Clinical Psych Exam 4

You got this!!

Who developed cognitive Psych Therapy?

Aaron and Albert Ellis

Goal for Cognitive Therapy

Thinking logically

What model do Cognitive Therapists endorse?

The three step model! Non professionals often mistaken emotional experiences to be a 2 step model…ex: an event happen and that impacts the individuals feelings.

What is the 3 step model?

1. An event happens

2. We interpret the event

3. The interpretations directly influence our feelings

(The events don’t make us happy or sad, but the way we think about the events will trigger our emotions)

Automatic Thoughts

take place in an instant without any deliberation. Challenging illogical thinking and replacing them w/ logical cognitions.

What is the typical structure of a Cognitive Therapy sessions…

• Check on the clients’ mood and emotional status

• Set an agenda for the session

• Establish a link with the previous session by reviewing the previous hw

• Progress of the person during the current session

• Develop and assign new hw

• Summarize the current session; ask for client feedback

How is hw in cooperated?

Cognitive therapists strongly believe that a lot of the work needed for therapy is conducted between sessions with assignments

Is Cognitive scientifically supported?

Yes! It is supported by empirical evidence and it continues to grow

Albert Ellis Model:

ABCDE:

(A)ctivating Event

(B)elief

Emotional (C)onsequence

(D)ispute
(E)ffective new belief

Aaron Beck Model:

Dysfunctional Thought Record: helps client organize their thoughts & experiences by asking them to identify the event. Describing their automatic thoughts & emotions about the event. And identifying adaptive responses.

Beck argued…

our beliefs are hypotheses. A good way to expose a belief as illogical is to “put it to the test” irl.

Beck and Colleagues identified a list of common thought distortions…

Labeling thoughts are illogical allows the client to dismiss them and replace them w/ more adaptive and logical thoughts

Common distortions identified by Beck…

All or nothing thinking, Catastrophizing, Magnification/Minimization, Personalization, Overgeneralization, Mind Reading

All or nothing thinking

irrationally evaluating situations as wonderful or terrible, no middle ground or “gray area”

Catastrophizing

expecting the worst but in reality something bad is unlikely to happen

Magnification/Minimization

for negative events “making a mountain out of a molehill” for positive events, playing down their importance

Personalization

assuming excessive responsibility for negative events

Overgeneralization

applying lessons learned from negative experiences more broadly than it’s warranted

Mind Reading

presuming to know that others are thinking critically or disapproving, when what they think is actually impossible.

In recent years Third Wave cognitive therapies has become…

increasingly popular. (Also know as mindfulness-based cognitive therapy)

Mindfulness-Based Cognitive Therapy is aimed to…

change the person’s relationship to their thoughts rather than change the thought themselves. clients are pushed to help understand their thoughts

2 examples of Mindfulness-Based Cognitive Therapy:

Acceptance and Commitment Therapy (ACT) developed by Steven Hayes

Dialectical Behavior Therapy (DBT) developed by Marsa Linehan to treat Borderline Personality Disorder

Acceptance and Commitment Therapy (ACT)

Accepting one’s inner experiences for what they are and nothing more. Ex: Hayes asks us to imagine our thoughts as a parade in which we are spectators but not participants.

Choosing directions in life based on one’s core values, which will enhance life’s meaning and purpose. Or commitment to one’s own personal values

Taking action in matters that are large and small that are consistent w/ one’s own values.

Dialectical Behavior Therapy (DBT)

teaches emotional regulation, distress tolerance, interpersonal effectiveness and mindfulness skills

Who supported group therapy…

Yalom, they believed that there was specific group therapeutic factors that benefited clients

Universality

the experience that one’s problems are not unique, but are common to others

Group Cohesiveness

the feelings of interconnectedness among group members (trust, warmth, acceptance, belongingness)

Interpersonal Learning

learning from the in-group interpersonal experiences (i.e. relationship practice)

Social Microcosm

the relationship tendencies that characterize clients’s relationships w/ important people in their personal lives will predictably characterize the relationships they form w/ fellow group members

The here and Now

Focus on the present interpersonal interactions w/ fellow group member rather than events that have happened in clients’ lives outside the group. Emphasis on feedback

Types of Group Membership:

Open-enrollment and Closed-enrollment

Open-enrollment

allow individuals to enter or leave the group at anytime

Closed-enrollment

allow members to start and finish therapy together w/ no new members added during the process

What are some concerns with including a client into group therapy…

Issues that would prevent the therapist from selecting a particular client as a group member include: Characteristics that would interfere w/ the client’s ability to interact meaningfully w/ others and reflect on that interaction

Extra-group Socializing

Clients who socialize w/ each other outside of the group setting can create significant problems. There are many potential consequences with this…

It’s important to make sure that the group members exhibiting antisocial behaviors are not socializing outside of the group

Ethical Issues in group therapy:

Confidentiality and when a client is in individual therapy and group therapy w/ the therapist

What’s the purpose of family therapy:

point out the unhealthy communication patterns among family members as the type of interaction that most significantly contributes to psychological problems

Family therapists emphasize…

Functionalism

Functionalism

even though psychological symptoms may appear maladaptive, they are in fact functional within the individual’s family environment

Family therapy divided into 2 broad categories:

Ahistorical Styles and Historical Styles

Ahistorical Styles

emphasizing current functioning and deemphasizing family history. (solution-focused therapy)

Historical Styles

Emphasizing family history and typically longer duration than ahistorical styles. (Structural family therapy)

Family Structure

the implicit rules that govern a family’s behaviors

Salvador Minuchin

developed structural family therapy

Structural Family Therapy

uncovering and correcting family rules—often w/ an emphasis on developing a clear hierarchy of power

Structural Family Therapists emphasize…

Subsystems and Boundaries

Subsystems

within families there's (parental subsystems, siblings subsystems)

Boundaries

• If boundaries are too loose, family members can become unclear or easy to break.

• If boundaries are too rigid, family members can become disengaged and not want to follow them

Examples of boundary issues

parentification, triangles/triangulation

Parentification

when a child takes on parental responsibilities, such as caretaking of a sibling or parent, managing family issues. In addition to parents look to their children for emotional and or practical support rather than providing it

Triangulation

dynamic where a third person is drawn into a conflict between 2 others often to manipulation or exert control

Solution focused therapists use…

A list of specific tasks and questions to call attention to solutions rather than problems

Formula First-session Task

Clients are instructed to note the aspect of their lives that they like and want to continue to happen

Family Therapists need to be aware of 3 things…

Cultural Competence, Confidentiality, Diagnostic Therapy (there are no DSM diagnostic labels for distorted family systems)

Why do some children develop disorders while others do not…

therapists study resilience and vulnerability because of this

Factors that contribute to vulnerability…

environmental factors, parental factors and child (internal) factors

Factors that contribute to resilience…

external supports, inner strengths and interpersonal and problem-solving skills

Comprehensive Assignment

Clinicians should strive to gain as much info as possible about children and adolescent psychological problems

Comprehensive Assessment Breakdown:

The presenting problem: what is the presenting problem? Do all parties agree?

Development: what is the child’s current state of physical, cognitive, linguistic and social development? History of development?

Parents/family: parenting style, relevant parental factors (e.g. psychological or medical difficulties)

Environment: what is the child’s larger environment outside the family? Are there any recent events that might impact the child?

Assessments should be…

multisource, multimethod, and multisetting

When do we employ behavioral observations?

when we can directly observe a behavior!

Behavioral observation is typically…

frequency-based, interval-based, or duration- based

Be cautious of…

reactivity

Reactivity

the child may exhibit different behaviors if they are aware of being observed

Narrative Therapy

form of psychotherapy that focuses on helping individuals re-author their life stories to create more positive and functional narratives.

Statistical Prediction Methods of Predicting Dangerousness

comparing an individual’s characteristics with known statistical relationships to future dangerousness. It’s data driven, using objective measures, examples, tools, and techniques.

Limitations include: they may not fully capture all the nuances of an individual’s circumstances or potential of change

Behavior Rating Scales

standardized pencil to paper or computer-based forms that parents, teacher or other adults complete regarding a child’s behaviors.

Ex: Behavior Assessment System for Children (BASC), Conner’s Rating Scale, the Children Behavior Checklist (part of the Achenbach System of Empirically Based Assessment)

Interview techniques used w/ children…

Open-ended questions aren’t as helpful. You have to tweak them to have a more concrete set of responses…provide the child w/ alternatives to to answer the clinician’s questions verbally

Provide visual stimuli for children to respond. Have them draw a picture or use a children’s book

• Try to understand silence; offer reassurance

Is CBT with kids supported empirically?

Yes. there is evidence that supports these therapies on children. Typically the treatments rely on the same principles used on adults with some modification for children.

Variation on Cognitive Therapy:

social skills training

Parent Training

a form of behavioral therapy in which therapists teach parents to use techniques based on condition to modify problematic behaviors w/ their children.

*Parents are typically the primary agents of change

Berms argues that play therapy has 3 basic functions:

• The formation of important relationships (I.e. the therapeutic relationship)

• Disclosure of thoughts and feelings

• Healing

Psychodynamic Play Therapy

• Theorists believe that a child’s play symbolically communicates important processes occurring within the child’s mind

• The goal is to make the unconscious conscious

• Clinicians are making interpretations just as they with adults in psychodynamic therapy.

Humanistic Play Therapy

• Therapist rarely offer interpretations

• Instead, play-centered therapists attempt to reflect their client’s feelings

• The goal is the same as humanistic therapy with adults: to facilitate self-actualization

• A core feature: unconditional positive regard from the therapist

Forensic Psychology

The application of psychological methods and principles within the legal system. Different from other psychologist roles in that it places the clinical psychologists in an adversarial relationship between parties in conflict with each other

Most common assessments…

are conducted by forensic psychologists are in the area of child custody, competency, presentencing evaluations.

Many techniques used in forensic assessment…

are the same as those used more generally by clinical psychologists. the use of clinical interviews, interviews, Intelligence and personality tests, etc. Forensic experts tend to endorse objective personality assessments

Not Guilty By Reason of Insanity (NGRI)

if an individual is not able to control their actions due to mental disorder (even if those actions were criminal nature), the individual would not be held responsible for the crime.

Focus is on the individual’s functioning at the time of the crime…

less than 1% of felony jury trials involved an NGRI defense; only about 25% of those trials result in an NGRI verdict

Competency

refers to the defendant’s present or current ability to understand the criminal process and function within it. Definition does not include the defendants prior mental status or mental status at the time of the crime. Focus is on present mental state

Custody Decisions…

• are made based on “the best interest of the child doctrine” currently

• Children are not considered by the court to be capable of making sound judgments

• If parents are unable to make sound decisions for their children, a guardian ad litem is often appointed to make sure the child’s rights are protected

Guardian ad Litem

neutral third party (often an attorney unaffiliated with either parent) appointed to avoid decisions being made by individuals who have a conflict of interest.

Custody Evaluations Typically Include:

• A clinical interviews w/ each parent and child

• An observation of parent-child interactions

• Psychological testing with the parents

• Review of relevant documents

Civil Commitment

a process by which a person is involuntarily hospitalized by civil authorities for the welfare of the person and others

Decisions typically follow a 2 step process:

1. Initial emergency admission is granted

2. Judicial approval is required for continued confinement

• Individuals must have a mental disorder

• An individual must be dangerous to themselves or others

• Most states consider an individual’s ability to care for basic needs

Voir Dire

Clinical psychologists can provide expert testimony to the court about mental health issues; the expert’s education, training, and professional experiences are examined