CCE: Clinical Psychology

Freudian Psychoanalysis

Pessimistic, deterministic, mechanistic, and reductionistic approach; assumes human beings are determined by irrational forces, unconscious motivations, biological and instinctual needs and drives, and psychosexual events that occurred during the first five years of life

Freudian Psychoanalysis Personality Theory

Involves two separate but interrelated theories: a structural drive theory and developmental theory. Personality has three structures (id, ego, and superego) that operate on instinct and drive and develop throughout aging process as a result of certain experiences that occur during developmental stages

Id

Present at birth, consisting of an individual’s life and death instincts which serve as the source of all psychic energy; operates on the basis of the pleasure principle, seeking instant gratification of instinctual drives and needs to avoid tension

Ego

Develops at about 6 months; operates on the reality principle, deferring gratification of instincts until an appropriate object is available in reality

Superego

Emerges between ages 4 and 5, represents an internalization of society’s values and standards as conveyed to child by parents through rewards and punishments; attempts to permanently block socially unacceptable impulses

Defense Mechanisms

Operate on an unconscious level and serve to deny/distort reality to avoid unwanted/uncomfortable emotions/anxiety/experiences

Freudian Psychoanalysis View of Maladaptive Behavior

Psychopathology stems from an unconscious, unresolved conflict that occurred during childhood

Freudian Psychoanalysis Therapy Goals and Techniques

Goal of therapy is to reduce/eliminate symptoms by bringing the unconscious into conscious awareness and integrating previously repressed material into the personality; primary technique is analysis, which targets free associations, dreams, resistances, and transferences through confrontation, clarification, interpretation, and working through

Jung’s Analytical Psychotherapy

Operates on belief that behavior is determined by both unconscious and conscious factors, including past events and future goals/behaviors

Jung’s Analytical Personality Theory

The consequence of both unconscious and conscious factors; conscious is oriented towards the external world, governed by the ego, representing their thoughts, feelings, ideas, sensory perceptions, and memories; unconscious made up of personal and collective

Collective Unconscious

Repository of latent memory traces that have been passed down generationally

Archetypes

primordial images that cause people to experience and understand certain phenomena in a universal way

Individuation

integration of the conscious and unconscious aspects of the psyche that leads to development of a unique identity; leads to the development of wisdom in the later years when interests turn towards spiritual and philosophical issues

Jung’s Analytical View of Maladaptive Behavior

Symptoms are unconscious messages to the individual that something is awry within them and present them with a task that demands to be fulfilled

Jung’s Analytical Therapy Goals and Techniques

Primary goal is to re-bridge the gap between the conscious and the personal/collective unconscious; this can be achieved through interpretations designed to help client become aware of their inner world through dreams/dream interpretation and other means

Object Relations Theory

Consider relationships with others to be a basic inborn drive, emphasizing a child’s early relationships with objects and their internalized representations of them, and how these become a part of the self and influence interactions with others in the future

Separation-Individuation

Four-stage process through which a child develops a permanent sense of self and object (object constancy) and is able to perceive others as both separate and related

Object Relations View of Maladaptive Behavior

The result of abnormalities in early relations, particularly those that occurred during separation-individuation; inadequate resolution of splitting/idealization/devaluation (failure to integrate positive and negative aspects of self and others)

Object Relations Therapy Goals and Techniques

Therapy viewed as an opportunity to provide client with support, acceptance, and other conditions that restore their ability to relate to others in meaningful/realistic ways by bringing maladaptive unconscious relationship dynamics into consciousness so that dysfunctional internalizations can be replaced with more appropriate ones

Adler’s Individual Psychology

Regards behavior as being largely motivated by a person’s future goals rather than past events

Adler’s Personality Theory

Emphasized inferiority feelings, striving for superiority, style of life, and social interest as key concepts of personality; begin developing in early childhood as the result of real or perceived bio/psycho/social weaknesses and efforts to compensate for them, determining style of life/unified personality

Adler’s View of Maladaptive Behavior

Mistaken style of life characterized by maladaptive attempts to compensate for feelings of inferiority, a preoccupation with achieving personal power, and lack of social interest

Adler’s Therapy Goals and Techniques

Establishing a collaborative relationship with client to help them identify and understand style of life and its consequences and reorienting their beliefs and goals so they support a more adaptive lifestyle; this can be accomplished using lifestyle investigation to unveil family constellations, fictional/hidden goals, and basic mistakes (distorted beliefs/attitudes)

Person-Centered Therapy

Belief that all people have an innate self-actualizing tendency that serves as the major source of motivation and guides them toward positive, healthy growth

Person-Centered Therapy Personality Theory

Each person has the ability to become self-actualized (reach full potential) but to do so, must have a unified, organized, and whole self

Person-Centered View of Maladaptive Behavior

Self becomes disorganized as the result of incongruence between self and experience which can occur when they experience conditions of worth

Person-Centered Therapy Goals and Techniques

Goal is to help client achieve congruence between self and experience so they may become a more fully functioning/self actualizing person

Facilitative Conditions

Unconditional positive regard, genuineness, and accurate empathetic understanding

Gestalt Therapy

Founded on the premise that each person is capable of assuming personal responsibility for their own thoughts, feelings, and actions and are capable of living as an integrated “whole”

Gestalt Therapy Personality Theory

Personality consists of the self (creative aspect that promotes inherent tendency for self-actualization/ability to live as a fully integrated person) and the self-image (darker side that hinders growth/actualization by imposing external standards); one typically dominates the other

Boundary Disturbances

Introjection (accepts standards from environment without fully assimilating/understanding them), projection (disowning aspects of the self by assigning them to others), retroflection (doing to oneself what one wants to do to others), confluence (absence of a boundary between self and environment)

Gestalt Therapy View of Maladaptive Behavior

Maladaptive behavior considered a “growth disorder” that involves an abandonment of the self for the self-image, resulting in lack of integration

Gestalt Therapy Goals and Techniques

Goal is to help client become a unified whole by integrating various aspects of the self; avoid diagnostic labels and regard transference as counterproductive, responding to it by helping them realize the difference between fantasy and reality; consider awareness as primary treatment factor, helping clients reach a full understanding of their thoughts, feelings, and actions in the here and now through exercises and experiments

Existential Therapy

Emphasis on personal choice and responsibility for developing a meaningful life and assume that people are not static but are in a constant state of evolving and becoming

Existential Therapy View of Maladaptive Behavior

Result of an inability to cope authentically with the ultimate concerns of existence (death, freedom, isolation, meaninglessness)

Existential Therapy Goals and Techniques

Goal is to help clients live in a more committed, self-aware, authentic, and meaningful way; clients are helped to recognize their freedom through the therapist-client relationship, paradoxical intention to reduce fears by focusing in an exaggerated and humorous way on feared situation

Reality Therapy

Based on choice theory which assumes that people are responsible for the choices they make, focusing on how people make choices that affect the course of their lives

Reality Therapy Personality Theory

People have five basic innate needs that serve as primary source of motivation (survival, love and belonging, power, freedom, and fun); when needs are fulfilled in a responsible way a person has adopted a “success identity,” but when needs are fulfilled in irresponsible ways or not at all, they adopt a “failure identity”

Reality Therapy View of Maladaptive Behavior

Result of an individual’s choices and adoption of a “failure identity” that causes mental and emotional disturbances

Reality Therapy Goals and Techniques

Rejects the medical model and focuses on current behaviors, viewing transference as detrimental, stressing conscious processes, and emphasizing value judgments in client’s life; primary goal is to help clients identify responsible/efficient ways to satisfy their needs and develop a success identity

Personal Construct Therapy

Focuses on how the client experiences the world, assuming that people choose the ways they deal with the world and that there are always alternative ways of doing so

Personal Construct Therapy Personality Theory

Personality determined by the way one construes events, involving personal constructs that develop in infancy and may operate on an unconscious or conscious level

Personal Construct Therapy View of Maladaptive Behavior

Result of inadequate personal constructs; recognition that the events with which one is confronted lie outside the range of their constructs

Personal Construct Therapy Goals and Techniques

Consider therapist and client mutual experts/co-experimenters who work together to derive tasks that will help client identify and revise/replace maladaptive personal constructs so they can make better sense of their experiences

Interpersonal Therapy (IPT)

Focuses on interpersonal relationships and social roles

Interpersonal View of Maladaptive Behavior

Related to problems in social roles and interpersonal relationships that are traceable to a lack of strong attachments early in life

Interpersonal Therapy Goals and Techniques

Focus on current social relationships with primary goal of symptom reduction and improved interpersonal functioning through education, instillation of hope, and pharmacotherapy when needed; interventions target one or more of four target areas — unresolved grief, interpersonal role disputes, role transitions, and interpersonal deficits

Solution-Focused Therapy

Focuses on solutions to client’s problems rather than the problems themselves

Solution Focused Therapy Goals and Techniques

Client viewed as expert while therapist viewed as consultant/collaborator who poses questions (miracle question, exception question, scaling questions) designed to assist client in recognizing and utilization strengths/resources to achieve specific goals

Transtheoretical Model

Recognizes that change entails a progress through a series of predictable stages; identifies 10 change processes/interventions (consciousness raising, self-liberation, social liberation, dramatic relief, self-reevaluation, counterconditioning, environmental reevaluation, reinforcement management, stimulus control, and helping/supportive relationships)

Stages of Change

Pre-contemplation, contemplation, preparation, action, maintenance, and termination

General Systems Theory

Defines system as an entity that is maintained by the mutual interactions of its components and assumes that the actions of interacting components are best understood by studying them in their context; believes families act in ways that maintain homeostasis and believes that if problems of one family member improve, disturbance is likely to appear elsewhere

Cybernetics

Feedback loop through which systems receive information; negative feedback loop reduces deviation while positive feedback loop amplifies deviation

Communication/Interaction Family Therapy

Focuses on impact of communication on family and individual functioning; assumes people are always communicating even when “doing nothing,” all communication as a “report” function and a “command” function, communication patterns are either symmetrical or complementary

Symmetrical vs. Complementary Communication

Symmetrical communications reflect equality between communicators but may escalate into competitive “one-upmanship” in which they try to outdo one another; complementary communications reflect inequality and minimize differences between communicators

Communication/Interaction Family Therapy View of Maladaptive Behavior

Symptoms are both a cause and effect of dysfunctional communication patterns (blaming, criticizing, mind reading, and overgeneralizing)

Communication/Interaction Family Therapy Goals and Techniques

Primary goal is to alter the interactional patterns that maintain the presenting symptoms; accomplished using both direct techniques and paradoxical strategies

Extended Family Systems Therapy

Extends general systems theory beyond the nuclear family and describes the functioning of the extended family and its members in terms of several interlocking concepts (differentiation of self, emotional triangle, and family projection process)

Differentiation

A person’s ability to separate their intellectual and emotional functioning

Emotional Triangle

When a two-person system experiences instability or stress, a third person may be recruited into the system to increase stability and reduce tension

Extended Family Systems Therapy View of Maladaptive Behavior

Result of multigenerational transmission process in which progressively lower levels of differentiation are transmitted from one generation to the next

Extended Family Systems Therapy Goals and Techniques

Goal is to increase the differentiation of all family members; uses genogram to depict the relationships between family members, dates of significant life events, and other important information; therapist assumes role of active expert/coach to help each partner achieve greater differentiation

Structural Family Therapy

Uses a here-and-now, directive, concrete approach that assumes all families have an implicit structure that determines how family members relate to one another, including power hierarchies, family subsystems, and boundaries (barriers/rules that determine amount of contact allowed between members)

Structural Family Therapy View of Maladaptive Behavior

Viewed as a result of an inflexible family structure that prohibits the family from adapting to maturational and situational stressors in a healthy way

Structural Family Therapy Goals and Techniques

Goal is to restructure the family; achieves through joining (blending with the family and tracking/mimesis), evaluating family structure, and restructuring the family

Strategic Family Therapy View of Maladaptive Behavior

Symptom is an interpersonal phenomenon that represents a strategy, adaptive to to a current social situation, for controlling a relationship when all other strategies have failed

Strategic Family Therapy Goals and Techniques

Focus on alleviating current symptoms by altering a family’s transactions and organization; may use Paradoxical Interventions that alters the behavior of family members by helping them see a symptom in an alternative way, recognize that have control over their behaviors, or using resistance in a constructive way

Object Relations Family Therapy View of Maladaptive Behavior

Result of both intrapsychic and interpersonal factors; unresolved intrapsychic conflicts in the family-of origin are replicated in current relationships; projective identification also occurs, when a family member projects old introjects onto another family member and reacts to that person as though they actually have the projected characteristics/provokes the person to act in ways consistent with those characteristics

Object Relations Family Therapy Goals and Techniques

Goal is to resolve each family member’s attachment to family introjects by interpreting transferences, resistances, and other factors in order to foster insight, which is considered essential to change; recognize multiple transferences of one family to another and each member to the therapist, and transferences of the family as a whole onto therapist

First Formative Stage of Group Therapy

Orientation, hesitant participation, search for meaning, dependency

Second Formative Stage of Group Therapy

Conflict, dominance, rebellion

Third Formative Stage of Group Therapy

Development of cohesiveness

Group Therapy Cohesiveness

When unity, intimacy, and closeness become the chief concerns among the group, trust and self-disclosure increase, attendance improves, and members show concern when a member is absent

Group Therapy Premature Termination

10-35% of group members experience this when they drop during the first 12 to 20 sessions; can be reduced by prescreening of potential group members

Feminist Therapy

Approach that places emphasis on the power differences between women and men and how that differential impacts both men and women’s behavior; intrapsychic events always occur (and must be interpreted) within an oppressive social context

Feminist Therapy View of Maladaptive Behavior

Related to the nature of traditional feminine roles or conflicts inherent to those roles; survival tactics/means of exercising personal power; arbitrary labels that society has assigned to certain behaviors to impose sanctions/exert social control

Feminist Therapy Goals and Techniques

Striving for an egalitarian relationship; avoiding labels; avoiding revictimization; involvement in social action; utilizes non-sexist therapies and often incorporates object relations therapies

Hypnosis

Involves experiencing alterations in memory, perception, and mood in response to suggestions; essential feature is a “subjective experiential change"; used to help people recover repressed memories but may not enhance the accuracy of said memories; additonally may cause pseudomemories and exaggerate a person’s confidence in memory validity

Acupuncture

Traditional Asian method for restoring health and involves stimulating specific anatomical points on the body, usually with a thin metallic needle; explanation for effects is that illness is due to a blockage of qi (life energy) and that this unblocks its flow; research suggests benefits may result from release of pain-suppressing substances or an alteration in blood flow in areas around the needle/certain regions of the brain

Primary Prevention

Make interventions available to all members of a target group/population in order to keep them from developing a disorder

Secondary Prevention

Identify at-risk individuals who are showing early signs of a disorder and offer them appropriate interventions

Tertiary Prevention

Designed to reduce the duration and consequences of an illness that has already occurred

Client-Centered Case Consultation

Working with the consultee to develop a plan that will enable the consultee to work more effectively with a particular client; consultant acts as an expert and provides the consultee with relevant information

Consultee-Centered Case Consultation

Goal is to enhance consultee’s performance in delivering services to a particular population or group of clients; focus is on the consultee’s skills, knowledge, abilities, and/or objectivity

Program-Centered Administrative Consultation

Involves working with one or more administrators (the consultees) to resolve problems related to an existing program

Consultee-Centered Administrative Consultation

Goal is to help administrative-level personnel improve their professional functioning so they can be more effective in the future with regard to program development, implementation, and evaluation

Health-Belief Model

Proposes that health behaviors are influenced by (1) the person’s readiness to take a particular action, which is related to their perceived susceptibility to the illness and perceived severity of its consequences; (2) the person’s evaluation of the benefits and costs of making a particular response; (3) the internal and external “cues to action” that trigger the response

Parallel Process

When a supervisee replicates problems/symptoms with supervisor that are being manifested by supervisee’s client(s)

Eysenck Psychotherapy Outcome Study

Found that 72% of untreated neurotic individuals improved without therapy while 66% of patients receiving eclectic psychotherapy and 44% receiving psychoanalytic therapy showed substantial decrease in symptoms; concluded that any apparent benefit of therapy is due to spontaneous remission

Smith, Glass, and Miller Psychotherapy Outcome Study

Used meta-analysis to combine the results of the psychotherapy outcome studies and found, contrary to Eysenck, that psychotherapy does have substantial benefits; found an average effect size of .85 indicating that typical therapy client is better off than 80% of individuals who need therapy but are untreated

Howard et al. Psychotherapy Outcome Study

Identified a dose dependent effect of psychotherapy; about 75% of patients show measurable improvement at 26 sessions and that this number increases to only about 85% at 52 sessions; identified a phgase model which predicts that the effects of psychotherapy are related to the number of sessions and distinguishes between three phases (remoralization, remediation, and rehabilitation)

Cultural Competence

(Sue and Sue, 2003) Therapist’s awareness of their cultural assumptions, values, and beliefs; knowledge about the worldviews of culturally diverse clients; skills that enable them to provide interventions that are appropriate and effective for culturally different clients

Acculturation

According to Berry, refers to a person’s adoption of their own culture and the culture of the dominant group; involves four categories (integration, assimilation, separation, marginalization)

Worldview

(Sue, 1978) A person’s locus of control and locus of responsibility, affected by cultural background

Cultural Encapsulation

(Wrenn) When a therapist interprets everyone’s reality through their own cultural assumptions and stereotypes and disregard cultural differences and their own cultural biases

Emic Orientation

Culture-specific; involves understanding the culture from the perspective of members of that culture

Etic Orientation

Culture-general; assumes that universal principles can be applied to all cultures

High-Context Communication

Relies on shared cultural understanding and nonverbal cues; helps unify a culture and is slow to change

Low-Context Communication

Relies primarily on the verbal message, is less unifying, and can change rapidly and easily

Cultural Paranoia

When a client does not disclose to a white therapist due to fear of being hurt or misunderstood