psyc 360 exam 2

what are the core concepts of motivational interviewing?

• skillful clinical style that can be taught to anyone (not just therapists!)

  • used to elicit a patient’s own motivations for change

what are the critical components of motivation?

• ready: how is change prioritized?

• willing: how important to them is changing?

• able: how confident are they in their ability?

what is the goal of motivational interviewing?

• create + amplify discrepancies between current behavior and goals

• resolve ambivalence for change

pre contemplation

not willing to yet think of/discuss change; we just want to plant little seeds of ideas in their mind

contemplation

people will get here naturally; willing to entertain the idea of change but might not yet be ready to act

preparation

discussing new methods or habits, delaying old ones (ex: delaying a usual cigarette for 10 mins), and preparing their environment

action

“today is the quitting day”

maintenance

recognizing that change is a perpetual process and they must continue to work and put effort into it

lapse

a small setback in treatment/change

• ex: getting a flat tire and replacing the spare

relapse

a large setback in change

• ex: getting a flat tire and slashing the other four and burning the car

principles of motivational interviewing

• ee

• dd

• ror

• sse

• express empathy: accept, reflect, and destigmatize

• develop discrepancy: identify their goals and arguments for change

• roll with resistance: avoid arguing, don’t oppose resistance

• support self efficacy: both pt and th must believe in capacity for change and build small successes

how do we assess importance and confidence in motivational interviewing?

on a scale from 1-10

• how can we get you to X, why are you important enough to be at a Y, why aren’t you any lower on the scale?

change talk

talking positively and openly about change

sustain talk

listing all the reasons to stay where you are; can acknowledge them but cannot live in them

open ended questions

require patient responds with information; cannot be yes or no

affirmations

statements of understanding and appreciation; reframing failure as a partial success or learning experience

simple reflection

a direct statement: so you’ve said xyz

paraphrase

making a suggestion about possible meaning

reframe

changing perspective, framing something in a positive light

amplified reflection

overstate/take to the extreme what you heard to snap someone out of sustain talk

double sided reflection

state both sides of the ambivalence; ‘so x, but also y’

how should information and advice be given to MI patients?

elicit, provide, elicit

• ask for permission

• provide them information/advice

• elicit their reaction for more information

What does it mean to be condemned to be free?

we are free to make our own choices but we are condemned to always bear the responsibility of the consequences of these choices

What does “existence precedes essence” mean?

you create yourself through who you are, what you do, and what decisions you make in your life

• we do not have an inherent essence; rather, we create our essence thru existing and making decisions and acting

Why isn’t existentialism a formal school of therapy?

there’s no institutions to “teach” this therapy

• its a philosophy on the human experience that is integrated into other methods of therapy

What are the differences between existential therapy and psychoanalytic therapy? How do their conceptualization of defenses differ?

PA: drive > anxiety > defenses

ET: ultimate concerns > anxiety > defenses

• human nature doesn’t cause the anxiety like in PA, but the ultimate concerns

What is living in bad faith?

living without taking responsibility for yourself and your actions

• a “failure of willing”

Define willing in existential therapy.

the process of becoming aware of what it is that we want/wish for and moving from wishing to deciding

In existential theory, why does pathology occur and what happens as a result of it? What is the difference between impulsivity and compulsivity?

pathology comes from failures of willing

• impulsivity: don’t think about what you want, just decide on something without knowing what you really want

• compulsivity: inability to reconcile your unconscious and conscious desires (stuck between what we think we want and what we actually want)

• decisional panic: aware of wishes but feel unable to choose what to do about it

What are the types of isolation that individuals experience?

• interpersonal: divide between self and others; never fully sharing a consciousness with others

• intrapersonal: isolated from parts of ourselves

• existential: alone in the universe

What are some ways individuals avoid experiencing isolation?

• crave witness: need someone to see our accomplishments and life to avoid isolation

• fusion: take on the roles and characteristics of others (Avoiding personal growth)

How do we combat meaninglessness?

how does a being who requires meaning find one in a universe that has none?

• we look for and create meaning in our own lives

• we follow values - tell us why and how to live

• if you don’t have your own, you can find them (religion, etc)

What are the four ultimate concerns? Which is the ultimate existential concern?

1. freedom

2. isolation

3. meaning

4. death (the ultimate ultimate)

What does it mean to be a fellow traveler?

therapist is not some divine being or expert, but another person going through life too

What are the two denial systems that people use to avoid confronting the ultimate concern of death?

• specialness: accidents, etc cant happen to us

• ultimate rescuer: someone is watching over us

What are the goals of existential psychotherapy?

• understand unconscious conflicts

• identify defenses

• discover how they can be destructive

• develop other, better coping mechanisms

life cannot be lived without anxiety, so we must find tolerable levels and use them constructively!

• How does existential therapy view culture and religion?

ultimate concerns transcend culture, and culture influences the defense mechanisms that people employ

What is the third force in psychology?

third force psychology focuses on inner needs, happiness, fulfillment, the search for identity, and other distinctly human concerns

• believer that change happens when an atmosphere is real and caring and not judgemental

Describe the differences between client centered and psychoanalytic therapy.

in contrast to the psychodynamic approach, the person-centerd approach focuses on the conscious mind and what is going on in the here-and-now whereas the psychodynamic approach focuses on the subconscious and looks to early childhood to examine unresolved conflicts.

What are the basic assumptions of client centered therapy?

• all humans have a self-actualizing tendency, and move clients towards insight, independence, and positive attitudes

• reacting as a whole

  • all humans are good and trying to do their best, if someone is engaging in maladaptive behavior it’s because their best doesn’t work for their environment

What three components that construct a person’s reality?

• experience

  • private world of the individual

• internal frame of reference

  • each person has their own individual vantage point for seeing the world

• organismic valuing process

  • we develop for ourself our own value judgments (right, wrong, etc)

How does distress occur in client centered theory?

distress can occur when there is a lack of congruence between a person's self-concept and their experiences or when there is a discrepancy between their ideal self and their actual self.

What is unconditional positive regard? How does it strengthen the therapeutic relationship?

holding someone in a positive regard if you agree with them or not

• separating a person from their behavior and actions, and can hold dearly their value as a person

• need is universal in humans, and persistent

• when patients perceive UPR, their self-concepts become more positive and realistic, and more open and free in their experiencing

Actualizing tendency

organisms are motivated to maintain and enhance themselves; people do the best they can under the circumstances they percieve

Reacting as a whole

• someone with maladaptive patterns are trying their best, and their AT is still there just not good for their environment

• MUST CONSIDER THE PERSON AS A WHOLE AS THEY STRIVE FOR AUTONOMY IN THE BEST WAY THEY CAN!

Experience

the private world of the individual

• the awareness of our own experiences is limited, and we might not know what we’ve experienced

Internal frame of reference

each person’s own internal viewpoint of the world

• seeing the world differently then friends

Organismic valuing process

we develop for ourselves our own judgments; we decide for ourselves what is right and what is wrong

The self

perceptions of the characteristics that make up me, and the values that i attach to those behaviors, thoughts, feelings, etx

Symbolization

the process of becoming aware and conscious of our own experience and how we can begin to fully experience it

Adjustment and maladjustment

adjustment: understanding others as individuals

Fully functioning person

functioning through your own frame of reference BUT need to be able to symbolize and making your own determinations of experiences

Self concept

how we perceive ourselves and our behaviors

• center of our own worlds; structure is consistent but fluid

• our behaviors can be consistent and inconsistent

Congruence

state of wholeness and integration within the experience of the person; the hallmark of psychological adjustment

• what i am experiencing inside is present in my awareness and comes out through my communication , when I have that quality i am all in one piece in the relationship

Unconditional positive regard

• Don’t have to like or agree to have a positive regard for you

  • Separate behavior from person and recognize that every person has value because they are a person

What should a therapist avoid when answering questions in the therapy room?

• direct advice

• interpreting/analyzing the clients experiences

• judging or evaluating the client

• redirecting or steering the conversation

Zimring's new paradigm

human beings become persons only through interaction with other persons and that this process takes place within a particular culture.

• folks are more comfortable speaking about things that are objectively happening outside of them, then we can move it into this interal world and get some movement there 

An objective context

the objective context that is stressed in our culture as significant and meaningful (object)

A subjective context

the subjective context having little real-world value (as a subject, person)

• the validation of a clients internal frame of reference

What is the moment of movement?

a “molecule” of change

• something that occurs in a existential moment, - an experience of an instant

• experiencing without barriers or holding back

• the past “experience” has never been fully experienced

  • the experience has the quality of being acceptable and capable of being integrated with the self concept

What are some important cultural considerations in client centered therapy?

• the differences between groups may not be as great as the diversity between group members

• well-suited for cross culture - viewing everyone as a unique individual

Who is the expert in client centered therapy?

the client !!!!!!

What is “demandigness” and its implications?

• EXPLICIT MUSTS; causes distress

• temporary solutions provide relief but do not fix it

  • satisfying demands

  • distraction

  • magic and mysticism

Define “Musterbation”.

whereby people live by a set of absolute and unrealistic demands that they place on themselves, others and the world. — too many musts placed on their shoulders

• i MUST do well and get approval

What are three types of unconditional acceptance?

• self (i exist, i deserve to)

• others (condemn bad things but still accept others as fallible humans)

• life (accepting life and adversity)

What is the primary cause of distress in REBT and who creates this distress?

humans create it themselves in our innate need for acceptance and doing the “musts”

• we can train ourselves to change self-sabotaging beliefs

Describe the therapeutic relationship in REBT and how it is unique from other therapies?

active, directive, and confrontational
doesn’t have to necessarily be warm; encourage clients to actively accept themselves and their fallibility — therapists are encouraged to use forceful and vigorous methods of convincing and encouraging their clients of change

Describe the three temporary solutions of demandingness and why they are not a permanent fix.

• satisfying their demands, distracting, magic/mysticism

What are the goals of REBT?

• correct demandingness

  • give up perfectionism

• develop high frustration tolerance

  • accept reality (even grim)

How can we distinguish between rational and irrational thinking?

these beliefs are irrational because they magically insist that something in the universe should, ought, or must be different from the way it is.

What are some examples of unhealthy and healthy negative emotions? How can we distinguish them from each other?

• unhealthy

  • jealousy, anxiety, rage, depression, guilt

• healthy

  • disappointment, concern, annoyance, sadness, regret, frustration

What is the ABCD model in REBT?

• activating event

• belief

• consequences

• dispute (does this help me?)

What techniques does a therapist use to address a client’s musts?

• roleplay

• humor

• unconditional acceptance

• strong disputing

How and why should clients engage in experiential exercises?

• take risks, seek pleasure, stay in poor circumstances, take on hard tasks

• help them overcome denial of their feelings and work at the ABCDs

How does a therapist engage in dispute with a client?

• Challenge patients to defend them

• Demonstrate logical fallacies

• Show why irrational beliefs do not work

• Reduce irrational beliefs to absurdity

What does REBT believe about culture and different cultural beliefs clients may have?

• unconditional acceptance

• members of minority cultures