Midterm 3: Clinical Psychology

In the 1900's most evidence was through:

Anecdotes, Testimonials, and Case Studies

Controlled studies appeared in the 1950's by _______________.

Hans Eyseneck

Meta-analysis definition

A method that statistically combines results from many separate studies to create numerical representations of the effects of psychotherapy as tested across massive numbers of settings, therapists, and clients.

Meta-analysis has yielded ________ results about psychotherapy.

consistent results about how well psychotherapy works.

3 Parties of the Tripartite Model (Hans Strupp)

1. Client

2. Therapist

3. Third Parties (Society)

Client (First Party) -- Tripartite Model

clients opinions are valid but also biased -- some may overestimate/underestimate the benefits of therapy

Therapist (Second Party) -- Tripartite Model

have more accurate expectations than the client due to more experience in mental health but can be biased because they are viewing only a fraction of their clients lives. They may feel client's negative evaluations reflect poorly in their skills and the clients progress

Society (Third Party) -- Tripartite Model

an outsider who has an interest in how therapy progresses

WHEN should researchers ask?

- Immediately after therapy?

- Follow-up?

- After months? Years?

- Before therapy ends?

- At certain points, or at every session?

It really depends!

HOW should researchers ask?

Self-report: through questionnaires and interviews

Behavioral Measures: Observing the client based on treatment and to determine if behavior has changed (ADHD example).

Efficacy Studies

the success of a particular therapy in a controlled study conducted with clients who were chosen according to a particular study criteria

-maximizing internal validity

-well-defined groups, random assignment, and manualized therapy guidelines

Effectivness Studies

The success of therapy in actual clinical settings in which client problems span wider and are not chosen based on diagnostic criteria

-maximizing external validity

-wide range of clients, greater variability in therapists' methods, and may/may not include a control group

Efficacy studies found that __________________ works.

Psychotherapy works

Smith, Glass, and Miller (1980) Meta-analysis

combined 475 outcome studies from 1941 to 1976 and found that an average therapy client is better off that 8-% of those who need therapy but remain untreated.

Results of Psychotherapy Efficacy studies (3)

1. Endure over long periods of time

2. Exceeds Placebo effect

3. Represent clinically significant change in clients well being

Psychotherapy is not pancea. Negative effects appear to be the _________ not the ______________.

1. exception 2. Not the rule

Survey of 700 therapists concluded that....

The research like efficacy studies showed to have little to no influence over their own clinical practice and they placed a higher value on their own clinical experience, intution and judgments than collected data.

Results of Effectiveness studies

(not conducted as frequently as efficacy studies) Indicated psychotherapy works as it is commonly applied in realistic settings

Empirical studies comparing the efficacy of one psychotherapy to the efficacy of another found....

a virtual tie --- they were found to work equally well due to common factors

The Dodo Bird Verdict

A nickname for the research finding that different dorms of psychotherapy are roughly equivalent to each other.

Common Factors of Psychotherapies

1. therapeutic alliance

2. Hope

3. Attention

Therapeutic relationship/Alliance

the partnership between the client and therapist, the quality of the relationship strongly contributes to the psychotherapy outcomes.

-- most crucial single aspect of therapy

T/F: Clients prefer a warm therapist whom they can relate to over a treatment with empirical support

True

T/F: Therapeutic relationships are vital no matter how much emphasis they place on it?

True

Different Emphasis on Therapeutic relationships in different forms of psychotherapy.

Behaviorist -- deemphasizes therapy relationships

Cognitive -- moderate therapy relationships

Humanistic -- heavy emphasis on therapy relationships

Therapeutic relationship and client improvement (3)

1. Good alliance facilitates client improvement

2. As client improves their relationship with therapist enhances

3. Reciprocal relationship could also exist

-- in turn correlation does not equal causation

OTHER COMMON FACTORS: Hope

Providing hope can help improvement begin before implementation

OTHER COMMON FACTORS: Attention

Acknowledging the problem and focusing on it with the therapist may result in improvement

Eclectic/Integrative Therapy Trend

commonly endorsed until 2010

Cognitive Therapy Trend

on a remarkable rise

Psychodynamic/Psychoanalytic Therapy Trend

declined in popularity significantly since the 1960s.

Sigmund Frued

pioneer of psychoanalysis/psychodynamic approach

Psychodynamic Psychotherapy

A contemporary version of psychoanalysis derived from Sigmund Freud's theories -- his original terms were replaced at various points in the evolution of his theories by others

Primary Goal of Psychodynamic

make the unconscious conscious

Insight

looking inside oneself and noticing something that had previously gone unseen and once we become aware we can make an effort to control them rather than letting them control us

Unconscious

mental activities occurring outside our awareness -- Freud's most important contribution to clinical psychology

We can access the unconscious in many ways... (2)

1. this is not done empirically/factually

2. done through inference, deduction, and conjecture

Psychoanalytic Psychotherapists try to "read" their clients and hypothesize about their unconscious activity using

free association, Freudian slip, dreams, resistance, defense mechanisms, and transference

Free association

a technique in which psychodynamic therapists ask clients to say whatever comes to mind without censoring themselves revealing their inner thoughts and feelings

-must be fully relaxed to work (hard to do)

Freudian Slips

Verbal or behavioral mistakes determined by unconscious motivations

Dreams

our dreams communicate unconscious material

Freud theorized our minds convert _______ content of a dream to __________ content.

1. latent content (inner raw feelings) 2. manifest content (the plot of the dream we remember)

Dream Work

process of converting latent content of a dream to manifest content

T/F: dreams interpretations are inferential rather than factual

true

Resistance (2)

1. client behavior that impedes discussion or conscious awareness of selected topics or emotions

2. clients feel anxious when thoughts or feelings are being laid bare extensively or too quickly

Freuds Structural Model of the Mind

3 forces: Id, superego, ego

The ID

the part of our mind that generates pleasure-seeking, selfish, indulgent, and animalistic impulses (unconscious)

The Superego

The part of the mind that establishes rules, restrictions, and prohibitions (unconscious and preconscious)

The Ego

The mediator and compromise maker between the ID and the Superego.

Two challenges of The Ego

1. partially satisfying both of these opposing forces

2. meeting demands of reality

T/F: the ID and Super Ego are always in conflict

True: believed to be a constant battle between instant gratification and restraint

Defense Mechanism

techniques used by the ego to manage conflict between the ID and Superego

Common Defense Mechanisms

repression, projection, reaction formation, displacement, sublimation

Repression

when the ID has an impulse and the superego rejects it, the ego represses conscious awareness of the impulse, and the conflict is "swept under the rug"

Projection

when the ID has an impulse and the superego rejects it, the ego can project the ID impulse onto other people around us -- convincing ourselves an unacceptable impulse belongs to someone else

Reaction Formation

when the ID has an impulse and the superego rejects it, the ego can form a reaction against the ID impulse doing the exact opposite

Displacement

when the ID has an impulse and the superego rejects it, the ego displaces the impulse to a safer target -- redirecting the impulse to a target or object to minimize repercussions

Sublimation

when the ID has an impulse and the superego rejects it, the ego can sublimate it by redirecting it in a way where the resulting behavior actually helps others

T/F: Some defense mechanisms are viewed as healthier/more mature than others.

True: Denial and Repression are considered immature and Sublimination is considered mature/healthy

Alternate definitions of Freudian Terms

1. Id = "it" - animalistic behaviors

2. Superego = "over-me" - internalization of rules and demands that came from authority figures (e.g., parents)

3. Ego = "me" - the person negotiating between the demands for instant pleasure and the demands to follow rules

Transference

the tendency for clients in psychoanalysis to form relationships with therapists in which they unconsciously and unrealistically expect the therapist to behave like important people from the clients past

T/F: Transference may be the most essential means for the psychodynamic therapist to access the clients unconscious materials

True

Countertransference

Therapists can also transfer onto the client and in psychodynamic therapy they generally try to minimize it

Psychosexual Stages

oral stage, anal stage, phallic stage

Fixation

unsuccessful resolution of psychological tasks of a particular developmental stage -- occurs when parents do "too much" or "too little" in response to child's needs at developmental period

Oral Stage

Dependency Issues

-0-1.5 yrs

-Pleasurable sensations through the mouth

-Overindulge: dependent, overly trusting, naive, unrealistically optimistic -- believes people should anticipate and meet their needs

-Under-indulge: avoidance, believing no one will help them, mistrusting and unrealistically pessimistic

Anal Stage

Control Issues

-1.5-3 yrs

-Learning potty training

-If parents are too demanding: children become concerned with getting everything just right; growing into obsessively and compulsively behaved adults

-If parents are too lenient: children become lazy and lax about organization

Phallic Stage

Self-Worth Issues

-3-6 yrs

-most controversial stage

-Too positive to overtures: inflates child's sense of self and can be viewed as egotistical as an adult

-If parent rejects their child's wishes for special/close relationship the child's self worth can be wounded and grow into adults who devalue themselves

two pioneers in the humanistic psychotherapy were

Carl Rogers and Abraham Maslow

Primary Goal of humanistic psycho

to foster self-actualization and psychological problems are the byproduct of stifled growth process

Self-Actualization

assume people arrive with inborn tendency to grow

Task of Humanistic therapists

To create a climate in which clients can resume their natural growth towards psychological wellness

T/F: The need for positive regard can, at times, override the need to self actualize

True

conditional postive regard

creates problems when positive regard isn't unconditional... prized "only if" we meet certain criteria

Conditions of Worth

the stipulations that individuals may place on their positive regard of others

T/F: children value parents positive regard and conditions of worth become so apparent that they go astray of their own self-actualization tendencies

True

Real self

the self that an individual actually experiences

Ideal Self

the self that an individual could experience if he or she fufilled or own potential

Incongurencey

the discrepancy between the real self and the ideal self

Congurence

a match between the real and actual self which is achieved when self actualization is allowed to guide a person's life without interference by any conditions of worth

Elements of Humanistic Psychotherapy (2)

-self-actualization is a primary natural tendency

-therapist fosters the client's self-healing tendencies toward growth

3 factors of humanistic therapy

1. Empathy

2. Unconditional positive regard

3. Genuineness

Empathy (3)

-therapists abilities to sense clients' emotions just as clients the client would

-involves deep nonjudgmental understanding

-therapists' POV and values are temporarily suspended

client-centered therapy

The therapist sees life through the client's eyes and adopts their frame of reference when using empathy

Unconditional positive regard (4)

1. acceptance "no matter what"

2. allows the client to grow in purely self directed way

3. clients can be wholly true to themselves

4. overtime, fosters a higher level of congruence and self-actualization

T/F: Conditional Relationships help foster growth and bring us to our true selves

false: they impede growth and drift us away from our true selves

Humanists top priority

to accept clients entirely and unconditionally

Genuineness

the quality in the therapist of truthfulness, realness, or congruence -- therapist must be genuine

Therapist Congruence

match between therapists ideal and real self

T/F: Personality plays an important role in therapy in Genuineness

true

T/F: Genuineness encourages a high degree of transparency by the therapist

true

Necessary and Sufficient

Carl rogers (and followers) believe unconditional positive regard, empathy and genuineness were both necessary and sufficient for therapy to be successful

- now considered common facots

t/f: unconditional positive regard, empathy and genuineness are attitudes NOT behaviors

true

Reflection

rephrase or restatement of client's statements which serves as 3 factors of humanistic therapy mechanisms

Existential psychotherapy

Each person is alone in the world and the realization of this causes anxiety which is considered to be the root of all psychopathology

Gestalt Therapy

holistic approach to the mental and physical created by Fritz Perls which dempiazhes clients past experiences and encourages them to be in the present

Positive Intervention + Strength Based Therapy (2)

--emphasizing human strengths and cultivation of happiness created by Martin Seligman

--rooted in the potential for individuals to develop and maintain positive attributions

T/F: Survey of 2400 therapists found that Carl Rogers was the single most prominent figure in terms of influence of practice

true

Emotionally Focused Therapy (EFT)

Emphasizes the expression, acknowledgment, and healing power of emotions in the present moment, as well as emotions that may have been "bottled up" for a long time; encourage clients to share their feelings toward others

Empty chair technique

A role-playing intervention in which clients play conflicting parts. This typically consists of clients engaging in an imaginary dialogue between different sides of themselves.