

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Freudian Structural Theory (drive theory): Id, Ego, Superego
Id: present at birth;
pleasure principle; seeks gratification
Ego: 6 months;
reality principle
positpones gratification of id until appropriate;
realistic thinking and planning;
mediate b/w id and superego
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
Adler: social factors
teleogical approach (future goals)
Inferiority feelings
Style of lifeSTEP; STET
Jung's Analytical Therapy: past and future
Archetypes
Individuation
egalitarian
Neo-Freudians: interpersonal and social influences
Horney, Sullivan
Horney: anxiety is basis of neurosis and chld interpersonal relationships
Sullivan: recognition of cognitive factors in personality
Prototaxic, parataxic (see relationship b/w events but unrelated), syntaxic
maladaptive bx due to parataxic distortions
Object Relations: Mahler
early relationships
Introjects
Maladaptive Bx due to probs during seperation-individuation
Splitting
Self Psychology: Kohut
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
empathy
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: Rogerian
Gestalt
Reality
Person-Centered Therapy: Rogers
self actualizing
self
malad bx = incongruence b/w self and experience;
unconditional positive regard;
empathy
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
homeostasis
identified patient; scapegoat
Cybernetics: 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: Bowen;
beyond nuclear family;
Differentiation of self (sep emotion and intellect);
Emotional Triangle;
multigenerational dysfunction
therapeutic triangle; genogram;
increase differentiation
Structural Family Therapy: Minuchin;
alter family structure (rigid triangle; power hierarchies; boundaries)
Rigid triangles (detouring, stable, triangulation)
joining (blend with family)
enactment; reframing
Strategic Family Therapy: Haley;
transactional patterns;
interpersonal comm probs
insight = bad
pradoxical interventions
homework
Milan Systematic Family Therapy: probs when family pattern is so fixed and members not making own choices;
circular patterns of action and reaction;
understanding;
therapeutic team
paradoxical
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;
insight;
transferences
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
empowerment
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
Hypnotherapy: 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
group
i.e. meals on wheels, immunization programs
Secondary Prevention: decrease prevalence by reducing duration through early detection and intervention;
individuals;
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
Acculturation (Berry): 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 (Cross): 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 (Helms): 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
directive
seek Tx for practical reasons
Therapy with NA Therapy guidelines: spiritual harmony
extended family and tribe > individual
present
listen > talk
network therapy

trust
collaborative
NOT directive
know NV differences
traditional healers
Therapy with Asian-Amer Therapy guidelines: group > indiviudal
hierarchical family structure
restraint of strong emotions

directive
prob-solv
formalism (address members to show status)
indirect and NV comm
disclose
somatic complaints
Therapy with H-Amer Therapy guidelines: family welfare > individual
no intimate details
control of life = GOD and external
multimodal
family therapy

personalismo (no 1st names 2st session)
folk cures
machismo
diff in acculturation
see MD for psych probs
Therapy with Elderly: cognitive symptoms most common problem
ID transitions
sexuality
depression
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
depressed
victim
M = F
bad Bx internal; good external
less affectionate
stressed
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
alcohol

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