psyc 360 exam 1

Describe each group/person’s theories and concepts that influenced psychotherapy:

hellenistic

leibniz

mesmer

a. Hellenistic physicians

hippocrates: “first, do no harm” – father of modern medicine

the brain is the seat of knowledge, depression, and delirium

brain is the seat of illnesses, not gods, outside forces

b. Leibniz

 dude invented calculus

focuses on perception through systematic scientific study (scientific for the 17th century)

believes in the “subliminal” – we perceive and act without conscious thought

“dynamic” – unconscious forces

c. Mesmer

 hypnotherapy & other useful things

patient rapport, client-confidence, and spontaneous remission 

 rapport between patient and therapist is SO important

unconscious shapes behavior 

people can and will go into spontaneous remission

Define each of the following and highlight the differences between them:

• natural science empiricists

• psychologist philosophers

• clinical researchers

a. Natural science empiricists (include important figures)

- gustav T fechner, herman von Helmholtz (19th)

organicism and empiricism → experiments and results

understanding the processes of the unconscious and how it influences the conscious 

fechner 

distinction between sleep (dream states) and wakefulness

helmholtz

“unconscious interference” - unconscious, instantaneous reconstruction of our past experience with an object

emil kraepelin (19-20th) 

we can classify diseases based on course and understand their prognosis

schematizing their courses and establishing benchmarks for prognosis

b. Psychologist philosophers (include important figures)

 arthur schopenhauer

the world as will and representation (1819) - we are driven by blind ??

we know things that we don’t know we know; we are largely driven by blind, irrational forces

carl gustav carus

role of the unconscious in communication (transference)

developed an early scheme for the unconscious & its several levels

communicating both consciously and unconsciously 

neitzsche

unconscious is a place of lying (defense mechanisms!)

 consciousness is just a “commentary” on our unconscious thoughts 

c. Clinical researchers/scientists

- emergence of analytical psychotherapy

- modern day scientific practitioner

Describe the impacts the following concepts had on the field of psychotherapy:

a. Neuroplasticity

b. epigenetics

c. cultural factors

a. Neuroplasticity

the brain changes through learning and experiencing new things

b. Epigenetics

the environment can influence our gene expression

external events can turn genes on or off by enabling the synthesis of specific proteins

c. Cultural factors

 demographics, culture, and language all shape our experiences

stigma is HUGE

culture & one’s immediate family can act as genetic enablers 

Explain the significance of the following aspects of therapy:

• client/therapist rapport

• therapists personal characteristics

• client confidence in the therapeutic procedure

• spontaneous remission

a. Client/therapist rapport

 important that they get along and can trust & be honest with one another!!

 important therapeutic rapport & bond can affect how clients respond to therapy (mesmer)

b. Therapist’s personal characteristics

 therapist is a person too, bringing their own experiences and mistakes and ideals into therapy that can influence treatment and rapport

c. Client confidence in the therapeutic procedure

 if client thinks it’s not going to work, it’s not gonna work

 they must BUY IN (mesmer)

d. Spontaneous remission

 sometimes stuff just gets better and we don’t really know why

 symptoms wax & wane, and some people just get better (mesmer)

-it’s why controls are necessary in research

Answer the following about systemic racism in psychotherapy:

• great chain of being

• eugenics, slavery, and institutionalization

• civil rights movement

• clark doll study

a. Describe the Great Chain of Being and how it was used to promote slavery

- GCB - everything can be put into a hierarchy and POC end up at the end of the chain

b. Explain the ways that the fields of psychiatry/psychology/psychotherapy were intertwined with eugenics, slavery, and institutionalization

disorders used to justify slavery and returning free/escaped slaves, saying symptoms made them incapable of living independently & slavery was a treatment for them

 drapetomania

- “runaway slave disorder” treated with violence

dysaethesia aethiopica 

- disorder of poor work ethic

institutionalization

before the emancipation proclamation, they were white only

after, they were segregated, and black patients were forced into labor under new fake diagnoses

eugenics

“breeding” out undesirable characteristics; in this case, “lesser groups” 

c. Explain how the civil rights movement impacted psychiatric diagnoses

 schizophrenia changed from a “docile neurosis of white housewives” to a “protest psychosis” that caused violence, aggression, and volatility among black men protesting for their civil rights in the 1960s

turned to deinstitutionalization → bad conditions → more outpatient care systems (usually prisons/the criminal justice system)

criminalizing substance use, psychosis, etc; prisons are the largest mental health providers in most, if not all, US states

d. Explain the Dr. and Dr. Clark Doll Study

 children view white and black dolls & assign them characteristics (good, bad, pretty, ugly) – racism is NOT inherent, but LEARNED

Answer the following about the DSM

• what is it, and how is it necessary and limiting

• how does the dsm categorize disorders

• how might these diagnoses be influenced by culture, and how might they impact people?

• a. What is the DSM and what is it used for? How is it both necessary and limiting?

  •  diagnostic and statistical manual; huge tome of all of the disorders and diagnoses of the time

  • necessary in that it allows us to communicate prognosis and history in a “shorthand” 

  • limiting in that who gets to decide what a disorder is and isn’t is very selective

    • eg homosexuality as a disorder/illness

• b. How does the DSM categorize psychiatric disorders? How else can we think of disorders?

  •  dsm categorizes as

    • a “shorthand”

    • categorizing helps us in research & to better understand how to dissuade distress in practice BUT is susceptible to fallacy and change

  • disorders are 

    • a continuum of symptoms and a collection of experiences

    • a way to describe what is causing distress in a specific individual 

• c. How might these diagnoses be influenced by culture, and how might they impact people?

  •  created by PEOPLE & extremely susceptible to societal opinions of the time (homosexuality) and power dynamics (who is writing the dsm?)

Explain the efficacy-effectiveness gap.

• the gap between effective treatments in the lab and then what works in the real world outside of the lab

• efficacy: works in a closely controlled study

• effectiveness: works in real life scenarios

  • must bridge the gap from a lab control to a real-world, plausible scenario to ensure that our treatments work and are valid

Explain the difference between experimental and observational research methods.

•  observational

  • we do not decide treatment (prospective chance) or manipulate any variables; we are simply observing

  • CANNOT establish cause and effect

  • contains

    • descriptive, analytical, cohort, case control, and cross section 

• experimental design

  • we be messin w shit fr

  • manipulating variables and establishing a cause and effect of X or Y

Observational Descriptive Study

•  no comparison groups, just describing a problem

  • helpful for establishing that a problem does exist

  • prevalence rates, co-occurrence, etc

• can follow patients over time and observe the natural course of a disorder or phenomena

• helps to identify correlates and identify what to study further

Analytical Study

• comparing one group to another in some way shape or form

• we DO NOT ASSIGN the groups, naturally occurring (does have x, doesn’t, etc)

Cohort Study (working from treatment out)

• two groups

  • one received a treatment

  • one did not receive a treatment

• follow these groups forward in time to determine if they experience different outcomes

• strengths

  • less prone to recall bias

  • treatment comes before the outcome (temporal precedence)

  • provides estimates of incidence of outcomes overtime

• limitations

  • rare outcomes are hard to observe

  • studies may need to be very long to observe outcomes

    • longer term, more money cost, more risk of participants leaving, opting out, moving, etc

Case-Control Study (working from outcome in)

•  identify two groups

  • one with an identified outcome

  • one without the outcome

• assess whether there were differences in treatment exposure retrospectively

  • chart reviews, self-reporting, interviews

• strengths

  • useful for rare outcomes, can save time and money

    • don’t need to do long term follow ups

• limitations

  • difficult to select an appropriate control group

    • need them to be as similar as possible, but we’re never going to get it perfect!

  • recall bias 

  • cannot tell us how prevalent the things are (we’ve selected them as inclusion criteria)

Cross-Sectional Study

•  using one time point to assess both outcome and treatment exposure

• can provide estimates of frequency or prevalence of an outcome or treatment

• are we seeing variables correlated together? NO CAUSE AND EFFECT

  • limits

    • cannot tell us what came first (we’re measuring at the same time)

    • subject to recall bias

Rate

•  the frequency of an event in the population over a defined period of time

# of people w/ depression who attended therapy in 2022 / # of people who had depression in 2022

Proportion

•  frequency of an event without a defined period of time

  • # of people who see a therapist/total # of people in the US

Ratio

• number of people in one condition relative to another

  • # of people who attended therapy in 2022 / # of people who did not attend therapy in 2022

Absolute Risk

•  the probability of an outcome

  • ex: womens overall rate of depression

Relative Risk

•  ratio representing how often the outcome happens in the treatment/exposed group relative to the control/unexposed group

  • does not tell you the TOTAL risk, just risk relative to another group

• ex: relapse 3 times faster if you have chronic pain; 3x faster than those without CP

  • women 3x more likely to have depression than men

Odds ratio

• likelihood of membership in one group, given membership in another

  • eg: being a membership in the treatment group (vs non treatment group), how likely are you to also be in the outcome group

  • if i’m in group A, how likely am i to be in group B?

Randomized Controlled Trial (RCT)

•  must make sure randomization is successful

• improves our ability to determine cause and effect

Non-Randomized Controlled Trial

•  failed to randomize (ex: first 15 in the door get treatment)

• cost effective, possible barriers to randomization – will not be able to determine cause and effect

Inclusion Criteria

•  many sources of possible bias – we must be selective with who we let into our studies

  • define severity (eg diagnosis)

  • specific course or duration of diagnosis

    • ex: if someone has received past treatment, they may be unresponsive to THIS one

  • staging and use of adaptive designs 

    • must do XYZ to pass stage 1, move onto stage 2

 Recruitment

•  where are you getting your recruits from? is the sample representative?

  • ex: only placing ads where rich people will see them; sample won’t be very generalizable 

Control Groups

• IMPORTANT! saying that a treatment works – must be able to say that it works RELATIVE to our control!

• no treatment or waitlist

  • minimal attention – “works better than the natural course”

• treatment as usual

  • is it better than what’s already being done in PCP offices?

• attention placebo control

  • treatment group got better just because they got attention from a therapist – must = time across control groups

• other active treatment

  • comparing your treatment to other active treatments

• additional controls needed when pharmacotherapy is used

Design

•  parallel treatment

  • everyone is getting simultaneous treatment regardless of group

• adaptive

  • changes based in responses from patients

• dismantling 

  • take a treatment apart and find which components are most effective

  • time saving, finding the minimum effective amount of treatment

Assessments

• treatment allocation should be blind from those administering assessments

• pre and post – consider length of followups

• must be sensitive to change; can you change a person/their behavior that slow or fast?

• patient-reported vs observer-rated

• assess for adverse effects, not just desired effects

 Outcomes

•  define a priori

• what level of improvement means the treatment works?

  • how do we define success? can’t change these later in the study!

What are the basic principles of psychoanalytic theories?

•  humans are motivated by wishes and fantasies that are unconscious

  • these desires motivate everything

•  humans have an interest in facilitating an awareness of these unconscious motivations (to increase choice)

• humans are ambivalent about changing

•  important to explore the ambivalence

• therapy should help clients understand how their own construction of the past & present plays a role in perpetuating patterns

Describe the significance of Anna O, a case study done by Breuer and Freud, and explain how the two differed in their views.

• hysteria

  • unexplained physiological conditions (temporary muteness, deafness, paralysis)

  • breuer: believes it’s caused by dissociative stress, traumatic memories

    • if so, we can cure with talk therapy, talking to change or alleviate symptoms

  • freud: results from trauma 

    • emotions from trauma are pent-up and unreleased causing physical distress

      • therapy uncovers and releases (catharsis) these emotions

      • in pursuit of true change, not just cause people think that talking is what you want to hear

      • emphasized free association

Defense Mechanism

• defensive styles or behaviors that allow us to stay distant from a problem and not deal with emotional stress or distress related to it

•  functions to avoid emotional pain by pushing thoughts, wishes, feelings, or fantasies out of awareness

Primary Process

•  begin at birth and operate unconsciously

• raw/primitive functioning - survival instincts

•  no distinction between past, present, and future

• dreams and fantasy

Secondary Process

•  functioning associated with consciousness

• logical, sequential, orderly, and rational, and reflective

•  psychic functioning associated with consciousness

Conflict Theory

•  childhood neurosis (distress) is common and expressed through anxiety

• in adulthood, neurosis occurs due to intrapsychic conflict

Intrapsychic Conflict

•  the conflict between unconscious wishes/desires/fantasies and defenses

•  personality/character styles can be understood as resulting from the compromise between underlying core wishes and defensive styles

Developmental Arrest

•  stalled development of a working model

  • distress is due to caregivers failing to create an adequate environment

False Self

•  my needs are never met as a baby; i will never know how to identify what i need or how to ask for it and ignore what i do need

• BUT i will always work to fulfill other people’s needs and allow them to take what they need from me in order to maintain proximity

Optimal Disillusionment

•  infant learns to accept the limitations of others and develops a working sense of self

• if the process by which the infant’s sense of omnipotence is frustrated is sufficiently gradual, then the infant can come to accept the limits of others without traumatization 

Transference

• for the patient, the therapist becomes an unconscious “stand in” for the people who helped shaped the schema or beliefs that the patient is discussing

•  clients will “transfer” a template from the past onto the present situation (the therapist) 

  • client w/ tyrannical mother may see therapist as tyrannical

  • helpful to problem the client an opportunity to help them discover how past relationships are influencing the experience of the present

Countertransference

•  how the patient responds/reacts to the transference

• used specifically to get the client engaged with treatment 

•  the totality of the therapist’s reactions to the client (feelings, associations, fantasies, and fleeting images)

  • a  VALUABLE source of information 

Resistance (and give an example of resistant behavior)

•  what is the client doing to resist change OR act in a way that undermines the therapeutic process?

  • not an obstacle, but an expected opportunity to find defense mechanisms and work with them

• ex: showing up late, no showing, refusing to answer

Free Association

• patient says “whatever comes to mind”

• therapists listens and interprets the material 

•  clients suspend self-critical functions and verbalize any thoughts, feelings, images, and associations that may be on the verge of awareness

Manifest Content

• manifest content = surface material

• pt: my boss is a bitch t: sounds like you feel unfairly treated

Latent Content

• latent content = deeper level; people repeat patterns of behavior

  • th: it seems like you tell similar stories a lot – you seem to perceive the world as unfair

Drive Theory and Pleasure Principle (and how they are related)

• drive theory

  • libido produces states of tension

  • we have innate instincts + they motivate our behavior (including fantasy)

• pleasure principle

  • we are driven to repeat experiences that release tension

Therapeutic Alliance

•  therapist cares for the patient and has mutual respect/trust for one another and an agreement on the goals of therapy

•  strength depends on how much the client and therapist agree about the tasks and goals of therapy and on the quality of the bond between them 

Enactment

•  going back and forth negotiating on what reality ia

•  therapist and client end up playing complementary roles in relational scenarios 

  • allows us to participate in a client’s relational world and develop a lived experience for them

Intersubjectivity

•  therapist and patients are subject to one another

  • consciously and unconsciously

•  meeting of two minds is thought to produce a new emergent product & an understanding in psychotherapy

• the ability to hold onto one’s own experience while at the same time beginning to experience the other asn independent center of subjectivity

Intellectualization

•  instead of feeling an emotion, distancing yourself from it and just rationalizing, logically thinking everything away

  • planning a funeral instead of grieving the loss

•  talking about something threatening while keeping an emotional distance from the feelings associated with it

Rationalization

• explaining something away

  • ex: i failed, so my teacher must hate me NOT that i didn’t study enough

Projection

•  attributing an uncomfortable feeling to someone else

  • “i’m worried i’m boring” → seeing someone asleep 

  • it’s easier to acknowledge someone else having the feeling about you than you having it about yourself

•  attributing a threatening feeling or motive you are experiencing to another person

Denial

• refusal to accept the reality of a problem

  • conscious disagreement (repression is unconscious)

Splitting

•  unable to hold neg + pos attributes at once

  • people are either all good or all bad; also applies to SELF IMAGE!

  • ex: “perfect” person cannot also be bad; split into 2 people

•  attempting to avoid your perception of the other as good from being contaminated by negative feelings, so you split the representation into two

  • two separate representations of mom: one all good, one all bad

Regression

• reverting to a child-like state, inability to emotionally regulate as you should

  • adult temper tantrum

Sublimation

 negative emotions channeled into productive outlets (ex: beating the fuck out of a punching bag)

Repression

• do nothing and attempt to forget the problem

  • push it completely out of your conscious awareness

Displacement

•  transfer feelings from the target to an “easier” target

  • ex: yelling at your wife because your boss was mean to you

Reaction Formation

• having a feeling and doing the opposite

  • bullying your crush; homophobic, closeted guy

What is Object Relations Theory and how does Attachment Theory play into development?

•  internal representations guide perceptions and actions

• attachment theory: humans build internal working models of caregivers that allow them to maintain proximity

  • IWM - what we expect to happen

    • if i do x, they will respond with y

List and describe the stages of Psychosexual Development.

•  oral phase - feeding

• anal phase - learning how to go bathroom

• phallic phase - generalizable genital etc

• latent period -  chilling

• genital phase - sexuality

Describe the differences between the Id, Ego, and Superego in Structural Theory.

•  majority of our personality is under the surface

  • id: unconscious, home of instincts and drives

  • ego: satisfying desire from the id w/in context (delayed gratification)

    • trying to satisfy the id and the superego

• emerges from the ID, functions to represent reality

• superego: external judgment (what will “they” think?); internalization of societal norms 

  • tends to be harsh and contrasts with your own id

Who are the proper candidates for psychoanalysis?

•  motivated

• openly disclosing

• willing to self-scrutinize

• not in need of immediate crisis intervention

  • PA is a long-term therapy

• “problems in living” reflected in stress

• personality disorders

Who was Carl Jung, what were his theories, and how did they differ from Freud’s?

•  studied under freud

• experimental studies of the unconscious 

  • we can “experimentally observe the unconscious & complexes”

• differences from freud

  • collective unconscious: vast/hidden unconscious shared by all humans but varied influence by personal experience

  • unconscious has creative and growth oriented components

    • drives to create, explore in the unconscious

  • understand unconscious through observing complexes

  • less emphasis on sexuality’s role in motivation

Describe the difference between one person and two person psychology.

• one person: therapist is a neutral observer, and other

•  freud’s original view: that the therapist is an objective and neutral observer who could serve as a blank screen for the client to project on

•  two person psych: therapist is coming in as their OWN person and actively engages with the treatment

•  therapists and clients are co-participants who engage in an ongoing process of therapy

List and describe both the methods and phases of psychoanalysis.

•  phases

  • empathy - “that would make me x”

  • clarification - ask clarifying questions, ensure they are supposed to hear it

  • interpretation - interpret what the client is saying

  • support/advise

• methods

  • opening

  • development of transference

  • working through

  • termination/end of therapy

List and describe the mechanisms of change for Psychoanalytic Therapy.

•  containment

  • therapy provides a space for difficult emotions 

  • as a therapist you can handle and make sense of their emotions

• rupture and repair

  • therapist will make a mistake BUT modeling the ability to healthily repair that rupture is important

How do psychoanalytic psychologists use the term “deep”?

 regards things farther back in life (latent content)

What are some cultural considerations that therapists should address when utilizing psychoanalysis?

•   developed for educated, middle-class western europeans

• therapists must

  • be aware of their own biases, societal attitudes, and moral judgments

  • utilize a range of techniques

Explain what is meant by the 65% barrier and how it relates to positive psychotherapy.

•  65% barrier – we can relieve symptoms but not CURE

  • depression:

    • treatment boasts a 65% response rate w/ a placebo rate of 45-55%

    • we have reached the limit of what palliative care can provide

Explain each component of the PERMA model as it relates to the positive psychology theory.

•  P - positive emotion

  • + in the past, pres, future

  • optimal ratio of +/- emotions (3:1)

    • pos emotions act as a buffer for negative emotions!

    • mindfulness, awareness, aspiration, confidence

  • savoring and mindfulness

• E - engagement

  • use signature strengths; beyond sensory pleasures

  • FLOW - state of intense focus/concentration

  • cultivating critical thinking, engaging in challenges

• R - relationships

  • facilitate happiness!

  • emphasizes relationships with people around use and how we can use them to enrich other areas of the perma model

• M - meaning

  • bigger than oneself!

  • provide: motivation, persistence, resilience

  • feeling like something out there is bigger than you & you’re working towards it!

• A - accomplishment

  • flow and motivation!!!!!!!

Why do positive psychologists argue that it’s important to cultivate wellness?

 removing the negative does not mean you’re positive/living a full life

Aristotle’s golden mean

 finding the appropriate middle ground/mean between two extremes

Flourishing

•  living a full, enriching life!

•  a state characterized by positive emotions, a strong sense of personal meaning, good work, and positive relationships

  • MORE THAN JUST RELIEVING DISTRESS

Tonic strengths

strength is always present – sometimes to a damaging degree

Phasic strengths

only used in certain situations and not others – not using it enough!

Savoring

•  slowing down

• not splitting or multitasking but appreciating the positive in situations as they happen!!

Gratitude

retrain attention from the - to the +!

Flow

intense concentration and focus that loses track of time!

According to positive psychology, what is the cause of distress?

•  distress is caused by an imbalance 

  • absence of strengths vs excess or misuse of others 

  • “thwarted capacities or unbalanced strengths”

According to positive psychology, what does a full life entail? In contrast, what does an empty life entail?

• PERMA can be pursued simultaneously and interrelatedly 

• engagement and meaning most correlated with life satisfaction

• connect chase positive emotions only

Describe each session of the general 14 session model of positive psychotherapy.

•  1-3: orientation to PPT; client writes “positive introductions” of self; assess signature strengths; develop action plan to incorporate strengths

• 4-6: reappraisal of bitter memories; forgiveness; gratitude letter

• 7: feedback, check in

• 8-9: cultivate positive emotions and growth from trauma

• 10-11: communication skills and strengths of others

• 12: savoring

• 13: altruism; helping others

• 14: integrate treatment gains – the full life

What do randomized control trials support effectiveness for with positive psychotherapy?

•  RCTs support effectiveness for

  • reduced depression

  • increased well being

  • adolescent substance use; behavior challenges; social skills; well being 

  • cardiovascular disease

What are some important cultural considerations to consider when implementing positive PT?

•  definition of happiness changes across cultures

• therapists must 

  • understand how strengths manifest themselves across cultures

  • discuss culture