Exam 2: Key Terms

Group Therapy: History

• 1905: Joseph Hersey Pratt creates first organized therapeutic group - recently-discharged patients with tuberculosis

• 1936: Paul Schilder & Louis Wender use group format - incarcerated individuals & people recently discharged from psychiatric hospitals

• World War II: utilized for those with emotional disturbances from the conflicts

• Increasingly used today (high needs and high costs)

  • Cost of living has gone up → higher costs to rent an office, etc. (higher cost to do therapy, so an increased cost of accessibility to therapy)

    • This therapy helps somewhat lower the cost as it’s not one-on-one

Feminist psychotherapy

A philosophical orientation that lends itself to an integration of feminist, multicultural, and social justice concepts and uses a variety of psychotherapy approaches

• The central concept is the importance of understanding and acknowledging psychological oppression and the constraints imposed by the sociopolitical status to which women and underrepresented marginalized individuals have been relegated.

• Took the stance that therapy needed to move away from an intrapsychic perspective on psychopathology (in which the sources of a woman’s unhappiness reside within her) to a focus on understanding the social, political, and cultural forces in society that damage, oppress, and constrain girls and women, as well as boys and men.

Relational-Cultural Theory (RCT)

Shares its origins with feminist therapy and emphasizes that growth occurs in connection

• Originally developed to better understand the experiences of women, but current practice includes members of other marginalized groups.

• Describes a process of relational movement in which people move through connections, disconnections, and enhanced transformative relationships throughout their lives

• Therapists recognize that both disconnections and opportunities for growth occur at the sociopolitical as well as at the individual level

  • Pay attention to the way societal practices such as stereotyping and stratifying affect people’s sense of connection and disconnection.

• Emphasize the qualities of authenticity and transparency that contribute to the flow of the relationship; being empathically present with the suffering of the client is at the core of treatment

• Therapists aim to reduce the suffering caused by disconnection and isolation, increase clients’ capacity for relational resilience, develop mutual empathy and mutual empowerment, and foster social justice

Differences Between Support Groups and Therapy Groups

Goals of Therapy Groups: Process Goals

Facilitate patients’ growth, comfort, & function within the group

Goals of Therapy Groups: Outcome Goals

• Outside the groups

  • Behavior corrections

  • Increased interpersonal skills

  • Use preventative measures and new coping skills

  • Increased functioning

Group Therapeutic Factors (Yalom): Altruism

Group members can improve their self-esteem, self-efficacy, etc. by helping others

Group Therapeutic Factors (Yalom): Instillation of Hope

Can see through groups that others can get better while struggling with similar issues.

Group Therapeutic Factors (Yalom): Imparting information

Clients don’t always want the expert’s opinion, but rather that of other group members

Group Therapeutic Factors (Yalom): Corrective recapitulation of primary family experience

Safe space to relearn how to attach and interact and trust others → relearning from family

Group Therapeutic Factors (Yalom): Universality

See that others are struggling with the same issues

Group Therapeutic Factors (Yalom): Development of Basic Socialization Techniques

Learning and practicing essential interpersonal skills, such as active listening, communication, expressing feelings, and respecting others, through interactions with group members.

• learn how to interpret and actively practice body language

Group Therapeutic Factors (Yalom): Imitation of Behavior

Learning new behaviors and coping strategies by observing and modeling other group members or the therapist

Group Therapeutic Factors (Yalom): Cohesiveness

The sense of belonging, acceptance, and connection among group members that creates a supportive environment where individuals feel safe sharing their experiences and working toward personal growth.

Group Therapeutic Factors (Yalom): Interpersonal learning

Gaining insight into one’s own behaviors, emotions, and relationship patterns through interactions and feedback from other group members.

Group Therapeutic Factors (Yalom): Modeling and managing existential factors

Learning to accept life’s unavoidable challenges, such as uncertainty, suffering, responsibility, and death, by observing how others cope and developing healthier ways to manage these realities.

Group Therapeutic Factors (Yalom): Public Catharsis

The release of strong emotions by openly expressing feelings and sharing personal experiences with the group, helping individuals process difficult emotions and feel emotional relief.

• Something powerful about telling your story to multiple people and having emotional release

Group Therapeutic Factors (Yalom): Self-understanding

Gaining insight into one’s own emotions, thoughts, behaviors, and relationship patterns, helping individuals recognize the underlying causes of their struggles and make positive changes.

Group Therapy: Selecting Patients

• Use the therapeutic alliance

  • Lean on this with the client if you’re referring them (say how it’s helpful for them in different ways than individual therapy)

• Consider a formal assessment (e.g., NEO-FFI)

  • ✅ extraversion, ✅ conscientiousness, ❌ neuroticism

• Consider the patient’s primary concerns & challenges

• Typical exclusions: acute distress, active suicidality, those who cannot take part due to logistical, cognitive, or interpersonal factors (people who are physically/actively aggressive towards others)

• Include patients at different stages of treatment

• Include patients with identical or similar conditions & concerns

Stages of Group Development: Forming

• Little agreement

• Unclear purpose

• Guidance and direction

Stages of Group Development: Storming

• Conflict

• Increased clarity of purpose

• Power struggles

• Coaching

Stages of Group Development: Norming

• Agreement and consensus

• Clear roles and responsibility

• Facilitation

Stages of Group Development: Performing

• Clear vision and purpose

• Focus on goal achievement

• Delegation

Stages of Group Development: Adjourning

• Task completion

• Good feelings about achievements

• Recognition

Group Therapy: Special Considerations - Confidentiality

Protecting the privacy of information shared during group therapy. It is difficult to maintain because the therapist cannot control whether group members share others’ personal experiences outside the group, so it depends on all members respecting one another’s privacy.

Group Therapy: Training

No special training is required for the therapist. There are some ways to train, but no requirement to graduate from a program

Group Therapy: Conflict

Disagreements or tensions between group members that should be acknowledged and discussed rather than ignored, even if they do not need to be fully resolved, because addressing them can promote self-awareness and interpersonal growth.

Group Therapy: Members who ramble

It is on the therapist to call it out and question why they feel the need to ramble.

• The therapist should gently interrupt members who talk excessively and explore why they feel the need to ramble, helping them become more self-aware while ensuring everyone has an opportunity to participate.

Group therapy: Members who are disengaged

The therapist should gently address members who are withdrawn or not participating and explore possible reasons for their disengagement, encouraging involvement without pressuring them.

• Some members feel as though they cannot talk, that they don’t deserve to, self-conscious, or other reasons

Group therapy: Patient’s individual limits

Recognizing and respecting each member’s emotional readiness, comfort level, and ability to participate, while encouraging growth without pushing them beyond what they can handle.

Group therapy: simultaneous individual therapy or pharmacotherapy

Receiving individual therapy or medication alongside group therapy can create challenges if treatments teach conflicting strategies or affect emotions differently. For example, medication that reduces anxiety may change a patient’s experience during exposure therapy, potentially affecting how they respond to and learn from exposure.

Group Therapy: Empirical Support

• Effective for a range of psychiatric & behavioral disorders

  • As effective as individual therapy for most conditions

  • More effective for some clients (e.g., those of marginalized identities: support & solidarity!)

    • Trauma & depression in refugee adults & children

    • LGBTQ+ patients coping with stress & bias

• Works through Yalom’s therapeutic factors

• It is cost-efficient

• It effectively provides unique & powerful training experiences

Motivational Interviewing: History

• First developed in early 1980s as a treatment for “problem drinkers” - Miller & Rollnick

• Grew out of a person-centered approach…

  • Core belief that client has capacity for self-direction & change

• …But much more directive

  • Explicit goals: draw out & explore ambivalence, enhance motivation for change

Problem drinkers

Individuals with alcoholism or those who don’t meet the critieria but whose drinking is still causing them problems

Motivational Interviewing: Current Support

• Alcohol and other addictions

• Health-related behaviors

• OCD (exposure and response prevention is the gold standard, but can be too distressing to face compulsions, so this therapy helps), anxiety, depression

• Other behavior changes

Motivational Interviewing: Stages of Change

1. Pre-Contemplation

2. Contemplation

3. Preparation

4. Action

5. Maintenance

6. Relapse

Upward Spiral - learn from each relapse

Motivational Interviewing: Pre-Contemplation

No intention of changing their behavior

• I don’t have a problem with drinking

Motivational Interviewing: Contemplation

Aware that a problem exists but with no commitment to action

• I have a problem with drinking

Motivational Interviewing: Preparation

Intent on taking action to address the problem

• Where can I find a therapist to help with my drinking addiction?

• Looking at sources online to help

Motivational Interviewing: Action

Active modification of behavior

• Going to see a therapist about alcoholism

Motivational Interviewing: Maintenance

Sustained change: new behavior replaces old

• No longer drinks as much alcohol, or any alcohol at all

Motivational Interviewing: Relapse

Fall back into old patterns of behavior

• Starts drinking alcohol again

Motivational Interviewing: Spirit of the Approach

• Motivation to change is elicited from the client (not imposed from therapist)

• It is the client’s task (not the therapist’s) to articulate & resolve ambivalence

• Direct persuasion is not effective for resolving ambivalence

• Counseling style is quiet & eliciting, collaborative & friendly

• Therapist is directive in helping clients examine & resolve ambivalence

• Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction

• Therapeutic relationship is more like a partnership than expert/recipient roles

• Is more of an interpersonal style than a set of techniques

• Express empathy. Support self-efficacy. Roll with resistance. Develop discrepancy

Motivational Interviewing: Some Specific Techniques

• Open-ended questions

• Providing feedback (e.g., the average American has 1 drink per week)

• Evoking personal meaning (“How does this statistic make you feel?”)

• Pros & cons (ask the client to talk about the pros and cons of drinking → usually realize the cons outweigh the pros)

• Enhancing motivation (how does their current behavior fit with their long-term goals?)

• Summarizing

• Reflection

• Readiness assessment

• Negotiating commitment

• Affirmations

Motivational Interviewing “Traps”: Confrontation/denial trap

Client voices really risky behavior, therapist wants to confront but client responds with reasonable explanation (want to lose weight but it’s hard, eating is pleasurable, etc)

Motivational Interviewing “Traps”: Expert traps

Dr.: Well, I can tell you that drinking that much alcohol is associated with a bunch of negative health outcomes like weight gain, cognitive decline, increased blood pressure and cholesterol, and more. Also, it can wreak havoc on your marriage and other relationships. We need to decrease your alcohol intake right away. Let’s make a weekly plan for strategies you can use to distract yourself and avoid drinking when you feel a craving.

• Client feels like you’re blaming them → dig their heels in

Motivational Interviewing “Traps”: Labeling trap

Dr.: Based on what you’ve told me, you meet criteria for 7 of the 11 possible diagnostic criteria for alcohol use disorder.

Motivational Interviewing “Traps”: Premature focus trap

Dr. (5 minutes into the first conversation): Ah! I see what the problem is. Let’s get to work.

• Therapist immediately assumes they know what’s going on without fully delving into the client’s issues

Motivational Interviewing “Traps”: Question/answer trap

Have you thought about trying to lose weight so your blood pressure comes down? Pt.: Well yes, but it's not so easy, and I must say, I really enjoy eating. It’s pleasurable to me. Dr.: But it's not a matter of depriving yourself of food. You just need to eat different, healthier foods. Do you know what I mean?. Pt.: Yes, I know, I did try to eat less meat and more fruit and that sort of thing, but I never keep going for too long. I always have these binges when I break all my rules, and I just gain weight. Dr.: What about....? Pt.: Yes, but....

• Not much discovery is happening, the therapist only asks close-ended questions and the client cannot fully realize their issues

Motivational Interviewing “Traps”: Blaming trap

• Client blaming others

  • Pt.: It’s not really possible to change how much I drink, though. My parents were both alcoholics and it’s so much a part of my social scene at this age.

• Therapist blaming Client

  • Dr.: I’m hearing you talk about all these problems in your life with your job, your friends, financial challenges, your health. You see how all of this is because of your drinking, though, right?

Family Systems Therapy: History

• Psychiatrist Murray Bowen (1950s)

  • Convergence of other lines of work (anthropology, history, social work)

• Yes, we are individuals, but we are born into families; individual ßà family

  • We are best understood through assessing interactions between & among family members

  • The “problem” is a symptom of how the family system functions

Family Systems Therapy: Problematic Behavior

• Serve a function or purpose for the family

  • ex. parents are constantly arguing → one kid acts out, and the other becomes anxious → acting out means the parents stop arguing and focus attention on them (positive reinforcement); the other kid is less anxious (negative reinforcement)

• Be unintentionally maintained by family processes

• Come from a family’s inability to operate productively

• Be a symptom of dysfunction handed down across generations

Family Systems Therapy: Subsystems

Smaller groups within a family system (e.g., parental, sibling, or parent-child subsystems) that have their own roles, boundaries, and relationships while influencing the functioning of the family as a whole.

Multicultural Therapy: Important Notes

• With a few exceptions, this therapy is not a single approach to counseling

• Attention to culture is critical in any & all psychotherapeutic interventions

• If aspects of your identity match the dominant culture, those aspects may be nearly invisible to you (& it may be easier to ignore the role of culture & identity in your clients!)

• No group is a monolith

• Conceptually, this therapy is a systems-based approach

Multicultural Therapy: History

• Interdisciplinary origins

  • Psychology PLUS anthropology, ethnopsychology, folk healing

• Recognition in the 1940s – 1960s that culture has a huge impact on mental health

• Formalization of attention to multiculturalism in 1970s & 1980s (e.g., APA Division 35 Society for the Psychology of Women in 1973, APA’s Office of Ethnic Minority Affairs in 1979, APA Division 44 Society for the Psychology of Sexual Orientation and Gender Diversity in 1985)

Multicultural Therapy: Key Ideas

• These therapies are therapies that infuse cultural competence into clinical practice

  • A set of congruent behaviors, attitudes, & policies that reflect an understanding of how cultural & sociopolitical influences shape individuals’ worldviews & related health behaviors

  • ADDRESSING Model

• Multicultural therapies are therapies that infuse cultural competence into clinical practice

  • A set of congruent behaviors, attitudes, & policies that reflect an understanding of how cultural & sociopolitical influences shape individuals’ worldviews & related health behaviors

  • Cross’s Cultural Competence Framework

• Minority Identity Development Stages

• White American Identity Development Stages

• LGBTQ+ Minority Identity Development Stages

• We all have multi-faceted identities & we as clinicians need to understand where our clients are in their identity development in order to meet them where they’re at

Multicultural Therapy: ADDRESSING Model

• Age and generational influences (children, elders)

• Developmental disabilities (people with developmental disabilities)

• Disabilities acquired later in life (people with disabilities acquired later in life)

• Religion and spiritual orientation (People of Muslim, Jewish, Buddhist, Hindu, and other minority religions and faiths)

• Ethnic and racial identity (people of Asian, South Asian, Pacific Island, Latino, African, African American, Arab, Middle Eastern heritage)

• Socioeconomic status (people of lower status because of occupation, education, income, or rural habitat)

• Sexual orientation (gay, lesbian, bisexual people)

• Indigenous heritage (American Indians, Alaska Natives, FirstNations, Inuit, Metis, Native Hawaiians)

• National origin (immigrants, refugees, international students)

• Gender (women, transgender people)

Multicultural Therapy: Cross’s Cultural Competence Framework

A model describing the stages of cultural competence, ranging from cultural destructiveness (actively harmful attitudes and practices) to cultural proficiency (actively promoting cultural knowledge, diversity, and effective services for different cultural groups).

Cross’s Cultural Competence Framework: Cultural Destructiveness

Actively engaging in practices that harm, suppress, or destroy other cultures. Differences are viewed as inferior or threatening, and discrimination may be intentional.

• Example: A therapist believes certain cultural groups are inferior and refuses to provide them with equal treatment.

Cross’s Cultural Competence Framework: Cultural Incapacity

Believing in the superiority of one's own culture and maintaining stereotypes or discriminatory practices, often without fully recognizing their harmful effects. There may be an inability or unwillingness to provide appropriate services to diverse populations.

• Example: A therapist assumes that all clients from a particular cultural group have the same beliefs and refuses to adapt treatment to their needs.

Cross’s Cultural Competence Framework: Cultural Blindness

Treating everyone the same regardless of cultural differences, often with the intention of being fair. However, ignoring cultural differences can overlook clients' unique experiences, values, and barriers to treatment.

• Example: A therapist insists on using the same treatment approach for every client without considering how cultural beliefs influence their understanding of mental health.

Cross’s Cultural Competence Framework: Cultural Precompetence

Recognizing the need for cultural competence and beginning to take steps toward improving cultural awareness and services. However, knowledge and efforts may be limited or inconsistent.

• Example: A therapist attends cultural-awareness training and begins learning about different cultural perspectives but still struggles to apply that knowledge consistently.

Cross’s Cultural Competence Framework: Cultural Competence and Proficiency

Actively developing the knowledge, skills, and attitudes needed to work effectively with people from different cultural backgrounds. This includes adapting treatment to clients' cultural needs, recognizing personal biases, and continuing to learn.

• Example: A therapist asks clients how their cultural backgrounds influence their experiences and collaborates with them to develop culturally appropriate treatment plans.

Multicultural Therapy: Minority Identity Development Stages

The stages describe a potential progression from adopting dominant cultural values toward questioning oppression, exploring identity, and developing a more integrated sense of self.

• Conformity

• Dissonance

• Resistance immersion

• Introspection

• Synergistic

Minority Identity Development Stages: Synergistic

Developing a more secure, integrated identity that combines personal values and cultural understanding while recognizing the worth of other groups.

• Example: A person embraces their cultural identity, recognizes systemic inequality, and respects other cultural perspectives without feeling the need to reject everything associated with the dominant culture.

Minority Identity Development Stages: Introspection

Reflecting on one's identity and questioning whether rejecting all dominant cultural values is necessary, while developing a more personal understanding of identity.

• Example: A person recognizes that some values from the dominant culture are meaningful to them, even while challenging discrimination.

Minority Identity Development Stages: Resistance immersion

Rejecting dominant cultural values and embracing one's own marginalized group, often with increased pride and anger toward oppression.

• Example: A person becomes actively involved in their community and strongly rejects the dominant culture's expectations.

Minority Identity Development Stages: Dissonance

Experiencing confusion or conflict when an event challenges previously held beliefs about the dominant culture or one's own group.

• Example: A person experiences discrimination despite believing that society treats everyone equally.

Minority Identity Development Stages: Conformity

Preferring or identifying with the dominant culture while accepting its values and potentially viewing one's own cultural group negatively.

• Example: A person downplays their cultural background to fit in with the dominant group.

Multicultural Therapy: White American Identity Development Stages

The stages describe a potential movement from limited racial awareness toward recognizing systemic racism, examining one's own identity and privilege, and actively supporting racial equity. Individuals may not experience the stages in a strict or linear order.

• Contact

• Disintegration

• Reintegration

• Pseudoindependence

• Autonomy

White American Identity Development Stages: Contact

Having limited awareness of racism or one's own racial identity, often assuming that everyone is treated equally and that race does not significantly affect people's experiences.

• Example: A person believes racism is no longer a major issue because they have not personally witnessed it.

White American Identity Development Stages: Disintegration

Experiencing discomfort, guilt, or conflict after recognizing racial inequality or realizing that one's previous beliefs about race were incomplete.

• Example: A person learns about racial discrimination and struggles to reconcile it with their belief that society is fair.

White American Identity Development Stages: Reintegration

Retreating toward the belief that one's own racial group is superior or that marginalized groups are responsible for their own disadvantages, often as a way to manage discomfort.

• Example: A person responds to discussions of systemic racism by arguing that minority groups simply need to work harder.

White American Identity Development Stages: Pseudoindependence

Beginning to recognize racism and question White privilege, often seeking information from or relationships with people of marginalized racial groups. However, understanding may still rely heavily on the perspectives of others rather than one's own deeper reflection.

• Example: A person actively learns about racial inequality but looks to people of color to explain racism rather than independently examining their own role in the system.

White American Identity Development Stages: Autonomy

Developing a more informed and integrated understanding of racial identity, privilege, and systemic racism, while actively working toward equity and continuing to learn.

• Example: A person acknowledges their own privilege, challenges racist practices, and consistently supports racial equity without needing recognition or reassurance.

Multicultural Therapy: LGBTQ+ Minority Identity Development Stages

The stages describe a possible progression from questioning one's identity toward acceptance, pride, and integration. Not everyone experiences every stage, and identity development does not necessarily follow a linear path.

• Confusion

• Comparison

• Tolerance

• Acceptance

• Pride

• Synthesis

LGBTQ+ Minority Identity Development Stages: Confusion

Beginning to question one's sexual orientation or gender identity and feeling uncertain, conflicted, or confused about what these feelings mean.

• Example: A person begins experiencing same-sex attraction but is unsure how to interpret those feelings.

LGBTQ+ Minority Identity Development Stages: Comparison

Recognizing the possibility of being LGBTQ+ and feeling different from others, potentially experiencing isolation or concern about belonging.

• Example: A person wonders whether they might be gay and worries about how friends or family would react.

LGBTQ+ Minority Identity Development Stages: Tolerance

Acknowledging the possibility of being LGBTQ+ and beginning to accept that identity, although the person may still feel uncertain, isolated, or reluctant to disclose it.

• Example: A person recognizes that they may be bisexual but keeps this possibility private while trying to understand their feelings.

LGBTQ+ Minority Identity Development Stages: Acceptance

Developing a more positive understanding of one's LGBTQ+ identity and seeking supportive people or communities, although acceptance may not yet extend to every area of life.

• Example: A person accepts their identity and begins connecting with LGBTQ+ friends or organizations.

LGBTQ+ Minority Identity Development Stages: Pride

Embracing one's LGBTQ+ identity with confidence and developing a stronger sense of connection to the LGBTQ+ community, sometimes accompanied by anger toward discrimination or rejection of dominant cultural expectations.

• Example: A person openly celebrates their identity and participates in Pride events or LGBTQ+ advocacy.

LGBTQ+ Minority Identity Development Stages: Synthesis

Integrating one's LGBTQ+ identity into a broader sense of self, recognizing that it is an important part of who they are without allowing it to define their entire identity.

• Example: A person feels comfortable with their identity while also recognizing their other interests, relationships, values, and personal characteristics.

Collectivism

• Fosters interdependence and group success

• Promotes adherence to norms, respect for authority/elders, and group consensus

• Associated with stable, hierarchical roles

• Associated with shared property and group ownership

Individualism

• Fosters independence and individual achievement

• Promotes self-expression, individual thinking, and personal choice

• Associated with egalitarian relationships and flexibility in roles

• Associated with private property and individual ownership

Multicultural Therapy: Strengths-Based and Empowerment Approaches

• Multicultural psychotherapists often focus explicitly on empowering clients

• Multicultural psychotherapists often actively engage in work to rectify social injustices

• Integration of community & indigenous resources for treatment

Multicultural Therapy: Specific Approaches

• Treatment designed to address oppression (e.g., re-evaluation counseling)

• Cultural adaptations of (mainstream) interventions (e.g., CBT)

• Holistic approaches that center spirituality

• Ethnopsychopharmacology

  • Pay attention to collectivism and multiculturalism (may combine medications with herbs, share medicine with family, MAOI/Monoamine Oxidase Inhibitors (cannot eat food that’s rich in specific amino acids, in particular cheese common in diets in Asia)

    • Patients need culturally appropriate dietary guidance based on their actual eating habits rather than assumptions about their cultural background.

How to work with clients: RESPECT

• R - respect (show)

• E - explanatory model (ask)

  • What’s your understanding of what’s going on for you?

• S - social context (ask)

  • Think about this broadly - how close are you with your extended family? What support do you get from your church or social network?

• P - power (share)

  • Make sure you emotionally + logistically level the playing field

• E - empathy (show)

• C - concerns/fears (ask)

  • What concerns (for example) a black client will have with a white clinician

• T - trust (build: don’t assume)

The Value of a Diverse Psychology Workforce

• More expertise

• Better organizational/institutional decisions & better research

  • More diverse organizations mean that they can connect with a wider range of clients, which is more profitable and organizations can make better informed decisions

• Marginalized & minoritized clients are more likely to seek out treatment & stay in treatment with providers who share key parts of their identities

• Impact of living with minority stress, historical events (e.g., medical apartheid), ongoing discrimination in medicine

  • Medical apartheid = gross systematic mistreatment and discrimination of marginalized and minority groups within healthcare (forced sterilization, refusal of treatment, unethical experimentation, unequal access to medical care, etc)

Feminism

• Belief in and advocacy for the political, economic, and social equality of all sexes

• Holds the view that most societies prioritize the male point of view & male well-being, and that women & other sexes are treated unjustly as a result

Feminist Therapy: History

• Developed in the 1960s, alongside the second-wave feminist movement

  • Comes together and talks about discrimination and its impact of it

• Initial goals were to serve as a safe space for corrective action against the sexist treatment approaches of the era (e.g., logistics, psychoanalysis (takes as a given women are inherently less than men)

• 1980s: Focus largely shifted to specific problems like body image, abusive relationships, eating disorders, incest, sexual abuse (Enns, 1993)

• Current: Liberatory, technically integrative approach that uses the analysis of gender, social location, & power as strategies for comprehending human difficulties

What do you think when you hear “feminist”?

• Most women believe perceptions about feminists are largely negative

• Many perceptions of feminists (especially among non-feminists) ARE negative (e.g., supports female superiority, dislikes men, discriminates based on gender, has negative personal characteristics) or unfounded (e.g., lesbian or “butch”)

• The label matters

  • Women who label themselves “feminist” are perceived by others as more competent but less warm than those who express gender-equal beliefs but don’t label themselves “feminist”

Feminist Therapy: Themes

• In-depth interrogation of most standpoints outside the dominant patriarchal mainstream

  • Maleness and anything associated with maleness are elevated, while anything feminist, anything outside of maleness, is looked down upon (LGBTQ, disabledness, etc)

• Human beings are responsive to the problems of their lives (“mental illness” isn’t the best way of thinking about clients’ problems!), capable of solving those problems, and desirous of change; the therapeutic relationship is egalitarian

  • Many people are scared of sexual assault, struggling to raise children while not being paid what they should → societal problem, not the client (no diagnostic labeling)

• Traditionally silenced voices & perspectives are the greatest sources of wisdom

• Actively aims for having a political impact (because “the personal is political”)

Feminist Therapy for Men

• Being socialized in a patriarchal society poses problems for men, too!

  • Toxic masculinity is harmful for everyone, including men

    • Men have to be aggressive, cannot cry, etc

  • Deaths of despair (deaths due to suicide, drug overdose, etc.) are on the rise, particularly among non-Hispanic White men

    • Contributed to men not being able to live up to the expectations of toxic masculinity

  • Feminist therapy empowers men to explore & assert their full selves (i.e., vulnerability, sadness, worry, nurturing, self-care, asking for help)

  • Encourages men to question where they got messages about strength, aggression, power, achievement, control, & sex & to examine whether these messages serve them well

Behavior Therapy: Basic Concepts

• Focus is on changing behavior

• Rooted in empiricism; collect data!

• Behaviors are assumed to have a function

  • …Usually getting positive reinforcement or negative reinforcement

• Emphasis is on the maintaining behaviors (not the initial triggers) • Supported by extensive research

• Active (for both client & therapist!)

  • Lots of effort to generalize behavior outside of therapy (ex., therapist rides the elevator with clients who have a phobia of elevators)

• Transparent: rationale is provided, step-by-step instructions are given, data are shared, client is an active partner

Behavior Therapy: History

• Roots stem from experimental research on learning processes (early to mid-1900s)

  • Ivan Pavlov & classical conditioning

  • Rise of behaviorism in America (e.g., Watson & Baby Albert)

  • Thorndike & Skinner & operant conditioning

• Albert Ellis & Aaron Beck introduced cognitive techniques (1950s & 1960s)

  • Said that’s not all there is (humans cannot really be compared to rats in a Skinner Box)

• Albert Bandura & social learning (1960s)

• “Third-wave,” acceptance-based behavioral approaches (MBCT, DBT, ACT; 2000s & beyond)

Classical conditioning

Learning in which the stimulus or experience occurs before the behavior, and then gets paired or associated with the behavior (one stimulus comes to signal the occurrence of a second stimulus)

• ex. Delaney has a visceral reaction (cringing) at just the sound of a dentist's drill 

• ex. Lightning → thunder → organism has a startled reaction (cringes) 

  • learns that every time there’s lightning, thunder will follow

    • After a while, the organism sees lightning and cringes (knows thunder will soon follow)

Unconditioned stimulus (UCS)

In classical conditioning, a stimulus that unconditionally – naturally and automatically – triggers an unconditioned response (UCR).

• Pavolv’s dog experiments, where he first noticed how dogs automatically drooled when presented with food. He then paired the sound of a tuning fork with the presentation of food, which naturally caused dogs to salivate. After repeated pairings, the dogs began to salivate at the sound of the bell alone, a behavior known as the conditioned response. 

  • UCS = food

  • UCR = drooling

  • CS = the tuning fork

  • CR = drooling

  • NS (Neutral) = tuning fork

Unconditioned response (UCR)

In classical conditioning, an unlearned, naturally occurring response (like drooling) to an unconditioned stimulus (UCS).

• Pavolv’s dog experiments, where he first noticed how dogs automatically drooled when presented with food. He then paired the sound of a tuning fork with the presentation of food, which naturally caused dogs to salivate. After repeated pairings, the dogs began to salivate at the sound of the bell alone, a behavior known as the conditioned response. 

  • UCS = food

  • UCR = drooling

  • CS = the tuning fork

  • CR = drooling

  • NS (Neutral) = tuning fork

Neutral stimulus (NS)

In classical conditioning, a stimulus that elicits no response before conditioning.

• ex. before conditioning, the dogs didn’t drool when they heard the tuning fork because there was no association for the dogs

  • HOWEVER, when the tuning fork was then paired with food, the dogs began to drool at JUST the sound 

Conditioned response (CR)

In classical conditioning, a learned response (behavior) to a previously neutral (but now conditioned) stimulus (CR) (ex. pairing the tuning fork with opening the food can)