Psych108 Sem 1 Week 7-12

Solution Focussed Therapy

• Founded by Steve de Shazer, Insoo Kim Berg

• Influenced by Milton Erikson who believed

  • Everyone possessed the skills and abilities to solve their own problems

• Small changes can lead to bigger changes

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• A small change is all that is necessary:

• Clients define the goal

• Rapid change or resolution of problems is possible

• There is no right way to view things

• Different views may be just as valid

Theory of Solution Foccused Therapy

• If it doesn’t work, do something different and if it works do more of it

• Clients have the strengths and resources to change

• Client problems result from not recognizing alternatives, rather than from underlying pathology

• A small change in any aspect of a problem begins the process of solving it

• Change comes from focusing on future possibilities and solutions (Cepeda and Davenport, 2006)

• Clients as customers, complainants or visitors

Underlying Assumptions

• Complaints stem from view of the world

• Even minimal can affect progress = self-perpetuating ripple effect

• Doing more of the same: what is working

• People have the ability to solve their difficulties they have just temporarily lost confidence, direction or awareness of resources

• People are doing the best they can with the resources they have

• Things cannot not change

• Exceptions to the problem give clues to the effective solution

Treatment stages

• Identifying a solvable complaint

• Normalizing the problem

• Must be within clients control

  • What do you want to change?

  • What would help me to really understand this situation?

  • How does this create a problem for you

• Presenting complaints = function of unsuccessful interactions with others of the mishandling of everyday experiences

Types of Clients

• Visitors: no complaints, along for the ride

  • Give compliments/identify specific strengths

  • Don’t give homework tasks

• Complainants: going along to placate and appease: complain, distant, observant and expectant

  • No expectations/no goals

  • Ask client to observe what is happening that tells them that this problem can be solved

  • Expectations/no goals

    • Ask client to make detailed observation of times that are better so that thy can be described at the next session

• Customers: Do Something - want to change

  • Give behavioral tasks

Interventions Solution Focused Therapy

• Normalization

• Execption Finding - focus for solution rather than problem

• Scaling Question

• Homework

• Mircle Question - what signs would there be if problem solved

Critisims of Soultion Foccused Therapy

• Is it only helpful for a short period of time because of placebo effect? Will change continue in 10 sessions

• May not allow opportunity to talk about problems and explore meaning

• Insight is viewed as distracting, ignored understanding of self

• As many strategies intuitive, difficult to study reliability and gain empirical evidence of effectiveness

Narrative Therapy

• Seeks to be respectful, non-blaming approach to counselling and community work

• Centers around people being experts of their own lives

• It views problems as separate from people

• Assumed people have many skills, competencies, beliefs, values, commitments and abilities that will assist them to reduce the influence of problems in their lives

• Link events

• Organize sequence of events

• Are influenced by social context, gender, family, socioeconomic status and culture

• Counsellor facilitates the creation of new storie

Post Modernism

• Deconstruction of meaning and truths

• Deconstruction of the dominant discourses we tell ourselves

• Reality is not fixed - is it constructed

• Our lives are a construction shaped by language and the stories we tell ourselves

Themes in Narrative therapy

• Realties are socially constructed

• Realities are constructed through language

• Narrative organizes and maintains reality

• There are no essential truths

Social Constructism

• Personal experience and meaning embedded and shaped by culture

• Personal identity is the product of history of the culture, persons position in society and linguistic resources

• Meanings are created by the sharing of the beliefs, ideas, thoughts, rules etc that we have as a society

• These meanings have been created across time in different scenarios

• Meanings have then started to create ideas or narratives of who we are in relation to other meanings and other beings

• Understanding our stories (our personal story) or narratives, are central ideas to the narrative ways of working

Key Concepts Narrative therapy:

• The focus of narrative therapy is on the relationship between experience and interpretation revealed in the narrative

• Attention by the therapist should be paid to the way people tell their stories, rather than the accuracy od the account

• Sometimes there is a mismatch between the dominant narrative and the actual life experience

• Truth is relative, subjective and fluid

• Dominant story can construct an impoverished life

• Dominant story may be problem story

• Peoples live are created and interpreted through their stories, the stories they hear, the ones they create on their own and the ones they use as statements of how they are

• Problems are manufactured in social, cultural, familial, political and historical context rather than being intrinsic or inherent in the person

Techniques

• Externalizing conversations - represent problem outside the person

• Naming the problem

• Identifying unique outcomes

How does it work? - DEMR

• Deconstruction:

  • "where did you learn that having a chronic illness makes you weak"

• Externalization:

  • "what messages have you received from diabetes"

• Mapping effects:

  • "what conclusions about yourself have you drawn because of diabetes"

• Re-authoring:

  • "what does it say about you, when you have been able to not give up when diabetes has made it so difficult"

Critisisms of Narrative Approach

• Has its own vocab

• Encourages client to externalize the problem, but what about responsibility?

• Can it be culturally sensitive?

• Need for complex vocab and more complex recognition?

Questions:

Closed question - lead to specific answer, responces are short

Open question - allow client to reflect in and explore relvevant material

• Exception questions:

  • When is the problem less present"

• Coping questions:

  • How have you managed to keep going"

• Scaling questions:

  • What would move you from a 4 to a 5

• Goal question:

Collaboration in Narrative therapy:

• The person consulting the therapist plays a significant part in mapping the direction of the journey

• Narrative conversations are interactive and always in collaboration with the people consulting the therapist

• Therapist seeks to understand what is of interest and how the journey is suiting their preferences

• Curiosity and willingness to ask questions to which we genuinely don’t know the answers are important principles

• There are many directions that any conversation can take

• Person consulting the therapist plays a significant role in determining the direction take

Effects of dominant stories

• Effects in the present and future

• Decisions or plans influences by dominant story

• Be more inclined to doing things when influenced by the story

• Meanings given events are not neutral in effects on ones life

• They will shape life in the future

• alternative stories, dominant and alternative plots

Broader social context of stories:

• The ways we understand out lives are influenced by the broader stories of the culture in which we live

• Some of the stories about our lives have positive effected and some have negative effects on life in past, present and future

• Context of gender, class, race, culture and sexual preference are contributors to plot of stories

• Beliefs, ideas and practices of the culture play a large part in meanings we make of our lives

Thin descriptions:

• Early in meeting therapist hear stories about the problem and the meanings that have been reached about them

• These meanings reached in the face of adversity are called thin description

• Thin description allows little space for the complexities and contradictions of life

• It allows little space for people to articulate their own meanings of their actions and the context to which they occurred

• Often thin descriptions of peoples actions are created by others

Thin conclusions and their effects

• Thin descriptions often lead to thin conclusions about peoples identies and these have negative effects

• Thin conclusions often expresses as a truth about a person who is struggling with problem and their identity

• Person with the problem may be understood to be bad, hopeless or a trouble maker

• Thin conclusions are drawn from problem saturated stories disempower people as they are based in terms of weakness, disabilities, dysfunctions or inadequacies

Alterantive stories

• Such as stories that are identified by the person as stories they would like to live their lies

• Therapist is interested to seek out and create stories of identity that assist people to break influence of problems

• Alternative stories can reduce the influence of problems and give new possibilities for living

Client must have

• privacy

• refuse treatment

• competent treatment

Resolving ethical conflicts

If you notice a colleague who is engaging in unethical practice you must intervene to protect the safety of others who could be harmed or in danger

Clinical misjudgment

• You will make mistakes, don't avoid or deny your mistakes

• Get supervision

• Discuss the mistakes with the client

• Mistakes can provide opportunities for learning and growth for client and counsellor

• Very different to malpractice or professional negligence.

• Pressure from setting and staff

• Relationships with former clients

Proffesional Code of Ethics

• Psychology Board of Australia Code of conduct (Dec 2025)

• The code outlines expectations for:

  • Professional behavior

  • Safe and ethical practice

  • Respect and cultural safety

  • Confidentiality and consent

  • Professional boundaries

• Breaches may lead to investigation by AHPRA and the Psychology Board

• ensures safe and effective practice, respect for clients, accountability

Profesional boundaries ensures

• Objectivity in treatment

• Protection from exploitation

• Professional trust

Dual relationships

A dual relationship occurs when a psychologist has more than one role with a client

• Dual relationships can create:

  • Power imbalances

  • Conflicts of interest

  • Risks of exploitation

• Psychologists must avoid or carefully manage them

• In small communities or universities, dual relationships may sometimes be unavoidable. The code requires psychologists to minimize risk and priorities the clients wellbeing

Conflict of Intrest

• A conflict of interest occurs when personal or professional interests could influence professional judgment

• Examples:

  • Financial incentives

  • Treating someone you supervise

  • Personal relationships with clients

• Psychologists must:

  • Identify conflicts

  • Disclose them when necessary

  • Manage or avoid them

Cultrally safe practice

• Psychologists must practice in culturally safe and respectful ways

• This includes:

  • Recognizing cultural differences

  • Respecting cultural knowledge and identity

  • Avoiding cultural assumptions

  • Adapting practice when needed

• Particular attention is given to ATSI

• Cultural safety means clients feel respected, understood and free from discrimination

• seld determination

• address racism and bias

Informed consent

• Clients must give informed consent before receiving psychological services

• They must understand:

  • What the service involves

  • Potential risks and benefits

  • Confidentiality

  • Their right to withdraw

• Consent should be voluntary, informed and ongoing

• Consent is not just a formed signed - it is an ongoing practice

Confidentiality

• Psychologists must protect client confidentiality

• Information shared in therapy is private

• However there are important limits.

• Confidentiality may be broken if:

  • There is risk of serious harm

  • Required by law

  • Required by a court order

• Clients must be informed about these limits

Making ethical decisions

• 1: Recognize that there is an ethical issue - you must be aware that a decision needs to be made

• 2: Describe the problem - figure out what is at stake, consider what harm can result to whom and anticipate the consequences: gather and organize information

• 3: Identify appropriate ethical standards involved - consult ethical codes, if unclear consult colleagues and supervisors

• 4: Review professional literature - to see if anyone else has experiences this ethical problem

• 5: Reflect on personal morals and values - is your ethical decision in best interest of your client or to meet your own needs: sometimes poor decisions are made

• 6: Deliberate and decide - prepare a course of action and document the process: get support and feedback from collogues and supervisors, also consider the consequences of your actions and alternative options if things don’t go to plan

• 7: Take action - follow through on the informed decision that you made, based on research and planning

• 8: Reflect - review the situation as it develops; identify what you have learned and what you may do differently in the future.

responce when your service harmed clients

• Act immediately to rectify the problem if possible, including seeking help and advice and referring the client if needed

• Report the incident to relevant authorities if requires, comply with relevant policies and procedures and seek advice if you are unsure about your obligation

• Communicate respectfully with clients and associated parties as necessary and

• Respond to client and associated parties request for information about the process for making a notification to the Board or complaints to other appropriate bodies

Concerns about performance

•  acknowledge the client’s right to raise the concern,

• provide information about complaints systems that are available,

• where possible, work with the client to resolve the issue locally,

• consider whether the raising of the concern might adversely affect delivery of services to the client. In some cases, it might be advisable to refer the client to another appropriate practitioner,

maintain conunity of services

• a. make arrangements for other practitioners to continue providing services to clients during emergencies or periods of your foreseeable absence,

• b. make reasonable plans for the continuity of service to clients in the event you become unavailable, for example due to your relocation, illness or death,

• c. make reasonable plans for the continuity of service to clients when your relationship must end, including helping clients identify alternative appropriate practitioners and passing on relevant information with clients’ consent when it is practical,

• d.. where practical, inform clients as early as possible if you need to end the service,

Genogram

• Gathers information about family structures and relationships

• Comprehensive map of all the members of a family over several generations

Emotion Focused couples therapy

• Primary emotions: this is our first reaction to events. It includes both adaptive and maladaptive responses

• E.g feel hurt when being rejected

• Secondary emotions: out emotional reactions to primary emotions that interfere with our function. This is often what client bring to therapy e.g feel angry when being rejected - anger is actually a response to the primary emotion of hurt

Thinking in a System

• A set of things working together, as parts of a mechanism or an interconnecting network, a complex whole

• A set of principles or procedures according to which something is done; an organised scheme or method

• Interconnected relationships - create change

• In systems point of view

Universal Features of Family and Relationship Counselling

• All family therapist think in terms of social systems. Rather than viewing problems in terms of simply cause- effect relationship - they are seen in terms of circular casualty

• Chain reactions influence each family member, who in turn influences everyone else

• Family therapists are more flexible, active and more structuring that practioners of other treatment modalities

Family versus Individual counselling

• problem located between people

• counsellors more active and directive

• looking at the bigger picture

Family Therapy Techniques

• Reframing: The counsellor redefines the presenting complaint for the family, using both ingenuity and creativity to think on concrete and metaphorical levels

• Opposition Through Compliance: when attempting success to solve a problem by a certain action, try something else - usually the opposite action

• Directives: are more active, struggling an directive than they would ever consider being when working with individual clients

• Slowing Down: Whenever anyone tries too hard to do something, the task becomes more difficulty. The directive to slow down is often most effective during initial interviews when clients are apprehensive about being asked to do something they wont be able to do

Triangulation

• A child will often develop problems as a way to protect the parents from having to face their own difficulties

  • Eating behavior - conflict is bad between parents

  • Parents stop focusing on each other and focus on trying to solve problem child has

• As a counsellor you will often see families who present a "problem" child and view themselves as concerned parents who have no problems of their own

Power in family relationships

• Family counsellors tend to see psychological symptoms like depression, anxiety and ED in terms of roles they play within a families power dynamics

• Balance of power between spouses can be viewed as a metaphor for other communications in the marriage

• The counsellor initially plots the family organization, then identifies the problems of each member, and finally develops a series of interventions

Interventions:

• Symptoms as solutions: Rather than approaching treatment with the intention of promoting individual insight and then helping the client make changes, the family counsellor often looks towards behavior of the disruptive family member as helpful or constructive in some regard

• Forcing the Spontaneous: a client who complcies with the suggestion is exhibigint control

Approaches

Experitneital Family Therapy:

• Get in touch with real feelings, hopes, desired, fears and anxieties

• Evoking strong emotions and create person to person encounters

• Assisting family members to take risks

Structural Family Therapy:

• Boundaries between members

• Attention to hierarchies

• Alliances

Bowen Family Therapy:

• Differentiation of self

• Ideas of triangles and nuclear family

• Multigenerational transmission process

• Importance of sibling positioning

• Emotional cut off

Stratgeic Family Therapy:

• Based on communication theory

• Use of questions (circularity)

• Focused on the problem

• Family homeostasis

Couple Therapy

• Growing demand has elevated status of couples therapy

  • Primary method of working with couples

• Significance of relationship distress in mental health has also been recognized

  • Relationship distress contributed to depression, anxiety, alcohol abuse

• Ongoing relationship distress has serious physical health implications and has been found to depress immune function

• positive effects

Counsellors role in couples counselling:

• Not your job to help couples stay together

• Rather your role is to hep each partner take responsibility in the relationship difficulties, develop skills in communicating individuals emotional needs with honesty and directness, learn to fight fairly, and allow each person to become emotionally open and vulnerable with their partner, perhaps the essential requirement for intimacy

Counselling Basics for Couples Therapy:

• Establish clear goals and focus

• Maintain balance

• Do not allow verbal abuse in a session

• Assess for domestic violence

• Stay clam regardless of the intensity of the couples arguing or covert tension

• Assessment of couples should be multidimensional regardless of theoretical orientation

• Be assertive when appropriate. Couples counsellors are not passive listeners

Approaches to Couples Therapy:

• Solution focused

• Behavioral focused couple therapy

• Couple CBT

• Narrative Therapy

• Bowen Therapy

• The Gottman Method

• Emotionally Focused Couple Therapy

The Gottman Method and Emotion Focused Therapy

• What makes relationships break down

• What makes relationships thrive and be satisfying

The 4 Horseman of the apocalypse - Gottman

• Anger itself was not a predictor of divorce, in fact couples who expressed anger showed increase in marital satisfaction over time, but there are 4 kinds of negative interactions that were found to also be destructive

  • Criticism

  • Stonewalling ( when one partner turns away from the other or leaves the room in the middle of a disagreement)

  • Defensiveness

  • Contempt

• It was the last two, that most powerfully predicted an unhappy marriage

Gottman The Sound Relationship House - CMTTSB

Pillars are trust and commitment

• Create shared meaning

• making life dreams come true

• the positive perspective

• turn towards instead of away

• share fondness and admiration

• build love maps

Emotion Foucces Therapy

• Sue Johnson

• EFT integrates attachment theory, systems theory and person-centered empathy to help couples express their deepest fears about becoming close to each other

• Emotionally focused counsellors identify the ways in which couples create negative cycles of interaction and reframe hostile behaviors as a partners protest that the relationships isn't closer

Goals

• Helping defensive couple to express and address fears, rather than use anger as a defensive pattern

• Help partners to experience and accept emotional experience

  • Increasing range and capacity of emotional expression and responses

  • Using understanding to alter relationship  dynamics that cause distress

  • Develop more rewarding patterns of behavior

  • Develop a secure attachment between the couples

Stages in Emotion Focussed Therapy: CCC

Stage 1: Cycle De-escalation:

• Identify the relational conflict between partners

• Identify the negative interaction cycle where this issues are expressed

• Access all unacknowledged, attachment oriented emptions underlying the interactional position each partner takes in this cycle

• Reframe the problem in terms of cycle, underlying emotions that accompany it and the attachment needs

Stage 2: Changing Interactional Positions:

• Promote identification with disowned attachment needs and aspects of self

• Promote each partners acceptance of the other experience

• Facilitate the expression of needs and wants to re-structure the interaction based on new understandings and create bonding events

Stage 3: Consolidation and Integration:

• Facilitate the emergence of solutions to old problems

• Consolidate new positions and cycles of attachment behavior

Family therapy

• intial phone call gains an overview of problem

• first interview helps build alliance with family - develop hypothesis of problem takes 2/3 sessiong to build relationship

• first stragey - asking process or circular questions

First session checklist:

• establish leadership

• make contact with each member of the family and acknowledge POV

• develop alliance

• compliment positive actions and family strengths

• develop hypothesis

Early Phase of treatment

• Devoted to refining the initial hypothesis into a formulation about what's maintain the problem - also work at resolving it

• Strategy shifts from building alliance to challenging actions and assumptions

• What sets apart good therapist is their willingness to push for change

• What's required to bring about change isn't a particular way of working it’s a commitment to make things better

• pointing our unhelpful patterns

• attentionn shifts from behaviour to advice

• homeowrk

Early Phase Checklist

• Identify major conflicts and bring them into the consulting room

• Develop a hypothesis and redefine it into a formulation about what the family is doing to perpetuate the presenting problem.

• Keep focus on primary problems and the interpersonal conditions supporting them. But do not neglect the support constructive interactions

• Assignment homework that addresses problems and the underlying structure and dynamics perpetuating them

• Challenge family members to see their own roles in the problems that trouble them

• Push for change, both during and between sessions

Middle phase of treatment

• Middle part is devoted to helping family members deal more constructive with each other in sessions

• If therapist is too active - family members wont earn to deal with each other

• Therapist should take less active role to encourage family members to interact with each other

• Therapist can step back and observe

• When dialogue bogs down the therapist can either point out what went wrong or encourage family members to keep talking - less interruption

• When family members address their conflicts directly - they become reactive

• Anxiety is enemy of listening

• Some therapists (Bownians) attempt to control anxiety by having family members talk only to them

Middle Phase Checklist

• Use intensity to challenge family members, ingenuity to get around resistance and empathy to reduce defensiveness

• Avoid being directive that the family doesn’t learn to improve their own ways of relating to each other

• Foster individual responsibility and mutual understanding

• Make certain efforts to improve relationships are having a positive effect on the presenting complaint

• When meeting with subgroups don’t lose sight of the whole family picture, and don’t neglect any individuals or relationships - especially those contentious ones that are tempting to avoid

Termination

• Termination comes for brief therapists as soon as problem is resolves

• For psychanalysts therapy may continue for years

• For most therapist termination comes between this - has to do when family feels they have achieved what they came for and therapist sense treatment as reached a point of diminishing returns

• Focus is more on what the family has been doing

• Termination is therefore a good time review what they have accomplished

• Families can be remined that their present harmony cant be maintained indefinitely

• check in after termination

Identifying the Systemic Context

• Its imperative to have a clear understanding of the interpersonal context of the problem

• Family therapy is an approach to people in context

• There are even times when a family isn't the most important context

Drug + DV

• Common mistake is to overlook substance abuse

• Common in people who are depressed or anxious

• Associated with violence, abuse and accidents

• It is critical to inquire about drinking

• Therapist should look into domestic violence or sexual abuse

• Process of questioning can start with family present

• If suggestion of abuse meet with members separately

• Most states require professionals to report child abuse

Red Flags about Unethical Practice

• Specialness: Something about this situation is special, ordinary rules don’t apply

• Attraction: intense attraction of any kind, both romantic and being impressed of the status of the client

• Alterations in the therapeutic frame: longer or more frequent sessions, excessive self-disclosure, being unable to say no to client and other things that signal violation of professional boundaries

• Violating Clinical Norms: Not referring someone in a troubled marriage for couples therapy, accepting personal counselling from a supervisor and so one

• Professional isolation: not being willing to discuss your decision with professional colleagues

 

Marital Violence

• Michael Johnson argue s there are two types of partner violence

  • Patriarchal terrorism:

  • Violence is used to exercise control over partner

  • Is frequent, severe and escalates over time

  • Common Couple Violence:

  • Doesn’t involve a pattern of power and control

  • Erupts as a response to a particular conflict and is likely mutual

  • Occurs infrequently and does not escalate

• Seeing them privately allows you to inquire what either one has left out information about level oof violence

• In order to form alliance with both partners its important to convey respect for the as persons

• Ask direct questions about how often violence occurs

Sexual Abuse of Children

• Primary goal to ensure the abuse doesn’t happen again and to reduce long term trauma

• Treatment falls into

  • Child-protective approach - undermines integrity of family

  • Family systems approach - could fail to protect child

• Discrepancies are best resolved by social and legal agencies

• The first priority is restricting unsupervised access to children for the offender

• A careful assessment should be made to uncover other possible incidents of abuse

• Supporting the parents in developing appropriate ways of carrying out responsibilities is best interest of the child

• When person is sent to jail therapists job is to help family draw a boundary that excludes the offender

• metphore of parts of self

Probalamtic use

• Explored function and context - assessment of triggers, coping needs, trauma

• Supports client autonomy - emphases choice, motivation and readiness to change rather than assuming denial

• Broadens treatment options - highlights skills based and psychological interventions not just recovery frameworks

• Promotes realistic change - focus on building alternative strategies

Phases

Phase 1:

• Build motivation

• Common in precontemplation and contemplation stages

 

Phase 2:

• Build commitment to change

• More common in preparation and action stages

• Basic building blocks of motivational interviewing

Opening Strategies

• Express empathy

• In the beginning rely on your OARS when working with clients with addictions

  • Open ended questions

  • Affirmations

  • Reflections

  • Summaries

Motivational Interviewing

• MI is designed to find a  constructive way through the challenges that arise when a helper ventures into someone else's motivation for change

• MI is about having conversations so that people talk themselves into change

• MI involves attention to natural language about change with implications for how to have more effective conversations about it

• MI is a collaborative conversation style for strengthening a persons own motivation and commitment to change

Continuum of Styles

• A directing style has complimentary roles for the recipient of direction

  • Obeying, adhering and complying

• Opposite end of continuum is a following style

• Good listeners take am interest in what person has to say, seek to understand and refrain from inserting their own material;

  • People should trust their own wisdom

• Some complementary roles to a following style are taking the lead, going ahead and exploring

Righting Reflex

• A variety of selfless motives can draw people into helping professions

  • Giving back, to prevent suffering, to make a positive difference

• These motives can lead to overuse of directing style in an ineffective way at helping people change

• Helpers want to help

Ambivalence

• Ambivalence is the most common place to get stuck on the way to change

• Ambivalence is simultaneously wanting and not wanting something

• One is change talk - the persons own statements that favor change

• The opposite is sustain talk - the persons own arguments for not changing

4 Process of motvational interviewing - EFEP

• Engaging  is the process by which both parties establish connection and a working relationship

• Focusing - Process of engaging lends to a focus on an agenda - what person came to talk about

• Evoking - Evoking involves eliciting the clients own motivations for change

• Planning - At this point people may seek information and advice about how to proceed

need to renegage along the way

Core Skills and 4 Prrocesses of motivational interviewing

• asking open questions

• affirming - honours clients capacity to change

• reflective listening

• summarising

• informing and advising - offer only if client wants

How do drugs work?

• Neurotransmitter vesicles

• Vesicles moves down to synaptic cleft

• Neurotransmitter is released into synaptic cleft

• Neurotransmitters binding to iron channel to post synaptic neuron

• Drugs change natural system

Mechanisms of Drug Actions at the synapse:

• Neurochemical production:

  • Manipulating the synthesis of a neurotransmitter may affect the amount available for release e.g more building blocks, carbohydrates, more tryptophan, more serotonin

• Neurochemical storage:

  • Interfering with the storage of neurotransmitters in the vesicles within a neuron

• Neurochemical release:

  • Can be modified in response to the arrival of an action potential by drugs

Receptor Effects

• Mimic the action of a neurotransmitter at the site (spare key to open a lock

• block the synaptic activity by occupying a binding site

• Influence the activity of the receptor

Dopamine and Norepinephrine

• Dopamine and norepinephrine are activating neurons, natural stimulants that increase alertness and motivation

• People experiencing the kind of depression where they don’t want to get out of bed in the morning, might be given drugs to increase these neurotransmitters

Dopamine - cocaine and ampetahamones

• Dopamine is associated with pleasure and reward

• Cocaine and amphetamines work in part by boosting the release of dopamine

• Effected by ridalin

• Cocaine block the reuptake

• Important for making sure not to much dopamine in cleft

• Put more dopamine in the cleft

• Amphetamines increase release of dopamine

Serotonin - SSRI and MDMA

• Appears to improve mood and regulate sleep, people with depression whose symptoms are anxiety and rumination are typically prescribed drugs to increase levels of serotonin in brain

• Most common prescribed mediations for depression and anxiety are class of drugs known as selective serotonin reuptake inhibitors (SSRIs); common brands are Prozac (fluoxetine), Zoloft (sertraline)

• Block the reuptake or serotonin

• More serotonin in system

• MDMA increases release of serotonin but blocks reuptake as well

• Tryptophan foods increase serotonin

GABA

• Another calming neurotransmitter, GABA is increased by taking tranquillizers like lorazepam or clonazepam

• Alcohol also increased GABA in the system, which is why it has an effect of relaxing us

• People who use alcohol may be self-medicating to increase GABA levels as a coping strategy for dealing with anxiety

Addiction

• Main features include:

  • A strong desire to take the drug

  • Taking the substance in larger amounts or for longer than intended

  • Difficulty in controlling use, despite attempts to cut down

  • Spending a great deal of time in obtaining, using or recovering from the effects of the substance

  • Addiction is defined as a chronic and intense focus on a single behavior pattern that feels (or is) out of control

  • Effects of drug use:

    • Death

    • Self neglect

    • Sleep disturbance

    • Damage to systems in the body

Individal risk of abuse/dependance

• Genetics: supposed substance dependency gene

• Physiological vulnerability e.g low arousal seeking/high arousal seeking

• Psychological factors: coping

• Personality factors: impulse control

• Social and cultural factors:

  • Social learning and social norms

  • Loss of social cohesion

Continuum of Drug Behaviour

• Occasional use of drugs

• Psychological dependancy

• Habit formation

• Phsyiological addiction

Treating Addiction

Medical Model:

• Views addiction as an illness - sees them as diagnosis

Advantages:

• Helps people make sense of the behavior of others

• Helps bring focus and structure to treatment

Disadvantages:

• Views problem as within people, creates responsibility of the individual to fix it

• People don’t consider about the impact of their alcohol use until they are an alcoholic

  • If stuck in a medical model " I drink a lot but I'm not an alcoholic"

  • Doesn't worry unless people are alcoholics

  • Lets not wait until addiction

• What are the alternatives

  • Focus on the behavior e.g inviting people to consider is they are in a phase of problematic use

Treatment Stratagies

• Alcholics Anonymus - lacks emirial support

• Motivation Interviewing - person centrerd, strengthen motivation for change

Motivational Stages - task of worker - PCPAM

• Precontemplation - raise doubts

• Contemplation - strengthen will to change

• Preparation - create action plan

• Action - maintain steps in action plan

• Maintaience - avert relapse

Affirming Therapy

• Unconditional Acceptance: celebrates and respects the clients authentic self rather than merely tolerating their identity

• Avoiding assumptions: Therapists do not assume a clients gender, pronouns, or sexual orientation based on their appearance, name or assigned sex at birth

• Culture competence: Providers use updated LGBTQIA+ terminology and respect chosen names and pronouns

Role of Psychologist LGBTQIA +

• Nothing needs to change

• Providing a safe space

• Facilitating acceptance

• Fear being treated differently

Biological Sex

• Classification of male and female among criteria based on anatomic and chromosomal characteristics

• Biological sex is an ambiguous word that has no sale and no meaning besides that is related to some sex characteristics - harmful to transgender people

• Note that not all aspects of biological sex (chromosomes, genitalia) is binary, lies on a spectrum

• Use sex assigned at birth - provides a more accurate understanding of what biological sex may be trying to communicate

Gender Identity

• Ones internal sense of being male female or another gender

• For transgender people, their sex assigned at birth and their own internal sense of gender identity

Sexual Orientation

• The clear, persistent desire of a person for affiliation with one sex rather the other. Also called sexual preference

Intersex

Is a term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male

Minority Stress Model

• External stressful events:

  • These could include a range of discrimination and prejudice from ongoing alienation by family to physical violence

• Expectations of such events:

  • This not only produces anxiety but also calls for hyper-vigilance which produces its own stresses

• The possible internalization of negative societal attitudes:

  • Potential shame, guilt and negative attitudes about sexuality, sex and gender difference

• Concealment:

  • Even for those who are in some ways out they may still engage in some level of concealment as part of their vigilance strategies

Gender Affirmative Care

• Social affirmation (names, pronouns, hairstyles, clothes) has been shown to provide benefit to trans people

• Medical affirmation: can involve a broad range of healthcare support, delivered by way of a gender-affirming approach to healthcare (puberty blockers, or feminizing or masculinizing hormones, surgery for older clients) as medically necessary and clinically relevant

• Legal affirmation: involves the updating of legal identity across institutions and with the state

• Gender-affirming healthcare is the widely accepted standard in the field - Aus PATH

Gender Non-Conformity

•  not all children fit into the sex binary or display sex-typical interests and behaviors

• Psychologists study two forms of gender nonconformity in childhood

  • Children who display cross-sex behavior, such as play preferences that deviate from traditional expectations

  • Children who display a gender identity that is odds with the sex assigned at birth

Gender Dysphoria

• DSM-V (2013) Gender dysphoria replaced Gender identity disorder

  • Focuses on dysphoria as the clinical problem and not identity

  • Emphases that gender non-conformity itself is not a disorder

• For a person to be diagnoses with gender dysphoria there must be strong and persistent cross-gender identification that causes clinically significant distress or impairment in social, occupational or other important areas of functioning

• In children the desire to be the other gender must be present and verbal

• Not all gender non-conforming kids have gender dysphoria