Forms of Therapy 2

Why would Paul Ekman say that implosion is effective?

• Implosion relies primarily on imagination which is one of his 9 ways to getting emotional • Through these 9 pathways, he believes we can unlearn triggers depending on various aspect of the trigger

According to Sarwer-Foner, what is a "curative medicine?"

An anesthetic that puts you to sleep reliably and allows you to wake up safely, a reliable and well-tested vaccine, etc Medicines that have a specific curative affect on the disease for which it is being used

What guidelines does Glick propose for the treatment of Axis I disorders?

First, I believe psychotherapy needs to be combined with medication for most Axis I disorders (and probably many Axis II as well). Although there are many reasons for this; at the very least it may improve medication compliance, which is a large part of the battle to improve outcome Second, where effective, psychotherapy alone in some form can be a first line treatment, e.g., for "mild depression" (15). Third, (and I may be in the minority of psychiatrists who believe this) family interventions can be a useful intervention for many Axis I disorders. It is uncommonly used in clinical practice at this juncture; The rationale is that most patients with Axis I disorders have (either or both) cognitive impairment or their families are heavily involved in management. Fourth, I do believe that individual therapy is an efficacious modality when combined with medication, but it is not emphasized here for two reasons. First of all, its use in integrated therapy has been well described (5) and two, it is commonly in use in clinical practice. Finally, I do believe psychodynamic individual therapy is useful, although empirical evidence is rare (5) Psychotherapy—^which can be hard work on the patient's part—should be given only to the extent that the patient can tolerate and utilize it. Most importantly, for most Axis I disorders, the patient as well as the family are viewed as partners on the treatment team rather that adversaries. This takes much work on the part of the therapist pointing out that their lives (both patient's and family's) are intertwined and interdependent. multimodal therapy (i.e., medication, a family intervention, and an individual therapy like CBT) may be necessary. Obviously, treatment must be individualized based on the needs of patient (and significant others). For most Axis I disorders, when cognitive impairment is suspected (for example, acute bipolar disorder), we suggest starting with family intervention (rather than individual) in the acute phase, and family therapy combined with supportive individual therapy in the maintenance phase. As to which model should be applied when the patient is cognitively impaired as in acute schizophrenia, we suggest initially a psychoeducational, then a cognitivebehavioral (rather than psychodynamic) approach in the acute phase (47). In the continuation and maintenance phases, CBT has been suggested (48) Lam (50) has described seven components of effective family approaches to schizophrenia, each of which can be adapted to most Axis I and II disorders. They include: 1. a positive approach and genuine working relationship between the therapist and family, 2. the provision of family therapy in a stable, structured format with the availability of additional contacts with therapists if necessary, 3. a focus on improving stress and coping in the "here and now," rather than dwelling on the past, 4. encouragement of respect for interpersonal boundaries within the family, 5. the provision of information about the biological nature of schizophrenia [and other mental illnesses] in order to reduce blaming the patient, stigma, and family guilt, 6. use of behavioral techniques, such as breaking down goals into manageable steps, and 7. improving communication among family members.

How might a psychotherapist treat a client differently if a LGBT model was normative?

If lgbt experiences were made central , than it would change and expand the ability to comprehend the intrapsychic and interpersonal Wider inquiry Continuously would be changing the degrees of ethical Ie dual relationships: ex lover now lover of new client -- not explicit rules already there Would allow for continuous reevaluation of taken for granted concepts Would allow for the study of l and g issues to change Behavior that is compatible with cultural expectations is referred to as gender normative; behaviors that are viewed as incompatible with these expectations constitute gender nonconformity.

According to Lazarus, what are the typical characteristics of an MMT therapist?

In matters of personality, we should subscribe to Occam's razor—entities should not be multi- plied unnecessarily and the simplest of competing theories is preferred. We do not have to look beyond several factors that shape and maintain human personality: associations and relations among events; modeling and imitation; noncon- scious processes; defensive reactions; private events; metacommunications; and physical thresh- olds (Lazarus, 1997). Therapeutic content: A central premise of multimodal therapy is that patients are troubled by a multitude of specific problems that should be remedied with a similar multitude of specific techniques. Unlike psy- chotherapists in some other systems, the multi- modal therapist neither dictates the particular content to be treated nor forces the client's pro- blems onto a Procrustean bed Rather, the task of the multimodal therapist is to comprehensively and systematically assess the patient's specific deficits and excesses. o All modalities but one can be dealt with directly in treatment. Affect (emotion) can only be worked with indirectly because one cannot elicit or change emotions directly. o In multimodal therapy, by contrast, the patient's problems, as cataloged through the multimodal assessment on each domain of the BASIC I.D., in large part determine the change processes to be employed. o The specific mechanisms operating in a given case depend on the selected techniques, which in turn depend on the patient's particular problems o Missing are social liberation and dramatic relief, the two change processes least frequently employed across the psychotherapies o Counterconditioning and contingency management are most expertly han- dled by the behavior therapists, cognitive restruc- turing by the cognitive therapists, helping relationships by the person-centered therapists, and so on. This is in keeping with the multimodal maxim of borrowing any clinical technique from any theoretical framework when it might prove effective in a particular case. Therapeutic processes o Multimodal therapy is an active and compar- atively demanding therapy, but it should be far less demanding on the client than on the therapist (Dryden & Lazarus, 1991). The skillful clinician will pace treatment according to the capacities and objectives of the individual client. o The therapist begins by obtaining information from initial interviews and a multimodal life his- tory inventory (Lazarus & Lazarus, 2005). This information leads to the creation of a modality profile—essentially, a BASIC I.D. chart listing the patient's problems by modality o To summarize: The work of the multimodal therapist is to conduct a multimodal assessment, determine the treatments of choice, and customize the therapeutic relationship to the needs of that particular client. Therapeutic relationship o therapeutic relationship as a precondition of change in practically all cases and as a content to be changed in only those cases in which specific interpersonal styles (such as assertion deficits or anger excesses) are identified as problematic in the interactions between the patient and therapist. A warm, caring relationship is the context for change, but only rarely the central process of change. o Lazarus (1991, 1993) has been particularly critical of the notion that genuine empathy, thera- pist congruence, and positive regard are the nec- essary and sufficient conditions for constructive personality change, as Rogers (1957) suggested. o The multimodal therapist modifies his or her participation in the therapeutic process in order to offer the most appropriate relationship for that particular client, as opposed to fitting the person to the treatment. The notion of the authentic cha- meleon is often invoked oThe only don'ts to which we sub- scribe are (1) Don't be rigid and (2) Don't humili- ate a person or strip away his or her dignity"

What are the common clinical methods used to control contingencies?

Institutional control type of contingency management is indicated when the managers of institutions are most effective in modifying contingencies. Use of token economies - As operant principles began to be applied to maladaptive behavior, clinicians in charge of wards or classrooms began to make reinforcements contingent on particular behaviors through this Tokens are symbolic reinforcers, such as poker chips or points on a tally sheet, that can be exchanged for items of direct reinforcement, such as social outings, recreational activities, and favorite foods. An economy involves an exchange system that determines exactly what the tokens can be exchanged for and the rate of exchange, or how many tokens it takes to get particular items or privileges. The economy also specifies the target behaviors that can earn tokens and the rate of responding required to earn a particular number of tokens Staff cooperation important; tokens must be gradually faded as problem behaviors are reduced and adaptive responses are established, because clients must be prepared to make the transition to larger society Self control In order to serve as their own behavior therapists, clients must be taught the fundamen- tals of the experimental analysis of behavior. They need to realize that self-control problems are not due to a paucity of mystical willpower or moral character but to inadequate manipulation of antece- dents and consequences that control behavior. Clients must appreciate the ABCs of behavioral analysis, including the cardinal rule that immediate consequences exert greater control over behavior than do delayed consequences. Obesity, smoking, alcohol abuse, sedentary lifestyle, and procrastinat- ing involve behaviors that have immediate positive consequences but long-term negative consequences clients should be careful to provide rein- forcement for small improvements, such as studying for 30 minutes, rather than withholding reinforcement until their ideal goal is attained. Immediate reinforcement for studying should also be provided—say, going for a fruit juice or listening to a CD for 15 minutes—because the positive con- sequences of studying are quite delayed. Also intervene early in the behavior chain that is terminated by the problem response Mutual control or contracting when two or more people in a relationship share control over the consequences that each wants. the most common form of mutual control of contingencies involves contracting. To form a contract, each person in a relationship must specify the consequences that he or she would like to have increased. Each can then begin to negotiate what he or she would want in exchange for giving the consequences the partner desires. Therapist control Therapists can, however, control social reinforcers, such as attention, recognition, and praise, that occur in treatment. Therapists can make their social reinforcers contingent on improvement in the client's behavior. Psychotherapists can gain greater control over contingencies by forming contracts with clients. A client can be required, for instance, to deposit $100 and to earn the money back through making appropriate responses, such as losing weight each week. A contingency contract in which the client earns, say, $10 for each pound of weight lost adds to the effectiveness of a self-control package (Harris & Bruner, 1971). The therapeutic contract can also include a provision for response cost, such as the client's paying $5 for each pound gained. Even bet- ter, the $5 can be donated to the client's least favor- ite organization, such as the White Supremacists Party or American Civil Liberties Union. Aversive control There are rare occasions when the control of discriminating stimuli and the management of reinforcements fail to change the maladaptive behavior. At these times, the behavior therapist will carefully consider the use of aversive controls. Maladaptive behaviors traditionally labeled impulse control problems—sexual deviations, alcohol dependence, and repetitive self-abuse, for example—may respond to aversive controls when more positive techniques have failed. This is an important point: Any behaviorist worth his or her salt will only attempt aversive conditioning after multiple efforts at positive alternatives have failed. When aversive controls are applied within contingency management, the emphasis is generally on the con- tingent use of punishment (when an aversive consequence follows a particular response). Guidelines for punishment - should be immediate, sufficiently intense, salient to that person, early in the behavioral chain, delivered on a continuous schedule, provided across all stimulus situations, delivered in a calm manner, be accompanied by demonstration and reinforcement of alternative, adaptive behaviors covert sensitization as an aversive technique has raised fewer objections, in part because it has frequently been conceptualized as a self-control approach to modifying behavior. conditioning is done through the use of covert stimuli and responses, such as thoughts and images. The client is first taught deep-muscle relaxation and then encouraged to imagine a scene that the therapist describes. Specific Behavior methods Relaxation training, autogenic training, social skills training, biofeedback , stress inoculation, behavioral activation, self-statement modification, contingency management, behavioral parent training, problem solving,

Why are therapists more likely to become eclectic with experience?

Opportunities for therapists to observe and experiment with various treatments. The estab- lishment of specialized clinics for the treatment of specific disorders—personality disorders, obsessive-compulsive disorders, and eating disorders, to name only a few—have afforded exposure to other therapies, and stimulated some therapists to consider the other therapies more seriously. Treatment manuals have also induced an informal version of "theoretical exposure": Previously feared and unknown therapies were approached gradually, anxiety dissipated, and the previously feared therapies were integrated into the clinical repertoire

Why is it important for cognitive therapists to recognize valid argument patterns?

People sometimes don't think logically, but create illogical things If people call me on my birthday, I am loved. No one called me, I am not loved (P, then Q. Not-P, not Q.) Think about how often people have erroneous thoughts in their head ; as a therapist, what you don't do is say "Denying the antecedent, you are invalid" ; never in therapy use these words, or learn Ps and Qs. Instead, as a therapist, be a master at recognizing what errors people are making in their thinking - ask questions and find ways to help people reveal to themselves the fallacy in their thinking ; instead "it seems that you are making this claim, is that true ? Our thinking is connected with our behavior and emotion ! If you change thinking, that affects their behavior and emotion ; and vice versa - all things interconnected - idea would be if you effectively alter how someone thinks about something or alter their belief; modern today today will change outcome tomorrow

After reading Sarwer-Foner's article on the relationship between psychotherapy and pharmacotherapy, what is your sense of how he (as a psychiatrist) views psychotherapy? Is it different from how a psychologist would view treatment?

Psychotherapy is another process to cure patients of a disease state? Views tehrapy through a medical model to relieve symptoms / an illness separate from the person's being/identity Psychologist may view treatment less along the medical model

What is "reparative therapy?" Is it considered to be ethical by licensed psychologists? Why/why not?

Reparative therapy and sexual conversion therapy constitute the opposite of affirming the LGBT identity; instead, they are designed to change or "convert" LGBT clients "back" to a heterosexual orientation or at least gain control over same-sex behavior Several studies have found that the use of reparative therapy negatively predicts beneficial outcomes; Because same-sex desire is no longer considered pathological, efforts to change sexual orientation are unwarranted and may even prove harmful American Psychological Association, American Psychiatric Association, and American Counseling Association have all issued position statements warning practitioners against attempting to change patients' sexual orientation. In 2012, the state of California outlawed therapies Not ethical - outlawed in some states, warned against; etc

What are two examples of therapeutic techniques that do not work together. Why?

Synchrotist encounters problem - using psychodynamic and CBT - someone comes in and asks if he has children - if using psychodynamic why do you ask, if CBT i have 2 lets move on - two responses exactly opponent Existential - about putting responsibility on individuals; IPT about taking responsibility/blame away, sick role IPT and Gestalt - IPT psychopathology is an illness, Gestalt is from games we play

What strategies do Ogrodniczuk et al. identify for reducing patient-initiated premature termination?

Strategies for Preventing or Reducing Patient-Initiated Premature Termination Pretherapy Pretherapy preparation - Prior to the commencement of therapy, implement procedures that teach the patient about the rationale for psychotherapy, role expectations, how treatment evolves, common misconceptions about psychotherapy, and possible difficulties one may experience in therapy Role induction is the most commonly described pretherapy preparation technique in the literature: instruction that focuses on educating patients about the rationale for therapy, the nature of the treatment process, the prognosis (i.e., realistic expectations for improvement), and the patient and therapist roles in therapy. Of these three studies, one18 found evidence of a reduced dropout rate among prepared patients. The study utilized a 17-minute roleinduction audiotape that patients listened to prior to beginning therapy. Jacobs and colleagues found that pretherapy training of therapists results in similar improvements in attendance as pretherapy training of patients The three other studies of role induction techniques did not find evidence of improved attendance.2 Vicarious therapy pretraining provides patients with examples of therapy.Through this procedure, the patient vicariously experiences therapy and learns about the treatment process. Experiential pretraining engages patients in a simulation of therapy. It is typically conducted in the context of group therapy. Patients often participate in a role induction interview prior to experiential pretraining. The experiential pretraining allows the patient both to experience firsthand what therapy will be like and to attempt expected behaviors. Patient selection - Use screening to choose the most appropriate candidates for particular forms of therapy Following a selection evaluation, patients who are believed to be at high risk for dropping out of a particular therapy may be offered a different treatment. Alternatively, they may be offered a preparation intervention that develops skills that are believed to be important for remaining in the particular treatment. It should be noted that although patient selection is a practice that clinicians frequently engage in, there is as yet little empirical evidence to guide selection decisions for the explicit purpose of reducing premature termination. As Malan34 has noted, accurate patient selection is "probably the most complex, subtle, and highly skilled procedure in the whole field. Time-limited or short-term treatment contracts- Implement a time limit on the duration of therapy or offer a shorter-term treatment contract Some patients may be more willing to persist with treatment if they know when it will end. Short-term contracts could enable the therapist to determine motivation for long-term treatment. Treatment negotiation - Negotiate an agreement on the nature of the patient's problem and the manner in which it should be addressed in therapy A central aspect of treatment negotiation concerns problem agreement—that is, reaching consensus regarding the nature of the patient's problem to be worked on and in which manner A common understanding with regard to treatment parameters will help foster the patient's perception of therapy as a collaborative effort. B Successful treatment negotiation also involves discussing the therapist's rationale for recommending a particular form of therapy. Explaining such a recommendation is perhaps most important for group therapy Finally, an integral part of treatment negotiation involves addressing, when relevant, the issue of a patient's involvement in multiple treatments from different therapists Case management- Provide support to the patient regarding difficult life circumstances that may preclude participation in psychotherapy (e.g., housing problems) For many patients, particularly those from impoverished social classes, stressful life circumstances and events often interfere with remaining in, and benefiting from, treatment Appointment reminders- Provide brief reminders of upcoming, scheduled appointments Motivation enhancement- Prior to the beginning of formal therapy, initiate procedures that increase the patient's willingness to enter into, and remain engaged in, treatment FRAMES involves feedback (providing and discussing results from pretreatment assessments), responsibility (making it clear to patients that it is up them to decide what to do about their problems), advice (offering professional opinion and guidance), menu of strategies (providing options for ways to change), empathy (demonstrating concern and understanding of patients' difficulties), and self-efficacy (stressing that treatment is likely to be successful if patients are committed to change Developing and maintaining motivation Facilitation of a therapeutic alliance- Foster a strong working relationship early in treatment and maintain awareness of the quality of this relationship throughout therapy The alliance is viewed as an essential ingredient of therapy that fosters both the patient's trust in the therapist's perspective and the patient's acceptance of the treatment goals. A strong alliance is believed to help the patient tolerate and continue through the difficult times in therapy Facilitation of affect expression - Provide a safe environment in which patients can explore both negative and positive feelings When patients fail to express negative feelings about their therapy experience, the therapist, or the group in the case of group treatment, they often resort to acting them out by leaving therapy.

Why does Glick suggest that clinicians should use the "allegiance effect?"

The practitioner awaits the outcome of this debate, but in the meanwhile allegiance bias might work in the clinician's favor. If the clinician can convince the patient that he enthusiastically endorses a given treatment, then there would appear to be a higher chance of treatment success. This is true both for psychotherapy and pharmacotherapy. As a clinical pearl, we suggest: use allegiance bias when you can. Proponents of psychosocial and pharmacotherapeutics have a longstanding argument in the literature regarding bias of the proponents that results in positive findings. Indeed, there is a known, high correlation between the allegiance of the research team to a particular theoretical orientation and the outcome of their treatment study Placebo effect; positive expectations account for ⅓ Beliefs /state of mind will change your anxiety, etc. levels: ie anxious about world ending

According to IPT theory, what are the possible causes of depression?

Theory Working theory of depression Psychopathology arises primarily out of early attachment issues Early attachment models that we have ; we form maladaptive frameworks early on that lead to problems later on interpersonally for us theory relies on many frameworks or causative factors for psychopathology Loss and grief Prolonged grief - we all will tend to have grief reaction in the face of loss; yet most of us will recover; when you have rpoglonged grief - person is unable to naturally get out of dysfunction - highly linked with depression; not uncommon that depression is temporally linked with some loss in life (doesnt have to be death) Ekman - say that loss is a universal cause of emotion or trigger ; universal theme ; also a strong negative emotion Can have psych associated with strong positive or negative emotion Loss and grief is interpersonal way of captiuring emotion that can lead to dysfunction; must be interpersonal because to lose means a loss of relationship Role dispute No other forms of therapy that specifically cute role dispute as a problem for people Interpersonally we all have roles in relationships; role might be that you are a parent; or the one who is in charge; Problems arise when there is an incompatible role expectation - disagreement or conflict about the role that happens Ex. who will stay with kids nad who will work Renegotiation- conflict about role and decide who is going to play each role Impasse - can't come up with solution, at a gridlock ; creates prolonged and high state of tension on this topic Dissolution - relationship is damaged beyond recovery - no going back; not able to save relationship IPT therapist will look at relationships, see if role dispute, what stage of dispute Also - this is individual therapy Interpersonal deficits Learned deficit - in a particular cultural context; I have learned a away of interacting that is producing problems for me- every time that I am in a group, I think it is funny to make fun of people's shoes - people dont like that - results in me losing friendships - learned problem with social skills that presumably could be taught on what not to do Adaptive - all of us have social skills ; probably fall on normal distribution ; some of us great at it, some struggle more; if we were taken out of normal environment with different culture/SES/Customs - we would flounder - we dont know that culture or how to interact/behave socially; some of us very good at being adaptive, watch others and adapt; others of us thrown in new environment and are rigid - when thinking about problem; could be an adaptive problem, learned, or genetic Genetic - disorder that prohibits us from interpreting facial expressions for example Role transitions - transition from one role to a diff role is gong to cause potential problems - pretty much all of us with role transition are going to exhibit stress Definition of stress - any time an organism is required to change , it results in stress in that organism - stress is having to change For many people a role transition is a trigger Single-parent families (for children/adolescents) Unconventional in modern society of according to social norms Also look at research - says kids in single-parent families are Harder time with attachment early in life Interesting why they just chose single parent families

What is "gay affirmative therapy?"

This proactive stance is evidenced in gay affirmative therapy, which celebrates and advo- cates for the integrity of LGBT. Such treatment is intended to counteract the destructive effects of a homophobic society and promote positive regard for the client. Gay affirmative therapy first emerged in the 1980s and 1990s when gay and lesbian thera- pists started writing about their own lives, when they realized the need for empowering therapists free of heterosexist bias

Why is the termination period generally considered to be a time of great change in clients?

Time and change - u shaped function - at the end you get significant amount of change Why ? - at the end, natural assumption is that the - same concept as procrastination - timae that things are due becomes a motivator - cant put off things that you have done previously Different otivations depending on circumstances of termination Eleventh hour phenomenon - patient maybe has more confidence in capacity to change ; Things feel more pressing ; developed skills to terminate process/get more out of it

What specific techniques are considered to be characteristic of Gestalt psychotherapy?

With Gloria - He is purposefully agitating her - not trying for rapport ; kind of doing the opposite, trying to confront and agitate her ; he is making micro observations of her behavior; calling her out in acting ineffectively ; uses consciousness raising and catharsis All of this happens in metabolic cycle - 4 components Contact - there is an exchange between the individual and the environment - between her and the therapist ; a way that we start to engage with the world Awareness - awareness of external environment leads to excitement Arousal - aroused to behave/motivate Action - ^what does that mean ? back to peeing example Contact - in environment, operating, drinking water, exchanging with environment Awareness- i have to pee Arousal - i need to go Action - go to the bathroom ] Perls would say most often people get stuck in awareness phase or prior to awareness phase - people get disrupted before even aware of what problem is/need/driver is As soon as clients enter the hot seat, indicating that they are ready to be the focus of the Gestalt therapist, they can be expected to reenact the phony layer of their neurosis; Some clients will play the helpless role, unable to proceed without more encouragement or direction from the therapist; others will play stupid, unable to understand just what the therapist means; others will strive to be the "perfect patient" with their Top Dog insisting that they should do just what is expected of them. Patients then asked to participate in Gestalt exercises designed to help them become more aware of their phony roles or games to prevent avoidance of conflicting emotions. In the Top Dog/Under Dog exercise, for example, the client sits in one chair as Top Dog shouting out the "shoulds" at Under Dog, then switches to Under Dog's chair to give all of the excuses for not being perfect. As clients participate in the Gestalt exercises, they become more deeply aware of their phobic layer, of what they run from in the here and now and the catastrophic expectations that they use as excuses to run. Clients are asked to express their con- scious experiences in action—for example, by taking the chair that represents their parents or their Top Dog and expressing exactly what that person would say- become more profoundly aware of what is interfering with their ability to exist in the here and now Consciousness raising exercises - Games of dialogue, in which patients carry on a dialogue between polarities of their personality, such as a repressed masculine polarity confronting a dominant feminine polarity I take responsibility, in which clients are asked to end every statement about themselves with "and I take responsibility for it" Playing the projection, in which clients play the role of the person involved in any of their projections, such as playing their parents when they blame their parents Reversals, in which patients are to act out the very opposite of the way they usually are in order to experience some hidden polarity of themselves Rehearsals, in which patients reveal to the group the thinking or rehearsal they most commonly do in preparation for playing social roles, including the role of patient May I feed you a sentence?, in which the therapist asks permission to repeat and try on for size a statement about the patient that the therapist feels is particularly significant for the patient Catharsis Gestalt dream work. Dreams are used in Gestalt therapy because they represent a spontaneous part of personality.; clients must act out dreams. Clients are encouraged to "become" each detail of a dream, no matter how insignificant it may seem, in order to give expression to the richness of their personality. catharsis - process as a form of corrective emotional experience. Gestalt therapy also entails dramatic relief, inasmuch as it is often conducted in groups or workshops; the corrective emotional experiences of the person on the hot seat serve as cathartic releases for the people who are actively observing what is occurring there. The empty-chair dialogue pioneered by Perls and systematized by his followers demonstrates the therapeutic value of dramatic relief followed by a corrective emotional experiencing; The empty chair used when emotional memories of other people trigger the reexperiencing of unresolved emotional reactions: for example, unfinished business with a dead parent or unavailable ex-spouse. The client is to express feelings fully to the imagined significant other, such as an alcoholic parent, in an empty chair; helps remobilize the client's suppressed needs and give full expression to them, thereby empowering the client to separate emotionally from the other. The critical components of the resolution of the unfinished business appear to be the arousal of intense emotions, the declaration of a need, and a shift in the view of the other person the Gestalt therapist will observe and listen for a process diagnosis—the emergence of markers of particular types of affective problems with which the client is currently struggling, such as splits between two parts of the self; When a marker emerges, the therapist will suggest a specific in- session experiment or task to facilitate conflict resolution therapists try to block avoidances by providing feedback and directing the client's attention to avoidance maneuvers; Clients may be challenged to use the repetition or exaggeration game until the true affect is expressed.

What is the learning principle that is most associated with contingency management?

principle of operant conditioning - that behavior is shaped by its consequences. Human behavior—whether adaptive or maladaptive—is largely controlled by its conse- quences ? theoretically, the therapeutic process is straightforward: change the contingencies and the behavior will change. Operant conditioning ? B → C

What is Lazarus' B.A.S.I.C. I.D.? How is it used to inform treatment?

task of the multimodal therapist is to comprehensively and systematically assess the patient's specific deficits and excesses · The multimodal assessment template is the BASIC I.D.: B = Behavior ; A =Affect; S = Sensation; I = Imagery; C = Cognition; I = Interpersonal relationships; D = Drugs/biology Behavior: Positive reinforcement; negative reinforcement; counterconditioning; extinc- tion; stimulus control Affect: Acknowledging, clarifying, and recog- nizing feelings; abreaction Sensation: Tension release; sensory pleasuring Imagery: Coping images; change in self-image Cognition: Cognitive restructuring; heighten- ing awareness; education Interpersonal relationships: Modeling; devel- oping assertive and other social skills; dis- persing unhealthy collusions; nonjudgmental acceptance Drugs/biology: Identifying medical illness; substance-abuse cessation; better nutrition and exercise; psychotropic medication when indicated

If you were a clinician, how might you use data from Craske's et al.'s study to inform your use of exposure? If it wouldn't change your practice, what additional data would you require to consider altering a traditional approach toward exposure?

Exposure in different places ? Evidence neither consistently supports nor refutes IFA effects Thus, whereas reported fear and physiological arousal generally decline within an exposure trial (although not always), there is no good evidence to indicate that such declines are indicative of learning or of long-lasting improvement. The premises of EPT are only weakly supported. There is no good, consistent evidence to support or refute the role of IFA. Fear often declines from the beginning to the end of an exposure trial (WSH), but the amount by which it declines or the level of fear on which a given exposure trial ends does not predict overall improvement; WSH appears to be mediated by mechanisms that are different than the mechanisms responsible for long-term outcomes. There is some evidence that the amount by which fear declines across occasions of exposure (BSH) predicts outcomes, although sustained heart rate and skin conductance responding across days of exposure does not preclude improvement following exposure therapy. Finally, we found no evidence for the premise that WSH is a necessary precursor to BSH; in the only study addressing this relationship, group differences in WSH of reported fear did not predict group differences in BSH (Jaycox et al., 1998). inhibitory mechanisms which explain the discrepancies between extinction training and post-extinction fear levels. Inhibitory pathways are also recognized in the neurobiology of fear extinction (see Sotres-Bayon, Cain, & LeDoux, 2006). Within a Pavlovian conditioning approach, inhibitory learning means that the original CS-US association learned during fear conditioning is not erased during extinction, but rather is left intact as a new, secondary learning about the CS-US develops (e.g., Bouton, 1993; Bouton & King, 1983). More specifically, Bouton and colleagues propose that after extinction, the CS possesses two meanings original excitatory meaning (CS-US) as well as an additional inhibitory meaning (CS-noUS). Therefore, even though fear subsides with enough trials of the CS in the absence of the UCS, retention of at least part of the original association can be uncovered by various procedures, including changing the test context (renewal; Bouton, 1993), presenting unsignaled unconditional stimuli toleration of fear may be more critical to exposure therapy than the reduction of fear The proposed methods for enhancing accessibility and retrievability of newly learned associations include variability, spaced scheduling of exposure trials, and retrieval cues for offsetting the renewal of fear. Multiple conditioned excitors ; wean safety signals and safety behaviors Reliance upon fear levels throughout exposure therapy as an index of learning is not only lacking empirical support, but assumes that performance during 'instruction' is a reliable index of learning; an assumption that is not supported by learning and memory research. Inhibitory processes are now recognized as being central to extinction learning, and evocation of such processes at the time of re-exposure to a previously feared stimulus largely shapes the level of fear, regardless of how much fear was expressed during or at completion of extinction training. Evocation of inhibitory associations is instead influenced by variables such as context and time. Furthermore, reliance upon fear reduction as an index of corrective learning is at odds with the importance of toleration of fear. Thus, in the paper, we argue for moving away from immediate fear reduction and toward fear toleration as a primary goal of exposure therapy. Also, we conceptualize exposure therapy as reshaping memory, forming new, secondary learning and involving brain regions that contribute to such learning. We posit that exposure efforts should be oriented towards facilitating inhibitory learning, or ways of developing competing, non-threat associations, at both propositional and automatic levels, and ways of enhancing the accessibility and retrievability of those associations over time and in different contexts. We have outlined methodologies for consolidation and retrievability of exposure-based learning that are derived from basic science of learning and memory, and extinction research, some of which have been investigated and some awaiting such investigation.

According to your textbook, what are the therapeutic techniques typically utilized by IPT therapists?

Features of therapy Feel of IPT is very medical in nature - probably comes from origin - from psychiatrist doing a study looking at psychotropic medications Medically oriented in nature - depression is an illness, something to be fixed Time-limited - average number of sessions in 12-16 Focused - very quickly identify what they are targeting and trying to change to help someone feel better Here and now - even though we think early childhood is important, will focus on present issues/relationships REMEMBER THE MOST - focus is improving interpersonal relationships Identify 1-3 important relationships in that person's life that you think would be helpful to change Concept or model - if you succeed and improve this relationship , other things in your life will change Other thing that is so important is models - component of implied generalization Identifying strengths and assets - person doing well themselves and recognizing what they are good at helps with interpersonal relationships Improving coping Techniques Medical model - means more than anything that you consider psychopathology in itself to be an illness, something to be fixed, and has symptoms ; you have x problem or a medical issue, and we will help you reduce these symptoms Help clients externalize a symptom - eliminate the blame - symptoms in a way are external to you - not that you are depressed, but that you have depression. Not who you are but something that you are experiencing Externalization of the problem is a medicalized model - what you do is use analogies or examples with people to help them think through what depression means for them (ex. 3-d glasses) Symptom review SIGECAPS - go through sleep, Interest (feeling interest in doing things? No change?), Guilt (more guilty, less, same?), Exercise, concentration, Appetite, Psychomotor agitation (jittery or really depressed energy), Suicidal ideation Example of how every time someone comes in they learn how to report on own symptoms - creates baseline of tracking progress over time Focused treatment Identify 1-2 interpersonal problems/relationships Person likely will have at least a couple, but help them pick the ones that they believe will have biggest impact on their health Drug intervention ? Not opposed to medication ; just a tool in toolbox; especially for depression treatment Building self-esteem through positive relationships Better self esteem = better relationships Why? Self fulfilling prophecy of sorts , more likely to engage with others To truly love others, you must first love yourself - if you are in a state of low self-esteem when you don't love or like yourself as a person - in a quandary in relationships with others - any time someone would love you or expresses care for you, you don't believe it - automatically in a state of thinking this person is wrong - i don't deserve it More that you are going to be abl to start believin gin yourself, the more that you will be able to give to others Build support networks - people generally healthier and happier if they have a strong and healthy support network Analysis of communication difficulties - medical precision like fashion, will try to understand what you are and arent good at with communication - many concrete skills we learn naturally, others that we dont two examples - think about what are some of the skills that we have developed to build friendships / recruit people into our lives? Operationalize it? Kind and approachable - close open bright expression ; similar to building rapport with a patient, eye contact, common ground; shared perspective; showing vulnerability with someone else (timing associated with it); creating a sense of care for the other person ; love languages ; one of best simplest tricks you can learn has to do with asking questions - universally become a more loved person - ask people questions about themselves Dissolution They are bold in their statement ; only form of therapy where they specifically promote dissolution Dissolve negative (unrepairable) interpersonal relationships to improve own health and that of others ; might even promote this for something like your parent or close friend - this is contentious ; sometimes directly opponent to some cultures (family is family etc); side where it is less contentious or more clear is when they are like ok your parent was using cocaine throughout early childhood and abused you etc, is this repairable? Probably no Other scenarios, parents are sober, can you forgive them? Trickier IPT therapist would say that at times a relationship should be resolved Collaborate Relationship with clients is by nature collaborative - focused one orkign with you and helping you identify your goals and solve them; different compared to an analyst/blank slate; instead you and i are working together; I am building skills with you - very clear what guidelines are and how I can help you accomplish those goals Find areas of meaning - people do require meaning in their lives to feel good about; help someone find something that they love IPT operationalized in treatment manuals ; adherence to treatment manual fairly distinctive of IPT Therapist role as strictly adhering to manual within collaborative relationship ith patient - focus upon completing manual-guided work in 16 or fewer sessions and moving steadily toward termination to minimize patient regression and intense transference reactions Time limited treatment - 12-16 weeks Combines meds with psychotherapy Initial sessions in 1st phase - consciousness raising heavily emphasized process ; reviews symptoms, names syndrome, accords sick role, and evaluates needs for meds Second phase - addresses primary problem area - grief, interpersonal deficits, role transitions, or interpersonal disputes ; one or two addressed in therapy Therapeutic strategies differ depending on primary problem - cathartic process for grief (relating symptom onset to loss of sig. Other, reconstructing patient's relationship with the deceased, describing the sequences and consequences of events surrounding the loss, exploring associated positive and negative feelings, and considering possible ways of becoming involved with others - after catharsis increase reliance on process of changing conditional stimuli Role disputes - restructuring or renegotiation the condition of the relationship to reduce interpersonal conflicts that can trigger depression, anxiety, substance abuse, and other disorders MEds used often ; for symptom reduction and relationship improvement Third phase of IPT -termination Overall uses consciousness raising, catharsis, conditional stimuli Other - build better relationships/interpersonal skills

In what ways are Beck's CBT and Ellis' REBT similar/different?

RET has variant REBT ; Cog therapy now CBT ; of the two CBT kind of won, the one used more commonly now; but both have a lot of similarities ; REBT bases its concepts of improved treatment of neurotic disorders and of severe personality dysfunctioning largely on philosophical, existential, and humanistic bases, while CT tends to align them with empirical results of outcome studies. Similar -Both REBT and CT, however, use philosophic and empirical outcome studies to construct and validate their theories. Different - Ellis's is more if then conditional logical rational' ' Beck's is more empirical reasoning with socratic questioning ; Ellis' treatment more based on philosophical, existential, and humanistic bases , Beck's more about empirical results of outcome studies

What are the commonalities of IPT and STPP?

Shared attributes Both approaches pull for affect and catharsis Shared attributes - time constraint, narrow-focus, and modality-trained therapists; both use support, a warm alliance, and careful exploration of interpersonal experiences; positive, empowering, collaborative stance; may both use clarification/other analytic techniques

How effective is implosion therapy?

All four studies found implosive ther- apy superior to no treatment: in one study, implosion was more effective than desensitization and in another study, the two treatments were equally effective. An independent review of the research on implosive therapy concurred that, when implosion was compared with systematic desensitization, there were no consistent differences in the effectiveness of the treatments One study - average effect size for all the psychotherapies was 0.93; the average effect size for implosive therapies was 1.12—a large effect in general, and a slightly larger effect than the other therapies to which it was com- pared.

What therapeutic change principles are most commonly used by multi-cultural therapies?

Consciousness Raising It can help patients to understand the oppression and adverse impact of the majority culture, to move from naïveté or acceptance to naming and resistance against oppressive systems, to reflect on self and self-in-culture, and to redefine themselves in a way that promotes pride Therapists begin by helping clients to understand how the dominant culture may have oppressed them and shaped their self-views. Negative internalization of the dominant culture separates many clients from their own identity. This liberation of consciousness helps clients to appreciate how oppression operates in their lives. Therapists points out that internal distress is often related to (or a reaction to) external stressors, such as racism and prejudice. Clients must face the truth about themselves—that they may hold the norms of the dominant culture in high esteem and may denigrate aspects of their own culture. Consciousness raising may also assist patients in recognizing how their cultural conditioning impedes their acceptance of psychological treat- ment and implementation of change. In responding to partner violence, for instance, some Mexican women will not seek help because they believe their situation is God's will. Catharsis Suppressed anger over discrimination and cultural alienation often comes to the surface once patients comprehend the negative impact of the dominant culture on them. therapeutic that minority clients express this anger and recognize that it is a normal and justified response. Choosing After consciousness raising and catharsis comes choices that lead to change. Once patients have acknowledged their oppression and expressed their wounds, they choose how to channel their newfound liberation and pride constructively. A critical choice facing clients is how to integrate their sense of self with their cultural group. "How much should I integrate? Which parts of myself and my culture am I willing to sacrifice? How do I cultivate healthy relationships in the face of cultural expectations?" Immigrant clients face choices regarding how to incorporate cultural traditions and roles with the norms of their new country. Clients must choose how much they want to acculturate into their new society and, if desired, determine how they can blend aspects of both cultures without losing central aspects of each. The basic choice for such clients comes down to how to achieve a healthy, comfortable balance Acculturation versus retention of minority culture Some clients may choose not to identity with the minority group, and their feelings of pain and guilt might be addressed Other clients may decide that they would like to identify with their cultural group, but fear rejection. In these instances, the therapist will work with the client in planning ways to reinte- grate with their cultural group and handle rejec- tion if it occurs Still other clients will select a bicultural iden- tity, and cultural-sensitive therapists may seek to help them to deal effectively with the potential backlash resulting from their choices.

In what ways do behavioral psychotherapists place emphasis on the therapeutic relationship?

The importance of the therapeutic relationship in behavior therapy varies according to the particular method and clinician. With systematic desensitization, for example, the relationship is not nearly as consequential as in CBM; the former has been successfully applied in large groups and with computers, whereas the latter emphasizes the active collaboration of patient and therapist. Similarly, the relationship assumes greater importance in some of the operant methods, especially if the therapist is using social reinforcement, and in cognitive-behavior therapy, especially if the therapist is treating complex psychopathology. Under such conditions, the more valuable the psycho- therapist is to the client, the more effective a social reinforcer the therapist can be. And behavior therapists can indeed be social reinforcers, leading clients to perceive them as empathic and warm. The educational and collaborative nature of the therapeutic relationship leads to patient ratings on therapist empathy, understanding, and warmth generally comparable to other, relationship-oriented psychotherapies (Glass & Arnkoff, 1992). study of Sloane and colleagues (1975), who compared behavior therapy and psychoanalytic psychotherapy; psychoanalytic therapists and behavior therapists were found not to differ on degree of warmth or positive regard; significant differences, however, on accurate empathy and genuineness. The behavior therapists were rated higher on both. Many behavior therapists prefer the operational term validation to the person-centered empathy in describing their relationship goals. Validation occurs when the therapist communicates to the patient that her responses make sense and are understandable within her current life context. There are multiple means of validating clients in session: listening and observing, accurately reflect- ing, articulating the unverbalized, reinforcing progress, validating as reasonable in the moment, and treating the person as important and valid (Linehan, 1993b). Validation is an end in itself, but it also facilitates client change. And all of these therapist skills can be identified, rated, and taught—in contrast to the fuzzy notions of thera- peutic presence or empathy. behaviorist is less concerned with accurate empathy than with accurate treatment-clients needa competent therapist, not one who is selfpreoccupied with authenticity. If there is any general value to a therapeutic relationship, it lies in establishing a secure precondition for psychotherapy and in therapist modeling. The behavior therapist must provide sufficient validation and invoke sufficient credibility, trust, and positive expectancies for clients to engage in the work expected of them during the session and in between sessions. The behavior therapist must also invoke modeling— observational learning in which the behavior of the therapist (the model) acts as a stimulus for similar thoughts, attitudes, and behaviors on the part of the client. Modeling is such a critical part of assertiveness training that therapists who are not genuinely assertive would probably not be competent as assertion trainers. Modeling occurs with most other forms of behavior therapy as well. A desensitizer, for example, models a fearless approach toward phobic stimuli, teaching clients that such stimuli can be mastered if approached in a gradual and relaxed manner. The contingency contractor models a positive approach toward problem solving and teaches clients that conflicts can best be solved through compromise and positive reinforcement rather than through criticism and punishment. Modeling can serve many important functions in changing behavior (Bandura, 1969; Perry & Furukawa, 1986). Through observation, clients can acquire new behaviors; for example, clients observe a competent asserter for the first time and then begin to acquire the essentials of effective assertion. Modeling can facilitate adaptive behaviors by inducing clients to perform behaviors that they are capable of performing but have not been per- forming in appropriate ways, such as expressing positive feelings toward a spouse after the therapist has been observed to express similar feelings. Modeling can disinhibit behaviors previously avoided because of anxiety, as when clients learn to talk openly about feelings because the therapist has been direct about them. Finally, modeling can lead to vicarious and direct extinction of anxiety associated with a stimulus, such as when children extinguish fear of dogs because they have observed the therapist's children having fun with dogs. Considerable research demonstrates how beneficial modeling can be and also how modeling can be most effective. If behaviorists make therapeutic relationships a part of the process of change, then they must attend closely to what they are modeling and how effective a model they are becoming.

What is "satori?"

What would perls think of as a successful treatment outcome? - has to do with satori and process of awakening - shedding the phoniness and psychopathology that we use / games we play to be genuine you - all of that to get her to be genine - she confused genuineness with aggressiveness - at the end she says i would never cry in front of you, and Perls says are you sure that's true , she says no - and thats the point - if she was crying he wouldnt attack her, he would be genuine in that moment ; so then she starters to get the point - realize that he is focused on genuineness

Is it important for cognitive therapists to provide valid argument patterns?

Yes to identify illogical thinking patterns in clients and to subtly point these out to the client (reveal their fallacies) and correct incorrect thinking patterns

What therapeutic change principle is utilized with implosive therapy? How does it work?

• Uses Contingency Control (operant conditioning) • Extinguish the anxiety by not rewarding or reinforcing it by escaping • The avoidance response is blocked and this then reduces anxiety • Therapist constructs scenes that have been repressed or cognitively avoided. These dynamic cues are assumed to be the stimuli that elicit the most anxiety (fear of losing control, sexual urges, anal impulses) • Therapist presents scene, see client experiencing anxiety and then intensifies and repeats scene to elicit and thereby extinguish more anxiety learning theory processes of avoidance conditioning and extinction. The symptoms and defense mechanisms that characterize psychopathology represent learned avoidance that serve to reduce anxiety in the short term. If the cause of psychopathology is conditioned anxiety and avoidance, then the solution is to apply the most effective methods of extinguishing both avoidance and anxiety responses. Extinction is the gradual disappearance of the conditioned anxiety because it is no longer reinforced—in this case, no longer reinforced by avoidance. Response prevention, on an animal level, extinguishes anxiety by forcing the animal to remain in the presence of the conditioned stimuli. On a human level, response prevention entails extinguishing pathological anxiety by working to prevent clients from avoiding the anxiety-eliciting stimuli. As implosive scenes are presented, clients are observed for overt signs of anxiety, such as rapid breathing, sweaty palms, crying, gripping the chair, or curling up and covering their faces. When signs of anxiety are observed, the therapist uses this feed- back to intensify or repeat the scene to elicit and thereby extinguish more anxiety. implosive therapist must stay with a scene until the anxiety has been noticeably reduced and at least partly extinguished.

Which clients are most often treated with DBT?

People with BPD

What are the common techniques used as part of counterconditioning (reciprocal inhibition, systematic desensitization, etc.)?

Reciproal inhibition - if response inhibiting anxiety can be made to occur in presence of anxiety producing stimulus - will weaken bond between stimulus and anxiety - something that is anti anxiety provoking in same situation Often can use parasympathetic nervous things to do, or exposure ; ex. Systematic desensitization, assertiveness training; reciprocal inhibition with sexual arousal problems; or stimulus control ; all possible targets for counter conditioning Systematic desentization - phobia - fear spiders - use systematic desenztiization to counter fear of spiders Fear hierarchy - rate how scary certain situations are 1-10; spider lose in room, spider in room, spider on forehead, etc After rating, order hierarchy, then systematically work through them from lowest fear to highest fear using some sort of exposure - in context of anxiety provoking stimulus - do somethign to recpirocally inhibit or reduce anxiety response in face of stimulus over successive trials progressive deep-muscle relaxation is the response that is incompatible with anxiety. Thera- pists first teach clients how to relax the muscles Clients are then encouraged to relax their arms and to feel the contrast between the ten- sion and the relaxation. The next step in desensitization is to construct an anxiety hierarchy that ranks stimuli from the most anxiety arousing to the least anxiety arousing. The hierarchy is frequently constructed along some stimulus dimension—time or space, for instance— as the stimulus situations move closer and closer in time to an anxiety-arousing situation, such as a job interview, or closer in space to a feared object, such as an elevator A desensitization session typically lasts 15 to 30 minutes, Assertiveness Training - choice for most anxieties related to interpersonal interactions; people who are characteristi- cally passive or aggressive in interpersonal situations are prime candidates for assertion training; includes teaching clients direct and effective verbal responses for specific social situations; Patients are encouraged to rehearse their new assertive responses both covertly and overtly; graduated homework assignments, beginning with less frightening situations and are most likely to lead to successes for the client; often in groups so members can provide reinforcement, practice, feedback Many clients need to first reevaluate their attitude about what it means to be an assertive person. For some, this involves cognitive restructuring (liter- ally, changing thinking), in which they realize their personal right to be assertive. Assertion training also entails operant conditioning as therapists rein- force clients for each attempt to become more assertive. Using the process of shaping, therapists reinforce clients' successive approximations to the finished goal of assertion Social skills training (applied to psychotic disorders and developmental disabilities), communication skills training (Instruction, modeling, practice, role-playing, HW), refusal skills training (addictive and consumption disorders) Any type of reciprocal inhibition and exposure - must get buy in of the user or client - REALLY important - dealing with negative emotion that invokes withdraw - must get them to buy in In general, try to start with in vivo exposures - quicker to achieve treatment outcome if you can do it ; if you ahve to imagine first - nto gonna get same level of emotional response Exposure he has done the most - exposure to vomiting - many adolescent girls afraid of vomiting Classical conditioning associated with sexuality Sexuality and sleep often associated People develop negative thought associated with sexuality - need parasympathetic nervous system to engage - identify what classically conditioning stimulus it - could be think or thought - then counter condition with calming thought/stimulus ; this works really well Clients are first asked to identify when in a potential sexual encounter they first feel anxious. They are instructed to limit their sexual approaches to that point where anxiety begins; Gradually the anxious person will find that more anxiety is being inhibited and counterconditioned by sexual arousal. X axis is time; vertical is anxiety ; when people come close to a fear event, people ramp up anxiety, get high, then after event goes down; before stimulus is ever encountered has ramps up in anxiety response - anticipatory anxiety - ex. Shot phobia - before even get to clini sweating and nervous ; about mid way in time sequence there is an escape or exist - then anxiety goes down- avoid it to reduce anxiety ; unintended consequence - over time increase anxiety in anticipation of event with repeated exposure - with exposure , help people to not escape, have to experience anxiety; dont do an exposure one, but do it hundreds of times; takes 8-10 exposures to have major effect - gradually gets lower - goal is to never have it be 0, but have it go from an 8 to a 3 ; never will be ok to have a spider on your forehead , but wont freak out May have spontaneous recovery - but instead of going back to 9 like before, will be 6 or 7 Behavioral Activation What is the healthy opposite, the coun- terconditioning technique for such depression? Behavioral activation—a combination of improv- ing daily activity, increasing pleasurable events, and enhancing feelings of personal mastery. breaks the cycle of depression by increasing the patient's daily activities. Patients are presented with graduated exercises to promote activities and people that are reinforcing. The first day might only entail taking a shower and making a sandwich; the twelfth day might require a shower, a sandwich, a meeting with friends, and several hours of productive work. As patients schedule and structure their daily activi- ties, they are asked to rate the degree of pleasure in each activity, and thus learn which are indeed gratifying. Success then gradually begets more success. Stimulus Control avoiding stimuli that elicit the problem behavior and inserting stimuli that cue the alternative, adap- tive behavior. If you want to reduce fat in your diet, then avoid fast-food restaurants and snack foods, and instead insert healthy reminders and foods at home. Unfortunately, while everything he told us is pretty intuitive, most of us dont act htis way or use this knowledge - parents are worst of this - have children that they care about , kids dont want to go in water cause of scared - parents tell them not to - parents start creating environments to have child avoid what they are afraid of - strengtehns anxiety to the water - sorry, but mom is making it worse - will get a Lisa like response - at first AHHH, then gradually better - major takehome - dont avoid fears, face them !- must confront discomfort, not withdraw from it; caveat - in case when no danger (if lava instead of water); cant be dangerous, just fear ; as long as being safe, try to overcome fears

How might clinicians be biased by their personal experiences?

"Biased" essentially means "nonrandom"--a tendency to operate in a particular patterned or directional manner. To contend realistically and effectively with the extraordinary array of information and possible interpretations and reactions that social workers encounter in their social and professional interactions, they simply must rely on some assumptions, rules of thumb, and habits to provide direction. Personal histories predispose people toward certain ways of thinking about how people should behave, what they are conveying through certain actions, and what their meanings and underlying motives are. social workers are all too ready to infer that they know what a client means when the client says he or she is "depressed" or wants more "respect. " If clients' attributes or experiences predispose social workers to view them as similar to themselves, then the ongoing risk of social workers' using themselves rather than the clients as the principal referents for meaning is exacerbated even further his concern over social workers' excessive reliance on their own experiences is underscored by the tendency among helping professionals to have personal backgrounds that have sensitized them to the negative effects of social and personal injustices and dysfunction. Indeed, these experiences may be a primary reason or catalyst for joining the profession.

What are the different principles of learning theory (negative/positive punishment, negative/positive reinforcement, classical conditioning, etc....)?

-Yes, you may be asked to identify the different learning principles in a vignette. positive reinforcement (if you do what i want, you get what you want) positive punishment (adding something negative to situation that hes gonna withdraw from , "billy if you dont give me that pen you will have to do 1000 pushups" Negative punishment (when you take away something good "if you dont give me the pen you lose recess, screen time, go outside etc"; activates negative system ) Negative reinforcement (if you give me pen, dont have to do the dishes tonight; take something negative away that you didnt like to make happy) Classical conditioning - a learning process that occurs when two stimuli are repeatedly paired: a response which is at first elicited by the second stimulus is eventually elicited by the first stimulus alone.

What are the characteristics of exposure therapy (number of sessions, etc.)?

8-12 individual sessions, each 1-2 hours long, ina soundproof room to let clients fully emote Longer than standard 50 minutes cause cant stop in the midst of intense anxiety Homework assigned between sessions - self-controlled exporue for at least 45 minutes or until anxiety decreases Exposure therpay - exposure therapists view anxiety as a conditioned response controlled by the two learning factors. Both respondent learning and operant learning are involved in the development and maintenance of behavioral disorders. Condi- tioning accounts for the acquisition of the fear, and extinction (or habituation) accounts for the fear reduction. Two-factor theory of learning factor is classical or respondent conditioning, through which an animal learns to fear a buzzer because it has been paired with shock. This condi- tioned fear is labeled anxiety. The buzzer becomes a conditioned stimulus capable of eliciting an auto- matic and autonomic conditioned response similar to fear. If the dog remains near the buzzer, the aver- sive anxiety increases in intensity. If the dog jumps over the barrier, the anxiety is reduced, and the dog's avoidance is reinforced by the powerful consequence of anxiety reduction. second factor in learning to avoid is called operant or instrumental conditioning because it is instrumental in minimizing the dog's anxiety classically conditioned anxiety serves as the motivating or drive stimulus that activates the avoidance response, whereas the anxiety reduction provides the consequence necessary for reinforce- ment of the instrumental avoidance. Mowrer coined the term neurotic paradox to describe this phenomenon: the failure of maladap- tive anxiety to extinguish despite its self-defeating nature. The therapeutic strategy is to reverse the reinforcement contingencies or the neurotic paradox: intentional, prolonged contact with the feared stimuli (prolonged exposure) and the active blocking of the associated avoidance (response prevention). In the short term, patients will cer- tainly experience increased anxiety, but through the process of extinction, they will with equal certainty experience reduced anxiety and avoid- ance in the long term.

What is avoidance repression?

The anxiety is repressed through avoiding the stimuli • Also called cognitive avoidancethe anxiety is repressed through avoiding the stimuli Don't fully consciously have something because we repress it. Repress something because of negative valence. Put it out of mind Why do we have consciousness (it is adaptive), focusing attention More challenging for the implosive therapist is to construct scenes that have been repressed or cognitively avoided. These repressed stimuli are similar to what psychoanalysts refer to as the dynamics of psychopathology, such as repressed feelings of rage. These dynamic cues are assumed to be the stimuli that elicit the most anxiety. Dynamic cues are based on psychodynamic theo- ries of psychopathology and on the therapist's clinical interpretations. Such cues include fears of losing control over hostile or sexual urges, anal impulses, fears of responsibility and facing one's conscience, and anxiety over anxiety itself. Implosive therapists use their full imaginations to create the most evocative scenes possible. As implosive scenes are presented, clients are observed for overt signs of anxiety, such as rapid breathing, sweaty palms, crying, gripping the chair, or curling up and covering their faces. When signs of anxiety are observed, the therapist uses this feed- back to intensify or repeat the scene to elicit and thereby extinguish more anxiety;the implosive therapist intentionally intensifies the image to make it more objectionable! the implosive therapist must stay with a scene until the anxiety has been noticeably reduced and at least partly extinguished. If a session or scene were terminated while the client was highly anxious, the client could become even more sensitized to the condi- tioned stimuli and might increase his or her avoidance once the session had ended. The client could also have anxiety conditioned to the treat- ment setting and might avoid returning to ther- apy. Consequently, implosive therapists are trained to stay with scenes until the client is drained of most of the emotion connected with a particular scene.

When given the opportunity, clients will typically choose a therapist of the same race or ethnicity. What does the data suggest about the effectiveness of a race/ethnicity match?

if you read data about gender of therapist and patient characteristics - does not impact therapeutic relationship - not what you would think - data is more in line with that to work with someone there will be differences, but when it comes down to it can I know your human experience ? yes, cna get over barriers Third, the research fails to show that ethnic minority therapists achieve better (or worse) treatment outcomes; Meta-analyses show no significant differences with respect to client functioning, treatment reten- tion, or number of sessions attended between client-clinician dyads racially-ethnically matched and those not matched If the therapist is of a racial minority back- ground, he or she can often serve as a positive role model in teaching the client how to respond to discrimination and anger. Minority therapists can share with clients their own feelings and coping methods. For example, a Native-American thera- pist who had a difficult time dealing with employ- ment discrimination can share her experiences with clients facing similar circumstances. Often, minority clients feel more comfortable with a psychotherapist from their own ethnic background. A same-culture therapist can serve as a role model and can genuinely empathize with the problems of the minority client. However, with so many diverse cultural groups, it would be impractical to expect that there would be a health care practitioner readily available to match each patient's cultural backgrounds. Since racial/ethnic matching of therapists and patient is not always possible and does not guarantee effectiveness, the responsibility for treating culturally diverse clients is distributed among all psychothera- pists. Therapists often find themselves working with clients from cultural backgrounds radically different from their own. This can be a problem for both the client, who may feel misunderstood by the therapist, and the clinician, who may struggle to understand the client's cultural framework and to adapt thera- peutic strategies to fit the client's individual needs.

According to Wagner-Moore, how has Gestalt therapy changed since Perls' death?

moving from the original Perlsian emphasis on skillful frustration and self-reliance to a gentler, "Rogerian-ized" version of gestalt therapy. The 1960s version of gestalt embodied existential principles of freedom and responsibility, analytic notions of defenses, and gestalt psychological principals of gestalt formation and destruction. Modern gestalt has retained many of Perls's original ideas but has also softened in many respects. Modern-day gestalt therapy- retained Perls's applied phenomenological approach and creative techniques. Contrary to Perls's style, modern gestaltists consider the relationship be- tween the therapist and client one of the most important aspects of psychotherapy and use less stereotypic techniques; modern gestalt therapy is less harsh and has turned its focus to the genuine contact between patient and therapist; no national organization or standards have been established as criteria for empirically validated gestalt treatments. Modern gestalt still embodies the majority of Perls's original ideas and therapeutic techniques; empirical validation of Perls' techniques unsupported until recently.

According to Joseph Wolpe, what is the cause of most psychological disorders?

organism has learned association between two things - try to counter it Anxiety is the primary learning problem in psychopathology. Once anxiety is established as a habitual response to specific stimuli, it can undermine or impair other behaviors and lead to secondary symptoms. Sleep may be disturbed by anxiety; tension headaches or stomach upsets may occur; irritability may increase; concentration, thinking, and memory may be impaired; or embarrassing tremors and sweating may occur. Over time, the chronic physiological reactions of anxiety may impair bodily functions and result in psychophysiological symptoms, such as gastrointestinal symptoms. These secondary symptoms themselves may elicit anxiety because of their painfulness, their association with learned fears of physical or mental disorder, or simply their embarrassing social consequences. If these secondary problems produce additional anxiety, then new learning may occur, and a "vicious circle" is created that leads to more complicated symptoms. Conditioned anxiety frequently leads to avoidance. Physical avoidance, such as phobias, may be learned because avoidance leads to the automatic consequence of terminating anxiety. Over time, the primary complaint is no longer anxiety but the phobias and addictions patients have developed in order to avoid anxiety. Of course, an addiction itself can produce anxiety and can lead to further problems in order to reduce the new anxiety, and the vicious circle goes on. Symptoms result from anxieties elicited by particular stimuli.- successful elimination of a specific anxiety and a specific secondary symptom will not lead to new symptoms. Symptom substitution or symptom return is a theoretical myth of those who see all behavior as interconnected by a single, underlying dynamic conflict. What is common to most behavior problems is the presence of conditioned anxiety that is highly specific in both the stimuli that elicit it and the consequences that result from it. Successful treatment thus calls for successful, and at times successive, elimination of specific anxiety responses.

In what ways does Dialectical Behavior Therapy differ from CBT?

working with people with borderline personality disorder - up to that time untreatable disorder - added modifications to CBT - with mindfulness - understand difference between rational and emotional mind - using modified approach , demonstrated c=good treatment outcomes with BPD using DBT - also used for eating disorders, generally fundtions equivalently to CBT, but more niche and focuses on specific disorder ? Third wave of CBT, combination of western and eastern philosophy, science and practice From west - build on behavioral and cognitive therapies including skill building, cognitive reframing, and exposure to fears. However, rather than teaching people to control their thoughts, feelings, memories, and other private events, they draw from the eastern traditions of noticing, accepting, and enhancing private events, especially previously unwanted experiences

According to Markowitz et al., what are the defining features of IPT?

time limit (strict, established at outset, 12-16 weekly sessions), medical model (patient's problem defined as medical illness; giving patient "sick role"; relieves guilt of patients), dual goals of solving interpersonal problems and syndromal remission, interpersonal focus on the patient solving current life problems (Here and now) , specific techniques (IPT more innovative; does not use STPP - short term psychodynamic psychotherapy - interventions such as genetic or dream interpretations), termination (graduation from therapy), therapeutic stance (therapist assumes openly supportive role of ally), and empirical support Goal for IPT is to treat a specific psychiatric syndrome by helping the patient change a current life situation, goal for STPP is to increase understanding of intrapsychic conflict IPT: defined by 1. Time limit Strict time limit: 12-16 weekly sessions → forces patient and thera to work quickly Psychodynamic: traditionally open ended Most STPPs = 20-25 sesh 2. Medical model IPT = illness based Give sick role and medical dx: to help recognize symptoms and relieve self criticism : blame an illness rather than selves Therapists use psychodynamic knowledge to read pscyh patterns of patients IPT relives guilt and prevents blaming selves STPP: focus on intrapsychic conflicts, unconscious feelings, character defneses rather than formal dx and concept of illness 3. Dual goals of solving interpersonal problems IPT: to solve meaningful interpersonal problem and thereby to relieve episode of mood disorder Therapist defines two targets during initial phase Goal to treat specific psychiatric syndrome by helping patient to change current life situation STPP: goal to increase patient's understanding of his internal functioning, external change follows (not prime focus of treatment) Goal: to increase understanding of intrapsychic conflict IPT only for : major depression, bulimia where efficacy empirically supported STPP less concerned with specific dx 4. Interpersonal focus on patient solving current life probs IPT focus on events in patients current life outside office and on patients reaction to these life events and situations STPP focuses on transference in office and linking of outside session interpersonal events to transference IPT : more than introspection, coaching for life 5. Specific techniques IPT = more innovative Each problem: set of strategies Sesh begins with how have things been since we last met? → focus on interval btw sesh and if elicits mood or event: then therapist links the tow Ie depressed learn to connect enviro sitch to mood and to realize they can control both IPT - no use of genetic or dream interps IPT - catharsis = not enough, must transmute feeling into life changes IPT emphasizes action rather than exploration and insight 6. Termination IPT: end: final sesh address patient's accomplishments, patients competence independent of therapist, relapse prevention STPP: more impt: focus on patients responses to therapy ending 7 thera stance STPP: therapist neutrality and relative abstinence for transference to develop IPT: openly supportive ally 8 empirical support IPT: demonstrated efficacy STPP meager support for particular symptoms

Is Gestalt therapy effective?

little systematic research on the outcomes of Gestalt therapy, and the early research that has been conducted frequently concerns growth experiences, decisional conflicts, and nondiagnosa- ble conditions. Across 475 studies examining various types of psychotherapy, Smith and colleagues (1980) found an overall effect size of 0.85, a large effect. Across 18 studies testing the efficacy of Gestalt therapy, the researchers found an effect size of 0.64, a number closer to the medium effect range. This effect size indicates that Gestalt therapy is consistently superior to no treatment but barely higher than placebo (effect size 1⁄4 0.56). it is superior to wait-list and no- treatment controls. No recent studies have compared it to an "active" placebo. Gestalt therapy has thus been found to be superior to no treatment but not to other tested systems of psychotherapy. Depending on one's perspective on the allegiance effect and clinical significance, Gestalt therapy is as effective or perhaps a bit less effective to tested cog- nitive and behavioral methods of therapy. Gestalt therapy has not been sufficiently researched with children, adolescents, or older adults to be included in those meta-analyses

According to Sarwer-Foner, what were the two early "schools" of psychopharmacology?

2 schools of psychopharmacology: 1. antipsychotic school: to treat disease as a whole 2. Target symptom approach: psychopharmacological profile of a medicine in appropriate clinical dosage = assessed in terms of which signs and symptoms. it is likely to physiologically influence Aim to enhance capacity for self mastery by controlling symptoms that are proof to patients of their disease staite, of their inability to control or master themselves without the drug It is then used to do this, whether or not this is seen as curative for the disease

What do effectiveness/efficacy studies tell us about integrative theories?

A review (Schottenbauer et al., 2005) finds that many different integrative therapies have substantial empirical support, defined as four or more controlled studies. transtheoretical ther- apy. The latter therapy has been described as "the most thoroughly tested model" of integra- tion These integrative thera- pies have been empirically shown to be effective in that they outperform no therapy and placebo therapy, but have not been shown to be superior (or inferior) to conventional, single-theory treat- ments, with a few exceptions.

According to Craske et al., what does the literature suggest about the spacing of exposure trials?

Believe that temporally spaced training trials often result in stronger acquisition-type learning than temporally massed trials • See greater storage in strength of memory that is gained by partial forgetting between learning episodes, which in turn is presumed to slow the loss of retrievability of a memory over time • Did not see this effect with rodents

How is attachment theory related to termination?

Abandonment - if client feels that it was premature termiantino - can be suit of malpractice - more likely to occur because of emotion involved - a way to act out otwards the therapist - must be thoughtful and cautious about it - take measures to ensure that everything is extremely clear ? Abandonment history - would think if someone ahs history of abandoning issues or difficulty with termination or there to see you for loss, actually counterintuitive because typically these people we would do a clean cut not tapering - think of it along the lines of exposure - if people struggling with it/focus of treatment, end goal in a way is that they would be able to tolerate good ending/termination However, if you dont think client would tolerate it, better to do a tapering type approach

How are common factors related to eclecticism?

Advo- cates of common factors argue that commonalities are more important in accounting for therapy out- come than the unique factors that differentiate among therapies a positive therapy relationship, a hardworking client, and an empathic therapist account for more of treatment success than the particular treatment method Bruce Wampold has been an ardent and influential supporter of the common factors approach. Relying on his extensive meta-analytic studies of psychotherapy, Wampold A common factors model of psychotherapy, one rooted in the individual therapist, the therapeutic relationship, and fit between the treatment and the client's values and culture. Clients should choose the best therapist and choose the treatment that best accords with their worldview. Psychotherapists should be trained "to appreciate and be skilled in the common core aspects of psy- chotherapy"; These include empathic listening, developing a working alliance, working through one's own conflicts, understanding interpersonal and intrapsychic dynamics, and learn- ing to be self-reflective about one's work. Therapists should learn as many treatment approaches as they find congenial and convincing. Psychotherapists should also provide clients with an explanation for their disorders that is acceptable to the client, enhance the client's expectations about overcoming his or her difficulties, and offer actions that are help- ful to the client. they demonstrate how commonalities pow- erfully operate in any behavior change, including individual therapy, medicine, pharmacotherapy, family therapy, and education They argue that an impartial reading of the outcome research sup- ports four major therapeutic factors: 1. Client factors (harnessing naturally occurring change in the client's life, minding the client's competence, and tapping the client's world outside therapy) 2. Relationship factors (fostering a positive therapeutic alliance 3. Hope and expectancy 4. Models and techniques

What are the 5 heuristics that Nurius et al. identifies that might influence clinician decision making?

Anchoring excessive weighing of initial information derived about a client that subsequently serves as a template against which further information is judged. Evidence indicates that judgments tend to be generated early and often on the basis of indirect sources (for example, a colleague's diagnostic comment [Temerlin, 1968]) and on limited direct information (Meehl, 1960). These early impressions tend to be tenacious, even in the presence of new, contradictory information and in the absence of behavioral manifestations after the initial diagnosis or problem formulation has been determined Availability Heuristic "availability" refers to how readily accessible information (for example, cases, situations) is--that is, how easily it can be recalled or brought to mind. Certain types of information are clearly more accessible than others- tends to be cases or situations that stand out-- that are salient, dramatic, or particularly noteworthy in one way or another; not mundane/average parts of lives that people recall most easily; these tend to blur together the exceptions--the brilliant highs, the agonizing lows-- as well as the freshest or most recent of people's experiences that stand out. employ the availability heuristic when one is estimating the frequency or likelihood of a set of circumstances or an outcome on the basis of the ease with which related information is brought to mind The potential dilemma is obvious: given the greater distinctiveness of exceptional instances, they will be far more likely to influence estimates and predictions than less distinctive, yet more normative, instances. Representativeness Heuristic involves judgments of how likely it is that a person is a member of a particular category (for example, a diagnostic group) or how likely a given sign (for example, one presented by a drawing or a projective test) or outcome can be explained by a particular set of antecedents (for example, interpretation of family of origin patterns). The degree of representativeness is the degree of similarity or identity that the target is judged as having relative to some preexisting set or hypothesis representativeness heuristic biases a practitioner to underestimate the importance of base-rate or prevalence information, for example, that a given condition occurs relatively rarely; tendency is to focus instead on single cases that seem "highly representative" and to generalize to the current case from such presumably representative cases. Here again, the effect of expectancies becomes evident not only through the clinician's selectively attending to information that fits with preexisting sets and hypotheses, but also through the clinician's inferring or interpreting its meaning consistent with these Clinicians, like everyone else, tend to draw more confidence from a small body of consistent data that seems to make sense than from a larger body of less consistent information that is therefore harder to get a handle on. Everyone needs and searches for coherence, at times interpreting information to increase its apparent consistency and ignoring or discounting evidence that does not fit our expectancies. Effects of the representativeness heuristic may be exacerbated in circumstances where greater detection of pathology or dysfunction is viewed as a sign of greater skill or status by one's colleagues Fundamental Attribution Error the tendency of actors to focus on situational influences in attributing or explaining causes of behavior, whereas observers tend to attribute causality for the same behavior to stable traits possessed by the actor ;In the case of assessment and problem formulation, the client is the actor or target and the clinician is the observer. A client in counseling for anger management, for example, may tend to see the problem as stemming from some factor in the environment, whereas the therapist is more inclined to see the behavior as a manifestation of underlying characterological factors This characterological orientation often is confounded by the limited information on which judgments are based. In assessment or diagnostic scenarios, clinicians typically have access to only a small portion of potential information on their clients and the clients' environments. Small samples (of, for example, observed client behaviors, different clients) tend to be less stable and less representative relative to larger samples, rendering it questionable that truly reliable, representative samples of client attributes, behaviors, and circumstances or environments are typically acquired. Effects of Mood on Memory and Judgement Two effects of mood on attentional focus have been established. The first is that of selectively attending to and reading information that is positive when one is feeling positive and negative when one is feeling negative (Bower, 1981). The second effect of mood is the shift of focus of one's attention to oneself (Salovey & Rodin, 1985). Specifically, when people have affective experiences, they typically become temporarily self focused. This transitory self-preoccupation is potentially problematic in interpretation and evaluation because of its augmentation of the practitioner's natural tendency to use himself or herself as the referent for the meaning of client experiences, issues, and concerns. A principal effect of mood on memory involves the tendency to recall information that is consistent with one's present mood; This suggests that a clinician is inclined not only to look for and see client behaviors congruent with the clinician's current mood, but also to recall and therefore inquire about client issues consistent with the clinician's current mood. Moreover, this predisposition carries the potential of eliciting responses from the clients that are congruent with the clinician's mood as the client responds to the clinician's questions and prompts Another relevant feature of mood to clinicians is its influence on their helping responsiveness. For example, when a practitioner feels joyful, the practitioner tends to extend help to others when the joy stems from his or her own experiences, but the practitioner tends to withhold help when the joy stems from the client's experiences (Rosenhan, Salovey, & Hargis, 1981). The reverse is found with sadness, in that practitioner helping is likely when the client feels sad but not when the practitioner feels sad from her or his own experiences (Thompson, Cowan, & Rosenhan, 1980). Moods also have been related to a variety of variables likely to influence clinician performance--perceived self efficacy, initiative and risk taking, ability to concentrate and reason, flexibility, and creativity.

Who was Fritz Perls? How do people tend to describe him?

As a human - eccentric, eclectic, abstract, provocative, manipulative, hostile; marched to beat of own drum; borrowed from a lot of people about how he thought he should help others; felt doing things was effective for change He did not like research or writing - he did not leave a lot of trail for people to follow him and do what he had done Gestalt - concept of the whole is greater than the sum of its parts ; also, personal experience can not be reduced down to elements; something more holistic about it

Why is treatment compliance lower for taking drugs alone than for psychotherapy or psychotherapy + drugs?

As mentioned above, compliance is the central issue and therefore combined therapy is needed. Behavior therapists have worked out methods to enhance compliance even in elderly patients with schizophrenia, so that alternatives to intramuscular injections may be available. For biologically oriented patients, psychotherapy promotes a sense of increased collaboration and targets interpersonal and intrapsychic problems that are usually neglected. For those patients who are psychologically oriented medication response can relieve the hopelessness associated with lack of improvement in psychotherapy as well as target the primary symptoms of the illness. NIMH Collaborative study, 21% of the variance was related to the power of the therapeutic alliance in improving compliance with medication Compliance to meds is worse than compliance to psychotherapy - in a way paradoxical - why ? patients have own experiences/beliefs or reasons to resist, may like themselves better without meds (i.e. bipolar individuals like manic state); stigma around taking medication ? also if not working an easier thing to quit; also keeping track of dosing/keeping track?

What do meta-analytic studies of IPT tell us about the effectiveness/efficacy of IPT?

Average effect size .67 (placebo =.56) ( has effect beyond placebo IPT + meds = best for depression NIMH collaborative treatment study found 70% of people went into remission for depression with IPT, compared to 69% for drugs, 65% for CBT Efficacy for other disorders Eating disorders ; pragmatic elements and effects Thoroughly researched Meta-analysis - Included 62 controlled studies of IPT for treating depression Overall effect size was .6, a medium-large effect Outperforms no treatment or waitlist for depressed adolescents, adults or older adults Effect size compated to other psych treatments 0, meaning was as effective as other therapies Results comparable to cognitive therapy for depression Effectiveness of IPT as a maintanance treatment Combination of IPT and medication most effective prophylatic/preventive effectiveness of IPT in depressed patients - IPT exerted positive therapeutic effect in patients discontinued from medication at the outset of maintenance ; value of IPT in maintaining treatment gains and protecting against early recurrence of depression Latest meta-analysis - IPT alone is equally effective as medication alone - combined treatment more effective ; in conjunction alos work quicker and delay relapses better than either treatment alone IPT produces significant effects on eating disorder - IPT and CBT leading for bulinia, but takes longer for IPT to achieve effects than CBT ; but IPT cant be used for anorexia Anxiety disorders - large effect sizes from IPT Substance abuse rarely helped by IPT - majority of addicts drop out Overall - effective for mood disorders, bulimia, and some anxiety disorders but not anorexia or substance use disorders

What is the "negative triad" of depression according to Beck?

Beck - negative cognitive triad - negative views of self, wold , future - lead to situation where someone might be suicidal - all dysfunctional ways of thinking about future - create negative framework about future - people engage with cognitive distortions - common maladaptive patterns that lead to inaccurate conclusions - distortions pretty common in people that arent depressed; commonly used amongst all of us ; people who are depressed more likely to have congitive distortions ; people who have this cognitive orientation (all or known or catastrophxiing ) more negative emotions, behave in withdrawn way, activate diathesis of depression cognitive triad: (1) Events are interpreted negatively, (2) depressed individuals dislike themselves, and (3) the future is appraised negatively.

What are some common criticisms of cognitive-behavioral therapies?

Behavioral Ellis - so little data on work Data on Beck's therapy does not prove how it works or how people become disordered , says from ebliefs and not event itself ? Target pathological environments and reinforcements, not pathological cognitions. Finally, cognitive therapists should look at the data from their own studies. Psychoanalytic Clients come to be cured, but are converted, tears apart patient's world view Patient's feel defenseless by onslaught of therapust ramming away at ego processes Humanistic perspective Alienation, not a negative schema, is the syndrome of our age CUltural perspective Focus on thinking not human processes - white, male european view Integrative perspective Think cognitive therapy is treatment of choice for everyone Overgeneralize about the status about certain emotions

According to Wampold (from the textbook), why should we be skeptical of specific factors research?

Bruce Wampold has been an ardent and influential supporter of the common factors approach. Relying on his extensive meta-analytic studies of psychotherapy, Wampold First, comparative psychotherapy studies frequently overestimate the effects of particular treatment methods because differences between treatments are due in part to individual therapists. in clinical trials, true treatment differences must be estimated by taking into account the variation among therapists; ignoring therapist effects results in an overesti- mation of treatment methods. Second, the purported superiority of some therapies is frequently due to comparisons between a treatment intended to be therapeutic and another treatment that is barely a therapy at all they are not structurally equivalent.; may be conducted by therapists who are not trained or do not have allegiance to that ther- apy, may have fewer sessions, and the therapists may be forbidden from using responses that they would normally use. When Wampold compares only bona fide therapies, he consistently finds their outcomes are equivalent.; The small- ness of the effect size supports the potency of com- mon factors and the Dodo bird verdict.; All tested bona fide psychotherapies work with equal success for the vast majority of disorders. And third, as we discussed in earlier chapters, Wampold notes that the theoretical allegiance of the researcher reliably exerts a strong influence on therapy outcomes Wampold's own meta-analyses find that the size of the allegiance effect is several times as great as the effect for differences among treatment approaches

What are some common criticisms of this IPT?

CB perspective Biggest gripe is the label - really a sophisticated form of cognitive-behavioral therapy wrapped in interpersonal alnguage; IPT really a close cousin/sibling of CBT Pychoanalytic IPT is not interpersonal Does not actively prize the therapy relatinoship and intensively work with complex patients Interpersonal theory without a person - IPT has no theory of the person, only a technology of change No explanation for driving forces of intrapsychic life Pateints left relating to an expert manual and medications ; no interest in character change, only symptom alleviation No interpersonal theory, relationship, or goal Humanistic Transactional analysis strengthens fragmentation by reassuring us taht personality comes in separate parts - cant realize holism essential to health Cultural Fails to go far enought ; stops short of family system and sociopolitical context Bereft of a cohesive theory of culture Integrative IPT and TA too common and too cognitive, too far from the depth and the passion that renders life vital

Who are some of the primary individuals associated with IPT? How was IPT developed and how is it fairly unique compared with most forms of therapy?

Came out as placebo control - this form of therapy was kind of a mistake When running this research study looking at efficacy of antidepressants in 1970s by Klerman and Weissman; wanted to have placebo control condition with inert therapy - put together something that resembled a talk therapy / working with someone, found that it was surprisingly effective Came from an error in original work ; After IPT was known to have done something, theory layered on top of it to help it Harry stack sullivan - I - you Interested in interpersonal relationships and impact on others I-you interpersonal orientation IPT rooted in interpersonal psychodynamic approaches of Harry Stack Sullivan and Adolph Meyer and is informed by Attachment theory of John Bowlby Sulivan was leading proponent of Interpersonal school of psychoanalysis Thought abnormal behavior rooted in impaired interpersonal relationships and could be ameliorated by interpersonal variant of psychodynamic therapy Therapist was a participant-observer in treatment, using reflectiveness and engagement Meyer Emphasized patient's current psychosocial environments - psychopathology represented misguided attempts to adjust to the environment, particularly under stressful circumstances or in a stressful environment Karen Horney Moving toward or away from others Neofreudian who believed in drive theory and human motivation in understanding psyche; believed humans more fundamentally motivated about moving towards or away others cause we are social species Bowlby early life attachment determines subsequent interpersonal relationships Lorna Smith Benjamin Interpersonal reconstructive Therapy - address complex cases with multiple disorders that have shown little benefit from previous treatments - focuses on patient's troubling symptoms and relationship patterns and links them to key attachment figures IRT focuses on the patient's troubling symptoms and relationship patterns and links them to key attachment figures. In short - all of these theoretical pieces or elements brought in to explain or think through how and why this form of therapy could have some legitimacy ; all connected by thread of interpersonal relationships All relationshionships seminal and important for creation of psychopathology and movement towards health Unique from other therapies - has eschewed detailed explanation of personality and development- substitutes stable interpersonal patterns for stable personality patterns

How does Curtis describe the therapist's reactions to termination?

Case 1: typical termination of a one-time-per-week psychotherapy - Mr. D:felt insecure in his performance at work and was having difficulties with the woman with whom he lived, including premature ejaculation. He was a patient who came for symptom relief This situation seems typical for many terminations—the patient has gotten what he or she came for, and although other issues may have arisen and not all of them have been resolved, the patient feels confident to take care of these problems without professional help. Case 2: I thought the patient was ready to terminate and the patient was not: young Ed - I do not know why he comes back, other than to continue discovering various undeveloped, potential ways of being. I assume he will terminate when he knows well enough what I might say that he does the therapeutic work on his own. Case 3: terminated abruptly - Lila o Seeing her three times per week, I felt very close to her, and she to me. o opportunities were much greater for her back home. For me, the experience was not completely different from what it would have been if one of my closest friends were suddenly leaving. o I was not encouraging, saying that I only read my E-mail once a week at most. Worried she would E-mail me once a week perhaps, I told her that I might not always be able to respond to her comments. I was then surprised when she had been gone several weeks and I still had not heard from her. But more than that, I was very disappointed o This brings me to another reaction of mine to termination in general. It bothers me when I do not hear from patients who have been in analysis. o In any therapy, there is a trust and a vulnerability that makes the relationship a special one, and this leads to a type of attachment

What are the primary change principle(s) utilized by IPT?

Change process of IPT Initial sessions Review of symptoms Relate symptoms to interpersonal context Identifying a major problem area Role dispute etc. Explain IPT process Work to resolve identified problem Terminate Sx reduction (most often linked) Overall uses consciousness raising, catharsis, conditional stimuli Consciousness raising in first phase, often catharsis or conditional stimuli for second phase (change principle depends on dispute)

According to Curtis, how do psychoanalytic psychotherapists know when to terminate?

Client initiated, when process has been exhausted Curtis: have client be able to feel without acting (on impulse) - indication of maturity/mature self defense mechanisms With patients who have come for psychoanalysis, Ferenczi's (1927/1955) criterion for termination is the one I might apply: "The proper ending of an analysis is when neither the physician nor the patient puts an end to it but when it dies from exhaustion" (p. 85). This might well come when the costs in time and money exceed the benefits In a 1974 review of the literature on termination in psychoanalysis, Firestein (1974) listed the following criteria (again, these are not my criteria, but those Firestein found for psychoanalysis): (a) an ability to love and work; (b) symptomatic disappearance—most analysts find this an unreliable criterion; (c) structural changes in the personality, such as an increase in ability to delay gratification and improved object relations; (d) termination based on the analyst's intuition that the patient has passed a critical turning point; (e) an assessment of the state of the transference resolution; (f) an assessment of the countertransference in termination; and (g) no criteria for deciding termination because final termination will be assessed on a trial-and-error basis. Freud (1917/1963) stated that termination was indicated when the patient had a sufficient capacity for "enjoyment" and "efficacy" (p. 451). Freud (1937/1964) noted that analysis ended when no further change would occur in the patient. Freud came to the conclusion that analysis was terminable only in theory. So a list of my principles for therapy is something like the following: 1. The timing of the termination is determined by the patient, with input from the therapist. Tolerance of feelings without acting is a criterion regarding which the therapist provides input, if appropriate. 2. Consider reducing the frequency of meetings and schedule a final appointment some time after the second-to-last meeting. 3. Review stressors and the patient's previous dominant way(s) of responding and new ways of responding (if there is no change in the response nor a reduction in the stressors, the therapist should mention this). 4. Assess what has been accomplished and what the patient may wish to address at a future time. 5. Inquire about what was helpful and what was not helpful. 6. Inquire, if appropriate, whether there is something negative about the therapy to lead the patient to terminate, as opposed to attainment of goals. 7. Equalize the relationship by helping the patient focus on what he or she did to lead to change, by revealing something personal, and so forth. 8. If it has been a long or intense relationship, the therapist should tell patient that he or she would be pleased to hear from the patient at some point.

How did Ellis use conditional claims to assist Gloria with her irrational beliefs?

Cognitive therapy is about rationality, truth finding; "you might be a bad person idk, but you can still be happier"; also he is using analogies, metaphors that she si familiar with to point out errors in her logical thinking ; uses analogy of mangled arm - because of mangled arm you were so focused on mangled arm that you couldnt be you; effectively your whole being is that stinky you - how this logic applies to your whole life - what they are are different - Ellis would say - think about all of those interactions that you have with people when your anxiety drives interaction - think about logic behind statement if that is actually what you are afraid of - jumping to another conclusion, if I perform badly, hten I will lose this person from my life, then I will be unhappy and never live a successful existence Chain analysis - If i can analyze everything from first conditional claim to last one, then can deconstruct logical fallacies that they have about themselves Safety net of having homework be "homework" - will it help later Talk with patients about real experience vs. imagined experience ; when you anticipate events you imagine them ; if you actually try it, real experience is very different - he is pushing her to have a real experience - will reveal to her degree to which ehr imagined experience is so different Can see the if then logical statements ; right now he is doing exploratory work to understand antecedents and consequences G - the thing I do feel is I get suspicious, will i only appeal to kind of men i don't like E - now you are getting closer to what I am talking about If i am this type of woman, then that would be awful If you were Jane doe, would that be so terrible; would you get an emotion like shyness, embarassment, or shame if you felt liek that G - i dont know ; E - i dont think you would E - if i dont get that type of man, then I am a no good person, and I will never get what I want, quite an extreme away, catastrophizing ; let's assume the worst - you never got the kind of man you want , look at all of the other things that you could do to be happy If i werent so anxious about trying to hook this guy, i would be more real ellis- 1-20 sessions with mostly mildly to moderately disturbed patients

What are some criticisms of Gestalt therapy?

Cognitive-behavioral perspective - Perls states directly that his ideal individual would not take responsibility for anyone else. What happens, then, to the socializing responsibility of parents? Is there any evidence that humans can live in relatively harmonious and secure societies if social ex- pectations are rejected as consequences for helping to direct human behavior? A review of 46 studies on negative effects for adult, nonpsychotic patients in psychotherapy found that expressive-experiential therapies produce higher rates of deterioration than other psychotherapies Psychoanalytic The naive Gestalt- ist would like to deny that there are indeed bio- logical impulses that can overwhelm both the individual's mental well-being and the social order. How would Gestaltists treat paranoid and other patients whose ego processes are in danger of being overwhelmed by rage? Encourage more rage? Cultural perspective Emphasis in Gestalt therapy on awareness, self-support, and responsibility magnifies the role of the individual qua individual, separate from other people, often with little attention to impor- tant ongoing relationships and cultural systems (Saner, 1989; Shepherd, 1976). Isolation and occa- sional dalliances with others are the probable results. Gestalt says social forces not culprit for problem - but real social forces of poverty, illness, sexism, racism, and crime are contributing cul- prits. Integrative reverse dualism that overvalues body at the expense of mind. Gestalt therapy is obviously in need of a cognitive theory to balance its overem- phasis on biology. Perls and his fellow Gestalt enthusiasts overextended the usefulness of the therapy into indiscriminate applications with promises that cannot be met.

According to Brown, what are the common features of the LGBT experience?

Common elements of lgbt; Biculturalism: in both heterosexual experiene and la dng exp; oriented one way/behaved hetero most of our lives Marginality: otherness, alienated Not patriarchal families threaten conservatives Assumption need both genders for healthy chidlren Normative creativity: no clear rules about how to be l and g so make up rules Scary and exhilarating

According to the integrationist theory of Psychodynamic-Behavior therapy, what are "cyclical psychodynamics?"

Conflicts that dominate a person's life can be understood as following from, as well as causing, the way he or she lives. Intrapsychic conflicts create problematic behavior; problematic behavior creates intrapsychic conflicts. This ongoing etiological process is known as cyclical psychodynamics A person's meek and self-denigrating lifestyle, for instance, may be caused by repressed rage. But a meek and self-denigrating lifestyle may also generate rage. It's a vicious, self-perpetuating cycle The patient's current way of living both stems from and simultaneously perpetuates his or her problems. The connection between past and present lies in the cyclical re-creation of interpersonal events. To invoke Piaget's notion of schema, we assimilate new experi- ences into older schemata—more familiar ways of viewing and thinking about things. The core of neurosis is the anxiety invoked and maintained by the client's cyclical psychodynamics. o Ie. She is caught in a vicious cycle in which intrapsychic conflicts generate anxiety over sexual arousal, which then leads to avoidance of sexual situations Thera processes. Cyclical psychodynamics value direct intervention in the patient's day-to-day problems in living

How are consciousness raising and contingency control used in REBT to produce change?

Consciousness raising In the process of explaining their problems, clients are quickly challenged to defend the beliefs that underlie their emotional upsets. They are challenged to give evidence, for example, for the belief that they must be popular in order to be happy. Clients soon learn that their favorite beliefs and biases are not accepted by the teacher/therapist just because the client presents the belief in an absolute or demanding way. Clients soon become aware that they have irrational beliefs that they cannot defend logically or empirically. the therapist can anticipate the nature of the underlying beliefs based on the activating events and inappropriate consequences Interpretations do not involve making conscious connections between present upsets and past events, but rather between current complaints and current beliefs that clients are using to upset themselves. In the process of giving clients feed- back about their specific irrational beliefs, therapists teach the ABCs of REBT. therapists direct their clients to complete various homework assign- ments designed to refute irrational hypotheses or to enable them to practice more rational thinking; sometimes use humor Contingency control/management If client is not completing homework assignments, may be asked to make a contingency contract that seems workable for the client Have clients re-evaluate particular consequences - "de-awfulize consequences"; have client imagine consequences until not longer elicits emotion Counterconditioning use rational-emotional imagery, role-playing, exposure, and in vivo desensitization Shame-attacking exercises - intentionally commit publicly foolish act PYA- Push your ass

What is the learning principle that is most associated with counterconditioning?

Counterconditioning - Best represented by Joseph Wolpe's reciprocal inhibition or counterconditioning therapy. Wolpe's approach has been based primarily on a respondent/classical conditioning of anxiety-related problems. His approach follows directly from the work of Pavlov and his conditioning of dogs; Therapists utilizing counterconditioning techniques, including the stalwarts of systematic desensitization and assertiveness train- ing, are most comfortable being called behavior therapists. Human behavior occurs in predictable order, just like A, B, C. First comes the A, the antecedent, which precipitates and triggers the B, the behavior. Pavlov, Wolpe, and counterconditioning primarily concern themselves with the A --> B (antecedent prompts behavior due to classical conditioning). Extinction - the gradual disappearance of the conditioned anxiety because it is no longer reinforced—in this case, no longer reinforced by avoidance. Classical conditioning - specific type of learning that we use frequently with kind of conditions Common for anxiety disorders ; Joseph Wolpe - counter conditioning - organsim has learned association between two things - try to counter it Thigns like phobias, GAD< social anxiety, sexual problems - works well beacaues anxiety something we treat often

How does psychopathology develop according to a multi-cultural perspective?

Culture is the major determinant of personality; each distinct culture includes events and expectations that shape both the group and the individual. Culture is an integrated constellation of human knowledge, belief, and behavior that is learned and transmitted to succeeding generations. The expression and manifestation of psychopathology are often culturally determined. Within individual cultures, there exist recurrent patterns of aberrant behavior particular to that culture, known as culture-bound syndromes. Members of nondominant culture face a number of unique challenges that generally fall into two areas. One: minority group members are expected to function in a world where they are simply not a member of the dominant culture; functioning in a world where their values may not be promoted, where various aspects of their culture may not be readily affirmed. Two: minority group members are likely to face systemic inequities not experi- enced by members of the dominant culture. Non- dominant cultures in our society live under an umbrella of individual, institutional, and cultural forces that often demean them, disadvantage them, and deny them equal opportunity. Prejudice and discrimination are a social reality for the cul- turally different that is largely unknowable to those of a majority status Minority group members may become distressed when they attempt to be successful within the dominant culture while maintaining their identity Psychopathology may stem not only from clashes with the dominant culture, but also from family responses to that dominant culture. Conflicts in minority families frequently revolve around acculturation. Differences in desired acculturation challenge members of minority groups. For those who desire to fully acculturate into the dominant culture, failure to be accepted by the dominant culture's standards can prove devastating. Not only have the individuals been rejected by a group they want to identify with, but they may now also be without their supportive reference group(s). This double rejection can precipitate psychopathology, including substance abuse, depression, and anxiety. Such stereotypes can trap minority group members in a cycle from which they struggle to escape. They may begin to develop negative attitudes about themselves and their cultural group, attitudes that can become self-fulfilling prophecies. As minority group members attempt to fit into the images of the dominant culture, may become discon- nected from own cultural group or struggle to establish a healthy sense of group identity. Racial/ ethnic minorities may internalize these messages for years, often passing them onto new generations.

What are some typical client reactions to termination?

Denial - comes from psychoanalytic or psychodynamic perspective - suggests one way we deal with these types of things is ignoring that they are happening Common for clients or any of us to have sense of denaail as we approach endings - even when you tell people many sessions prior to last session, often still see people being like today is my last session ?!?! Emotional Response Universal theme - Ekman says lsos is a universal theme, which results in sadness, grief (typicaly experience strong negative and sad emotion); this is powerful stuff; strongest positive emotion we can experience is love, strongest negative is loss and grief/opponent - people highly motivated towards love and away from loss - stronger the love, stronger the loss experience - losing partner that you have had for 40 yers is traumatic, known for a week is less so, but still probably sad Uncertainty Anxiety - often because change/termination one fo uncerstainty, which causes anxiety, because fear/a threat - we dont know what is going to ahppen next Stress - any time of uncerstainty or change will have stress response - Avoidance No show Distracting yourself, not dealing with it; in context of psychotheraoy, avoidance results in a no show - avoidance of termination /end phase of relationship Acting out Anger; acting out common expression ; will actively do something to change emotion from one that is uncofmrtable to one that is comfortable ; most commonly anger (anger is masking type/secondary type of emotion, usually expressed through pain; if uncomfortable with pain, do something to elicit anger; in context of relationship, mess things up like cheat because easier to break up that way) Also happens in context of therapy - Regression Effort to maintain relationship with therapist ; made progress but starting to have symptoms again so maybe keep working ? Helpful to understand these things - can predict and prevent problems and create ebst ending experience for people because you know these things are at play

What does the technique of EMDR look like?

EMDR - tell client to look at object as they track back and forth - have them talk through the trauma - question - does this in itself have anything to do with something more than person talking about this himself Theory comes from sleep - when you sleep you move you eyes back and forth during REM sleep - linked with emotional processing - why do we move eyes during rem sleep ; also puts you in altered brain state because redirection of consciousness - alpha brain wave state Does this do anything? Hudenko is not convinces that this does anything beyond exposure ; nonetheless book says some studies says it does do something beyond normal exposure ; but if you look at studies that book references, he doesnt think they are great; however, does work Thinking about the disturbing trigger and focus on controlling eye movements • Adaptive information processing o Accessing the traumatic memories activates the information-processing system, which then takes the information to adaptive resolution o This system transforms traumatic memories and disturbing info but also concomitantly shifts feelings, thoughts, and sensations. • Counterconditioning via desensitization, distancing, and cognitive restructuring. • Multiple Phases: 1. Taking client history and planning treatment a. Clients unable to tolerate high lefts of distress are no suitable 2. Encompasses preparation a. The clinician introduces the client to EMDR procedures, explains the rationale, and prepares the client for possible between-session disturbance 3. Assessment phase a. Clinician identifies the target and collects baseline data before desensitization 4. Desensitization phase a. Patient asked to bring up traumatic image, think of negative cognition, and notice the feelings attached to it as he or she follows the therapist's hand with his or her eyes b. Therapist generates eye movements from one side of the client's rang of vision to the other as rapidly as possible • Systematically stimulated bilateral person's vision, while engaging / thinking about traumatic experience • Essential change process is EMDR is counterconditioning via desensitization, distancing, and cognitive restructuring

How are Solomon's early experiments on escape conditioning with dogs related to implosion therapy?

Early on, experimental research studies (e.g., Baum, 1970; Black, 1958; Solomon et al., 1953) documented that avoidance can be effectively extinguished if an animal is blocked from avoiding in the presence of anxiety-eliciting stimuli. When the animal is blocked in the presence of anxiety-eliciting stimuli, intense emotional reactions are evoked. The animal will scramble about the cage, climb the walls or attack the barrier, freeze in the corner, and shake, all followed by more scrambling. Response prevention, on an animal level, extinguishes anxiety by forcing the animal to remain in the presence of the conditioned stimuli. On a human level, response prevention entails extinguishing pathological anxiety by working to prevent clients from avoiding the anxiety-eliciting stimuli.

Which is more effective, CBT or REBT?

Efficacy/ effectiveness of CBT and RET (CT and RT) For RET The overall effect size pre- to post- treatment for RET was 0.95, which translates into 73% of the treated patients demonstrating signifi- cant clinical improvement over those not receiving RET ; consistently outperdorms control groups and no treatment ; parallel conflusions for REBT (Results indicate that the average effect size (d) pre- to post- treatment was 0.89, REBT versus no treatment 0.57) Very amenable to research CT outperformed RET; later studies show pretty much equivalence; but beck's therapy won out, probably because of personality compared to Ellis'; but really fairly equivalent Effect size 1.0; range from 0-2; in general pretty good; for depression 1.0; CBT plus meds has additive effect (1.2 or 1.3); meds equivalent to CBT alone, but if you stop no long term benefits , but CBT you do; so if you chose just ne CBT probably better Someone comes in with depressions - prob recommend CBT plus meds Higher effect size for other disorders - GAD highest efficacy treatment number (1.69); people with GAD have heightened sense of danger, mostly associated with thoughts - challenge thoughts about what is or isnt dangerous ); Social phobia 1.0; CBT best treatment fo rpanic disorder, cognitive restructuring plus exposure (people with panic disorder need exposure to get over panic but also have destructuve thoughts; PTSD - exposure generally frontline treatment, but evidence CBT can be just as effective (d=1.43 for CBT) Eating disorders CBT treatment of choice, also chronic pain Personality disorders - CBT only effective treatment for a pErsonality disorder; CBT treatment for psychosis too, evidence showing that it works ( still not frontline treatment) Help give person tools ot reality test - example to clarify that - lets say person with psychosis is hearing voices, telling them to do things; is that voice me or something else? Let's test the voice to see if accurate - look out window and ask the voice what color is the third car that will drive by - they say blue, but third car is actually yellow - logical conclusion is voices arent always correct ; same with visual hallucinations -

What are the different stances that a client might use according to Transactional Analysis?

Ego states - consistent pattern of feeling and experience directly related to a cor- responding consistent pattern of behavior Parent, child, adult Adult - effectively trying to eliminate emotion from the encounter; essentially a computer, an unfeeling organ that gathers and processes data; gradually developed ego state that emerges as the person interacts with the physical and social environment over many years. The Adult acts more clearly on the basis of logic and reason and is the best evalu- ator of reality because it is not clouded by emo- tion. The Adult can realistically evaluate not only the environment but also the emotions and demands of the Child or the Parent. Parental - when control is necessary; basically composed of behaviors and attitudes copied from parents or authority figures. Although much of the Parent is based on videotape-like recordings from childhood, the Parent can be modified throughout life as the person emulates new paren- tal figures or changes as a result of parenting experiences. When the Parent is in control, people use the language of controlling parents: "should," "ought," "must," "better not," and "you'll be sorry" predominate. Gestures such as pointing a finger or standing impatiently with hands on the hips are common expressions of the Parent; Parent is the controlling, limit setting, and rigid rule maker of the personality, as well as the nurturing and comforting part of the per- sonality; repository of traditions and values and is, therefore, vital for the survival of civilization. In ambiguous or unknown situations, when adequate information is unavail- able to the Adult, then the Parent is the best basis for decision makin Child - stimulus driven or impulsive side that comes out in the interaction; sit, stand, speak, think, perceive, and feel as they did in child- hood. Behavior of the Child is impulsive and stimulus-bound rather than mediated and delayed by reason. Throwing temper tantrums, acting irre- sponsibly, and engaging in wishful thinking or day- dreams are classic expressions of the Child; essentially preserved intact from childhood Many times when we have taken one of these three stances ; this theory talking about that you can engage like a child with a friend or your own child - we are all capable of all three Help people understand how and when they are using an ego state incompatible in situation Games we play Life positions (games we play in interpersonal interactions - frameworks that we carry with us about interpersonal relationships Im ok-youre ok Im ok- youre not ok I'm not ok - you're ok I'm not ok - you're not ok (im ok- i see myself as ok in most situations; im not ok - im damaged, unlovable, etc) (You're ok - other people are good, good intentions, not harm but help; your not ok - i'm suspicious of you, i think you are out to get me, others have bad intentions ) Based on life positions - we have a framework for how we interact with others Challenge each of us - what is my life position ? thoughts about myself and other people? This position is predictive - comes from childhood/ background, and can change it Simple, possibly over simplified, but interesting Not used very much, but most appropriately categorized under IPT Not gonna get tested on Transactional analysis

Why were some of the unintended consequences of punishment in Lovaas et al.'s study viewed as positive?

Evidence that the side effects of punishments, instead of being undesirable, were judged therapeutically desirable Generalization of the shock effects to behaviors that were not punished. As self destructive behavior was brought down by shock, john avoided the attending adult less and also whined less. Apparently, avoiding, whining, and self-destructive behavior fell within the same response class; this data indicated that teh side effects of punishment were desirable ; less distance and less fussing reported Generalization of teh suppression effect across experimenters - was only punished by one experimenter until session 30, when he generalized across other experimenters Immediate increase in socially directed behavior, such as eye-to-eye contact and physical contact, as well as simultaneous decrease in a large variety of inappropriate behaviorss, such as wining, fussing, and facial grimacing After punishment - more socially outgoing, happier, and better adjusted to the ward setting; after shock patients appeared more aware of and interact with the axaminar

How does habituation differ from desensitization?

Exposure - difference between desensitization and habituation Desensitization - must be sensitized to something to desensitize; to be senitized you had a negative experience to that thing to dessensitize to whatever that thing is Mollusk example - sea snail; very neurologically simple organisms; can map neuro structure fairly easily, but can be habituated, sensitized, an ddesensitized to things If you swim to a mollusk, poke it in an eyeball , will scoot back into its shell; if you do this a few times, the mollusk will go into shell before you poke it - learned that this person will hurt me - you have sensitized that mollusk to you To desensitize - go down, sit next to it, not do anything - mollusk would first peek out at you, then go in, then go back; with enough time, will fully come out Process of desensitization - happens with mollusks; doesnt require any discussion - happens naturally ; this process is effectively the underpinning of exposure ; help you learn that same process as the mollusk - be comfortable in place/situation that caused you discomfort; Many different forms of exposure that we might use; Habituation - the repeated exposure to a non threatening stimulus reduces the response to teh stimulus Ex. if next to someone who is stinky, over a period of time it doesnt smell as much - neurological principle of habibutation A nonthreatening stimulus, experience less over time, occurs in most brains Habituation → repeated exposure to non-threatening stimulus results in decrease of response to stimulus Desensitization → repeated exposure in non-threatening way to threatening stimuli/a stimulus to which you were previously sensitized Cant use unless been sentized. Need emotional charge a. Have to be sensitized to be desensitized However: Probably rely on same neural mechanism

What are some of the dangers of the two-chair approach?

Fagan et al. (1974) cautioned unskilled, untrained therapists about the use of this technique. Neither the therapist nor the client knows what may unfold during the work, and it often includes the expression of deeply felt, painful emotions (Fagan et al., 1974). Fagan et al. (1974) wisely suggested that therapists should (a) not use the technique unless they have had personal experi-ence with the technique, (b) be ready for "explo- sions or strong emotional responses," and (c) know their patients well enough to know how to provide follow-up support; not resolving an in- tense conflict can be damaging for fragile patients. These cautions are rarely cited in the current literature but are absolutely essential points that need to be made. As a trauma therapist, I caution the use of these techniques with trauma survivors who can have primitive, visceral emotional eruptions that can lead to regression, retraumatization, or dissociative episodes. It is not always the initial accessing of repressed emotion that is dangerous but rather the therapist's encouragement to heighten and intensify the felt emotion and the expression of that emotion that may lead to volatile situations. The use of clinical judgment, preparation of the patient, titration of patient exposure to intense afue care in the application of these techniques cannot be emphasized enough. This work calls for exceptional fortitude on the part of the therapist and may contribute to secondary traumatization, confusing countertransferential responses, and unexpected transference-countertransference dynamics for neophyte therapists or therapists who have poor psychological boundaries. In addition, gestalt techniques may be contraindicated for patients with organic conditions, severe cognitive disorders (in which loosening emotional expression results in chaotic rather than struc- tured thought processes), impulse control difficulty, severe personality disorders, socio- paths, and psychotic patients (Saltzman, 1989) or for those who need crisis intervention (Elliott & Greenberg, 1995). The techniques obviously have limited applicability and are vulnerable to iatrogenic harm if not used carefully.

Why are there so few specific therapeutic techniques identified for multi-cultural therapy?

Few controlled studies have been conducted in the United States on the effectiveness of psy- chotherapy with culturally diverse populations. While cultural adaptations of existing thera- pies are generally effective, the effectiveness of multicultural therapies as a separate system of psychotherapy per se has not been adequately tested with members of minority races, ethnicities, and sexual orientations

Which minority populations in the U.S. are known to be particularly likely to underutilize psychotherapy? Why

First, many racial and ethnic minorities are underserved in the mental health arena (Lopez et al., 2012; Sue & Lam, 2002). Studies show that Asian Americans/Pacific Islanders and Latino Americans/Hispanics, in particular, underutilize mental health services Second, the evidence supports preferences for ethnically similar therapists by members of racial minority groups (Abramowitz & Murray, 1983; Atkinson, 1985). Meta-analyses of relevant studies demonstrate that ethnic minorities definitely tend to prefer ethnically similar counselors over European-American counselors Consciousness raising may also assist patients in recognizing how their cultural conditioning impedes their acceptance of psychological treat- ment and implementation of change. In responding to partner violence, for instance, some Mexican women will not seek help because they believe their situation is God's will. Under the same circumstances, some Southeast Asian women may be afraid to confide in clinicians because Hmong tradition requires that, in times of conflict, clan elders must be consulted first. Battered African- American women may have been socialized to believe that seeking psychological treatment is only for Whites (Mitchell-Meadows, 1992). In such situations, a culturally sensitive therapist can help women become aware of these detrimental influences of socialization.

According to Ellis, what are the two most common features of irrational beliefs?

First, they have at their core rigid, dogmatic, powerful demands, usually expressed in the verbs must, should, ought to, have to, and got to. This is musturbatory thinking: "I absolutely must have this important goal unblocked and fulfilled!" Second, the self-disturbing philosophies, usually as derivatives of these demands, generate highly unrealistic and overgeneralized attributions. This is catastrophizing: "If I don't have my absolutely important goal fulfilled, then it's awful, I can't bear it, I'm probably worthless, and I'll never get what I want!" Molehills are made into mountains.

According to Overholser, what are the five elements of the Socratic questioning process?

Five elements of the questioning process have been identified: the leading question, the explication, the defense, a sequential progression, and the use of short sequences leading question contains an implied assumption, often serving as a spotlight to focus the client's attention onto a specific area. "Do you think talking about this with your spouse would help the two of you learn to deal with this problem, or would it just stir up more of an argument?" The explication occurs when the client has not understood the leading question. It can be important to make all assumptions explicit in order to test them (Haden, 1984). For example, clients are likely to respond "I don't know" if asked "What else could you have done?" For example, asking "Could you have done anything else?" forces the client to evaluate the basic assumption underlying the leading question However, it is important that the explication not occur very often because it implies the therapist has misjudged the client's level of understanding and disrupts the therapeutic relationship (Kahn & Cannell, 1957). Clients may feel threatened if repeatedly unable to follow the line of questioning The defense follows an explication, asking clients to defend their view A sequential progression occurs when a second leading question is used to carry the discussion closer to the intended goal. Finally, systematic questioning should be used in short sequences, alternating between Socratic and non-Socratic dialogue. Despite the advan-tages of the systematic questioning process, it should not be overused. Questions can limit spontaneity by restricting the client's communi-cation to responses to specific questions

According to Goldfried, is it possible to have a long-lasting change without a change in self-efficacy?

For coping skills to be effective, the individual must believe that he or she has the ability to use them when needed. Bandura (1977) has referred to this belief as self-efficacy expectancies. These expectancies may be thought of as an indication that the individual has learned that he or she is capable of successfully coping with a given situation. In many respects, these expectancies are much like self-confidence, but within a specific situational context and with specific methods of coping. The important aspect of self-efficacy is that it is a good predictor of future functioning. Thus, if one is interested in the extent to which the changes produced during the course of therapy will be lasting, it is important that this self-efficacy index be present. Without it, there is a chance that the change may not be lasting following termination. No, better explain o A COPING SKILL MODEL OF CHANGE o It is difficult to discuss the topic of termination from within a cognitive-behavioral point of view without considering its underlying coping skills model of treatment. o As a response to early criticisms of behavior therapy for not providing clients with a sense of autonomy, the coping skills model reflects a recognition that, in addition to the treatment of specific problems, cognitive-behavior therapy also helps clients learn to develop more general skills for dealing with life difficulties (Goldfried, 1980). Among such coping skills is the use of relaxation as a way of reducing anxiety, interpersonal problem-solving methods, and cognitive restructuring as a method for altering how one perceives—or misperceives—life situations o For coping skills to be effective, the individual must believe that he or she has the ability to use them when needed. Bandura (1977) has referred to this belief as self-efficacy expectancies o Once a client has learned certain coping skills and has successfully dealt with the goals as originally agreed on, cognitive-behavior therapy moves into a maintenance phase o During this maintenance phase, treatment is phased out so that sessions occur less frequently, and clients are encouraged to function as their own therapist. o The essence of the relapse prevention model is that during the maintenance phase of treatment, both client and therapist identify those problematic situations that are likely to result in a setback, construed more as temporary lapses rather than relapses. If clients know in advance the potential trigger points that are likely to create difficulties for them, and anticipate and rehearse methods of coping with them during the maintenance phase, they are more likely to maintain their treatment gains

What are some criticisms of a multi-cultural approach to psychotherapy?

From a psychoanalytic perspective The multicultural movement threatens to discredit traditional, insight-oriented psychotherapy and replace it with identity politics. Multicultural therapy holds that psychopathology is primarily cultural and imposes a rigid framework of racial politics. Let's bring back individual responsibility and insight-oriented psychotherapy. From CBT: Multicultural diversity represents one important value in psychotherapy, but only one value. Mandating diversity can have unintended negative effects culturally sensitive practices are not compelling. Should we avoid using demonstrably effective treatments just because they have not been extensively researched with ethnic minority clients? cognitive-behavioral therapies already proven effective with ethnic minority children and adults Humanistic Values of equality and diversity evoke compassion. But if we want diversity, what's wrong with individuality? Why does an individual's racial or ethnic group confer identity more than does personality? A humanistic society and a humanistic psychotherapy hold that all individuals are uniquely valuable. Integrative; How can we help patients become free from oppressive ideologies if we are dogmatic? How can we empower individuals to be autonomous adults by convincing them that they are victims? clecticism posits that the context for every individual, African, Asian, Latino, or Anglo, is unique. And each psychotherapy needs to be indi- vidually constructed to match the needs of a par- ticular person

How is the "empty-chair" technique used to complete "unfinished business?"

Gestalt therapists often create experiments that help clients increase awareness by uncovering aspects of their experience; these therapists may share hunches about what is occurring or may teach clients ways in which they are interrupting or avoiding their own experience ; A core belief is that clients will more fully understand their own emotions and needs through a process of discovery, rather than through insight or interpretation. client may discover a conflict between aspects of experience or conflicts within the self The confrontation between these conflicting aspects of experience can be facilitated by techniques such as the two-chair or empty-chair dialogue. A small number of studies support the efficacy of empty-chair work for unfinished business inability to express intense affects puts people at risk for both depres- sion and chronic pain- They found empty-chair work for anger led to the reduction of anger and a decrease in subjectively reported physical pain and that empty chair work was as effective as an education group for the reduction of depression and chronic pain Other study demonstrated that the empty chair dialogue led to greater resolution of unfinished business as compared with a psychoeducational group. At this point, the data on the empty-chair tech- nique for anger reduction and unfinished business are inconclusive.

According to Wagner-Moore, what is a "split?" What are the different types of splits?

Greenberg' s formal analyses of gestalt therapists suggest that two-chair work is most often used when the client expresses a split A split is "a division of the self process into partial aspects of the self " three types of splits: conflict split, subject-object split, and attribution splits conflict split occurs when an individual wishes for a desired goal, such as to be married, but simultaneously feels that he or she should remain single to preserve his or her independence COnflict Split In this split, there are two "I's" that oppose each other, resulting in a sense of struggle; usually involves a conflict between an individual's principles and fundamental emotional needs and wants During two-chair work, the part of the self that primarily embodies needs, wants, and gut-level emotions is called the "experiencing self "; the part of the self that embodies either "shoulds" (e.g., "I should be able to be happy"), negative evaluations of the self (e.g., "I'm just worthless"), or societal standards or values is called the internal critic The goal for two-chair work is to bring the experiencing self and the internal critic into contact with each other, for the client to attend to both sides, for "covert internal dialogue to be made overt," and for change to result as the client increases self-acceptance and develops new cognitive schemas The Subject/Object Split is when clients are doing something to themselves ("I am too hard on myself.") The Attribution Split is when clients attribute some aspect of themselves to the world ("She made me feel stupid.")

What is a "heterosexist" statement? What are some heterosexist assumptions that therapists might commonly make and how might they affect clients?

Heterosexism is founded upon the initial assumption that the client is heterosexual. It can manifest itself in something as simple as the intake form, where questions about relational denomina- tions often exclude LGBT experiences. Ie. term "marital" therapy instead of "couples" therapy - bc not granted legal right In this regard, bisexuals are inadvertently mis- classified by most therapists and researchers. Bisexual individuals share a diverse set of experi- ences and relationships that distinguish them from their gay and lesbian counterparts. The polarization of sexual orientation into heterosex- ual and homosexual categories has the potential to invalidate bisexuality, leaving it to be inaccurately represented as a transitional state.

What is the suggested method to reduce negative behaviors in individuals who engage in self-harm?

I think shocks? Self-destructive behavior is socially reinforced SO If social reward consequences withheld, behavior should decrease Behavior should increase if socially reinforced Aversive stimuli should suppress it Prior to Lovaas study - Most common form of treatment consists of some combination of drugs and supportive, interpersonal therapy, and occascional electro-convulsive therapy, but little evidence that it is effective Study - centers on extinction by "ignoring" vs. suppression with sever aversive stimulation Suppression with severe aversive stimuli/shock - ˆf punishment to suppress self-destruction is to be maximally therapeutic (durable and general) it has to be administered by more than one person in more than one setting; also some side effects from shocks that are favorable , but unsure if they will last

What are your thoughts on the use of pharmaceuticals? If you were a psychotherapist, would your recommend them as a substitution for psychotherapy? Why/why not?

I would not as a substitution - be better to establish self-reliance/coping methods/increased self esteem to help patients in the long term. However, I would support combined method if need be / statistically supported; also help prevent attrition

How might you use in vivo exposure to treat a disorder like PTSD?

In the treatment of PTSD, Foa uses both desensitization and cognitive change. The early sessions entail a thorough assessment, education about com- mon reactions to trauma, and breathing retraining (teaching clients to breathe calmly from the dia- phragm). Before exposure begins, clients receive a clear rationale for the treatment method. Repeated exposure to the trauma is then achieved in the office through imaginal exposure, which enhances the emotional processing, and then through in vivo exposure, which enables the client to realize that the trauma-related situations are not dangerous. The exposure therapist warns the client that, "the treatment involves confronting you with situa- tions and memories which generate anxiety and urge to avoid," but the therapist also reminds the client of the rationale for exposure treatment, some- thing along the lines of, "Confronting these horrible memories, rather than avoiding them, will decrease your fear. Although it is quite natural for you to want to avoid the fear associated with them, as we discussed, the more you avoid these painful memo- ries, the more they disturb your life." For in vivo exposure, the therapist might accompany the client to the scene of the actual trauma or ask the client to wear the same clothing as when the trauma occurred. In Foa's treatment, in vivo exposure is carried out as homework to be practiced between sessions. Clients are instructed to remain in the fearful situations for at least 45 minutes or until the anxiety decreases. You practice approaching situations that are safe, but which you may have been avoiding because they are related to the trauma. • An example would be a Veteran who avoids driving since he experienced a roadside bomb while deployed. • This type of exposure practice helps your trauma-related distress to lessen over time. When distress goes down, you can gain more control over your life. • The patient comes to understand that the "consequences" of their anxieties are not reasonable • Must be done carefully in order to not re-traumatize the patient.

How is implosion different from "imagined exposure?"

Implosion - the implosive therapist must construct stimulus scenes that evoke the maximum level of anxiety. Stimuli most directly related to the client's symp- toms will be first in the series of anxiety-eliciting cues, such as bugs for a person with a morbid dread of bugs. When implosive therapists ask cli- ents to vividly imagine scenes about bugs, they have the person imagine the bugs as close to them as possible, crawling on their arms, in their hair, sleeping with them in bed, under the covers, all over their bodies, with their bug eyes popping out, their antennas touching the client's lips, as they come mouth-to-mouth with each other; More challenging for the implosive therapist is to construct scenes that have been repressed or cognitively avoided. involving imagined stimuli and in attempting to enhance anxiety arousal by adding imaginary exposure cues believed by the therapist to be relevant to the client's fear Imagined exposure - feared stimulus presented in imagination in an intensive or gradual fashion; During imaginal exposure, the client is asked to recall the memories of the trauma—be it an assault; combat, or disaster. The client is instructed to "recall these memories as fully and vividly as possi- ble. Don't tell me the story in the third person, but in the present tense, as if it were happening right now, right here." As the client gets into the memo- ries and becomes fearful, the therapist reinforces the client's persistence, saying, for example, "stay with the memory; you are doing fine," and "you are being courageous. Let's keep going with the image." The exposure therapist comments on the gradually dissipating anxiety and reassures the client that the anxiety decreases if he or she stays with it long enough Real event

Albert Ellis is considered to be a hedonist. How did this effect the creation of REBT?

In his workshops, as in his therapy sessions, Ellis was a directive therapist who got right to the heart of an issue without mincing his words because some- one might get anxious or upset. That is the other person's problem. Ellis's problem is to convince people to use their cognitive processes to create a life that maximmizes the pleasure and minimizes the pain of existence. He was fond of stating, "The purpose of life is to have a ****ing good time," but Ellis was a long-term hedonist, not an irrational, short-term hedonist who indulges every momentary desire at the expense of long-term suffering. Accepting our tendencies to put our self-interests first, we will nevertheless be determined to change unpleasant social conditions along more rational lines, because we recognize that in the long run it is in our own self-interest to live in a more rational world. In a more rational world, we would accept our natural predispositions to be self-preserving and pleasure producing. We would be less likely to engage in such self-defeating activities as the short-term hedonism of smoking or overreacting, which provide immediate gratification at the expense of lessening our aliveness.

What are the characteristics of Beck's cognitive therapy?

In place of Ellis's irrational beliefs, Beck is more inclined to speak of maladaptive cognitions, dysfunctional attitudes, or in the case of his early research on depression, depressogenic (depression-causing) assumptions Psychopathology originates in the client's pre- conscious or preattentive constructions of reality. These constructions reflect the operation of the client's underlying cognitive organization, called schemas, in interaction with the current environ- ment. As in REBT, life events are interpreted through cognitive lenses or structures, which then lead to distressing thoughts and disturbing behaviors. In cognitive therapy, the underlying cognitions are assumed to vary specifically with the behavioral disorder of clients, an idea known as the content specificity hypothesis. Beck's therapy tends to emphasize the process of empiricism to a greater extent than does Ellis's REBT; clients in cognitive therapy are encouraged to treat their beliefs as hypotheses to be tested by way of their own behavioral experiments. Whereas Ellis strives for a philosophical conversion based on rationality and logic, Beck encourages a reliance on the evidence to alter existing beliefs. cognitive therapy tends to be more structured and precise than REBT. With depression, for example, Beck generally limits therapy to 20 hours. He adheres to treatment manuals specific to each disorder—depression, anxiety, and substance abuse, among others; routinely administer brief symptom checklists, including the Beck Depression Inventory and the Beck Anxiety Inventory, before sessions to monitor the condition and progress of the patient. This structure encourages a problem orientation, discourages wasting time, and provides the client with a therapeutic rationale and direction. In one of the early sessions of cognitive treatment, therapist introduces the influence of cognitions on affect and behavior./ therapist introduces the cognitive model to patients Three basic approaches to cognitive restructuring—modifying the thinking process— are to ask, in various ways, (1) What's the evidence? (2) What's another way of looking at it? (3) So what if it happens? teach patients the method of distancing- learn to deal with upsetting thoughts objectively, reevaluating them rather than automatically accepting them; clients are taught the disattribution technique- in which they disabuse themselves of the belief that they are entirely responsible for their plight. By becoming conscious of depressogenic assumptions and dysfunctional cognitions, clients begin to free themselves from debilitating expectations that they are doomed to depression and other forms of pathology. Schema-focused psychotherapy leading the way for personality disorders BEck uses Socratic Dialogue - Clients are led to make personal discoveries by a tactful progression of questions. This approach is described as collaborative empiricism: The parti- cipants are on a shared mission to determine from the evidence they gather which thoughts may be dysfunctional and which avenues they might pursue to enhance those thoughts From video BEck was doing a specific thing to uncover what is going on with Richard - asking about his past and childhood, but not a form of therapy where you delve into path and childhood; But beck was trying to identify core beliefs and thoughts ; to an expert like Beck, he knows what his core beliefs are - i'm unlovable, automatic thought - I'll be alone forever Depression in general - two big core beliefs - im unlovable and im a failure - remember that you can't change that very easily - by analogy that is his round earth/flat earth ; therapy would be easy if it were that easy to change - instead, Beck will help him identify automatic thoughts, like I'm always going to be alone - that you can disprove; when you get enough of automatic thoughts that you can start to learn to fight; over time can shift core belief - Rest of video - Beck asks more questions; identifies what a problematic time for richard - Richard says hardest time when i'm depressed is when home alone and feels like a loser - Beck helps him identify strategies for what to do in that situation - what thoughts do you have? What can you say to combat those thoughts? And what could you do? Well i could take a walk, call my friend James; thought side and behavioral side of action Beck writes notes ; helps organize thinking Beck's stance - relaxed, attentive, but not too attentive - not like he is Carl Rogers type fuzzy bear, also not client centered, but engaged; but also not on other extreme like ellis; Beck approaches this like a hypothesis/scientific testing; 'let's work together to see what is going on with you/works best for you; help client come to conclusion with guidance of therapist Ultimate goal is to correct patients misconceptions - once corrected, depressed patient becomes less depressed... etc CBT - collaborative empiricism approach - about hypothesis testing ; comes from a basis of truth - im therapist and can teach you skills, can be more effective to see what is true or not true; when you come in, you might believe something to be true ; if you come in and say I am a horrible soccer player, might be true; therapist is here to help someone find what is true Scale analogy - imagine hands are balance - one hand is say all confirming evidence for belief that you have; other hand put all evidence of disconfirming belief Socratic questions - walking through process of questioning - article - CBT approach one of socratic questioning - art of making you think it is your idea - can't tell you what to do or think - really an art form, help someone arrive at own conclusion with series of open ended questions Practicalities - Active, directive, and structured style ; manuals for beck's cog therapy prescribe 12-16 sessions ellis for 1-20 sessions

According to Goldfried, why should a discussion of termination also include a discussion of treatment goals?

In setting goals for treatment, I make every attempt not to set too lofty a standard for termination. I have been particularly sensitive about not imposing my own personal goals on a client. Having emphasized the importance of not departing too greatly from what the client hopes to get out of treatment, I also must note that cognitive-behavior therapists should take care not to overlook other potential problems about which the client may be unaware What I—and many other cognitive-behavior therapists with whom I have spoken—typically do in setting goals is agree to begin by focusing on symptom reduction, after which the patient and I will consider working on issues that may have contributed to the initial onset of the symptoms Very early and devastating experiences can create a vulnerability that no amount of treatment can erase. It is a disservice both to our patients and to ourselves to expect that they can totally overcome the influences of the past. Consequently, modest treatment goals are, at times, clearly in order— even when the therapist is working from within a cognitive-behavioral orientation.

Is MMT efficacious/effective?

In the Netherlands, a treatment outcome study involved 84 inpatients suffering from anxiety disorders, the vast majority of whom had received prior treatment without success. Mul- timodal therapy resulted in substantial improve- ment and durable 9-month follow-ups (Kwee, 1984; Kwee & Kwee-Taams, 1994). In Scotland, a controlled outcome study on children with learning disabilities compared multimodal treatment to less integrative approaches. The results favored the multimodal therapy (Williams, 1988). · Lazarus himself has conducted several follow- up inquiries on patients receiving multimodal treatment, finding that durable outcomes are in direct proportion to the number of modalities deliberately traversed. It is a multimodal maxim that the more a client learns in psychotherapy, the less likely he or she is to relapse · The few controlled studies on the effectiveness of multimodal therapy are supportive, but not definitive. · A compre- hensive review of the adult literature (Grawe et al., 1998) located 22 controlled studies covering 1,743 patients treated with diverse therapies described as eclectic: either explicitly no school connection or multiple combinations of methods. In 9 of the 13 comparisons, the eclectic therapy outperformed the control treatment in terms of symptom relief and in 4 of the 6 comparisons in terms of subjec- tive well-being. · A comprehensive meta-analysis of the child literature (Weisz, Weiss, et al., 1995) located 20 controlled studies on mixed treatments, which produced a respectable effect size of 0.63 compared to control conditions, a moderate to large effect. The interpretative problem, however, is that we possess little understanding of what these multifarious treatments represent. Perhaps the only conclusions that can be reliably drawn are that coherent "eclectic" and "mixed" psy- chotherapies outperform no treatment and that these treatments are insufficiently compared to other systems of psychotherapy. · In 14 studies, more complex therapies were compared with less complex treatments. effect size for the complex therapies was slightly higher (0.15), which translates into an increase in improvement rates from 66% to 81%. · Third and more specifically, ongoing program- matic research supports the effectiveness of a disciplined eclecticism that prescriptively matches different treatments to different people. An exem- plar of prescriptive matching is Larry Beutler's systematic treatment selection ·For example, matching therapist directiveness to the client's degree of resistance improves therapy outcome. In 80% of the studies, clients presenting with high resistance benefit more from self-control methods and minimal therapist directiveness, such as motivational interviewing

Why might punishment (through shocking) lead to other prosocial behaviors?

Mechanical reasons - it is difficult for a child who wines to smile simultaneously; easier for a child, removed from the restraints of his bed, to come into contact with more rewarding aspects of his environment Some beneficial changes will be specific to certain children - ex. Suppression of self-destruction in Linda permitted surgery for her cataracts, with resultant alleviatin of her restricted vision Some of hte behavioral changes accompanying shock probably occur because reinforcements have been given to the child for behaving appropriately when faced with aversive stimuli in the past Certain behaviors may be elicited by shock as unconditioned stimulus - certain kinds of stress, fears, or pains may call forth socially oriented behavior at a purely biological level

What are figure-background relationships?

Metabolic cycle - Perls said that throughout our existence, we continuously have metabolic cycle that we go through - figure ground relationship usually associated with needs that we have - example of bladder - at this moment/whole life - bladder is receiving urine - what starts to happen - as bladder extends - biofeedback mechanism goes to brain, says im uncomfortable - figure ground relationship - for a while need to urinate is the ground when not bothering you; then comes to figure and bothers you; ex. In movie near the end you have to pee - don't want to leave - want to make it to end of movie - bladder became figure of mind - interestingly we can switch figure ground relationships based on attention Duck rabbit example How brain is pulling certain concepts out of the world - right now have an audial environment t - hear prof and other things around us - somehow brain is able to focus in on hudenko's voice - might be in part because he is louder; not only thing, but in a party able to look at someone and hones in on what they are saying ; the cocktail phenomenon too- how this works is largely a mystery - auditory and physical examples of figure ground relationships - brain is able to identify figure ( thing in our mind, represented in mind from external environment); figure is what you are seeing currently in example of rabbit and duck - switch figure to see the other Perls - normative metabolic cycle - when people develop psychopathology , disrupts metabolic cycle - ex. Someone in childhood didn't get love - instead of going back to ground, need continues to arise in inappropriate frequency/ other things or never declines to abnormal degree ?

Be prepared to recognize and label conditional argument patterns (Modus Ponens etc.)

Modus Ponens - If P then Q, / P. Therefore Q. If then statement is called conditional plane - if is antecedent, and then portion is consequence, or consequentially related to antecedent ; if P is stated, called affirming antecedent ; P happened, then therefore Q will happen If it is raining then I have an umbrella. It is raining, so i have an umbrella If he were to say this claim to us, many of us automatically will think of this is not necessarily true ; but the point is, in conditional claim like this, if then relationship is true - it is always true , relationship between variables is true. Logical world does not always map on to real world of variability (what is the benefit then ?) Affirming the consequent - if P then Q. /Q. Therefore P. If i go outside, then I will sweat. I sweat. Therefore I must be outside Connection between these two is not necessarily the same Invalid claim Modus Tollens - If P then Q. Not-Q. Therefore, not-P. If it is raining, then I have my umbrella. I dont have my umbrell Denying the antecedent If P then Q. Not-P. Therefore, not-Q; Invalid Chain Argument (If P then Q. If Q then R. Therefore, if P then r.) Valid Can save a life with chain argument Work with people who are suicidal - try to help them save their lives, keep them from hurting themselves - use chain argument to help someone find motivation to live First, establish conditional relationship in persons mind with leading questions Do you believe it is ok to hurt other people (most say no) Ok, if you believe that's true, if someone hurts themselves does it hurt other people (if you affirm both of these relationships, you are trapped) Logical chain argument - if hurting yourself hurts other, and hurting others isn't ok, then logical conclusion is hurting yourself isnt ok Then you are less likely to hurt yourself If P (hurting yourself) harms others (q), an (GO BACK AND LOOK) Reverse Chain Argument If P then Q. If Q then R. Therefore if R then P. Invalid Like affirming consequent in chaing form ; cant go backwards

What are the assumptions of behavioral therapy?

Most abnormal behavior is acquired and maintained according to the same principles as normal behavior. Assessment is continuous and focuses on the current determinants of behavior. People are best described by what they think, feel, and do in specific life situations. Treatment is derived from theory and experimental findings of scientific psychology. • Treatment methods are precisely specified and replicable. • Research evaluates the effects of specific techniques on specific problems. • Outcome is evaluated in terms of the initial induction of behavior change, its generaliza- tion to real-life settings, and its maintenance over time First point - behaviorism relies on simple fact that you are an animal - why important? Because we know behaviorism relies upon brain physiology that exists almost across the entire animal kingdom - works on frogs, bats, badgers, horses, and you- reason ? common brain mechanisms operate in same basic way - most important part of it is motivation and limbic system Motivational system of organism is biggest tool to motivate behavioral change - different lens than say psychoanalysis - unconscious drive towards sexual reproduction - instead says two core brain processes that are opponent and underlies most of our behavior First - moving towards things - positive affective system; neurological basis - when something feels good i do it more - thorndike's law of effect - also means affiliate for humans, approach or move towards things that are positive Opponent system - negative emotion or negative affect - withdrawal system - feels and do it less - don't like it , makes me uncomfortable and sad/depressed If you understand organism and what drives positive and negative processes of organism - you have immense power to enact change Understand motivation and you can change behavior ! First important point - behaviorism does work ; one of big issues is what is motivator? What is its strength ? Next point - motivators are different depending on person - some of us motivated by food, others not; some motivated by being embarrassed, others not so much - it means you need to know the person - what drives that person Next point - thresholds - there is variability amongst us - different amount of motivators needed depending on the person - never give above the minimum amount to achieve desired outcome - any type of reinforcement or punishment requires cost or resources , resources limited , don't have more , lose power ? always lose minimally viable amount of motivator to achieve desired outcome Beware of habituation - problem with almost any reinforcer or punisher - need to vary reinforcer over time Need to be thoughtful about finding a reinforcer that is replicable and has a higher value to that individual than a monetary value

If clients terminate prematurely, what are some common consequences for therapists?

Most commonly, it is acknowledged that patient-initiated premature termination can be demoralizing to therapists, particularly for beginning therapists.5 Therapists may believe that they have failed, or were rejected by, the patient. Such a belief may, in turn, impair therapists' confidence and effectiveness. There may be a sense among therapists that they have wasted their time and effort when they experience a premature termination Narcissistic injury is also common among therapists. That is, for therapists whose own self-esteem is closely tied to their ability to help others, the loss of a patient through premature termination threatens their sense of self-worth. Painful reactions to losing a patient through premature termination, such as hurt, rejection, or anger, may interfere with other aspects of the therapist's professional or personal life (e.g., interfering with the therapy of another patient who may be similar to the one who prematurely terminated).

What is "in vivo" exposure and how does it work?

Present anxiety-producing stimuli in real life For in vivo exposure, the therapist might accompany the client to the scene of the actual trauma or ask the client to wear the same clothing as when the trauma occurred. In Foa's treatment, in vivo exposure is carried out as homework to be practiced between sessions. Clients are instructed to remain in the fearful situations for at least 45 minutes or until the anxiety decreases. • Often 13-15 exposures is a strong enough effect to extinguish the anxiety o Ex. Having kid who is afraid of dog stand next to a dog

Define the following terms: cultural relativism, cultural universality, unconscious racism, acculturation, and internalized racism.

Multicultural psychotherapy is based on one of three perspectives on the ideal therapeutic process. The first, cultural relativism, consists of developing culture-specific psychotherapies for each patient group. This transforms psychotherapy by applying culture-specific theories and techniques to the unique sociocultural reality of each group, such as African-American clients, Asian-American clients, Latino/Hispanic-American clients, and Native-Americans clients. The second perspective, cultural universality, consists of developing general transcultural therapeutic skills applicable across a wide array of minority groups. The third perspective, cultural adaptation, splits the difference. Research-supported therapies based on cultural universality, such as short-term psychodynamic or cognitive-behavioral therapies, are tailored to the individual cultures of the patient, as in cultural relativism. In this way, culturally adapted therapies enjoy, at once, the nomothetic support of following controlled research and the idi- ographic sensitivity of tailoring treatment to the patient's cultures Conflicts in minority families frequently revolve around acculturation. Acculturation is the cultural modification of an individual or group by adapting to or borrowing traits from another culture; individuals are torn between remaining loyal to their family of origin and cultural group, on the one hand, and desiring to experience new ways of thinking and acting, on the other. Differences in desired acculturation challenge members of minority groups. For those who desire to fully acculturate into the dominant culture, failure to be accepted by dominant culture's standards can be devastating. Those with power and privilege frequently believe that they are not discriminatory or pre- judiced in principle, but society is structured to preserve their privilege. In terms of race, this often leads to unconscious racism, unknown and unintentional expressions of prejudice that lead to discriminatory behaviors. When minorities are constantly bombarded with messages that the dominant culture is best, they begin to accept these messages and denigrate both themselves and their own cultural group—a process known as internalized racism. Minorities often begin to idolize the dominant culture and see their own culture and themselves as inferior.

What kind of multicultural training do most graduate programs in clinical psychology provide for students?

Multicultural therapy demands diversifying the training curriculum beyond the mainstream of contemporary Western thought. A meta- analysis of multicultural education in the mental health professions revealed that such educational interventions are typically associated with posi- tive outcomes, but that interventions explicitly based on theory and research yield outcomes nearly twice as beneficial as those that were not (Smith et al., 2006). Multicultural training should be grounded in theory and research, like other systems of psychotherapy, and should be spread throughout the curriculum, instead of relegated to a single course. Students must have educational experiences that generate cultural sensitivity and skill. Students need to acquire knowledge of the particular cultures of patients they will be treating, of course, but they should also develop an awareness of inter- ethnic relationships, racism, and the historical, social, and psychological context in which cultural groups have functioned. With this background, even when therapists cannot articulate the cultural context of each patient, they can demonstrate cul- tural sensitivity and respect These forms of therapy not very well studies or researched; partly because very new, newest field of psych; Also multicultural ideas and gender sensitive ideas often taught in integrative fashion with other forms of therapy Not as common that people practice this solely Few training programs where you end up being a gender sensitive/multicultural psychotherapist

According to Brown, is there one LGBT reality? Is there one heterosexual reality?

No Different intersectionalities - woman, lesbian, poc/race Different backgrounds: orthodox versus liberal settings Age cohort impacts experience, age of coming out, past hx of overt heterosexual identity Class: defines expression of lgbt Different countries Even gender: gay vs lesbian

How do technical eclecticists decide which techniques to use? What are some of the factors that go into their decision-making process?

No one right answer - as a therapist, you will come into this with a perspective - we do not come in with a vacuum - if trained with one form of therapy - simple - use CBT - once you know more - now harder, what is the best one? What is the goal of therapy ? Help the person change, help them get better; danger is that you come in with preconceived notino about what is best for someone - guideposts to help us make decisions on what is best form of therapy What does the client want ? Why are you here? What did you come for? What brings you here? How may I help you? By asking you what I want, helps therapist decide best method for achieving outcome Ex. if husband comes in and says i want help with marriage - now you know what the goal is- now maybe couples therapy might be more helpful Different goal - help with anger - Problem we often encounter - someone comes in and they dont know what they want or what they want isnt really what they want Ex. someone says he wants to fix marriage because he is unhappy - is it really because he wants a better marriage or is unhappy? Client goal will guide, but determine what that person wants , help them figure out what is their desire ? Two therapies - switch half way; different issues ? Therapist-client conflict Health - help someone be helathy; improve or increase health in some way - will transform life A whole field on what do we mean by health - movement credited to seligman - movement of field of psychology to start incorporating positive psychology into way of thinking Prior to that movement, when someone would come in we would think of them as havin gprobelms/in medical model - years of research/folks like slegiman started to uncover something - successfully treat someone's depression - end up with a person who is empty/nondepressed- nondepressed is not happy, nondepressed is empty - positive psych came to forefront to say goal should not be not a disease state, but should be flourishing Flourishing - "wellbeing" Encompases idea that to be maximally healthy, means that you flourish in your world - doing well, fully living; one goal you can always use is how can I help this person flourishe When prof helps people, sometimes problems getting in way of flourishing that you have to address - but never end of treatment - end is when someone is flourishing - then I feel like we can be done As it turns out, we know how to define flourishing - secrets of flourishing in own life PERMA P (positive emotion); data and research to show us people who are flourishing have lots of small instances of positive motion throughout courses of days - people who are happier dn flourishing recognize that big positive things in life are not what they are made out to be - focused on big positive goals (get car, graduate, go to disneyland then happy etc) big goals, take a lot of time to achieve them - doesnt last after you achieve goal - actually small things frequently administered that create more happiness and wellbeing - over course of day build in moments intentionally - wake up and have great coffee - at 12 text friend, then watch some show, etc E (engagemet)- ability and awareness of some type of strong engagement in their life; also flow - if you have soemthing in life when fully engaged, time stops; 2 hours go by and you dont realize ; during times of flow and engagement, dont necessarily feel positive or express positive emotion, but in retrospect those moments are extremely positive - dientify things that you can get lost in - have it built in regularly to life R (Relatinoships) of the five, relationships has the strongest effect on flourishing ; people who flourish more have strong positive healthy relationshisp with multiple people ; doesnt mean necessarily that always life of party, but you might have five very close friends, and they rely on you and you rely on them - that factor alone accounts for biggest piece of floursihing M (meaningfulness) Build meaning into your life - most often activities that people find meaningful are related to doing something for someone else; donating your time to teach at school; volunteering at homeless shelter - build it into life A (Achievement) lowest, most questionable; but setting goals for yourself and trying to achieve them One hand, what are your goals/how can i help; other goals like perma that all help Also with those goals in mind; good to consider client characteristics; intelligence of client ; many things insight oriented; insight therapies require moderate level of intelligence ; low IQ might go more towards behavioral psychotherapy ; pragmatic factors like how many sessions do we have/what resources does this patient have Also think about based on problem that I am trying to sole, what is the ebay match for this problem ; ex. If someone comes in and is depressed, strongest research is prob on CBT plus meds

For which disorders is behavior therapy most effective?

OCD - antidepressants, behavior therapy, and combo more effective than control group On patients' self- ratings, the meta-analysis indicated that behavior therapy was significantly more effective than the antidepressants and that the combination of behav- ior therapy and antidepressants tended to be more effective than the antidepressant medication alone. behavior therapy, with or without adjunctive medi- cation, is a premier treatment for OCD. Trichotillomania habit-reversal therapy (ES 1⁄4 1.14) was quite effective and more effective than medication (Bloch et al., 2007). Habit-reversal therapy (Azrin & Nunn, 1973) is a multicomponent behavioral interven- tion that combines self-monitoring of the prob- lem, competing response training in which a healthy alternative is applied until the hair- pulling urge dissipates (a form of countercondi- tioning), and social support to increase motivation and treatment compliance. Developmental Disability Contingency management procedures were significantly more effective than were other procedures. Interestingly, the analyses found that performing a for- mal behavioral or functional analysis increased treatment effectiveness. That and other meta-analyses (Prout & Nowak- Drabik, 2003) demonstrate the probable superiority of behavioral and cognitive-behavioral therapies over other, less studied psychotherapies in the treat- ment of developmental disabilities. Individual treat- ment, as opposed to group treatment, employing contingency management seems to produce the most positive results. Eating Disorders - favorable treatment outcomes ADHD - combined treat- ment proved superior to the intensive behavioral treatment. For most ADHD symptoms, children in the combined treatment and medication groups showed significantly greater improvement than those given intensive behavioral treatment.However, subsequent analyses revealed that the behavioral treatment alone was equally effec- tive to the combined treatment on 82 of the 87 measures when the behavioral treatment was being intensively applied Schizophrenia, anger disorders, cigarette smoking, nocturnal enuresis, hypertension, migraine headaches, insomnia, IBS EFFICACY Very effective ; especially for exposure In general effect size is 1.12; in cohens d (range from 0-2); placebo is .56; so 1.12 is very good Use a lot of PTSD Use a lot with OCD Exposure and response prevention - specific form of therapy that we use for OCD - use exposure, but because the client ahs obsessions and compulsions - intentionally activate obsession then prevent them from compulsions Person will have anxiety response - get to point where anxiety is high and they want to do compulsions , but dont let them; anxiety still goes down - they learn that they dont need to do compulsion to treat anxiety High potential for drop out - 20% will refuse, 20% drop out prematurely Effectiveness lower than efficacy Because of things like attrition As few as three sessions; 3-20 Dont stop session prematurely before anxiety lowers - can be dangerous to not 50 minutes usually but can go more

How do you define an observation? How do you define an inference?

Observation is one method for collecting research data. It involves watching a participant and recording relevant behavior for later analysis. Inference - conclusions reached on the basis of evidence and reasoning. Cognitive psychologists use computer models to draw conclusions (make inferences) regarding mental processes. Clinical judgment and the observational, inferential, and reasoning processes upon which it is based are perhaps practitioners' most fundamental and frequently used processes in clinical activities. Yet, paradoxically, these processes are also among the most vulnerable to unintended biasing influence and to underrecognized fallacies, constituting an insidious Achilles' heel. Social workers continually draw inferences and exercise judgment as they attend to the constant flow of information about their clients and the clients' environments.

Why do CBT therapists use a "tapering" approach to termination?

Once a client has learned certain coping skills and has successfully dealt with the goals as originally agreed on, cognitive-behavior therapy moves into a maintenance phase o During this maintenance phase, treatment is phased out so that sessions occur less frequently, and clients are encouraged to function as their own therapist. The focus in these maintenance sessions is on how clients have been able to successfully cope with situations that would have created difficulties in the past and on what specific thoughts, emotions, and actions enabled them to do so. In the case of clinical problems for which relapse or recurrence is likely, it is often wise to continue treatment over a long period of time. o The essence of the relapse prevention model is that during the maintenance phase of treatment, both client and therapist identify those problematic situations that are likely to result in a setback, construed more as temporary lapses rather than relapses. If clients know in advance the potential trigger points that are likely to create difficulties for them, and anticipate and rehearse methods of coping with them during the maintenance phase, they are more likely to maintain their treatment gains As indicated above, the focus is on the tapering off of sessions to allow the client to have increasingly more opportunity to make use of his or her coping skills

Provide examples of 3 common cognitive errors according to Beck.

Overgeneralizing - If it's true in one situation, it applies to any situation that is even remotely similar. ; after interviewing for a job and not getting it, we overgeneralize by thinking we'll never get a job, and as a result feel hopeless Selective abstraction- The only events that matter are the failures, which are the sole measure of myself; Someone attends a party and afterward focuses on the one awkward look directed her way and ignores the hours of smiles Excessive responsibility - I am responsible for all bad things, rotten events, and life failures.; "It's all my fault. I should have worked harder, not taken those 2 weeks of vacation last year, never purchased that expensive computer. Self-references- I am at the center of everyone's attention, particularly when I fail at something; All our neighbors and friends know I screwed up, and they're laughing at me behind my back Dichotomous thinking- Everything is either one extreme or another (black or white, good or bad). ; It's all hopeless; there is nothing salvageable from the business"

What are the characteristics of Gestalt therapy (number of sessions, etc.)?

Perls said that to do his psychotherapy, all he needed was a chair for the hot seat, an empty chair for the client's role-play, a client willing to enter the hot seat, and an audience or group willing to participate in the work between therapist and client. Perls seldom saw clients in an office; Most of his work was done in workshops, lectures, or seminars; prefer to conduct psychotherapy in a group setting, even though their work occurs primarily between the therapist and the person in the hot seat, not among group mem- bers; the proportion of Gestalt therapy now conducted in an individual format far surpasses that performed in a group format. Increasingly work with couples and families Most tend to see their clients weekly, although as a rule they prefer at least 2 hours with a group and frequently longer, including marathon sessions. In Perls's workshops, clients did not pay extra for the therapy they received while in the hot seat, but rather just paid the entrance fee to the workshop or lecture; the client's responsibility to secure therapy by requesting or assertively taking the hot seat. Gestalt therapists include psychologists, social workers, psychiatrists, counselors, and educators; tend to be informal about Gestalt training, the more respectable route includes a minimum of 1 year of intensive training at one of the Gestalt training institutes. more informal about patient screening and outcome follow-up, following Perls's precedent that it is the client's responsibility to decide to enter or terminate treatment The length of Gestalt therapy tends to vary considerably, from a single workshop session to weekly sessions for 6 months, but tends toward the briefer end. initial development of a contract with the client narrows the focus on what conflicts the client would most like to resolve; here-and-now focus uses the present as the point of reference, as contrasted to extended analysis of the there- and-then; active and directive techniques, such as the empty-chair dialogue to resolve unfinished business can bring conflicts into full awareness and move them toward resolution in just a few ses- sions. Training in Gestalt is experiential.

What are some examples of biases that clinicians might make during the therapy or assessment process?

Personal Experiences - If clinician suffered from an abusive relationship, this experience may color her perspective - perhaps to search out and read relationship issues in terms of abuse, to assum that his or her experiences and reactions generalize to others, and ot infer emotions, meanings, and theories of causation using his or her own experiences to go beyond the information given Attention and Perception - expectations that the social worker brings will influence the process of assessment and problem formulation; produce selective attention to cues and events consistent with expectations, but also fuel active searches for expected input from the social environment and discount or overlook information or possibilities inconsistent with expectations and proclivities Implicit personality theories - social workers tend to hold implicit theories organized around social categories (for example, "welfare mothers," "homeless," "old people," "homosexuals," "drug addicts") as well as problem types or diagnostic groups (for example, "passive- aggressive," "histrionic," "adult survivors," "juvenile delinquents," "sex offenders").

According to Perls is it possible for an individual to become completely healthy? If so, how would society react to him/her?

Phoniness - we struggle to become someone because we are really not satisfied with ourselves; unhappy fundamentally with our sense of self (aligns closely with ideal/perceived self); phoniness effectively a game - people play games of phoniness - consciously aware or not aware - therapists help patients become aware of laye of phoniness Perls - made assertion that most people are messed up - at a societal level, things are kinda screwed up - what is he talking about fundamentally ? - all of us play games with each other, not actually authentic in how we interact with each other Ex. ou and friend - friend texts you and says ill be 5 minutes late - your reaction instantly is man they dont care about me, they dont value relationship, etc. - at this moment have option in how to respond /decision points in how to react in environment - one way could be whatever i wont say anything; other thing would b to yell at frien d; another thing would be you really hurt my feelings ; Perls would say for the most part you are gonna play a game , like ignoring it/pretending it didnt happen - but really you are marking a point against them; adding more black marks ; ultimately playing games with others - perls would say to eliminate phoniness - be you and be genuine Why society is messed up - people can't tolerate genuineness - we should all stop doing so Perls would say psychopathology is a manifestation of these issues - it is a working model to apply to psychopathology This way of being means to put yourself above others at times - raw genuineness can be hurtful to others if they have insecurities One person who is genuine cant live with others who arent genuine - why he ended up in commune like setting Challenges core conceptualizations about how relationships run - everyone is really aware of it

According to Perls, what are the different "layers" of psychopathology?

Phony layer - perls says we progress towards layers of psychopathology towards health - first layer you get through is phony layer - you put on false pretense; pretend to be something you are not; try to express genuineness; Perls says you are not Then phobic layer - afraid and fearful of who you really are Impasse - deadness - don't think that you can get better Implosive - real deadness layer - after you can get by, i can do this Explosive - emancipation of life's energy

What factors are thought to have contributed to the eclectic movement since the early 1970's?

Proliferation of therapies. Which of 500-plus therapies should be studied, taught, or bought? The hyperinflation of brand-name therapies has produced narcissistic fatigue: "With so many brand names around that no one can recognize, let alone remember, and so many competitors doing psychotherapy, it is becoming too arduous to launch still another new brand"; "exhaustion theory" of integration: Peace among warring schools is the last resort. Inadequacy of any single theory for all patients/problems. No therapy/therapist immune to failure. External socioeconomic contingencies. Psychotherapy has experienced mounting pressures from not easily disregarded sources such as policy makers, informed consumers, and insurance companies. Everyone is demanding hard research evidence of effective treatments. Unless they demonstrate accountability, psychotherapists stand to lose prestige, customers, and money Ascendancy of short-term, problem-focused treatments. The brief, problem focus has brought divergent therapies closer together and has created variations of different therapies that are more compatible with each other. Integra- tion, particularly in the form of eclecticism, responds to the pragmatic time-limited injunc- tion of "whatever therapy works better— and quicker—for this patient with this problem." Opportunities for therapists to observe and experiment with various treatments. Treatment manuals have also induced an informal version of "theoretical exposure": Previously feared and unknown therapies were approached gradually, anxiety dissipated, and the previously feared therapies were integrated into the clinical repertoire. Recognition that therapeutic commonalities heavily contribute to treatment outcome. As discussed in Chapter 1, only about 8% to 12% of outcome is generally accounted for by the spe- cific treatment method. Therapeutic success can be best predicted by common elements of psy- chotherapy, such as the contributions of the patient, the therapy relationship, and facilitative qualities of the therapist. Development of professional societies for integration. The creation of professional networks has been both a consequence and cause of interest in psychotherapy integration

What are some common criticisms of behavioral psychotherapy?

Psychoanalytic Preoccupation with short term success; research biased; symptom relief should not be the only goal for therapy HUmanistic Barely any studies assess patient's happiness and harmony as criteria for successful treatment Cultural perspective Whod efines what is adaptive and ladaptive behavior ? Who and what has to change ? Implicit standards used to determine what and who is in need of change Integrative perspective Proliferation of behavioral techniques without an integrating theory is adding more complexity than clarity

What are some examples of how Lovaas used punishment and reinforcement in the video you watched on the treatment of autism?

Punishment - reduces tantrums by ignoring them Reinforcement - The teacher will reinforce sitting and good behavior using food and praise; Kissing is reinforcer for lisa - discovers this! Lisa tantrums when anyone attempts to teach her Prompts lisa with shoulder tap Good sitting ! ; gives water ; good looking lisa ! She starts smiling Extinction of tantrums and minutes extinction bursts Reduced tantrums by ignoring them

What did the video reveal about the long-term use of behavioral therapy on individuals with autism?

Reduced tantrums by ignoring them Why does this happen - in 10 minutes, huge behavior change - screaming and tantrums nd then smiling Engaged in rpedictable extinction burst - when asked to do something she didnt want to do, behaves extremely - if you get through it though, it will be very valuable Lavas not only using conditioning, but also classical conditioning When giving treats - positive reinforcement by pairing it with other things ; while he does it says "oh yay so cute Lisa! Yay lisa!" over time starts removing food, then just praises !! establishes himself as positive reinforcer We all are subject ot his - classical conditioning; part of how our brain is wired to work ??? One should be less optimistic about long-term behavioral change under certain conditions ????? keep maintaining?

What are the ABCDE's of REBT?

Remember what ellis says about steps in generalities of RET - A- Identify person's activating event, what happened; can be something from real life or thought trigger B - belief; rational or irrational beliefs; irrational subject to distortion, catastrophizing, overgeneralization C- Emotional Consequences of A and B ; what happens after you have that belief, what do you do; through process of RET, next is Dispute D- Dispute irrational thoughts/beliefs; take what you believe and challenge it; I should be a good sister - is it true; if you effectively dispute then E E- Cognitive and emotional effects of updated beliefs; effective new philosophy ; translate life into life with more rational thinking

Why did Lovaas et al. suggest that extinction may not be the best treatment approach?

Rick eventually did stop hitting himself under this arrangement, but the reduction in self-destruction was not immediate, and even took a turn for the worse when the extinction was first initiated, causing considerable bleeding and apparent physical discomfort. For some children extinction is ill-advised because the self-destructive behavior is severe enough to pose a high risk of severe or fatal damage, for example in children who bite themselves, tearing tissue. In summary, we can conclude that although extinction seemingly works, it is not an ideal form of treatment because the large amount of self-destructive behavior during the early stages of extinction subjects the child to much apparent discomfort. while the self-destructive behavior fell to zero in the room used for extinction, it remained unaffected in other situations (these data are presented below). It is likely, therefore, that the child has to undergo extinction in a variety of situations. It is important to note that the extinction of John's self-destructive behavior in the experimental room, as presented in Fig. 1, was going on during this time, and while he had reached Session 10 in the lap situation, he was effectively extinguished in the experimental room. The extinction, then, did not generalize to this situation.

How might IPT and STPP therapists react differently to an irritable, depressed client?

STPP therapist - allow transference to develop, then interpret it to the patient ot explore its meaning focus on intrapsychic conflicts, unconscious feelings, character defenses rather than formal dx and concept of illness IPT therapist would focus the patient on interpersonal relationships and events in the patient's outside life that might provoke anger or irritability, and would also blame the depressive disorder itself when appropriate; active, outward-looking approach minimizes opportunity for negative transference to build; rather therapist becomes patient's ally in fighting depression and outside problems Resolving outside problems and depressive symptoms cements the therapeutic alliance, so that negative transference fades If the patient's feelings unavoidably perturb the therapeutic alliance, the IPT therapist explores them as interpersonal, real-life, here-and-now issues rather than as transference IPT would first diagnose, then link onset of disorder to either role transition, role dispute, grief, interpersonal deficits - presents linkage to patients, give patients sick role, make ormulation on what to do ;

How is resistance viewed differently by IPT vs. STPP?

STPP treats the patient's resistance to employing healthy solutions as meaningful Corrective emotional experiences lies primarily inside the office in the patient's newfound ability to express warded-off feelings to an optimally responsive person If a patient repeatedly arrives late for sessions, STPP therapist might explore aspects of the patient's character and feelings about the therapist that might contribute to the lateness IPT treats the resistance as an illness - namely depression IPT corrective emotional experience lies partly outside the office, in the amelioration of interpersonal situations external to therapy From IPT perspective, dont want to reinforce patient's already excessive self-blame; would excuse patient's lateness, sympathizing that it is hard to get out of bed and arrive punctually when you feel depressed and alck energy, and acknowledging that the patient's elvel of anxiety might make it ahrd to contemplate sittiong through a full session Would blame the depression, not the patient; therapist would mention time limit to discourage future tardinesses ; lateness in other relationships might be explored with the goal of building interpersonal skills in external settings

How was EMDR developed?

Shapiro walking through park - thinking about things that made her upset - more she was moving her eyes, less stressed she was feeling Eye movement desensitzation and reprocessing EMDR appears to work - but is it swirling glass type - do eye movements contribute anything beyond exposure • Francine Shapiro was diagnosed with cancer • Enrolled in doctoral program in clinical psychology to try to deal with the psychological effects of having cancer • She was walking through the park and noticed that a lot of her disturbing thoughts disappeared and when they were brought back into her mind, they were not as upsetting or as valid as before • When the disturbing thoughts did come to her mind, she noticed her eyes spontaneously started moving rapidly back and forth • When she did they deliberately, while concentrating on disturbing thoughts, thoughts disappeared and lost their charge • Found positive results with others as well • Began training others and modifying the procedure o Realized the optimal procedure entailed simultaneous desensitization and cognitive restructuring of traumatic memories Renamed to eye movement desensitization and reprocessing (EMDR) • One of most rapidly disseminated psychological methods in history

What behaviors were monitored/targeted in Lovaas et al.'s study of self-destructive children?

Small n study, 8-11 years old, IQ in 24 range; all of them had extremely frequent self-harm behaviors - children either had to be chemically sedated or physically restrained Self-destructive behavior Specific self-destructive behaviors monitored/targeted Child would strike his head with his fists or hit his head against the side of the bed, the blows generating considerable noise; their agreement in recording this behavior exceeded 95% without training Two additional behaviors - changes were recorded in withdrawal from attending adults ; the adult would attempt to maintain close physical proximity to child (less than 1 ft) and re-establish contact as soon as the child moved away Withdrawal was scored when the child was in the process of moving away from the adult Instance of emotional behavior, whining, was also recorded - child would emit an annoying, screeching sound, without tears, and without communicating sadness or apprehension, but rather anger

What is "begging the question?"

Smuggling the argument's conclusion into the premises - conslusion can be stated as a premise more or less explicitly, or one or more of the premises may depend on the conclusion. In either case, the person is assuming exactly what it is that needs to be proved A form of circular reasoning, begging the question is one of the most common types of fallacies. It occurs when the premises that are meant to support an argument already assume that the conclusion is true. If you start from a place where the conclusion being argued is already assumed true, then you're not really making an argument at all. There is no supporting evidence. The Apple iPhone is the best smartphone on the planet because no one makes a better smartphone than Apple does.

According to Wright & Hollifield, what are some of the hypothesized positive and negative interactions between pharmacotherapy and psychotherapy?

Some of the hypothesized positive interactions between treatments: Medications could improve concentration and thus improve ability to participate in and learn from psychotherapy. Medications could reduce distorted or irrational thinking and thus promote salutary effects of psychotherapy. Medications could decrease anxiety, physiological arousal, or other painful mood states and thereby influence patient's ability to gain from psychotherapy. Psychotherapy could improve medication adherence. Psychotherapy could help patients better understand and manage their illnesses. Psychotherapy could assist patients with dealing with stress, interpersonal issues, and other psychosocial infl uences that pharmacotherapy may not target directly. Psychotherapy could improve the relapse prevention effects of medication. Psychotherapy could have biological effects that work togetherwith medication to reverse biological abnormalities Negative Medication could interfere with learning and memory, impairing the ability of the patient to recall or use lessons learned in treatment sessions. Pharmacotherapy could cause a heightened risk for relapse after medication is discontinued which may negatively affect the longterm relapse prevention effects of certain psychotherapies. Dependency on benzodiazepines could have deleterious effects on the influence of psychotherapy Medications could lead to premature relief of symptoms that might reduce motivation to continue in psychotherapy. Psychotherapy could place undue stress or burden on patients with biologically driven illnesses.

What are the six steps of contingency management?

State the general problem in behavioral terms, including the maladaptive responses and the situations in which they occur. This step is known as operationalizing the target behavior. Identify behavioral objectives, which includes specifying target behaviors and if the behaviors should be increased/decreased/ reinforced only when emitted in more appropriate situations. Develop behavioral measures and take baseline measures in order to be able to determine whether treatment is effective. Baseline measures show the rate of responses prior to the initiation of treatment. Conduct naturalistic observations, which involves observing patients in their natural environments in order to determine the exist- ing contingencies and therefore the effective reinforcements for a particular patient. Modify existing contingencies, involves specifying the conditions under which reinforcements are or are not to be given, what the reinforcements will be, and who will administer them. Monitor the results by continuing to chart the rate of responses and comparing the results to baseline measures to determine the treatment's effectiveness. Changes in treatment can be made when necessary; treatment can be terminated when behavioral objectives have been met.

According to Overholser, which clients are unlikely to benefit from a cognitive exploratory process?

Systematic questioning should not be used when the client is unlikely to benefit from a cognitive exploratory process. Young children are too concrete to appreciate the complexities of the Socratic method Likewise, patients suffering from psychosis, dementia or other organic brain syndromes may lack the abstract abilities to benefit. Finally, because of the emphasis on verbal interactions, the Socratic method may be ineffective with hearing impaired individuals and clients whose primary language is different from that of the therapist. Many complications can arise when interviewing clients from a different cultural background

According to Goldfried, when should a CBT therapist terminate a client?

Tapering off Biggest concern = relapse Goal to be equipped with the skills to essentially be own therapist Combat with maintenance Stimulus generalization = goal Because CBT is a skills-based therapy Apply and translate skills to all other relationships Apply less emphasis on termination, more course of what happens at end Freud (1937/1953) was quite clear in defining what he meant by "the end of an analysis." The two possible criteria he specified were (a) the reduction of symptoms and elimination of the specific pathological processes that brought it about and (b) the achievement of "absolute psychical normality" (p. 320). Freud acknowledged that the second criterion might be unrealistic, especially as analysts themselves rarely reach this state. The first criterion for successful treatment, however, has a most contemporary ring, in that it deals with symptom reduction and its maintenance over time. Inasmuch as cognitive-behavior therapy involves having a client develop coping skills, relatively little emphasis is placed on the ending of the therapist-client relationship. As indicated above, the focus is on the tapering off of sessions to allow the client to have increasingly more opportunity to make use of his or her coping skills. Of course, issues of loss need to be addressed when cognitive-behavior therapy is modified to deal with more complex cases in which the relationship plays a very significant role, such as dialectical behavior therapy in the treatment of borderline personality disorder (Linehan, 1993).

Can any universal formula be applied to all terminations?

Tapering vs. Clean cut Tapering: see less and less; tapering in number of sessions that you have over time - start meeting few times a week, once a week, once a month, once every few months Clean cut - this is our last session/class, we are done How to choose: Based on individual character Consider length of treatment (Shorter gives cleancut?); depend on psychological profile and what they are being seen for i.e.: Attachment style ie.: relapse probable taper Reason for termination Ie moving Medication - might require tapering Form of therapy CBT - tapering more common Psychodynamic - clean cut Abandonment hx - clean cut To be able to prove client can tolerate a good ending So can apply to other relationships (they probably extend other relationships past due date in fear of abandonment) Predict reactions!! Very hard to do Building self-competency (self-efficacy) Try to "get fired" to "not need you (therapist)" Ultimate goal: patient believes they have done it themselves Strategies: switch language to reflect you did it convincing somebody that it was their idea - convice them that you were the result of change - not dishonest, true, people do have to work hard, but takes away agency of therapist - in a way say statements that reflect our view of who someone is - "You are so strong that you have gotten to a place to deal with this on your own " Different models to decide when to terminate Self-efficacy Symptom reduction model External reasons: insurance companies / managed care Contracts Goal of short term therapy: to be very focused, knowing end is in sight Managed care will even require predetermined number of sessions Never wise to have forced termination

What is a technical eclecticist? What is a syncretist?\

Technical eclecticism seeks to improve our abil- ity to select the best treatment for the person and the problem (Lazarus et al., 1992). This search is guided primarily by research on what has worked best in the past for others with similar problems and similar characteristics. Eclecticism focuses on predicting for whom interventions will work: The foundation is actu- arial rather than theoretical. · Proponents of technical eclecticism use proce- dures drawn from different sources without nec- essarily subscribing to the theories that spawned them ·But these accusations of being "wishy-washy" should be properly redirected to syncretism— uncritical and unsystematic combinations o Such haphazard "eclecti- cism" is primarily an outgrowth of pet techniques and inadequate training, which produce an arbi- trary, if not capricious, blend of methods by default. · Eysenck (1970, p. 145) characterizes this indiscriminate smorgasbord as a "mish- mash of theories, a hugger-mugger of procedures, a gallimaufry of therapies," having no proper rationale or empirical verification. This muddle of idiosyncratic clinical creations is the opposite of effective psychotherapy, which is the product of years of painstaking clinical research and experience. Rotter (1954, p. 14), years ago, sum- marized the matter as follows: "All systematic thinking involves the synthesis of preexisting points of view. It is not a question of whether or not to be eclectic but of whether or not to be consistent and systematic." One is technical eclectism - best represented by Lazarus and multimodal therapy; general concept is that you are going to take elements of different approaches; starts with assessment of a client; BASIC ID - a way of thinking of profile of person you are working with B is behavior, A is affect; S is sensation, I imagery Profile may indicate using different techniques on different people Knows a lot fo techniques of differen ttherapies Danger is syncratism - syncratist is somebody who uses haphazard schmorbegusbaord of techniqeust that dont match In contrast, technical eclectist is well informed and uses techniques that go well together Synchrotist encounters problem - using psychodynamic an dCBT - someone comes in and asks if he has children - if using psychodynamic why do you ask, if CBT i have 2 lets move on - two reponses exactly opponent - In contrast - take two chair technique and also the stuff from cognitive therapy - those thigns work and might go well together - be aware adn thoughtful of two approaches

What is the difference between integration and eclecticism?

Technical eclecticism seeks to improve our ability to select best treatment for the person and the problem Eclecticism focuses on predicting for whom interventions will work: The foundation is actuarial rather than theoretical. Proponents of technical eclecticism use procedures drawn from different sources without necessarily subscribing to the theories that spawned them theoretical integrationist draws from diverse systems that may be philosophically incompatible. In theoretical integration, two or more psychotherapy systems are integrated in the hope that the result will be better than the constituent therapies alone. One is technical eclectism - best represented by Lazarus and multimodal therapy; general concept is that you are going to take elements of different approaches; starts with assessment of a client; BASIC ID - a way of thinking of profile of person you are working with B is behavior, A is affect; S is sensation, I imagery Profile may indicate using different techniques on different people Knows a lot of techniques of different therapies Danger is syncretism - syncretist is somebody who uses haphazard schmor bagus board of techniquest that don't match In contrast, technical eclecticism is well informed and uses techniques that go well together One is theoretical integration Taking two whole forms of therapy and theoretically combining them together - creating psychodynamic therapy -combining them together to create a new thing - find in theory different forms of therapy things that are compatible and incompatible Many examples of these orientations - sometimes seem incompatible and ways to combine them ; two big camps that we use ; approaching a problem in an eclectic way

According to Nurius et al., why might veteran clinicians be at a greater risk of making "mindless" decisions than beginning clinicians?

That is, when a client or task is novel, practitioners tend to be hyper-vigilant, to attend closely to their observations, hunches, and decisions. With repeated exposure, experience, and routinization, a more "mindless" state develops, in which clinicians are less conscious of their cognitive processes and constructions and react more automatically (Benner, 1984). The more automatic expectations, attention, and perceptions become, the less likely they are to undergo scrutiny or revision and the more likely the clinician's perceptions--including inferences used to fill in missing information--will seem to him or her to be fact. The dilemma facing the practitioner is twofold. The practitioner needs these knowledge structures even to begin to make sense out of what otherwise would be a bewildering cacophony of social stimuli. However, the practitioner then must contend with the natural biasing, telescoping, and rigidifying effects that these knowledge structures have on his or her expectations and perceptions.

Why do clinicians typically recommend that you start with psychotherapy before trying medication?

The authors believe in the principle of therapeutic parsimony when combining modalities: if one modality is effective, do not add the second. For some clinical situations, start with family therapy (for example, when the family problem is paramount, and/or may interfere with individual psychotherapy or medication adherence), for others, medication (for example, in the acute psychosis associated with schizophrenia, bipolar disorder, organic mental disorders, etc) Untoward effects (glick): but adverse changes in individual and family dynamics as well as potentially adverse interactions of administering combined therapies. For example, medication-induced sedation or dysphoria may decrease the patient's ability to socialize with family and/or friends. Within the family dynamics, there may be issues around the patient needing less care, or becoming more assertive, or family members no longer perceiving the patient as ill or stigmatized, and, of course, the ensuing loss of secondary gain of being ill. Side effects, Dependence, Relapse, Stigma, Avoid meds if family hx of substance use Dont want to prescribe someone something that is highly addictive if they struggled with substance abuse If drugs interefere with therapy Cost benefit equation - also money/availability of resource to get it; also what may a strong negative side effect the person might have Question of parsimony If it is working dont break it - if doing psychotherapy and it is working, dont add meds to it - rule of parsimony - might do more harm if you do meds cause always some kind of cost associated with it - rule is do what works and is smallest amount needed to achieve effect ; so if therapy working cost/ patient wouldnt want to be willing to spend money to take the drug

Why are "sequencing effects" important?

The clinician who accepts the role of a "combination therapist" must be aware of when, and in what sequence, to use each of the modalities. Since good evidence is not available, the sequence will vary according to clinical considerations of the type of illness, its severity, and the clinicianpatient concept of the nature of the illness. Where treatments are essentially equal in reducing symptoms, the question arises as to which treatment should be administered first? O'Conner et al. (37) found that for obsessive-compulsive disorder it was more beneficial clinically to give medication first and then move to a combination of medication and CBT. Thase et al. (18a) found combined treatment to be superior among those with more severe depression, and Keller et al. (22) found combined treatment to be substantially superior to medication or psychotherapy alone, at least in the acute phase of treatment for chronic depression (no long-term findings have yet been published from that trial). Fava et al. (38) have found that CBT is helpful for the treatment of residual symptoms following pharmacotherapy for depression. Different order better for different therapies

Why do therapists typically ask open-ended questions?

The questions involve the active and collaborative involvement of both therapist and client. Also, a progressive series of questions can be used to shape the client's thought processes. The content of most Socratic questions is designed to foster independent, rational problemsolving in clients. The therapist should provide structure only to the extent necessary because if questions are overly directive, clients may begin to passively wait for therapist to lead the session

According to Curtis, what are the 8 steps of termination?

The timing of the termination is determined by the patient, with input from the therapist. Tolerance of feelings without acting is a criterion regarding which the therapist provides input, if appropriate. 2. Consider reducing the frequency of meetings and schedule a final appointment some time after the second-to-last meeting. 3. Review stressors and the patient's previous dominant way(s) of responding and new ways of responding (if there is no change in the response nor a reduction in the stressors, the therapist should mention this). 4. Assess what has been accomplished and what the patient may wish to address at a future time. 5. Inquire about what was helpful and what was not helpful. 6. Inquire, if appropriate, whether there is something negative about the therapy to lead the patient to terminate, as opposed to attainment of goals. 7. Equalize the relationship by helping the patient focus on what he or she did to lead to change, by revealing something personal, and so forth. 8. If it has been a long or intense relationship, the therapist should tell patient that he or she would be pleased to hear from the patient at some point.

What is the two-chair dialogue and how does it work?

The two-chair technique is one of the most powerful and widely used of the gestalt tech- niques. Greenberg and colleagues have both modified and clarified the arcane orthodox gestalt ideas in their "process-experiential ap- proach," which combines Rogerian humanism with Perlsian techniques. Greenberg's marriage of the two orientations has resulted in the birth of a well-defined and well-researched integrated therapeutic orientation. two chairs can be described as the experiencing chair and the other chair and that the metaphorical individuals present in the two chairs undergo different transformations during therapy. During the work, the experiencing chair deepens in depth of experiencing and inner exploration and uses an expressive voice while the other chair is "filled with the person's 'shoulds,' negative self statements and attributions" and uses an externalizing and lecturing voice A primary goal for the therapist during two- chair work is to help the client keep the partial aspects of the self separated, which can aid in conflict resolution and integration principles that guide the therapist's work include (a) clearly separating out partial aspects of the client's self, (b) encouraging client attention to and heightening of emotional experiencing and expression, and (c) assessing the two-chair work and cognitive and emotional changes with the client

What were the three different approaches or "studies" that were attempted to reduce self-harm in Lovaas et al.'s study?

Three studies - extinction through removal of the interpersonal consequences (neg punishment), suppression by the use of painful shock (positive punishment), and increasing self-destruction through attention (Positive reinforcement?) Availability of interpersonal stimulation had no effect on self-destruction? Continuing to attend to self-destruction could have hurt children badly Class notes Used approach using negative punishment with operant conditiong, four ways - one is negative punishment - reducing a behavior; taking something away to reduce behavior What did they do for negative punishment? they left them alone in the room when they started to inflict self-harm- negative punishment was affective, but at a cost Second piece - positive punishment of shocking - shocking is standardized punishment - ex. Spanking would not be standardized and adds variability to punishment ; shocking is same across all conditions; also, can find minimal punishment to cause behavior change - a little chock, enough, to change beahvior Identify amount of shock that is required, and only use minimum amount Thing you consider - will punishment damage child? Will not damage child long term, just hurt at the time Classical conditioning - vary with punisher - any time you punish someone - must worry that they will associate punishment with you - why you must vary punisher Pair punishment with something else with shock - do the self-harm, then say no; then shock you - do this so eventually they can just say no - trying to eventually move away from shocking - might mean occasionally that you need to reinitiate shock - with enough times get habituation - pair it to make an effective tool

Why might an individual choose medication over psychotherapy if the side effects of the drug are extensive?

Time- saver Less money (at least short term)

What did Lovaas et al. find when he administered shocks? Were there any stimulus generalization effects?

Two additional observations are of interest. The first pertains to the generalization of the suppression effect across experimenters. Up to Session 29, he was punished only by Experimenter 1. The suppression effected by Experimenter 1 generalized only partly to the other experimenters. By Sessions 25, 26, and 27 it can be observed that his rate of self-destructive behavior with the non-punishing adults was climbing alarmingly; he started to form a discrimination between the adult who punished him for self-destruction, and those who did not. In Session 30, Experimenter 3 punished John for self-destruction, producing generalization across other experimenters. The second observation of interest pertained to the generalization of the shock effects to behaviors that were not punished. As selfdestructive behavior was brought down by shock, John avoided the attending adult less and also whined less. Apparently, avoiding, whining, and self-destructive behavior fell within the same response class. These data indicated that the side effects of punishment were desirable. Informal clinical observations further confirmed the finding (John was observed by some 20 staff members), the nurse's notes reporting less distance and less fussing. The hallway and the bath were immediately adjacent to the location in which he was shocked, and maintained the suppression. The effect of shock did not generalize to rooms some distance away (e.g., in another part of the ward) from punishment situation. What is the conclusion ? Does positive punishment work? To distinguish behavior like self-harm Yes, but did not generalize much outside of experimental environment - would be in rooms similar or close to experimental room Was not a follow up of these children after this study This highlights one of real strengths and drawbacks of behaviorism - this works, study was example of one of the hardest things to change; downside - because of how learning works difficulties with treatment (stimulus generalization) Stimulus generalization biggest difficulty of all education - organizm will learn an association, but what it learns will typically be stimulus generalization- will learn in environment ; this class is problematic in terms of generalization - this class is useless unless we can generalize it, apply to other class/life/work; if not and compartmentalize to 50 minutes - useless All learning relies on generalization to be successful - whether frog or child- more cog capability you have, more ability to abstract to other settings/concepts

What are common emotions associated with termination?

Universal theme - Ekman says loss is a universal theme, which results in sadness, grief (typically experience strong negative and sad emotion); this is powerful stuff; strongest positive emotion we can experience is love, strongest negative is loss and grief/opponent - people highly motivated towards love and away from loss - stronger the love, stronger the loss experience - losing partner that you have had for 40 years is traumatic, known for a week is less so, but still probably sad Typical emotions associated with termination Denial Emotional response Universal theme: Sadness/grief to loss Uncertainty Causes anxiety Threat Stress - in response to change Avoidance No show Don't show up for last session, so you don't have to deal with saying goodbye Acting out Actively do something to make something uncomfortable into comfortable Anger Ie. In a relationship cheat as way to get out In therapy, "you've never helped me!" Regression of symptoms (to keep you in therapy)

How effective is exposure therapy?

Very effective ; especially for exposure In general effect size is 1.12; in cohens d (range from 0-2); placebo is .56; so 1.12 is very good Use a lot of PTSD Use a lot with OCD Exposure and response prevention - specific form of therapy that we use for OCD - use exposure, but because the client ahs obsessions and compulsions - intentionally activate obsession then prevent them from compulsions Person will have anxiety response - get to point where anxiety is high and they want to do compulsions , but dont let them; anxiety still goes down - they learn that they dont need to do compulsion to treat anxiety High potential for drop out - 20% will refuse, 20% drop out prematurely Effectiveness lower than efficacy Because of things like attrition As few as three sessions; 3-20 Dont stop session prematurely before anxiety lowers - can be dangerous to not 50 minutes usually but can go more It is very effective because it is associated directly with the central nervous system and deals with habituation • Most effective for PTSD o Especially prolonged exposure o Better than drug therapies and non-exposure treatments o Decrease symptoms of intrusive images and physiological arousal • Effective with OCD o More so than medication when combined with response prevention • Most consistent strong effect for Panic Disorder • Effective with Social Anxiety disorder

According to Glick, why is there so little evidence about combining therapy and medication?

Why is there so little evidence? In part it is because controlled studies take considerable time and money, and in part, because some of the studies that have been done have not found the synergistic or additive benefits we discuss. It also may be that negative findings result from low power to detect additive benefits of combined treatment over the benefits of either modality alone. And finally it may be because the methodology is so complex, i.e. a medication placebo control may be needed The evidence summarized above supports the finding that combining medication with psychotherapy is more effective than drugs alone in treatment of schizophrenia, bipolar disorder, depression, ADHD, bulimia, sleep disorders, and possibly PTSD. In no other disorders has combined treatment met the standard criteria that establish empirical support.

Is behavioral therapy an effective treatment for children with autism?

Yes Contingency management procedures were significantly more effective than were other procedures. Interestingly, the analyses found that performing a for- mal behavioral or functional analysis increased treatment effectiveness. That and other meta-analyses (Prout & Nowak- Drabik, 2003) demonstrate the probable superiority of behavioral and cognitive-behavioral therapies over other, less studied psychotherapies in the treat- ment of developmental disabilities. Individual treat- ment, as opposed to group treatment, employing contingency management seems to produce the most positive results.

According to Nurius et al., why don't clinicians always use "mindful" decisions?

t is simply not tenable to be continually "on" in a wholly thoughtful or mindful fashion; Even when a decision is personally important, a person rarely has sufficient time, energy, or inclination to consider each option, to weigh every consideration. And even if it were possible, such a strategy would be very costly in terms of time and energy, and thus it would be inefficient and even stifling. Instead, social workers often rely on a number of cost-effective, "quick and dirty" inferential shortcuts to help them sort through and winnow the vast numbers of inputs and outputs. reliance on inferential shortcuts is as true of everyday life as it is of the myriad activities involved in clinical practice. The pressures to draw on and subsequently rely on these distilling aids is further amplified in clinical practice--where information typically is biases are inherent in the human cognitive apparatus rather than errors stemming from mere confusion or insufficient information - reliance on biasing aids is essential to manageable reasoning strategies. The authors qualify the term "bias" to emphasize the meaning intended here. "Biased" essentially means "nonrandom"--a tendency to operate in a particular patterned or directional manner. must rely on some assumptions, rules of thumb, and habits to provide direction

What is an ABAB design and why is it used?

the person receiving the treatment is measured repeatedly: before intervention (baseline, A); during the time when the intervention is in effect (B); during a subsequent period when the intervention is temporarily discontinued (return to baseline, A); and again under the influence of the therapeutic intervention (B). if client's behavior improves during the periods when treatment is administered and is worse during the initial period and at any other time when treatment is withdrawn, then the treatment itself is presumed to be causally responsible for the change. Here again we cannot determine precisely what in the treatment package accounts for the behavior change. Was it the client's expectations, the therapist's special attention, the treatment itself, or another uncontrolled variable? many behavior therapists have argued persuasively that there are legitimate research alternatives to the traditional multigroup design that uses placebo and/or no-treatment control groups. They argue that well-controlled case studies or studies with a small-n can yield valid data with techniques such as multiple baseline or ABAB designs

What are the characteristics of implosive therapy (number of sessions, etc.)?

• 3-20 sessions, brief, problem focused, run over 50 min • Want to finish the session, if not, anxiety can increase and it reinforces avoidance or escape • Rapport is critical because need connection or they will quit

According to Craske et al., what is emotional processing theory?

• EPT -- combines habituation with the concept of corrective learning to explain the effects of exposure therapy proposes a hypothetical sequence of fear-reducing changes that is evoked by emotional engagement with the memory of a significant event, particularly a trauma. • from activation of a "fear structure" and integration of info that is incompatible with it, resulting in the development of a non-fear structure that replaces or competes with the original one • Fear structure = set of propositions about a stimulus (spider), response (racing heart), and their meaning (I will be poisoned). Fear structure is placed when inputs match part of the structure, which generalizes to activate other parts of the structure. The concept of habituation was combined with the concept of 'corrective learning' to explain the effects of exposure therapy in the widely known 'emotional processing' theory; subsequently revised to take into account developments in context specificity of extinction (Foa & McNally, 1996). EPT purports that the effects of exposure therapy derive from activation of a 'fear structure' and integration of information that is incompatible with it, resulting in the development of a non-fear structure that replaces or competes with the original one. A 'fear structure', as first put forth by Lang (1971), is a set of propositions about a stimulus (e.g., spider), response (e.g., racing heart) and their meaning (e.g., 'I will be poisoned') that are stored in memory. The fear structure is posited to be activated by inputs that match part of the structure (such as a spider, a racing heart or a thought about poisoning), which generalizes to activate other parts of the structure. The index of activation is fear, measured subjectively and physiologically. Once activated, corrective learning occurs through integration of information that is incompatible with the structure. Incompatible information derives from two primary sources. The first is within-session habituation (WSH) of the physiological and/or verbalized fear response, that disassociates the stimulus from response propositions (i.e., the stimulus is no longer connected with fear responding). WSH is considered a necessary pre-requisite for the second piece of incompatible information, which derives from between-session habituation (BSH) over repeated occasions of exposure. BSH is purported to form the basis for long-term learning, and to be mediated by changes in the meaning proposition, in the form of lowered probability of harm (i.e., risk) and lessened negativity (i.e., valence) of the stimulus. Hence, successful learning is indexed by initial fear activation (IFA), WSH and BSH habituation of the fear response. EPT clearly guided the focus of exposure therapy upon initial elevation followed by within- and between-session reductions in reported fear and physiological arousal, as continuation of those responses was presumed to represent erroneous evaluation of the probability of risk and negative valence.

What are some criticisms of exposure therapies?

• Theory of EMDR is not well developed • It is basically CBT • Very hard for patient- stressful • Eye movements may be benign • Psychoanalytic- Reducing phobic behavior is insufficient • Humanistic- Client does not play a central role in giving meaning to the feared scenes or events • Cultural- Traumatized people require compassion and respect

According to Craske et al., what do the data suggest about within-session and between-session habituation?

• Within Session → appears to mediated by mechanisms that are different than the mechanisms responsible for long-term outcomes There is very little evidence that WSH relates to superior outcomes overall • Between Session → some evidence that the amount by which fear declines across occasion of exposure predicts outcomes • Also doesn't seem to be a required precursor to BSH Group differences in WSH of reported fear did not predict group difference in BSH • WSH disassociates the stimulus from response propositions (stimulus is no longer connected with fear responding) Need WHS as pre-requisite for the second piece of incompatible info which comes from BSH 2 WSH is measured as the difference between the peak response and the end response of an exposure trial. there is very little evidence that WSH relates to superior outcomes overall. Other studies do not find support for WSH as a predictor of outcome there is no good evidence to indicate that such declines are indicative of learning or of long-lasting improvement. • BSH appears to form the basis for long-term learning and to be mediated by changes in the meaning proposition, in the form of lowered probability of harm and lessened negativity of the stimulus BSH is measured either as the difference in peak responses from the first to the last exposure trial or the difference between the end response of a former exposure trial and the beginning response of the next exposure trial, although this latter method confounds WSH with BSH Thus, like the other indices of EPT, the evidence for BSH is limited. • Evaluation of the role of IFA, WSH and BSH requires continuous measurement of self-reported fear and physiology throughout exposure trials that are conducted on at least two separate occasions, spaced apart enough to capture long-term learning • As seen below, only a handful of studies adequately assess IFA, WSH and BSH Basically what these do is measure the changes in the fear response after exposures. They found that this was not an accurate way to measure change and does not relate to a better outcome.