Clinical Psych

Minuchin Structural Family Therapy

Family = a system of subsystems

Boundaries between systems

Goal of Minuchin’s therapy

Reorganize family systems to improve functioning

Gestalt-therapy primary goal

Achieving awareness of thoughts, feelings, and behaviors in the here-and-now

Glasser's reality therapy success identity

Satisfying needs in a responsible way (in a way that does not interfere with the ability of other people to satisfy their needs)

Glasser's reality therapy failure identity

When people are unable to fulfill their needs or do so in an irresponsible way

Roger: Main cause of psychological problems

Incongruence between self-concept and actual experience.

Depression as a result of unresolved grief, interpersonal deficits, role disputes, or role transitions: which approach?

Interpersonal therapy

Solution-focused therapy: miracle question

Helps identify goals and imagine a future without the problem.

Example: “If a miracle happened and the problem was solved, how would you know?”

Transtheoretical Model (Stages of Change)

Interventions are most effective when they match the client’s stage of change.

Primary goal of Bowen's extended family systems therapy

Increase differentiation of family members

Meichenbaum's self-instructional training goal

Help impulsive children have greater self-control when completing tasks by teaching them to use helpful self-statements to guide their behaviors.

Meichenbaum's self-instructional training steps

1) Cognitive modelling
2) Overt external guidance
3) Overt self-guidance
4) Faded overt self-cuidance
5) Covert self-instruction

“Collaborative empiricism” describes the therapeutic relationship in which type of therapy?

Beck's CBT

Cost-benefit analysis

Costs and benefits are both converted to money.
Example: Therapy A costs $5,000 and produces $12,000 in estimated savings.

Cost-effectiveness analysis

Non-monetary outcomes
Example: Symptom improvement, hospitalization rates

Cost-utility analysis

Costs are compared using quality-adjusted life years (QALY)
Example: $20,000 per QALY gained.

Cost-consequences analysis

Costs and multiple outcomes are listed separately rather than combined into one summary ratio.

Example: Therapy A costs $5,000, reduces depression by 8 points, and prevents 3 hospitalizations.

QALY - Quality-Adjusted Life Year

Health gained
Combines quantity + quality of life

DALY = Disability-Adjusted Life Year

Health lost
Burden of disease / healthy life lost

A White therapist with an internal locus of control and internal locus of responsibility has more difficulties with clients from a minority group who have an:

Internal locus of control
External locus of responsibility

They are most likely to challenge the therapist's credibility and trustworthyness

Cognitive therapy for suicide prevention (CT-SP) stages

Emotion regulation
Cognitive flexibility
Relapse prevention.

Effects of ROM (routine outcome monitoring) on symptom reduction and premature termination and deterioration

Improves symptom reduction
Decreases premature termination and deterioration during therapy, especially for “not-on-track” clients (clients at risk for treatment failure)

Types of detouring according to Minuchin

Detouring-attack coalition: scapegoating child for problems
Detouring-support coalition: parents avoid conflict overprotecting child

Rogers:
Self-reality incongruence → anxiety → [which defense?]

Denying or distorting experience

Interpersonal Therapy (IPT): depression is

A medically based condition

Multisystemic Therapy (MST) - Bronfenbrenner

Adolescents with serious ANTISOCIAL behaviour at risk for out-of-home placement
Multiple systems (ECOLOGICAL): family, peers, school, community
Home and community-based
Treatment fidelity is essential

MDFT — Multidimensional Family Therapy

Adolescents with SUBSTANCE USE + behavioral problems

Targets multiple domains: adolescent + family + peers + school/community

Goal: improve family functioning and reduce substance use/problem behavior

Functional Family Therapy (FFT)

• Adolescents with behavioral/conduct problems

• Behavior is understood in terms of its function within family relationships

• 3 phases:
  Engagement & Motivation → therapeutic alliance, reducing hopelessness, increasing motivation for change, developoing a family-focused understanding of the family's problems
  Behavior Change
  Generalization

Family-Focused Therapy (FFT)

BIPOLAR DISORDER (adolescents and adults)
Focus: high expressed emotion
Interventions: Psychoeducation, communication training, problem-solving

Goal: reduce expressed emotion, reduce relapse and improve family functioning

Transference-Focused Psychotherapy (TFP)

BORDERLINE

Based on object relations theory

Focuses on transference in the therapist–patient relationship

Integrates split positive/negative representations of self and others

Systems theory: positive and negative feedback effects

Positive → deviation amplifying from status quo (promotes change)

Negative → deviation counteracting (maintains status quo)

Mindfulness based cognitive therapy (MBCT): depressive episode can be avoided by…

Adopting a decentered position at the first sign of depression (disengaging from and accepting negative thoughts and feelings associated with depression rather than avoiding or fighting them and recognizing that they’re just thoughts and feelings, not reality.)

Positive Psychology: primary antecedent of flow = ?

Balance between challenge and skill

Glasser's five needs:

Love and belonging
Power
Fun
Freedom
Survival

Jung: primary goal of the analytical psychotherapy?

Bring uncounscious material into counsciousness to facilitate individuation

Jung: individuation means

Reclaiming the undeveloped and unconscious parts of oneself
Achieving individual “wholeness", being a unique unified person by becoming conscious and harmonizing the varios parts of the psyche

Family systems theory: negative feedback means

Resists change/deviation → maintains/restores homeostasis

Family systems theory: positive feedback means

Amplifies changes/deviation → changes the system

Solution-Focused Therapy: exception questions

Identify times when the problem was absent or less intense.

Example: “When was a time you and your partner did not argue?”

Solution-Focused Therapy: scaling questions

Help clients rate current status or progress.

Example: “On a scale from 1 to 10, how stressed are you now?”

Biases in research: WEIRD

Participants from

Western

Educated

Industrialized

Rich

Democratic societies

Limits generalizability.

Biases in research: Alpha

Exaggerates gender differences

Biases in research: Beta

Minimizes or ignores gender differences

ACT: primary cause of dirty discomfort = ?

Experiential avoidance: when someone avoids contact with unwanted thoughts, feelings, physical sensations → engages in counterproductive behaviors to avoid or control them.

African woman using skin-lightening cream to become more attractive and be treated with greater respect = ?

Colorism

Asian American complimented on his “good English” = micro…?

Microinvalidation

Messages that exclude, negate, or dismiss the thoughts, feelings, or lived experiences of minorities.

I don't see colour
You're being too sensitive
Are you sure that it happened?

Diagnostic overshadowing

Attributing a client’s presenting problem to the client’s cultural/racial background without considering the possibility that the problem could be due to an unrelated issue or condition.

Cultural distance

Culture ←→ Culture
How the immigrant's culture fits the culture of the new country

Cultural fit

Personality ←→ Culture
How the immigrant's personality fits the new country's culture

Name-calling and explicit discriminatory acts = micro…?

Microassault

Explicit racial derogations, usually intentional and meant to hurt. Similar to “old-fashioned” racism.

Assuming intelligence based on race = micro…?

Microinsults

Insensitive or demeaning messages about a person’s racial/ethnic background or identity.

Ex: implying someone was hired only because of affirmative action, pathologizing cultural communication styles.

ACT: Experiential avoidance definition

Experiential avoidance: when someone avoids contact with unwanted thoughts, feelings, physical sensations → engages in counterproductive behaviors to avoid or control them.

Beck: selective abstraction vs arbitrary inference

Selective abstraction = drawing conclusion based on a detail that was taken out of context

Arbitraty inference = drawing a conclusion without any evidence

Impact of age and gender on psychotherapy outcomes?

No consistent impact

Howard et al. (1986) — Dose-Effect Relationship for Psychotherapy

8 sessions = 50%;

26 sessions = 75%;

52 sessions = 85%.

Efficacy vs. Effectiveness Studies —> difference?

Efficacy: Does it work under ideal, controlled conditions? → Internal validity

Effectiveness: Does it work in real-world clinical settings? → External validity

Sequence: Efficacy first → Effectiveness second.

High-context communication

Relies on context, shared understanding, nonverbal cues, and implicit meaning.

Knowledge is situational → tem que entender o contexto pra entender algo.

Low-context communication

Relies mainly on explicit verbal messages.

Knowledge is transferable → conhecimento comunicado de forma direta

Immigrant paradox

Recent immigrant → better health and educational outcomes than more estabilished immigrants and non-immigrants

Integration paradox

Higher status immigrants → report discrimination and lower sense of belonging to the new culture than lower-status immigrants