PSYC 360- Exam 1, Psyc 360- Exam 2

Behavioral Techniques (CT)

Behavioral techniques are also used to expand patients' response repertories (skills training), relax them (progressive muscle relaxation) or make them active (activity scheduling), prepare them for avoided situations (behavioral rehearsal), or expose them to feared stimuli (exposure therapy). Homework gives patients the opportunity to apply cognitive principles between sessions. Exposure therapy serves to provide data on the thoughts, images, physiological symptoms, and self-reported level of tension experienced by the anxious patient. Specific thoughts and images can be examined for distortions, and specific coping skills can be taught Behavioral rehearsal and role playing are used to practice skills or techniques that are later applied in real life. Modeling is also used in skills training Diversion techniques, which are used to reduce strong emotions and decrease negative thinking, include physical activity, social contact, work, play, and visual imagery. Activity scheduling provides structure and encourages involvement. Rating (on a scale of 0 to 10) the degree of mastery and pleasure experienced during each activity of the day achieves several things: Patients who believe their depression is at a constant level sec mood fluctuations; those who believe they cannot accomplish or enjoy anything are contradicted by the evidence; and those who believe they arc inactive because of an inherent defect arc shown that activity involves some planning and is reinforcing in itself. Graded-task assignment calls for the patient to initiate an activity at a nonthreatening level while the therapist gradually increases the difficulty of assigned tasks Cognitive therapists work in a variety of settings. Cognitive therapists generally adhere to 45-minute sessions Confidentiality is always maintained, and the therapist obtains informed consent for audiotaping and videotaping. Such recording is used in skills training or as a way to present evidence contradicting the patient's assumptions. Sessions arc usually conducted on a weekly basis, with severely disturbed patients seen more frequently in the beginning Whenever possible, and with the patient's permission, significant others such as friends and family members are included in a therapy session to review the treatment goals and explore ways in which the significant others might be helpful. Problems sometimes result from unrealistic expectations about how quickly behaviors should change, from the incorrect or inflexible application of a technique, or from lack of attention to central issues Beck, Rush, Shaw, and Emery (1979) provide guidelines for working with difficult patients and those who have histories of unsuccessful therapy: ( 1) Avoid stereotyping the patient as being the problem rather than having the problem, (2) remain optimistic, (3) identify and deal with your own dysfunctional cognitions, (4) remain focused on the task instead of blaming the patient, and (5) maintain a problem-solving attitude.

enactments

Client and therapist end up playing complementary roles in relational scenarios

1949 Boulder Conference

Scientist-practitioner model adopted with Clinical Psychology

expressing emotions

y termination rate. In traditional deficit-oriented psychotherapy, many therapists believe one way to minimize negative emotions is to express them, especially bottled-up anger. Clients are encouraged to express anger with an assumption that if it is not expressed then it will simply manifest itself through other symptoms. The self-help therapeutic literature abounds with phrases such as "hit a pillow," "blow off the steam," and "let it out" that illustrate this kind of hydraulic thinking. However, this approach has left current psychotherapy as largely a science of victimology, one that portrays clients as passive respondents to life and life circumstances. Drive, instinct, and need create inevitable conflicts, which can only be partially relieved through venting. In our view, venting is at best a cosmetic remedy and at worse a treatment that may trigger both resentment and heart disease (Chida & Steptoe, 2009). There is an alternative approach: learning to function well in face of dysphoria or psychological distress.

Philip Romberg

"From outside in"- Understanding the client through the schemas they have built Allows them to get a glimpse of how the client processes info

Historical foundations of psychotherapy

-Practiced in pre-Christian retreat centers, tribal ceremonies, religious healing -Hellinist physicians: Hippocrates gave us concept of "do no harm"

Transpersonal Growth

Techniques: -The Cultivation of Love, Compassion, and Joy -Lucid Dreaming

Behavioral Health

"The interdisciplinary field concerned with the development and itnegration of behavioral, psychosocial, and biomedical science knowledge and techniques relevant to the understanding of health and illness, and the application of this knowledge and these techniques to prevention, diagnosis, treatment and rehabilitation." - Society of Behavioral Medicine -Preserving health and preventing illness through lifestyle changes -Managing chronic illness

Socratic Dialogue

(1) asking informational questions (2) listening (3) summarizing (4) asking synthesizing or analytical questions that apply discovered information to the patient's original belief Socratic dialogue implies that the patient arrives at logical conclusions based on the questions posed by the therapist. Questions are not used to "trap" patients, lead them to inevitable conclusions, or attack them. Questions enable the therapist to understand the patient's point of view and are posed with sensitivity so that patients may look at their assumptions objectively and nondefensively.

Self Psychology (Kohut)

*Relationships create the structure for the self *Initial needs involving others (selfobject) are narcissistic *Responding to a child's narcissistic needs in an empathic accepting way establishes a sense of self *Initial sense of self is grandiose *Grandiosity eventually evolves into ambition and self-esteem *Love illustrates an adult form of mirroring—people represent self objects for each other and demonstrate mutual mirroring

Mesmer

- Discredited exorcist tradition in pre-Enlightenment Europe -Promoted the principle that rapport between therapist and patient was important -Stressed that influence of the unconscious in shaping behavior and demonstrated the influence of personal qualities of therapists; spontaneous remission of disorders; hypnotic somnambulism; the selective, inferential function of memories of which we have no conscious awareness

What is a psychiatric disorder?

-"Theory of personality" What causes distress? Why might someone develop distress? *Distress is normal, common, and expected* Trying to describe distress, its function, and how it is interfering in someone's life- distress is expressed in terms of symptoms

Gottfried Wilhelm Leibniz

-1646-1716 -Looked at the role of subliminal perceptions in our daily life -Coined the term *dynamic* to explain the forces that operate in unconscious mentation

Johann Friedrich Herbart

-1776-1841 - Continued Leibniz's work -Attempted to mathematize the passage of memories to and from the conscious and unconscious -Suggested that tacit ideas struggle with each other for access to consciousness as dissonant ideas repel and depress each other

Comparing psychotherapies

-Each variable is VALUABLE BUT ONLY PARTIAL to understanding and treatment -Claims for blanket supremacy of any one approach are subject -Effective therapies share a variety of methods and mechanisms -Different therapies may be complementary -Therapists familiar with one system are likely to treat everyone the same -Good therapists are flexible and familiar with multiple methods

Natural science empiricists

-Fechner: Tried to measure the intensity of psychic stimulation needed for ideas to cross the threshold from the unconscious to full awareness and intensity of resultant perception-had an impact on Europe at the time -Helmholtz: discovered the the phenomenon of "unconscious interference," which was seen as an instantaneous and unconscious reconstruction of what our past taught about the project -Kraeplin: How do we get the science out of the lab? Begins to classify illnesses with the DSM

Freud

-Hysteria resulted from trauma -Therapy attempts to uncover painful emotions -Emphasized scientific rigor

REBT, CT, and CBT

-REBT practitioners assume their clients practically always have explicit and implicit "musts" that contribute to their emotional disturbances, and practitioners sometimes will quickly get to clients' core beliefs in the first session so that the clients clearly identify and start modifying these beliefs. -REBT emphasizes philosophizing more than CT does and encourages healthy use of the mind to facilitate greater happiness. REBT uses cognitive methods with strong emotional and behavioral overtones; it uses emotional-evocative techniques with powerful thinking and behaving; and it uses its behavioral techniques with forceful thinking and emotions. -REBT emphasizes the benefits of incorporating the practice of unconditional acceptance-specifically: (1) unconditional self-acceptance (USA), (2) unconditional other acceptance (UOA), and (3) unconditional life acceptance (ULA). -REBT practitioners tend to use their techniques more directly, forcefully, strongly and quickly than cognitive therapists. Can be tested by creating experiments and studying which method is more effective with different kinds of clients.

empirically supported treatments

-Randomized controlled trials -Treatment manuals -Limitations: most therapists don't use them on a day-to-day basis

Psychologist-Philosophers

-Schopenhauer: The World as Will and Representation (1819)- Schopenhauer argues that will is the being of all things, but the advanced cognitive abilities of humans, serve the ends of willing—an illogical, directionless, ceaseless striving that condemns the human individual to a life of suffering unredeemed by any final purpose. -Carl Gustav Carus: Looked at role of unconscious in communication and how to draw the unconscious out; therapist transference occurs at an unconscious level even as therapist and patient greet each other for the first time -Neitzsche: We lie to ourselves more than we lie to others; developed notions of self-deception, sublimation, repression, conscience, and "neurotic guilt"; unlocked many of the defense mechanisms that humans employ to embellish their persona and self-image

Issues with CT

-Some people mistake mindfulness for the totality of contemplative practices -Meditation practices have been ripped from their context, which reduces their benefits -Contemplative research measured is easy to measure while the unique benefits remain unresearched -Motive to foster one's well being and that of others is often overlooked -Some professionals are rushing to set themselves up as contemplative therapists, sometimes with little training and practice

Integrating CT

-The search for underlying common factors -Technical eclecticism(combining techniques) -Theoretical integration Widespread popularity Limitations -Misperceptions -Heterogeneous outcomes -Therapists training -Incomplete implementations

Necessary and Sufficient Conditions

-Two people are in psychological contact -Client is in a state of incongruence -Therapist is congruent or integrated in relationship -Therapist experiences unconditional positive regard for the client -Therapist experiences an empathic understanding of the client -Client perceives therapists' empathic understanding and unconditional

Classical Conditioning

-a conditioned stimulus (CS), comes to signal the occurrence of a second stimulus, an unconditioned stimulus (US), which causes an unconditioned response (UR) -Extinction: CS no longer signals the occurrence of the US and stops triggering a response -Reinstatement: Return of fear after extinction

Treatment (BT)

.Behavioral Assessment: -Uses multiple methods in multiple situations -targets may include behavioral deficits, behavioral excesses, and problems· in the client's environment -functional analysis: manipulating variables in the environment and measuring their impact on target behaviors; ABC method -Consider info sources Behavioral Interviews: Therapist obtains a detailed description of the problem behavior, including information on the frequency, duration, and severity. The therapist also typically asks about the development and course of the problem over time. Behavioral Observation: -Naturalistic Observation: Assessment occurs in natural environment -Analog Observation: Assessment occurs in simulated situation -Reactivity: Behavior is affected by the assessment Monitoring Forms and Diaries: Can help a client become more aware of a problematic behavior that would otherwise go unnoticed Self-Report Scales: Quick ways to assess behavior; only offers some indication Psychophysiological Assessment: Measurements of the client's physiological responses

developmental arrest

1. Psychological problems are due to caregivers' failure to provide "good enough" environment 2. Infants believe they are omnipotent and wishes are fulfilled by mother- have to learn slowly to accept limitations of others 3. Optimal Disillusionment 4. False Self- develops if all needs are met

Invisible Knapsack

1. Go shopping alone most of the time, pretty well assured they will not be followed or harassed. 2. Turn on the television or open to the front page of the paper and see European American people widely represented. 3. Count on their skin color not to work against the appearance of financial reliability whenever they use checks, credit cards, or cash. 4. Be pretty sure of renting or purchasing housing in an area that they can afford and in which they would want to live. 5. Avoid the need to educate their children to be aware of systemic racism for their own daily physical protection. 6. Remain oblivious of the language and customs of persons of color who constitute the world's majority without feeling any penalty for such oblivion. 7. Exist with little fear about the consequences of ignoring the perspectives and powers of people of other races. 8. Confront a person of their own race if they ask to talk to the "person in charge." 9. Be confident that if a state trooper pulls them over, they haven't been singled out because of their race. 10. Take jobs with affirmative action employers without having co-workers suspect that they were hired because of their race.

stages of psychosexual development

1. Oral Stage 2. Anal Stage 3. Phallic Stage 4. Latency Stage 5. Genital Stage

Psychological theory (REBT)

1. People can stand obnoxious adversities, even though they may never like them. 2. Adversities are hardly awful, because awful is an essentially indefinable term, with surplus meaning and little empirical referent. 3. By holding that the unfortunate happenings in their lives absolutely should not exist, people really imply that they have godly power and that whatever they want not to exist must not. T 4. By contending that they are worthless persons because they have not been able to ward off unfortunate events, people hold that they should be able to control the universe and that because they are not succeeding in doing what they cannot do, they are obviously worthless.

Gay/lesbian Identity development stages

1. confusion-individuals question their sexual orientation; 2. comparison-individuals accept the possibility that they may bel_ong to a ·sexual minority; · 3. tolerance-recognition that one is gay or lesbian; 4. acceptance-individuals increase contacts with other gays and lesbians; 5. pride-people prefer to be gay or lesbian; and 6. synthesis-people find peace with their own sexual orientation and reach out to supportive heterosexuals

stages of white racial identity development

1. contact-individuals are aware of minorities but do not perceive themselves as racial beings; 2. disintegration-they acknowledge prejudice and discrimination; 3. reintegration-they engage in blaming the victim and in reverse discrimination; 4. pseudoindependence-they become interested in understanding cultural differences; and 5. autonomy-they learn about cultural differences and accept, respect, and appreciate both minority and majority group members.

First set of multicultural guidelines

1. recognize cultural diversity; 2. understand the central role that culture, ethnicity, and race play in culturally diverse individuals; 3. appreciate the significant impact of socioeconomic and political factors on mental health; and 4. help clients understand their cultural identification (APA, 1990).

Second set of principles

1. recognize that we are cultural beings, 2. value cultural sensitivity and awareness, 3. use multicultural constructs in education ) 4. conduct culture-centered and ethical psychological research with culturally diverse individuals, 5. use culturally appropriate_ skills in applied psychological practices, and 6. implement organizational change processes to support culturally informed organizational practices and policy (APA, 2003).

Roger's Theory of Personality

1. self-actualizing tendency 2. self-concept 3. real self 4. ideal self

token economy

A behavioral therapy technique based on operant conditioning in which patients' positive behaviors are reinforced with tokens that they can exchange for desirable items.

Cultural Considerations (BT)

A challenge in behavior therapy is finding ways to encourage clients to use methods that may not fit with their cultural assumptions and beliefs or to adapt behavioral methods so they arc more consistent with the client's values or expectations. Increasingly, therapists are being taught to adopt a more culturally responsive approach to behavior therapy, including being more aware of their own biases, learning about the cultures of their clients from a variety of sources (other than just the client), and learning about the unique ways in which one's clients have been influenced by their cultural experiences. Culture can influence a client's behaviors and response to treatment in many ways. Culture may also affect the client's reactions to the therapist (including the therapist's gender or manner of dressing, for example) Cultural differences between therapist and client may create language barriers that make psychotherapy difficult, or they may affect a client's trust in the therapist. For example, Native American clients are profoundly aware of their people's history of mistreatment from European Americans, and some Native American clients may find it difficult to trust therapists from a European ancestry. For most psychotherapies, there is relatively little research on treating individuals from ethnic minority groups, and behavior therapy is no exception.

projective identification(Klein)

A defense mechanism that operates unconsciously, whereby unwanted aspects of the self are attributed to another person and that person is induced to behave in accordance with these projected attitudes and feelings.

evaluation phobias

A fear of disparagement or failure in social situations, examinations, and public speaking. The behavioral and physiological reactions to the potential "danger" (rejection, devaluation, failure) may interfere with the patient's functioning to the extent that they can produce just what the patient fears will happen.

Dichos

A form of flash psychotherapy that consists of Spanish proverbs or idiomatic expressions that capture folk wisdom

manualized therapy

A form of therapy, often used in research, in which a manual describes a set course of therapy, indicating what steps the therapist should take, what instructions to offer, and so on. Advantages: -Lets the therapist and client see what is going to happen Disadvantages: -Doesn't normally generalize to other groups very well -Can lose out on more general steps to help clients, because it is so narrow

emotional insight

A level of understanding or awareness that one has emotional problems; it facilitates positive changes in personality and behavior when present

Ethnocultural Assessment (MT)

A multicultural tool for both evaluation and treatment, the ethnocultural assessment explores diverse areas in the development of cultural identity. The domains of ethnocultural assessment include heritage, journey, self-adjustment, and relationships (Comas-Diaz &Jacobsen, 2004). In exploring heritage, therapists examine clients' ethnocultural ancestry (including parents' genealogy), history, genetics, and sociopolitical contexts. Of particular relevance is the examination of cultural trauma. Exploring journey entails examining the family, clan, and group story. In addition, they explore their clients' history of immigration and other significant transitions. Moreover, they explore the post transition analysis, giving special attention to clients' intellectual and emotional interpretation of their journey. Therapists examine clients' individual adaptation separate from their family during the self-adjustment phase. Clients' coping styles, including cultural resilience, are assessed in this domain. In the relationships domain, therapists explore clients' significant affiliations, including the therapeutic relationship.

one-person psychology

A phrase referring to the classical psychoanalytic understanding of the analyst and patient being distinctly separate people, with the analyst in possession of objective knowledge about the patient that is imparted to her or him via interpretation and other interventions.

testimonio

A reaction to Latin American political oppression, testimonio chronicles traumatic experiences and bow these have affected the individual, family, and community

fellow travelers

A relationship between the patient and therapist that seeks to break down distinctions to become on the same level "We're all in this together" No one is immune to the other concerns

motivational interviewing

A skillful clinical style for eliciting from patients their own good motivations for making behavior change- Miller and Rollnick Interviewing = strategic questioning and listening -Both open-ended and directive

Neoteny

A slowing of the process of maturation, allowing more time for growth; an important factor in the development of large brains

Psychotherapy (REBT)

A therapist who sees someone who is afraid of being rejected (that is, one who demands that significant others accept him) can try to divert him into activities, exercises, meditation, or preoccupation with the events of his childhood If a client's insistences are always catered to, she or he will tend to feel better, so a therapist can give her or his love and approval, provide pleasurable sensations (for example, put the client in an encounter group to be hugged or massaged), which teach methods of having demands met. Adolescent and adult demanders can be led to believe (by a therapist or someone else) that their therapist is a kind of magician who will take away their troubles merely by listening to what bothers them, but they rarely work for any length of time and frequently lead to eventual disillusionment. The most elegant solution to the problems resulting from irrational demandingness is to help individuals become less demanding.

systemic desensitization

A type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias.

Primary Assumptions (PPT)

Distress is caused by thwarted capacities or unbalanced strengths Positive emotions and strengths are real and valuable Effective therapeutic relationships can be built on exploration of positive personal characteristics

ADDRESSING framework

Age, disability status, religion, ethnicity/race, sexual orientation, socioeconomic status, indigenous background, national origin, gender

Current status (CCT)

Association for the Development of the Person-Centered Approach (1986) -Interdisciplinary -Meets annually Person-Centered Journal

Fusion

Attempt to deal with isolation by softening their ego boundaries and become part of another individual Fills the void of isolation

Containment

Attending to our own emotions when working with clients and cultivating the ability to tolerate and process painful or disturbing feelings in a non defensive fashion By which someone comes to learn and tolerate their emotions instead of using defense mechanisms to avoid

Goals of Multicultural Therapy

Address cultural trauma Experience is valuable knowledge Healing results from: -Empowerment -Sharing multiple perspectives -Anchored in meaningful and relevant contexts

Methods of psychotherapy (REBT)

Address must -Role play -Humor -Unconditional acceptance -Strong disputing ABCD: -Identify ABC -Ask: Does this serve me? -Dispute: irrational (awfulizing, absolutist) beliefs; demonstrate logical fallacies -Admit and face: own role in reindoctrination

methods of psychotherapy

Empathy: I know exactly what you're going through Clarification: Used to build on empathy Interpretation: How accurate is my interpretation? Support/Advise: Look to balance any support/advice with empathy Framework to understand suffering Not a comprehensive system of techniques

Beginnings of REBT

Albert Ellis discovered that no matter how much insight his clients gained or how well they seemed to understand events from their early childhood, they rarely lost their symptoms and still retained tendencies to create new ones since they constructed dysfunctional demands on themselves and others and kept indoctrinating themselves with these commands. Ellis also discovered that as he pressed his clients to surrender their basic irrational premises, they often tended to resist giving up these ideas. Ellis concluded that humans are self-talking, self evaluating, and self-construing. They frequently take strong preferences, such as desires for love, approval, success, and pleasure, and misleadingly define them as needs. They thereby create many of their "emotional" difficulties. Ellis also discovered that people's irrational assumptions were so biosocially deep rooted that weak methods were unlikely to budge them. Passive, nondirective methodologies (such as reflection of feeling and free association) rarely changed them. Warmth and support often helped clients live more "happily" with unrealistic notions. Suggestion or "positive thinking" sometimes enabled them to cover up and live more "successfully" with underlying negative self-evaluations. What did work effectively, Ellis found, was an active-directive, cognitive-emotive behavioral attack on major self-defeating "musts" and commands.

BT and other systems

Aligns with other directive and brief therapies, such as cognitive therapy and rational emotionative behavior therapy Combines behavioral strategies with cognitive oriented techniques, such as changing negative thoughts Different from psychoanalysis, as BT's don't accept views about the unconscious, such as psychosexual conflicts Different from CCT, as it is directive and includes hw practices Overlaps with Gestalt and Family therapy

Theory of Psychotherapy (BT)

All behavior is learned through association, consequences, observation, or rules learned through communication and language BT does not emphasize the relationship between therapist and client Challenge in behavior therapy is to keep clients motivated so that they are fully engaged in treatment Clients can be helped using techniques such as motivational interviewing (a client-centered approach designed to help clients explore and resolve sources of ambivalence about therapy) before starting behavioral treatment

Basic assumptions (CCT)

All humans have an actualizing tendency -Formative tendency -Best that they can doesn't work in the environment they are in Reacting as a whole Humans are basically good

Other Systems (PPT)

Almost all other psychotherapy systems aim to address basic human deficiencies, and all of them focus on what can be called negative thoughts, feelings, and behavior Likewise, most psychotherapies focus much more on undoing the wrongs rather than on what has gone well in clients' lives. Although this focus has resulted in treatments that reduce symptoms for many disorders—including depression, schizophrenia, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, phobias, panic disorder, and eating disorders (Barlow, 2014)—we believe this exclusive focus on negatives has reached a dead end. About 30% to 40% of clients see no benefits. Moreover, a small group of clients—between 5% and 10%—actually deteriorate during therapy (Lambert, 2007). Psychotherapy, in our view, faces a high and significant barrier termed the 65% barrier. We believe that PPT can aid in overcoming this obstacle

Theory of Personality(REBT)

Although REBT holds (1) that people are born constructivists and have considerable resources for human growth and (2) that they are in many important ways able to change their social and personal destinies, it also holds (3) that they have powerful innate tendencies to think irrationally and to defeat themselves People frequently defeat themselves by their inborn and acquired self-sabotaging ways. Emotional disturbance is frequently associated with caring too much about what others think. This stems from people's belief that they can accept themselves only if others think well of them.

Existential Psychotherapy

An approach to psychotherapy, related to the humanistic approach, that centers on the premise that each person is essentially alone in the world, and that realization of this fact can cause overwhelming anxiety Focuses on the present to help confront the ultimate concerns

British Independents

Analysts that were influenced by both Freudian and Kleinian ideas, but unwilling to politically align with either tradition

Liberation (MT)

Another communal ethnic psychotherapy is the psychology of liberation. Based on the Latin American theology of Iiberation, the 'psychotherapy of liberation emerged as a response to sociopolitical oppression. Its architect-Ignacio MartinBaro (in Blanco, 1998)-was both a psychologist and a priest. Likewise, psychology of liberation resonates with African American psychology based on black liberation theology and Africanist traditions. Such a spiritual basis affirms ethno-racial-cultural strengths through indigenous traditions and practices. Liberation practitioners attempt to work with people in context through strategies that enhance awareness of oppression and of the ideologies and structural inequality that have kept them subjugated and oppressed. Similar to Paulo Freire's critical consciousness, liberation therapists collaborate with the oppressed in developing critical analysis and engaging in transformative actions.

satisficing versus maximizing

Another exercise in the middle part of PPT that helps clients understand how to be aware of energy and time expenditures on tasks and to manage this expenditure toward appropriate and beneficial ends The intent of this exercise is to raise awareness in clients that we often spend a lot of time in purchasing material goods that either distract us from encountering negatives head-on or fail to add much to our well-being

Client-centered approach

Approach asserts clients are persons

Cognitive Distortions (CT)

Arbitrary inference: Drawing a specific conclusion without supporting evidence or even in the face of contradictory evidence. An example is the working mother who concludes, after a particularly busy day, I'm a terrible mother." Selective abstraction: Conceptualizing a situation on the basis of a detail taken out of context, ignoring other information. An example is the man who becomes jealous on seeing his girlfriend tilt her head toward another man to hear him better at a noisy party. Overgeneralization. Abstracting a general rule from one or a few isolated incidents and applying it too broadly and to unrelated situations. After a discouraging date, a woman concluded, "All men are alike. I'll always be rejected." Magnification and minimization: Seeing something as far more significant or less significant than it actually is. A student catastrophizes, "If I appear the least bit nervous in class, it will mean disaster." Another person, rather than facing the fact that his mother is terminally ill, decides that she will soon recover from her "cold." Personalization: Attributing external events to oneself without evidence supporting a causal connection. A man waved to an acquaintance across a busy street. After not getting a greeting in return, he concluded, "I must have done something to offend him." Dichotomous thinking: Categorizing experiences in one of two extremes-for example, as complete success or total failure. A doctoral candidate stated, "Unless I write the best exam they've ever seen, I'm a failure as a student."

Middle and Later Sessions (CT)

As cognitive therapy proceeds, the emphasis shifts from the patient's symptoms to the patient's patterns of thinking. There is usually a greater emphasis on cognitive than on behavioral techniques in later sessions, which focus on complex problems that involve several dysfunctional thoughts. Often these thoughts are more amenable to logical analysis than to behavioral experimentation Often such assumptions outside the patient's awareness are discovered as themes of automatic thoughts. When automatic thoughts are observed over time and across situations, assumptions appear or can be inferred In later sessions, the patient assumes more responsibility for identifying problems a11J solutions and for creating homework assignments. The therapist takes on the role of adviser rather than teacher as the patient becomes better able to use cognitive techniques to solve problems. The frequency of sessions decreases as the patient becomes more self-sufficient. Therapy is terminated when goals have been reached and the patient feels able to practice his or her new skills and perspectives independently.

Precursors (MT)

Attention to the other dates from the beginning of time. r rcqucntly, such attention has been in the form of concern, awareness, and even fascination. Diverse religious and spiritual traditions assigned an important role to the other. For instance, in Judaism the other is associated with sacred because otherness means holy in Hebrew. In Christianity, the concept of the necessary other facilitates the recovery of the divided self. Furthermore, a Buddhist view on the other as enemy entails that enemies are our best teachers because we learn the most from them. In accordance with spiritual traditions, multicultural psychotherapies aim to enhance the .relationship between self and other.

Addressing death

Awakening experience-confrontation of death Examine regret- Looks at things an individual might regret in their past Choice towards a "lived life"

Theory of Personality (PPT)

Bad childhood events do not determine adult personality Hundreds of studies investigating the effects of genetics on personality document that roughly 50% of all adult personality traits are directly attributable to personal genetic inheritance. Some highly heritable traits (such as sexual orientation and body weight) do not change much at all, whereas other highly heritable traits (such as pessimism and fearfulness) are extremely malleable. We believe happiness is one of those personality traits that can be changed It is not positive psychology's job to promulgate the belief that one should be optimistic or spiritual, or kind or good humored; however, PPT therapists can describe Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 488 | Chapter 13 the consequence of these traits. For example, meta-analytic finding show that optimism, spirituality, and positive coping style was associated with posttraumatic growth independently of posttraumatic stress

Addressing isolation

Balance isolation and support Reciprocity and mutuality Authenticity Alone together- encourage patients to be fellow travellers to others

Basic Concepts (CT)

Based on the idea that the processing of information is crucial for the survival of any organism. Cognitive schemas contain people's perceptions of themselves and others and of their goals and expectations, memories, fantasies, and previous learning. These greatly influence, if not control, the processing of information. Contributing to these shifts are certain specific attitudes or core beliefs that predispose people under the influence of certain life situations to interpret their experiences in a biased way. These are known as cognitive vulnerabilities. Current cognitive theory, benefiting from recent developments in clinical, evolutionary, and cognitive psychology, views all systems as acting together as a mode. Modes are networks of cognitive, affective, motivational, and behavioral schemas that compose personality and interpret ongoing situations. Phenomenological approach to psychology Structural theory and depth psychology

Assessment Scales (CT)

Beck's work has generated a number of assessment scales The Beck Depression Inventory is the best known of these. It has been used in hundreds of outcome studies and is routinely employed by psychologists, physicians, and social workers to monitor depression in their patients and clients.

Biomedical vs. Biopsychosocial

Biomedical: -Disease is always explained by abnormal, biological processes -Health means absence of disease -DIsease should be treated with medications and surgical intervention Biopsychosocial Model -Illness is explained by the interaction between biological, social and psychological factors -Health means balance between the 3 components -Illness should be treated with a combination of psychological, social, and medical approaches to approaches. Prevented through lifestyle choices

The influence of Freud

Bleuler and Jung began to use Freud's theories to account for findings: -delayed response times to emotionally charged words reflect the unconscious functioning of emotional complexes, where charged ideas are repressed because they are emotionally threatening Psychiatrists working with Jung and Bleuler established the Zurich Psychoanalytic Society- Freud thought Jung would become his successor and lead the movement, but theoretical and personal tensions caused a bitter end to their relationship

Current status of Behavior Therapy

Boundaries expanded with practice of REBT and cognitive therapy Albert Bandura: -Social learning and modeling -Social Cognitive Theory

Criticism of Client-Centered Therapy

Breaks down the problems of each individual as parts or constructs, instead of acknowledging that each human is a complex being Biased towards white, Western, middle class that fit within their issues and solutions Does not educated clients on the political context of their distress

Contemplative practices(CP)

Buddhist mindfulness- vipassana (insight meditation) Transcendental meditation- directing attention to a repetitive mantra that settles the mind into a clear, peaceful state Methods: -Meditation: Overlap with Jung's drive for individuation, Maslow's self-actualization and self-transcendence, Carl Rogers' formative tendency, and the contemplative motive for self-transcendence and awakening *Able to develop remarkable degrees of cognitive control with meditation practice *Seek to train attention and perception -Yoga *Encompasses practice of meditation *Movement is key piece Agree that we are all prone to numerous erroneous thoughts that easily become unrecognized erroneous assumptions and beliefs

Cuento Therapy

Empirically proven to be an effective treatment for Puerto Rican children

Theory of Psychotherapy (Roger)

CCT, in common with other therapeutic approaches, aim to ENHANCE THE LIFE FUNCTIONING and self-experience of clients. Unlike other therapies, CCT DOES NOT USE TECHNIQUES, treatment planning, or goal setting to achieve these end

Format and Structure of Behavior Therapy

Can be individual or group Interventions can be directed by therapist or others- Internet can help Therapy sessions vary in length and location Time limited: usually 10-20 sessions

Ethical issues (BT)

Can coerce clients to do something they don't want to: exposure therapy Client and therapist can disagree on treatment goals Therapist must maintain clear boundaries and confidentiality

Integrating psychopathology

Can look at multiple sources and a variety of causes

Goals of BT

Change Behavior Correct Maladaptive Learning Experiences Introduce Adaptive Learning

epigenetic changes

Changes to the chemical groups that associate with DNA that are transmitted to daughter cells after cell division based on external events and the richness of the culture

Operant Conditioning Strategies

Changing patterns of reinforcement and punishment in the environment Reinforcement-Based Procedures: -Differential reinforcement: reinforcing the absence of unwanted behaviors and the occurrence of desired alternative behaviors -Token economy -Contingency management: client's environment is changed so that unwanted behaviors are no longer reinforced Punishment-Based Strategies -Adverse conditioning: Disulfiram- treats alcohol dependence -Less effective

Conflict theory

Childhood neurosis common and expressed through anxiety In adulthood, neurosis occurs due to conflict between unconscious wishes and defense= intrapsychic conflict

Evaluating Psychological Disorders (PPT)

Chris Peterson (2006) has proposed a model for evaluating psychological disorders, and he addresses each of the 24 VIA strengths by asking: (1) What psychological state or trait reflects absence of character strength? (2) What state or trait signifies its opposite? (3) What state or trait displays its exaggeration? A disorder may result from the absence of a given character strength, but it can also result from its presence in extreme forms. Peterson (2006) argues that if psychology as usual uses a lens of abnormality to view normality, "then why not use the lens of normality or even super normality to view abnormality?

Activity Scheduling

Chronic illness can interfere with patients' abilities to engage in pleasurable or valued activities Decreased engagement can contribute to -Depression and anxiety -Social isolation and lower quality of life -Difficulties with treatment adherence and worsening of medical symptoms

Countertransference

Circumstances in which a psychoanalyst develops personal feelings about a client because of perceived similarity of the client to significant people in the therapist's life. Therapist reacts to the patient as a whole

Variety of Concept

Classical Conditioning: -a conditioned stimulus (CS), comes to signal the occurrence of a second stimulus, an unconditioned stimulus (US), which causes an unconditioned response (UR) -Extinction: CS no longer signals the occurrence of the US and stops triggering a response -Reinstatement: Return of fear after extinction Operant Conditioning: form of learning in which the frequency, form, or strength of a behavior is influenced by its consequences -Positive and negative reinforcement -Positive and negative punishment -Extinction- child stops tantrum when they don't get what they want -Discrimination learning: Response is reinforced or punished in one situation, but not another -Generalization: Generalizing a behavior to other situations -Vicarious Learning: Learning about environmental contingencies through others -RUle-Governed Behavior: People learning about contingencies through information they hear or read

Cultural Empathy (MT)

Clients of color expect psychotherapists to demonstrate cultural credibility. Credibility refers to the client's perception of the psychotherapist as a trustworthy and effective helper. Certainly, a therapist's credibility and trust foster a positive therapeutic alliance. To achieve this goal, multicultural psychotherapists aim to develop empathy for the "other." Types of empathy: -Somatic: nonverbal communication and body language -Cognitive empathy: emotional connectedness, a capacity to take in and contain the feelings of the client -Cultural: ability to place yourself in the other's culture Learned ability to understand experiences of culturally diverse individuals -Informed by cultural knowledge and interpretation -Empathic witness

Treatment (PPT)

Clients with symptoms of depression appear to benefit most from PPT exercises because these exercises explicitly generate positive emotions and experiences that counteract the client's depressed mood and feelings of sadness, hopelessness, and helplessness. In addition to depression, clients with co-occurring disorders (e.g., depression and anxiety, depression and adjustment issues) can benefit from PPT exercises that teach them to explore, develop, and use their character strengths such as hope, optimism, perseverance, and self-regulation The PPT treatment protocol shown in Table 13.3 may appear structured and sequential. However, PPT is actually a flexible psychoeducational approach. Its exercises can be adapted to address individual concerns and can be used in any sequence that meets a particular client's clinical needs Group PPT is more structured and more powerful than individual PPT because listening to group members' strength-based narratives and their ways of creating positive emotions and engagement often creates a therapeutic synergy that helps group members bond together in supporting each other's well-being. Group PPT has also been shown to be effective with a range of psychological disorders, including depression (Csillik, Aguerre, & Bay, 2012), addiction (Akhtar & Boniwell, 2010), borderline personality disorder (Uliaszek et al., 2016), posttraumatic stress (Gilman et al., 2012), and schizophrenia (Meyer, Johnson, Parks, Iwanski, & Penn, 2012) and with both children and adolescents (Rashid & Anjum, 2008). Similarly, positive relationship exercises help family members acknowledge, discuss, own, and value the character strengths they see in their families and themselves. PPT can be done as a stand-alone treatment, or its exercises can be used through a dismantling approach or easily integrated into well-established protocols such as cognitive behavior therapy

Cognitive Therapy (CT)

Cognitive therapy aims to adjust information processing and initiate positive change in all systems by acting through the cognitive system. In a collaborative process, the therapist and patient examine the patient's beliefs about him- or herself, other people, and the world. The patient's maladaptive conclusions arc treated as testable hypotheses. Behavioral experiments and verbal procedures are used to examine alternative interpretations and generate contradictory evidence that supports more adaptive beliefs and leads to therapeutic change.

Beginnings (CT)

Cognitive therapy began in the early 1960s as the result of Aaron Beck's research on depression. Trained in psychoanalysis, Beck attempted to validate Freud's theory of depression as having at its core "anger turned on the self." To substantiate this formulation, Beck made clinical observations of depressed patients and investigated their treatment under traditional psychoanalysis. Rather than finding retroflected anger in their thoughts and dreams, Beck observed a negative bias in their cognitive processing. With continued clinical observations and experimental testing, Beck developed his theory of emotional disorders and a cognitive model of depression. Both Ellis and Beck believed that people can consciously adopt reason, and both viewed the patient's underlying assumptions as targets of intervention. Similarly, they both rejected their analytic training and replaced passive listening with active, direct dialogues with patients. Whereas Ellis confronted patients and persuaded them that the philosophies they lived by were unrealistic, Beck "turned the client into a colleague who researches verifiable reality" Bandura's ( 1977) concepts of expectancy of reinforcement, self and outcome efficacies, the interaction between person and environment, modeling, and vicarious learning catalyzed a shift in behavior therapy toward the cognitive domain. Mahoney's (1974) early work on the cognitive control of behavior and his later theoretical contributions also influenced cognitive therapy. Meichenbaum's combination of cognitive modification and skills training in a coping-skills paradigm is particularly useful in treating anxiety, anger, and stress

Cognitive Therapy and Culture

Cognitive therapy begins with an understanding of the patient's beliefs, values, and attitudes. These exist within a cultural context, and the therapist must understand that context. Cognitive therapy focuses on whether these beliefs are adaptive for the patient and whether they pose difficulties or lead to dysfunctional behavior. Cognitive therapy does not work on changing beliefs in an arbitrary way, nor is it an attempt to impose the therapist's beliefs on the patient. Rather, it helps the individual examine his or her own beliefs and whether they foster emotional well-being. Sometimes people's personal beliefs arc at odds with the cultural values around them. Other times, a person's beliefs may be changing with cultural changes, as in rapid modernization or migration to a new country, and discrepancies may cause distress. In these cases, cognitive therapy may help patients think flexibly in order to reconcile their beliefs with environmental constraints or empower them to find solutions.

Theory of Personality

Cognitive therapy emphasizes the role of information processing in human responses and adaptation. When an individual perceives that the situation requires a response, a whole set of cognitive, emotional, motivational, and behavioral schemas are mobilized. Current thinking views all aspects of human functioning as acting simultaneously as a mode. Cognitive therapy views personality as shaped by the interaction between innate disposition and environment Cognitive therapy maintains that psychological distress results from several luctors. Although people may have biochemical predispositions to illness, they respond to specific stressors because of their learning history Individuals experience psychological distress when they perceive a situation as threatening their vital interests. At such times, their perceptions and interpretations of events are highly selective, egocentric, and rigid

Who can we help? (CT)

Cognitive therapy is widely recognized as an effective treatment for unipolar depression Recent research by DeRubeis et al. (2005) indicates that cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression. Cognitive therapy is not recommended as the exclusive treatment in cases of bipolar affective disorder or psychotic depression. It is also not used alone for the treatment of other psychoses such as schizophrenia Cognitive therapy produces the best results with patients who have adequate reality testing (i.e., no hallucinations or delusions), good concentration, and sufficient memory functions. lt is ideally suited to patients who can focus on their automatic thoughts, accept the therapist-patient roles, are willing to tolerate anxiety in order to do experiments, can alter assumptions permanently, take responsibility for their problems, and are willing to postpone gratification in order to complete therapy Cognitive therapy is effective for patients with different levels of income, education, and background

Strategies (CT)

Collaborative Empiricism: the therapist asks questions to understand the patient's point of view, not solely to change the patient's mind. The patient, in turn, plays an active role in describing how he or she would like things to be different. Guided discovery: therapist and patient collaboratively weave a tapestry that tells the story of the development of the patient's disorder. Implicit in guided discovery is the notion that the therapist does not provide answers to the patient but is curious about what they will discover us they gather data, examine the data in different ways, and ask the patient what to make of new perspectives Approaches to dysfunctional modes: (l) deactivate them (2) modify their content and structure (3) construct more adaptive modes to neutralize them

Personality (CT)

Combination of schemas and temperament Might make people vulnerable to develop distress

Final Multicultural Guidelines

Commitment to Cultural Awareness and Knowledge of Self and Others 1. Psychologists are encouraged to recognize that, as cultural beings, they may hold attitudes and beliefs that can detrimentally influence their perceptions of and interactions with individuals who are ethnically and racially different from themselves. 2. Psychologists are encouraged to recognize the importance of multicultural sensitivity and responsiveness, knowledge, and understanding about ethnically and racially different individuals. Education 3. As educators, psychologists are encouraged to employ the constructs of multiculturalism and diversity in psychological education. MULTICULTURAL THEORIES OF PSYCHOTHERAPY 5 3 7 Research 4. Culturally sensitive psychological researchers are encouraged to recognize the importance of conducting culture-centered and ethical psychological research among persons from ethnic, linguistic, and racial minority backgrounds. Practice 5. Psychologists strive to apply culturally appropriate skills in clinical and other applied psychological practices. Organizational Change and Policy Development 6. Psychologists are encouraged to use organizational change processes to support culturally informed organizational (policy) development and practices. The interested reader can access the complete document at www.apa.org/pi/oema /resources/policy/provider-guidelines.aspx. All multicultural guidelines provide a context for multicultural psychotherapies. Nonetheless, three areas are of particular relevance to multicultural psychotherapies. These are the commitment to cultural awareness and knowledge of self and others, guidelines related to psychological practice, and organizational change and policy development. Multicultural psychotherapists respond to their ethics code (APA, ~010) regardless of the purview of practice and setting. The development of cultural competence is a lifelong process that requires acknowledging the need for ongoing learning. Cross and his colleagues (1989) identified the development of cultural competence across the following spectrum. .· 1. Cultural destructiveness is characterized by attitudes, policies, and practices that are destructive to cultures and to individuals within cultures (e.g., English-only mandates). 2. In cultural incapacity, individuals believe in the racial superiority of the dominant group and assume a paternalistic and ignorant position toward culturally diverse people. 3. In cultural blindness, individuals believe that culture makes no difference and thus the values of the dominant culture are universally applicable and beneficial. 4. In cultural precompetence, individuals desire to provide an equitable and fair treatment with cultural sensitivity but do not know exactly how to proceed. 5. In cultural competence, individuals value and respect cultural differences, engage in continuing sdf-assessment regarding culture, pay attention to the dynamics of difference, continue expanding their knowledge and resources, and endorse a varietv of adaptations to belief systems, policies, and practices. , Multicultural psychotherapies' emphasis on context nurtured the emergence of cultural competence guidelines for organizations. Because many psychotherapists function within formal organizations, the APA formulated multicultural guidelines for psychologists within organizations through its multicultural guideline number (1. Addressing this problem, Howard-Hamilton and colleagues (1998) outlined principles for those counselors working with multicultural clients. They exhorted therapists to: 1. evaluate their institution's mission statement and policies to determine whether they include diversity issues, 2. assess policies with regards to diversity, 3. evaluate how people of color may perceive specific policies,_ 4. acknowledge within group diversity, 5. he aware that diversity requires cxaini~ation from both the individual and the institutional levels, and ,. 538 LILLIAN COMAS-DIAZ 6. recognize that multicultural sensitivity may mean advocating for culturally diverse people. Similarly, Wu and Martinez (2006) asked multicultural practitioners to help their organizations achieve cultural competence by: 1 1. including community representation and input at all stages of implementation; 2. integrating all systems of the health-care organization; 3. ensuring that changes made are manageable, measurable, and sustainable; 4. making the business case for implementation of cultural competency polices; 5. requiring commitment from leadership; and 6. helping to establish staff training on an ongoing basis.

Ultimate Concerns

Concerns that are timeless and intractable: -Death: We live our lives with the awareness that we will cease to exist one day -Freedom: Am I responsible for my own choices?; we are authors of our own lives -Isolation: You begin alone and also end alone; Interpersonal: Isolation from others Intrapersonal: Isolation from yourself Existential: Knowledge that we all are alone in world -Meaning: You must find your sense of purpose, instead of having it laid out in front of you

Reindoctrinatation

Condemning ourselves over and over again based on our belief

Precursors (PPT)

Confucius believed that the meaning of life lies in the ordinary human existence harnessed through discipline, education, and harmonious social relationships. Socrates, Plato, and Aristotle all saw the pursuit of a virtuous life as a necessary condition for happiness Before World War II, psychology had three clear missions: curing psychopathology, making the lives of all people more productive and fulfilling, and identifying and nurturing high talent. Immediately after the war, largely because of economic and political exigencies, the assessment and treatment of psychopathology became virtually the exclusive mission of psychology. However, humanistic psychologists and others continued to advocate for positive approaches to psychotherapy. Carl Rogers, Abraham Maslow, Henry Murray, Gordon Allport, and Rollo May all tried to describe the good life and identified ways our inherent tendency toward growth can facilitate this life. Psychology's Mission changed after WWII

Theory of Personality (CT)

Consciousness -CT enable people to "awaken" from a "waking dream": known by liberation, enlightenment, salvation, and satori, fana, and nirvana -Describes a broad spectrum of beneficial states- many as yet unrecognized by mainstream Western psychology- and provide practices for attaining them -Our usual waking state of consciousness is not optimal Identity -Self sense is continuously and selectively constructed from a flux of thoughts, images, and emotions -What we usually take to be our real self is a mental construction -We suffer from a case of mistaken identity- illusion, imprecise, impermanent -We are victims of our own creation Motivation- Higher motives are essential elements that need to be exercised -Basic Needs -Hedonic Needs- We become more interested in self-gratification *Hedonic treadmill: Even if we do succeed in getting them, we inevitably habituate and want more -Metamotives- Higher motives that are ahead of self gratification *Metapathologies: Metamotive frustrations that mushroom up Development: -Higher levels merge into experiences that have traditionally been thought of as religious, spiritual, or mystical, but can now also be understood psychologically Monophasic Cultures -We derive ourselves from one state of consciousness Polyphasic Cultures -We derive ourselves from multiple states of consciousness

What is race?

Constructed by people for a purpose Colonialism- people from different nations have different races Great Chain of Being- races have different origins, which gave rationality for slaver

Teachable Moments

Context or event in which behavior change becomes more salient due to health concerns Teachable moments are an excellent opportunitiy for lifestyle interventions Some teachable moments include: -Office visit for health screenings/preventive care -DIagnosis of chronic medical condition -Office visit for an acute health concern -When a patient expresses worry about a loved one's health

Stimulus Control (BT)

Control stimuli in the environment Extinguish stimuli with inappropriate control Develop adaptive conditioning Insomnia: -Extinguish inappropriate conditioning *Bed can only be used for sleep and sex *If you can't sleep, get out of bed -Condition appropriate stimuli *Set consistent sleep/wake time *Avoid napping *Establish consistent bedtime routine

Goals of Therapy (CT)

Correct faulty info processing -Not simply substitution of positive beliefs for negative ones -Treat thoughts as testable hypotheses

Mechanisms of Psychotherapy (PPT)

Cultivation of Positive Emotions (Reeducation of Attention). Several PPT exercises explicitly cultivate positive emotions. PPT exercises cultivate positive emotions that open our attentional resources. PPT exercises such as the gratitude journal, gratitude letter and visit, and savoring specifically facilitate cultivation of positive emotions Positive Appraisal (Rewriting of Memories). The middle phase of PPT is focused on helping clients encounter negative or, as termed in PPT, open memories in a systematic way. This emphasis is on helping clients see the adverse impact of carrying negative memories and developing a richer, deeper, and more nuanced emotional and cognitive vocabulary. Clients also learn specific strategies to shift their attention from negative moods that keep them trapped in more neutral ones. Therapeutic Writing. Many PPT exercises previously noted that facilitated positive appraisal involves reflection and writing. Following reflection (individual) and discussion (with the therapist), writing about the significant experience is another potential mechanism of change. Resource Activation (Using Strengths). PPT is based on a resource-activation model (Flückiger & Grosse Holtforth, 2008) of psychotherapy that applies clients' preexisting resources such as individual strengths, abilities, and readiness to the very problems for which they seek therapy. Undertaking these exercises helps clients experience the abstract idea of strengths into reality that, in turn, changes their feelings. Experiential Skill Building. PPT exercises allow clients to develop their signature strengths. Symptomatic distress keeps these assets hidden, and clients coming for therapy are often unaware of their specific strengths. Unlike hedonic activities, which are shortcuts and rely on modern gadgets, PPT exercises are intentional activities that are time-order intensive (e.g., first writing about and then completing a gratitude visit, devising a plan to use signature strengths, writing three good things in the journal daily, arranging a savoring date, giving a gift of time).

Cultural considerations (REBT)

Cultural beliefs -Patient does not always need to meet the bar for cultural beliefs Unconditional acceptance Members of minority cultures -Work with patients to follow cultural beliefs or make their own path

Cultural Considerations(CT)

Cultural relativism Ethnocentric vs worldcentric Always be in "discovery mode"

Therapeutic Relationship (MT)

Culture affects how clients perceive therapists. The ideal therapist role varies from culture to culture. Hence, psychotherapists need to understand culturally diverse expectations. Similarly, Atkinson, Thompson, and Grant (1993) identified eight intersecting therapist roles that depend on clients' acculturation to the mainstream society. They asserted that low acculturated clients expect therapists to behave as adviser, advocate, or facilitator of indigenous support systems. However, in reality, culturally diverse clients have complex expectations of their therapists. Besides acculturation, clients' expectations are shaped by interpersonal needs, developmental stages, ethnic identity, spirituality, and numerous other factors. Even though clients' expectations range from a collaborative to a hierarchical therapeutic style, these expectations are not mutually exclusive. Concisely put, clients of color exhibited psychological mindedness and viewed psychotherapy as a process to work though their issues.

Underlying Assumptions (MT)

Culture is complex and dynamic. Every encounter is multicultural. Reality is constructed and embedded in context. A Western worldvicw has dominated mainstream psychotherapy and has minimized the contributions of non-Western healing practices. Multicultural psychotherapies arc relevant to all individuals. Cultural competence is crucial for effective psychotherapy. Multicultural psychotherapists engage in self-awareness. Healing entails empowering individuals and groups. Healing involves multiple perspectives. Healing is holistic and libcratory.

Evidence (BT)

Currently, the list of empirically supported psychological treatments includes 77 treatments for particular disorders of which 60 are behavioral or cognitive-behavioral treatments and several others include behavioral elements, meaning the evidence supporting behavioral and cognitive-behavioral treatments for particular problems is much better developed than is the case for anv other form of psychotherapy. Behavior therapy is historically an idiographic approach in which each client's treatment is tailored to the individual, based on a detailed functional analysis

The three poisons (CT)

Delusion: -Unrecognized Mental Dullness Mindlessness Craving: -Compulsive necessity -Iron chains and golden chains- Constantly desiring greedy or good things in our lives, making us stuck -IF only I had X, THEN I would have Y Aversion: -Compulsive avoidance

What is a psychiatric diagnosis?

DSM- evolving document that is created by human, *gold standard for standardization when classifying disorders*; disorder must reach a threshold to be classified as a certain illness

cultural factors

Demographics: culture is constantly changing with the interactions of multiple groups across the world Multicultural psychotherapy: It matters if the "authority" figure is a member of the same culture or not when the patient and therapist are from different traditional cultures Language and metaphor: different phrases and metaphors can cause issues between a therapist and patient

Cognitive Models (CT)

Depression: -A cognitive triad characterizes depression (Beck, 1967). The depressed individual has a negative view of the self, the world, and the future and perceives the self as inadequate, deserted, and worthless -The increased dependency often observed in depressed patients reflects the view of self as incompetent, an overestimation of the difficulty of normal life tasks, the expectation of failure, and the desire for someone more capable to take over. Anxiety Disorders: -Mania: Such individuals selectively perceive significant gains in each life experience, blocking out negative experiences or reinterpreting them as positive, and unrealistically expecting favorable results from various enterprises -Panic Disorders: Patients with panic disorder are prone to regard any unexplained symptom or sensation as a sign of some impending catastrophe. Their cognitive processing system focuses their attention on bodily or psychological experiences and shapes these sources of internal information into the conviction that disaster is imminent. Each patient has a specific "equation." For one, distress in the chest or stomach equals heart attack; for another, shortness of breath means the cessation of all -Agoraphobia: The anticipation of such an attack triggers a variety of autonomic symptoms that are then misinterpreted as signs of an impending disaster (e.g., heart attack, loss of consciousness, suffocation), which can lead to a full-blown panic attack -Phobia:In phobias, there is anticipation of physical or psychological harm in specific situations. As long as patients can avoid these situations, they do not feel threatened and may be relatively comfortable. When they enter into these situations, however, they experience the typical subjective and physiological symptoms of severe anxiety. As a result of this unpleasant reaction, their tendency to avoid the situation in the future is reinforced. -Paranoid States: The paranoid persists in assuming that other people are deliberately abusive, interfering, or critical. In contrast to depressed patients, who believe that supposed insults or rejections are justified, paranoid patients persevere in thinking that others treat them unjustly. Obsessions and Compulsions: A key characteristic of obsessives is this sense of responsibility and the belief that they are accountable for having taken an action-or having failed to take an action-that could harm them or others; Compulsions arc attempts to reduce excessive doubts by performing rituals designed to neutralize the anticipated disaster Suicidal Behavior: The cognitive processing in suicidal individuals has two features. First, there is a high degree of hopelessness or belief that things cannot improve. A second feature is a cognitive deficit-a difficulty in solving problems Anorexia Nervosa: Anorexia nervosa and bulimia represent a constellation of maladaptive beliefs that revolve around one central assumption: "My body weight and shape determine my worth and/ or my social acceptability." Schizophrenia: Delusions stem from the interplay of cognitive biases such as external attributions and the cognitive shortcut of jumping to conclusions. A tendency to distort perceptions combines with negative self-schemas to generate auditory hallucinations, which are exacerbated by beliefs that the "voice" is uncontrollable, powerful, infallible, and externally generated

positive psychology

Desirability of focusing on clients' strength as the engine of change Roger's conception of the "Fully functioning person" establishes the notion of optimal functioning and well-being Positive psychology cannot "transcend" the illness focus, but be used as a tool in concordance

History (client centered therapy)

Developed by Carl Rogers Also termed: Humanistic, Phenomenological, Person-centered Third force in Psychology

Cultural Considerations

Developed for educated, middle-class Western Europeans Therapists must: -Be aware of their own bias, society attitudes, moral judgements -Utilize a range of techniques

Impact of psychiatric diagnoses

Diagnosis can be seen as stigmatizing- should not be used as a label, as it is mainly a collection of symptoms and experiences Homosexuality was once an illness in the DSM I- used to justify discrimination against homosexuals; wasn't removed until 1987 Diagnoses should not be taken lightly, as they can impact a person's experiences in their daily lives

Therapeutic Style (BT)

Directive and Transparent -Step-by-step instructions accompanied by clear rationale Therapeutic Relationship -Not emphasized in traditional behaviorism -Can bolster motivation

Empowerment (MT)

Dominant psychotherapists' ignorance of the historical and sociopolitical contexts further disempowered marginalized individuals. This disempowering effect is detrimental for visible people of color, who, unlike majority group members, experience individual and collective oppression. subscribe to the following assumptions: 1. Reality is constructed in a context. 2. Experience is valuable knowledge. 3. Learning and healing results from sharing multiple perspectives. 4. Learning and healing is anchored in meaningful and relevant contexts. To undertake this appreciation, therapists engage in cultural self-awareness. Therapists' cultural self-awareness includes learning about one's position in relation to societal power and privilege. Understanding power dynamics is an important part of appreciating the relationship between oneself and others.

Anti-racism in psychology

Drs. Mamie Phipps Clarks & Kenneth Clark- Doll Study: asked kids to describe characteristics to white and black dolls; used as argument for ending segregation in schools -Brown V. Board of Education Current research Clinical practice

Cognitive Vulnerability (CT)

Each individual has a set of idiosyncratic vulnerabilities and sensitivities that predispose him or her to psychological distress. These vulnerabilities appear to be related to personality structure. Personality is shaped by temperament and cognitive schemas. Cognitive schemas may be adaptive or dysfunctional. They may be general or specific in nature. A person may have competing schemas. Cognitive schemas arc generally latent but become active when stimulated by specific stressors, circumstances, or stimuli.

Theory of Personality (BT)

Each individual has unique, enduring patterns of behavior that can be observed across a wide range of situations Five-factor model: Costa and McCrae (1992) -Openness -Conscientiousness -Extraversion -Agreeableness -Neuroticism Behavior is influenced primarily by variables in the environment (reinforcement, punishment, classical conditioning, etc.) and that individuals behave differently across situations Strong evidence supports the notion of individual temperaments that influence behavior.

Efficacy vs. Effectiveness

Efficacy- determined by well controlled studies that hold many variables constant while trying to manipulate as few variables as possible; well defined set of criteria Effectiveness- how well does the treatment work in the real world?

Clinician researchers

Emergence of analytic psychotherapy Modern day scientist practitioner Benedikt (1835-1920): developed the concept of seeking out and clinically purging pathogenic secrets

Mechanisms for Psychotherapy

Empathy Here-and-now Fellow Traveler

History in existentialism

Epicurus: -Emphasized that death concerns may not be conscious to the individual but might be inferred to disguised manifestations -Believed that soul was mortal and perishes with the body, so there is nothing to fear -Idea of symmetry: our state of nonbeing after death is the same as before birth Nabokov: -Our life is a crack of light between two eternities of darkness St. Augustine: -Only in death is a person's self born Not a formal school of psychotherapy Can be integrated with other formalized approaches Represents a way of thinking with the human experience Currently represented by a shared philosophy: Understanding of psychological distress, in part, arises from "*a confrontation with our existence*"

Types of Treatment (CT)

Ethical Behavior: Say only what is true and helpful Transforming Emotions: Use wise attention to cultivate beneficial emotions Transforming Motivation: Explore the experience of craving Develop Concentration and Calm: Do one thing at a time Cultivate Awareness: Mindfulness meditation and mindful eating Developing Wisdom: Reflect on our mortality Generosity and Service: Transform pain into compassion

Seven qualities of psychotherapy (CT)

Ethics: Ethical vs Unethical -Record temptations to lie and look for the motives Emotional transformation -Cultivate positive emotions -Foster emotional intelligence Redirecting motivation: Let go of Three Poisons -Self actualization -Self transcendence -Selfless service Training attention -"The faculty of voluntarily bring back a wandering attention over and over again is the very root of judgement, character, and will" *William James Refining awareness -Make perception more sensitive and accurate -Empathy -Introspection Wisdom -Deep understanding -Practical skill Altruism and service -Empathic joy -Paradox of pleasure

Ethnic Family Therapy (MT)

Ethnic family therapists attempt to (1) know their own culture, (2) avoid ethnocentric attitudes and behaviors, (3) achieve an insider status, (4) use intermediaries, and (5) have selective disclosure. multicultural psychotherapies. For example, the American Psychological Association has a recent history of examining the needs of minority populations. Several of its societiessuch as the Society of the Psychology of Women, the Society for the Psychological Study of Ethnic Minority Psychology, and the Society for the Psychological Study of Gay, Lesbian, Bisexual and Transgcnder Issues-are examples. In particular, the Society for the Psychological Study of Ethnic Minority Psychology has promoted the need for multiculturalism in all aspects of psychology, especially in professional psychology Counseling psychologists demonstrated a commitment t~) multicultural issues and have recognized the importance of multiculturalism in publications such as the Journal of Multicultural Counseling and Development. The ethnic minority psychological associations-the Asian American Psychological Association, the Association of Black Psychologists, the National Latina(o) Psychological Association, and the Society of Indian Psychologists-have been powerful advocates for the mental-health needs of people of color In addition, the Society for the Study of Culture and Psychiatry is an interdisciplinary and international society devoted to furthering research, clinical care, and education in cultural aspects of mental health and illness

Ethnopsychopharmacology

Ethnopsychopharmacology is the field that specializes in the relationship between ethnicity and responses to medications emerged out of the need to address the specific mental-health needs of culturally diverse people. Ethnopsychopharmacologists take special care in assessing potential gender and ethnic interactions when prescribing medications. In addition, they are knowledgeable about the interface of multiculturalism and psychopharmacology Therefore, multicultural psychotherapists are alert to the need to educate clients about the dangers of self-medication, sharing medications with relatives, using medications obtained over the counter from outside the United States, and combining herbal remedies with psychotropic medications. Besides exploring the biological characteristics that affect response to medications, multicultural clinicians examine their clients' lifestyles. In addition, multicultural psychotherapists collaborate with psychopharmacologists who are knowledgeable about ethnicity medication interactions.

Evidence (CT)

Evidence-based practice in psychology (EBPP) advocates the application of empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention in the delivery of effective psychological care A fundamental component of evidence-based practice is empirically supported treatments, those demonstrated to work for a certain disorder or problem under spcci fied circumstances, Randomized controlled trials (RCTs) in psychology, as in other health fields, are the standard for drawing causal inferences and provide the most direct and internally valid demonstration of treatment efficacy. Meta-analysis, a systematic way to synthesize results from multiple studies, is used to quantitatively measure treatment outcome and effect sizes Cognitive therapy (CT) and cognitive-behavioral therapies (CBT, the atheoretical combination of cognitive and behavioral strategies) are based on empirical studies. Individual RCTs, reviews of the literature of outcome studies for a range of disorders, and meta-analyses all document the success of CT and CBT in the treatment of depression and anxiety disorders in particular One criticism of the reliance on RCTs in psychotherapy research is that the samples studied are so carefully screened to eliminate comorbidity or other threats to experimental control that they do not represent real groups in the community, who often have multiple problems In addition to best available research, another component of evidence-based practice is clinical expertise-the advanced clinical skills to assess, diagnose, and.treat disorders. The importance of clinical expertise is demonstrated in the study by DeRubeis et al. (2005), which concluded that CT can be as effective as medications for the initial treatment of depression, hut the degree of effectiveness may depend on a high level of therapist experience or expertise. Large Effects: -Depression -Generalized Anxiety disorder, panic disorder, social phobia -Childhood depression or anxiety Medium Effects: -Marital distress -Anger -Chronic Pain -Childhood somatic disorders

Anxiety

Exaggerated perception of danger Difficulty recognizing cues of safety Minimize ability to cope

The self

Experience -Must symbolize experiences, otherwise they remain outside our awareness Internal frame of reference -Everyone sees the world differently Organismic Valuing Process -Need to be capable of making determinations for self

Freud's influences

Exposure to developments in French neurology and psychiatry: -Work of Jean Martin Charcot: theorized that hysterical symptoms emerged as a result of a type of splitting off of aspects of consciousness as a result of an organic weakness, which hypnosis could help treat or make worse Began to collaborate with Josef Breuer -Told Freud about the "talking cure"- female patient (Anna O) felt better after talking freely about painful and traumatic experiences and recovering dissociated painful memories -Both thought that hysterical symptoms were a result of long term suppressed emotions seen within physical symptoms and hypnosis could help

Clinician approaches (BH)

Express empathy Develop discrepancy Roll with resistance Support self-efficacy

Extratherapeutic factors

Factors that include the environment of the client, various vulnerabilities and problems he or she is dealing with, the presence or absence of adequate social support, and any particular events that influence the course of therapy

psychotherapy model (BT)

Fearful associations are stored in memory in a fear network comprised of a stimulus component (e.g., dog), a response component (e.g., fear), and a meaning component (e.g., I will get attacked). Conditioning experiences cause these components to become associated with one another so that experiencing any one of these elements (e.g., seeing a dog) makes it more likely that the other components (e.g., fear, thoughts about being attacked) will also be activated. According to the theory, exposure to feared situations works by (1) fully activating the fear network and (2) incorporating new, corrective information.

Basic Concepts (Behavior Therapy)

Focuses on changing behavior: Increasing chance of helpful behavior Rooted in empiricism: Collect data and use evidence-based methods Assumed to have a function: Clients are not blamed for their behaviors or their problems Emphasizes maintaining factors rather than factors that may have initially triggered a problem Supported by research: Used with wide range of problems Client is actively engaged and therapist provides frequent advice and suggestions Therapy is transparent: Data collected is readily shared and the client is active in the therapy process

Folk healing

Folk healing reestablishes clients' sense of cultural belonging and historical continuity, promotes self-healing, and nurtures a balance between the sufferer, family, community, and cosmos (Comas-Diaz, 2006). Folk healers use mechanisms similar to those used by mainstream psychotherapists; the main difference revolves around folk healers' spiritual belief systems. In other words, folk healers foster empowerment, encourage liberation, and promote spiritual development.

empathic understanding of the client's internal frame of reference

Following the client's opinions with understanding, making the client the author of their own life and architect of the therapy

Network Therapy

Following these notions, Carolyn Attneave developed network therapy as an extended family treatment and group intervention (Speck & Attncave, 1973). Based on a Native American healing approach, network therapy re-creates the entire social context of a clan's network in order to activate and mobilize· a 'person's family, kin, and relationships in the healing process. Network therapy is a community-based form of healing.

Operant COnditioning

Form of learning in which the frequency, form, or strength of a behavior is influenced by its consequences -Positive and negative reinforcement -Positive and negative punishment -Extinction- child stops tantrum when they don't get what they want -Discrimination learning: Response is reinforced or punished in one situation, but not another -Generalization: Generalizing a behavior to other situations -Vicarious Learning: Learning about environmental contingencies through others -RUle-Governed Behavior: People learning about contingencies through information they hear or read

Unconcious mind (freud)

Found to be an area of psychic functioning where impulses and wishes, as well as certain memories, are split off from awareness Others argue that it is problematic to speculate about the hypothetical psychic agencies, such as the ego and id- Others find it useful to think of the unconscious as the dissociation of experience because of the failure of attention and narrative construction

Psychoanalysis

Freud's theory of personality that attributes thoughts and actions to unconscious motives and conflicts; the techniques used in treating psychological disorders by seeking to expose and interpret unconscious tensions Overlooks human strengths and possibilities

Modern Conflict Theory

Generally associated w/work of Coser, Dahrendorf, and Mills, the modern conflict theory sees conflict between groups or social organizations, not just class; Recognizes that the powerful can oppress those who work for them by claiming the profits from their labor.

Gratitude (PPT)

Gratitude is a state of being thankful for recognized positives in one's life Two related exercises are essential to cultivating gratitude in this phase of PPT. The first is the gratitude letter. Participants recall a person who did something kind for them for which they never thanked them. In session, participants write a first draft of a letter that clearly and authentically expresses their gratitude, describing the specifics of their acts of kindness and its positive consequences. For homework, participants write another two drafts and then organize a gratitude visit. In this second exercise, clients are then encouraged to read the letter to the recipient in person or over the phone. When done in person, this exercise often generates powerful positive emotions on both ends and is often described by clients as a deeply moving experience that they were initially reluctant to engage in.

History (REBT)

Greek and Roman stoic philosophers Adler (1931) put the A-B-C or stimulus-organism-response (S-0-R) theory of human disturbance neatly: No experience is a cause of success or failure. We do not suffer from the shock of our experiences-the so-called trauma-but we make out of them just what suits our purposes -"Everything depends on opinion" Paul DuBois, using persuasive forms of psychotherapy, was another important precursor of REBT. Alexander Herzberg was one of the inventors of homework assignments. Hippolyte Bernheim, Andrew Salter, and a host of other therapists have employed hypnosis and suggestion in a highly active-directive manner. Frederick Thorne created what he called directive therapy.

Psychotherapy in a Multicultural World (PPT)

Happiness, at least in Western culture, has become synonymous with feeling good (hedonism). However, we believe that PPT's approach, largely based on the notion of the pursuit of the good life (eudemonia), is more conducive to multicultural clients because it includes a broader notion of happiness through multiple routes, positive emotions, character strengths, positive relationship, and meaning. Therefore, it accommodates cultural sensitivities more than a traditional deficit-oriented psychotherapy framework largely based on Western notions of psychopathology does. When viewed within a specific cultural context, these difficulties, instead of being pathologized within DSM-based categories, could simply be viewed as the challenges associated with being human ountries—might be interpreted as enmeshment. When working with clients from diverse cultural background and using a strengthsbased therapeutic perspective, clinicians must be cognizant and sensitive to the fact that a strength may look quite different from culture to culture, depending on the cultural context and worldview espoused by the culture in which it manifests and develops In PPT, not all idiosyncratic patterns of behaving, thinking, feeling, or desiring qualify for medical labels. Pathologizing culturally relevant behavior may discourage minorities from seeking psychotherapy, and these individuals may believe therapy as portrayed in popular media only involves discussing weaknesses in minuscule detail or identifying childhood resentments or monitoring distorted thoughts. PPT, on the other hand, starts with a positive introduction; through stories, anecdotes, and experiences of resilience, it elicits meaning, relationship, engagement, and accomplishment Csillik, Aguerre, and Bay (2012), from France, compared group PPT with CBT and with medication and found that clients in PPT experienced greater therapeutic benefits on measures of depression, optimism, life satisfaction, and emotional intelligence.

Intervention Levels (BH)

National: Taxes on cigarettes Group: Behavior rolled out University-wide Individual: -Single or multiple behaviors done one-on-one

Worldviews (MT)

Harry Triandis (1995) classified worldviews according to how individuals define themselves and how they relate to others. Those cultures where individuals' identity is associated with their relationships to others are called collectivistic. In contrast, members who frequently view themselves independently from others are denominated individualistic (Triandis, 1995). Western societies tend to be identified as individualistic because their members define themselves primarily in terms of internal features such as traits, attitudes, abilities, and agencies. In other words, their ideal personal characteristics include being direct, assertive, competitive, self-assured, self sufficient, and efficient. On the other hand, collectivistic members endorse relational values, prefer interdependence, encourage sharing resources, value harmony, tolerate the views of significant others, and prefer communication that minimizes conflicts Because the notion of being understood is an important aspect in healing, effective psychotherapy depends on the therapist's understanding of his or her client's worldview.

Who does BT help?

Has been demonstrated with almost every type of psychological problem Works with both adults and children Anxiety: Found to be effective with all types of disorder Depression: Most likely to be used as adjuncts to treatments rather than on their own Substance Use: Considerable support, but less effective methods are used in place, such as incarceration Schizophrenia: Can be done with antipsychotic medication

Addressing Meaning

Help patients focus on values beyond themselves Develop curiosity and concern for others Remove obstacles to whole-hearted engagement

Meaninglessness

How does a being who requires meaning find meaning in a universe that has no meaning? Construct values and narratives in our lives

Common principles of psychoanalytic perspectives

Humans are motivated by wishes and fantasies that are unconscious Humans are ambivalent about changing Therapy should help clients understand how their own construction of the past and present plays a role in perpetuating patterns

existential isolation

Idea of being separated from the world, even with human connections- people dread when they are alone or the fact that they will die alone Fromm believed that isolation is the primary source for anxiety Interpersonal: Isolation from others Intrapersonal: Isolation from yourself Existential: Knowledge that we all are alone in world Requires balance between wish for contact and knowledge of aloneness Defenses against isolation: -Crave witness -Fusion

65% barrier

Idea that therapy only works 65% of the time for patients, and can make a situation worse for some But why is there a 65% barrier, and why are the specific effects of therapy so small? We believe this is because behavioral change is difficult for people in general, and it is especially difficult for clients seeking therapy. They may lack motivation, have comorbid issues, or live in unhealthy environments that are not amenable to change. Psychotherapy faces another serious problem: approximately 40% of clients terminate therapy prematurely. Often clients only make superficial changes as a result of therapy, partly because traditional psychotherapy takes a palliative approach. Palliation is not a bad thing, but it is—and should be—only a way station on the way to cure One thing psychotherapy needs is to develop interventions that train clients to function well despite the presence of these dominant dysphorias. We are convinced PPT can help clients function well in the presence of dysphorias—and possibly break the 65% barrier.

Future Directions in Behavior Therapy

Improving Effectiveness: Researchers are working on finding ways to enhance our existing treatments so that more people can benefit. Understanding the Mechanisms Underlying Treatment: With the expansion of behavior therapy to include mindfulness- and acceptance-based strategics, for example, researchers have been studying the mechanisms underlying these new approaches, trying to better understand how their goals, mechanisms, and methods are similar and different from traditional behavioral and cognitive-behavioral treatments. Enhancing Dissemination: There is a widely recognized gap between the availability of effective behavioral treatments and the use of these treatments in clinical practice. The Role of Cognitive Enhancers Such as D-Cycloserine (DCS): Despite emerging evidence supporting DCS for augmenting the effects of exposure, questions remain, including: (l) Which learning processes are targeted by DCS during exposure therapy? (2) Can DCS enhance the effects of other behavioral or cognitive-behavioral strategies? (3) What is the optimal way to administer DCS (dosage, frequency, timing)? (4) Might DCS enhance behavioral treatments for problems other than anxiety disorders?

Role of Moderator Variables in Therapeutic Change

In considering role of moderators, clinicians should keep several questions in mind such as are clients motivated toward change? If so, what is their level of commitment and sense of self-efficacy? Do clients perceive overall PPT and specific PPT exercises efficacious? Do clients value PPT exercises enough that their commitment level will not wane despite challenges? If it wanes, do they have social support that could help them reengage? What are overall contextual features in terms of the optimal level of intensity, timing, sequence, and integration of specific exercises (Schueller, Kashdan, & Parks, 2014)? This personalization calls into question the degree of flexibility allowed within each exercise to address unique personality, cultural, and contextual features in creating individualized treatment packages without comprising core treatment integrity , the PPT client and therapist cover subjects that focus on personal strengths that are likely to be more potent generators of change than a focus on personal weaknesses would be. These subjects can include instances when the parents meet the needs of the child, when the client transgressed but was forgiven, and when criticism was balanced by genuine appreciation

Phase Two Exercises (PPT)

In the middle phase of PPT, after establishing therapeutic rapport and helping clients identify their strengths, clients are encouraged to write down grudges, bitter memories, or resentments and then discuss the effects of holding onto them. PPT does not discourage expression of negative emotions. Instead, it encourages clients to access a full range of emotions—positive and negative. Many PPT exercises help clients deal with these negative memories adaptively. For example, positive appraisal (Rashid & Seligman, 2013) helps clients unpack their grudges and resentments and reappraise them through four strategies: 1. Creating Psychological Space: Clients write a bitter memory from a third-person perspective, one that is less personal and more neutral. This exercise helps clients dispense less effort and time on recounting emotionally evocative details of negative memories (Kross, Ayduk, & Mischel, 2005). As a result, more cognitive and attentional resources are available for clients to reconstitute their feelings and the meaning of the negative memory rather than rehashing what happened and what they felt. 2. Reconsolidation: Clients recall finer and subtle aspects of a bitter memory in a relaxed state. The purpose is to recollect, refile, and reconsolidate positive or adaptive aspects of the bitter memory that might have been overlooked because of the mind's penchant for negativity. 3. Mindful Self-Focus: Clients are encouraged to observe negative memories rather than react to them. It is about stepping back and letting the open and negative memories unfold in front of the clients' eyes—like watching a film. Clients are taught to be observers rather than participants of these memories, with a deliberate effort to loosen the emotional strings attached to the memory. 4. Diversion: Clients are encouraged to recognize cues that activate the recall of a bitter memory and are helped to immediately engage in an alternative physical or cognitive activity (diversion) to stop the full rehearsing of the bitter memory. Densely interconnected, the bitter memories of psychologically distressed clients are often triggered by external cues. Engaging in an alternative activity diverts attention, interrupting the cascade of mutually triggering emotions and memories. The clinician explores scenarios with clients to help them understand what forgiveness is and what it is not. Forgiveness in PPT is conceptualized as a process of change The intent of this exercise is to raise awareness in clients that we often spend a lot of time in purchasing material goods that either distract us from encountering negatives head-on or fail to add much to our well-being

Other Systems (MT)

Indeed, partly because of multiculturalism's criticisms, mainstream clinicians are revising psychotherapy's basic tenets with respect to their applicability to culturally diverse clients. Psychoanalysts, for instance, are including the experiences of culturally diverse individuals to incorporate their social, communal, and spiritual orientations into treatment. Indeed, after reviewing the research on dominant psychotherapies' cultural adaptations, Whaley and Davis (2007) concluded that culture affects psychotherapeutic process more than it affects treatment outcome. Dominant psychotherapies' ethnocentrism could partly explain Whaley and Davis's conclusion. To illustrate, a major area of discontent among people of color is their history of medical experimentation and abuse. Called medical apartheid, this history included the Tuskegee project-a research project in which African American men with syphilis were given a placebo instead of medication (penicillin), despite the fact that a cure for syphilis was found during the course of the research and administered to white men-and the involuntary sterilization of Puerto Rican women during routine medical examinations (Comas-Diaz, 2008). As many culturally diverse individuals endorse a collectivistic orientation, they situate themselves in context and time. Therefore, personal and collective history is an important element in the lives of people of color.

Treatment Modality (REBT)

Individual therapy Group therapy Workshops Marriage and Family Therapy Self-Help

Influence Of Rogers

Influenced other theories: -Brodley: Resurrection and exegesis of the nondirective attitude -Bozarth: Reconceptualization of the "necessary and sufficient" conditions -Grant: Advocacy for an "ethics-only" approach to client-centered practice -Sanders: Politicization of the approach -Mearns: Work on relational depth -Cooper: Existential approach -Schmid: Ethics-based dialogical encounter

Jung

Initially studied under Freud Experimental studies of the unconscious Broke from Freud in 1912 and went on to develop his own school known as analytical or Jungian psychology Differences from Freud: -Collective unconscious -Unconscious has creative and growth-oriented components -Understand unconscious through observing complexes -Less emphasis on sexuality's role in motivation

History (MT)

Interdisciplinary influences Cultural psychoanalysis Transcultural psychology Education for the Oppressed model (1973) -Dominant models maintain inequality -Develop critical consciousness Re Evaluation Counseling (1998) -Individuals listen to each other to recover from effects of racism, classism, sexis and other types of oppression -Co-counseling

Ethnic Transference

Interethnic transference: overcompliance, mistrust, denial, ambivalence Intraethnic transference: Views therapist as omniscient or omnipotent; traitor (betrayal of culture); autoracist Interethnic countertransference: deny cultural differences, become overly curious about differences at the expense of psychological needs, guilt or pity Interethnic countertransference: overidentification; shared victimization; distancing; survivor's guilt, cultural myopia (can't see clearly)

Defenses (Freud and Klein)

Intrapsychic process that functions to avoid emotional pain by pushing thoughts, wishes, feelings, or fantasies out of awareness Concept introduced by SIgmund Freud and Developed by Anna Freud Defensive styles: -Impact our physical and mental health -Have implications for treatment Freud: -Intellectualization: Individual talks about something threatening while keeping an emotional distance from associated feelings -Projection: Person attributes a threatening feeling or motive onto another person- say that someone else feels how you actually feel -Reaction formation/ denial: Someone denies a threatening feeling and proclaims they feel the opposite Klein: -Splitting: Individual splits the representation of some object into two different images- a good version and a bad one

Cultural Adaptation (MT)

Involve diverse people in development Include collectivistic values Attend to religion Pay attention to relevance of acculturation Acknowledge effects of oppression

Rational vs irrational thinking

Irrational thought: -Bc something once strongly affected us, it should indefinitely affect it -It's horrible when things aren't the way we want them to be -We should be completely component in all way Rational: -We can learn from past experiences, but not be overly influenced by them -Focus on trying to change bad situations or accept the situation -Accept yourself as imperfect

boundary situations

Issues that causes us to search for existential meeting, such as death

REBT vs other personality theories

It opposes the Freudian concept that people have clear-cut libidinous instincts that, if thwarted, must lead to emotional disturbances and instead posits strong human desires that become needs or necessities only when people foolishly define them as such. Places the oedipal complex as a relatively minor subheading under people's major irrational belief that they absolutely have to receive the approval of their parents (and others), that they must not fail (at lusting or almost anything else), and that when they are disapproved of and when they fail, they are worthless. 3. REBT holds that people's environment, particularly their childhood parental environment, reaffirms but does not always create strong tendencies to think irrationally and to be disturbed. 4. REBT looks skeptically at anything mystical, devout, transpersonal, or magical when these terms arc used in the strict sense. 5. No part of a human is to be reified into an entity called the unconscious, although it holds that people have many thoughts, feelings, and even acts of which they are unaware. REBT overlaps with Beck's cognitive therapy in several ways, but it also differs in significant ways: 1. It usually disputes clients' irrational beliefs more actively, directly, quickly, and forcefully than does CT. 2. It emphasizes absolutist musts more than CT and holds that most major irrationalities implicitly stem from dogmatic shoulds and musts. 3. It uses psychoeducational approaches-such as books, pamphlets, audiovisual materials, talks, and workshops-as intrinsic elements and stresses their use more than CT does. 4. It clearly distinguishes between healthy negative feelings (e.g., sadness and frustration) and unhealthy negative feelings (e.g., depression and hostility). 5. REBT emphasizes several emotive-evocative mctbods=-such as shame-attacking exercises, rational emotive imagery, and strong self-statements and self-dialogues that CT often neglects. 6. REBT favors in vivo desensitization, preferably done impulsively, more than CT does. 7. REBT often uses penalties as well as reinforcements to help people do their homework 8. It emphasizes profound philosophical and unconditional acceptance of oneself, other people, and the world more than CT does

Who Doesn't Benefit (PPT)

It would be clinically imprudent to apply PPT with clients experiencing acute symptoms of panic disorder, selective mutism, and paranoid personality disorder, as there is currently no evidence that PPT could be effective for these disorders. Furthermore, some clients may have a strong feeling that their symptoms, not strengths, ought to be the focus of treatment. PPT is not be appropriate for all clients in all situations. For example, clients who have experienced trauma may not benefit from a PPT approach initially and may respond better to a treatment specifically targeting their trauma and its aftermath. It is important that the therapist does not dismiss or minimize the debilitating impact of trauma and rush toward posttraumatic growth (PTG). Knowing that PTG is a built-in process can be reassuring to clients, but clinical judgment and collaborative decision making are needed to determine the suitability, timing, and completion of all PPT exercises. Both therapists and clients expecting a linear progression of improvement may not do well with PPT, in part because the motivation to change long-standing behavioral and emotional patterns fluctuates during the course of therapy

Nature vs. Nurture

It's both -We can be changed & moled, which psychotherapy takes advantage of

Lacanian Theory

Jacques Lacan; signifiers are substitutions w/o clear referent (compare to Saussure or Hegel); language structures the unconscious (compare to Freud, the other way around); marriage of linguistic and psychological theory; buzzwords: mirror, phallus, signifier/ signified, substitution, desire, jouissance, objet petit a, imaginary order, symbolic order, real order There is a lack- fundamental sense of alienation from self

Beginnings of BT

Joseph Wolfe: -First studied classical conditioning and learning theory as a student -Developed systematic desentization with the imagination -Called the process underlying this treatment reciprocal inhibition -Conditioning Therapy --> Behavior Therapy (Suggested by Lazarus) -Launched the "Journal of Behavior Therapy and Experimental Psychiatry" Lazarus: First person to use behavior therapy/ therapist in a published article Hans Eysenck: -founded the first behavior therapy journal in 1963, "Behaviour Research and Therapy" -helped to popularize the term behavior therapy through his writings in the 1960s Franks: Student of Eysenck -founded the Association for the Advancement of the Behavioral Therapies (AABT) in 1966 Nathan Azrin: -Established the field of applied behavior analysis and programs for treating substance-use disorders -Sought to reverse unwanted habits -Token Economy

Ending Treatment (CT)

Length of treatment depends primarily on the severity of the client's problems. The usual length for unipolar depression is 15 to 25 sessions at weekly intervals (Beck, Rush, Shaw, & Emery, 1979). Moderately to severely depressed patients usually require sessions twice a week for 4 to 5 weeks and then weekly sessions for 10 to 15 weeks Because cognitive therapy is present centered and time limited, there tend to be fewer problems with termination than in longer forms of therapy During the usual course of therapy, the patient experiences both successes and setbacks. Such problems give the patient the opportunity to practice new skills. As termination approaches, the patient can be reminded that setbacks arc normal and have been handled before Termination is usually followed by one to two booster sessions, usually one month and two months after termination. Such sessions consolidate gains and assist the patient in employing new skills.

MBSR vs Mindfulness

MBSR offers additional treatments in education, yoga, and social support, while allows for a much larger effect size, meaning that MBSR is more beneficial than mindfulness alone

Mechanisms of Change

Making the unconscious conscious Emotional insight Creating meaning and historical reconstruction Increasing and appreciating limits of agency

Mechanisms of Psychotherapy (MT)

Many multicultural psychotherapists integrate holism into their practices. Most of these practices are based on non-Western philosophical and spiritual traditions. In addition to verbal therapy, many clients of color require a mind, body, and spirit approach. Also known as contemplative practices (see Chapter 12), holistic approaches such as meditation, yoga, breathwork, creative visualization, and indigenous healing are gaining popularity among mainstream psychotherapists. With their holistic emphasis, many multicultural psychotherapists promote spiritual development Multicultural psychotherapists foster creativity as part of their holistic approach, and they encourage clients to use art, folklore, ethnic practices, and other creative cultural forms. The therapeutic use of creativity enhances resilience and cultural consciousness- the affirmation, redemption, and celebration of one's ethnicity and culture Moreover, because of their experiences of disconnection and trauma, people of color use creativity to cope with past trauma and create meaning and purpose in their lives. Using photos for storytelling enhances self-esteem among visible people of color (Falicov, 1998) and addresses issues of skin color and race. Empirical studies revealed that folk healers who encouraged their patients to publicly perform their dreams in poetry, song, and dance were significantly more effective in healing as opposed to therapists who encouraged their patients to talk about their dreams in private

Positive Psychotherapy (Basic Concepts)

Many therapists believe simply helping clients to get rid of their misery will make them happy. But it does not. Instead, what results are empty clients because psychotherapy often ends—or at least is suspended—when the symptoms of suffering are no longer present. Teaching clients about flourishing —a state characterized by positive emotions, a strong sense of personal meaning, good work, and positive relationships—requires far more than simply relieving the symptoms of psychological distress. To foster these skills, systematic and sustained therapeutic effort is essential. Therefore, in our view, psychotherapy is a partnership between client and therapist in which the building of positive resources should get every bit as much attention as the amelioration of symptoms In PPT, clients are taught to employ their highest and intact resources—both personal and interpersonal—to meet life's toughest challenges. For psychologically distressed clients, knowing their personal strengths, learning the skills necessary to cultivate positive emotions, strengthening positive relationships, and imbuing their lives with meaning and purpose can be tremendously motivating, empowering, and therapeutic PPT is simply an approach that seeks to balance the attention given to negative and positive life events in psychotherapy We do not consider positive psychotherapy a new genre of psychotherapy but a therapeutic reorientation to a build-what's-strong model that supplements the traditional fix-what's-wrong approach The absence of normal and positive characteristics predicts the onset of depression far better than the presence of negative factors such as a history of depression, neuroticism, or physical illness.

Variety of concepts (CT)

Meditation -Concentration -Awareness Psychopathology -Delusion: Unrecognized Mental Dullness Mindlessness -Craving: Compulsive necessity -Aversion: Compulsive avoidance Psychological Health -Relinquishment of unhealthy mental qualities such as delusion, craving, and aversion -Development of specific healthy mental qualities and capacities -Maturation to postconventional, transpersonal levels Good News, Bad News -Bad news: Our ordinary state of mind leads to suffering -Good news: we can train and develop our minds beyond conventional levels

Psychotherapy mechanisms (CT)

Metaphorical: -Awakening from trance -Freeing from illusions and conditioning -Purifying the mind of toxic qualities -Uncovering and enlightening true identity -Unfolding innate potentials Calming the Mind: relaxation response Enhanced Awareness: Disidentification Rebalancing Mental Element: Seven factors of enlightenment -Mindfulness -Effort -Investigation -Rapture -Concentration -Calm -Equanimity Deautomatization becomes less automatic and coming under greater voluntary control One idea is that meditation may work many of its effects by restarting and catalyzing development Evidence Base: -Large Effects (RCTs) for *Anxiety Disorders *Stress *Depression -Application to Healthcare *Cardiovascular System *Hormonal and Immune Effects *Asthma, psoriasis, prostate cancer, chronic pain, cancer, rheumatoid arthritis, gastrointestinal disorders

Mechanisms of psychotherapy (CCT)

Molecules of Change -Moments of movement: It is acceptable and capable of being integrative Zimring's new paradigm -Objective to Subjective: Inner experiences based on others--> Inner experiences based on self

Appropriate Candidates

Motivated Openly disclosing Willing to self-scrutinize Not in need of immediate crisis intervention "Problems in living" reflected in stress Personality disorders

Evidence (MT)

Multicultural psychotherapies' evidence base is a reality based perspective, one that moves from the "couch to the bench" and from the "clinic to the laboratory." Such an approach reflects the need for psychotherapy research to be culturally relevant and accountable to ethnic communities. Some early psychotherapy research focused on ethnic similarities between psychotherapists and clients. Empirical findings suggested that clients working with psychotherapists of similar ethnic backgrounds and languages tended to remain in treatment longer than those whose therapists were not ethnically or linguistically similar. However, ethnic and linguistic match does not necessarily translate into mutual cultural identification (Hall, 2001) nor is it necessarily desirable for some clients. A review of the research on therapist-client ethnic matching revealed inconclusive results and low validity for ethnic matching (Karlsson, 2005). Nonetheless, research has indi- . cared that clients of color in similar race dyads participate more in their care than do those in racially dissimilar dyads (Cooper-Patrick et al., 1999). In contrast, an empirical study on the effects of ethnic matching on treatment satisfaction among migrant patients showed that these clients did not view ethnic matching as important, and they considered clinical competence, compassion, and sharing their worldview as far more important factors (Knipscheer & Kleber, 2004). In toto, however, the available research suggests .that culturally competent therapists enhance their clients' satisfaction with treatment Some of the questions that need to be answered include the following: What kinds of treatments work best with which kind of clients? What is the connection between a psychotherapist's cultural competence and his or her treatment outcomes? What is spirituality's effect on psychotherapy effectiveness? What are the effects of cultural resilience on physical and mental health? How does language (e.g., bilingualism, being a polyglot) influence psychotherapy process? How do creativity and multicultural experiences affect mental health? What are the gender, ethnobiological, and neurohormonal factors that influence clients' responses to psychotropic medications? What are the cultural and ethical contexts of therapists' self-disclosure? The empirical exploration of these questions and others can reveal the effectiveness

Theory of Psychotherapy (MT)

Multicultural psychotherapists do not subscribe to a unifying theory of psychotherapy; instead, they endorse multiple perspectives. Therefore, a multicultural metatheory recognizes that all helping traditions are culturally embedded Multiculturalists view the cultivation of the therapeutic alliance as a crucial aspect in healing and critically important to understanding clients. For this reason, the therapeutic alliance guides the multicultural psychotherapy process.

Explanatory Model of Distress

Multicultural psychotherapists use the explanatory model to unfold clients' treatment expectations by asking the following questions (Kleinman, 1980): What do you call your problem (illness)? What do you think your problem (illness) does? What do you think the natural course of your illness is? What do you fear? Why do you think this illness or problem has occurred? How do you think the distress should be treated? How do want me to help you? Who do you turn to for help? Who should be involved in decision making?

Distinctive Components (CCT)

Necessary and sufficient conditions for change Focuses on the client's internal frame of reference Not focused on changing structure of personality Same principles of psychotherapy apply to all people

Methods in CCT

Non-Directive -Therapists exist to use skills they have to allow patient the ability to self actualize Respect - Seek to create positive regard Understanding Recognize implicit feelings Clarify Answer questions without -Reassurance -Advise

Basic Concepts

Notwithstanding its increasing presence in society, multiculturalism has not fully reached dominant psychotherapy. Accordingly, the lack of cultural relevance in dominant psychotherapies has given birth to multicultural psychotherapies. Simply put, multicultural psychotherapies in/use cultural competence into clinical practice. A multicultural dimension is crucial to psychotherapy because cultural misunderstandings and communication problems between psychotherapists and clients interfere with treatment effectiveness.

One person vs. Two person psychology

One: Therapist comes in w/ expectation that only client is being addressed; everything that happens is because of client Two: Therapist does influence the course of interactions

Phases of psychotherapy

Opening: Therapist is looking for conflicts that patients are trying to protect against Development of Transference: Reacts to memories of the past and transfers them onto the therapist- therapist can use transference to see how patient reacts to real world Working through: Works through interpersonal conflicts and gain insight Termination: Patient can see their role in their own change and no longer needs the treatment

Dynamistic vs organistic

Organic: Views world and psychology problems revolve from natural issues Dynamistic: Distress come from internal energies Moved towards a mix

Freud's shift in theory

Originally supported the seduction theory: sexual trauma always lies at the root of psychological problems Moved towards the drive theory when it became clear all of his patients did not have proof of previous sexual abuse: a psychobiological push to repeat experiences that have become associated with tension reduction (pleasure principle) libido produces states of tension Pleasure principle = we are driven to repeat experiences that release tension

Assumptions of CP

Our usual state of mind is significantly uncontrolled, underdeveloped, and dysfunctional The full extent of "normal" dysfunction goes unrecognized because: -We are share this dysfunction, making it "normal" -Dysfunction is self-masking, so we conceal them Mental dysfunction creates our psychological suffering CP are used to train and develop the min These claims can be tested for oneself

REBT and other systems

Overlaps significantly with Adlerian theory but departs from the Adlerian practices of stressing early childhood memories and insisting that social interest is the heart of therapeutic effectiveness Common with Jungian therapeutic outlook, since it holds that the goals of therapy include growth and achievement of potential as well as relief of disturbed symptoms, and it emphasizes enlightened individuality Similar to person-centered therapy, but they differ in teaching that blaming is the core of much emotional disturbance; that it often leads to self-defeating and destructive results Common with behavior modification since they are mainly concerned with symptom removal and ignore the cognitive aspects of conditioning and deconditioning

Current Status (PPT)

PPIs have been applied effectively on several clinical conditions such as depression, posttraumatic stress disorder, borderline personality disorder, and psychosis In the past 18 years, positive psychology has made tremendous strides. The quantitative biometric analysis by Rusk and Waters (2013) chartered the growth of positive psychology since its inception at the turn of the new millennium. Their analysis documented more than 18,000 relevant published papers that capture some 4% of the indexed database of PsycInfo. Many scientific journals, including the Journal of Positive Psychology, Journal of Happiness Studies, Journal of Wellbeing, Applied Psychology: Health & Well-being, and the International Journal of Applied Positive Psychology have also been established. Furthermore, positive psychology is being taught at the graduate level at numerous reputable institutions, including the University of Pennsylvania, the University of Melbourne, Claremont University, the University of East London, and IE University in Madrid, Spain.

Evidence (PPT)

PPT has a growing body of empirical evidence. The exercises in PPT were initially validated individually (Seligman, Steen, Park, & Peterson, 2005) before being coalesced into the PPT manual (Rashid & Seligman, in press; Seligman, Rashid, & Parks, 2006), which has since been used in 20 studies (see Table 13.4 for an overview). These studies have been conducted internationally and have addressed a variety of clinical populations (e.g., depression, anxiety, borderline personality disorder, psychosis, and nicotine dependence). Most of these studies have been conducted in a group therapy format. Overall, PPT has been shown to significantly lower symptoms of distress and enhance well-being at posttreatment with medium to large effect sizes (see Rashid, 2015, for pre- to postmeasure score changes on outcome measures and effect sizes) Overall, PPT outcome studies report decreases in depression and increases in well-being compared to control or pretreatment scores. When compared to other established treatments such as cognitive behavior therapy or dialectical behavior therapy, PPT has performed with comparable effectiveness, notably on well-being measures. One important caution in reviewing these studies is that most have small sample sizes.

Basic Concepts (REBT)

People are born with a potential to be rational (self-constructive) as well as irrational (self-defeating) People's tendency to irrational thinking, self-damaging habituations, wishful thinking, and intolerance is frequently exacerbated by their culture and their family group Humans perceive, think, emote, and behave simultaneously Even though all the major psychotherapies employ a variety of cognitive, emotive, and behavioral techniques, and even though any and all such therapies (including unscientific methods such as superstitious rituals and witch doctoring) may help individuals who have faith in them, they are probably not all equally effective or efficient REBT emphasizes the philosophy of unconditional acceptance: specifically, unconditional self-acceptance (USA), unconditional other acceptance (UOA), and unconditional life acceptance (ULA)

Theory of Personality

People are meaning-making beings that are subjects of experience and objects of self-reflection Emotions and behaviors that constitute personality can be in or out of awareness and may conflict -Concerns whether people are living as authentically and meaningfully as possible Central conflict is between individual and the ultimate concerns of existence -Existential psychology attends to how individuals deal with ultimate concerns

Theory of Psychotherapy (PPT)

PPT is based primarily based on two major theories: (1) Seligman's PERMA conceptualization of well-being (2) character strengths as active therapeutic ingredients Research has shown that fulfillment in these five components is associated with lower rates of depression and higher life satisfaction: -Positive Emotions: Positive emotions about the past include satisfaction, contentment, fulfilment, pride, and serenity. Positive emotions about the future include hope and optimism, faith, trust, and confidence. Positive emotions about the present include complex experiences such as savoring and mindfulness -2. Engagement: This dimension of well-being relates to the pursuit of engagement, involvement, and absorption in work, intimate relations, and leisure. The notion of engagement stems from Csikszentmihalyi's (1990) work on flow, which is the psychological state brought about by intense concentration that typically results in a lost sense of time while engaged in an activity and feeling "one with the music." -Relationships: All humans have a fundamental "need to belong" that has been shaped by natural selection over the course of human evolution -Meaning: Meaning consists of using signature strengths to belong to and serve something bigger than oneself. Victor Frankl (1963), a pioneer in the study of meaning, emphasized that happiness cannot be attained, only ensued. -Meaning: Meaning consists of using signature strengths to belong to and serve something bigger than oneself. Victor Frankl (1963), a pioneer in the study of meaning, emphasized that happiness cannot be attained, only ensued.

Variety of Concepts (PPT)

PPT rests on the fundamental belief that psychopathology results when clients' inherent capacities for growth, fulfillment, and happiness are thwarted by sociocultural factors-Positive psychotherapists do not believe that happiness and psychopathology somehow reside "inside" the person; instead, it is the interaction between clients and their environments that engenders both happiness and psychopathology Positive emotions and strengths are authentic and as real as symptoms and disorders- They are not merely by-products resulting from the absence of negative traits. Effective therapeutic relationships can be built on exploration and analysis of positive personal characteristics and experiences Explicitly focusing on positive emotions in therapy has been found to be effective in enhancing hope Engendering positive emotions, particularly in the early part of therapy, opens clients up to the therapeutic process

Phase One: Exercises

Participants begin PPT with a positive introduction that provides the opportunity for clients to be introduced through a story that depicts them when they believe they are at their best, especially in overcoming a challenge. For homework, participants reflect further and concretize this into an approximately 300-word written story. For the remainder of the first phase, the focus is on strengths exercises. This begins with a comprehensive strengths assessment. PPT recommends using two valid and reliable measures, the 240- or 120-item Values in Action Inventory of Strengths (VIA-IS) (Peterson & Seligman, 2004) or the 72-item self-report measure, Signature Strength Questionnaire (Rashid et al., 2013). All three of these measures are derived from the Classification of Strengths & Virtues To keep signature strengths in equal prominence with symptoms throughout therapy, clinicians gently nudge clients to share memories, experiences, real-life stories, anecdotes, accomplishments, and skills that illustrate use and development their signature strengths. However, in discussing strengths, negative characteristics are not undermined or minimized; context is important to determining when to use strengths The first phase of PPT ends with clients setting specific, attainable, and behavioral goals that adaptively use their signature strengths to address their presenting concerns.

Mechanisms of therapy (REBT)

Patient Beliefs Therapist approach -Not sympathizing with patient -Logical and empirical Evidence Base: -Cognition, emotion, and behavior occur simultaneously and interdependently -Approaches *Directive *Acceptance-based -Patient *Hw *Beliefs

Promoting Treatment Adherence

Patients can face many common barriers to treatment adherence Clinicians should try to respond non-judgmentally to patient disclosures of non-adherence -Adopt an investigator mentality in which your goal is to learn more about the patient's experience -Express an interest in helping the patient figure out why adherence has been difficult

Rogers' 19 Basic Propositions

Perception -Individuals react to reality based on their own perception -Behavior is a goal directed attempt to satisfy needs -Understand behavior through the individual Self concept: -Center of our own world -Structure is consistent yet fluid -Behavior can be Consistent/ Inconsistent Psychological Adjustment -Experiences consistent with self- we are doing the best we can -Understanding of others -Sees values as a continuous process

TOP (Theory of Personality) for REBT

Physiological -We are hardwired to want things and condemn ourselves if we don't get these thing Psychological -People needlessly psych ourselves out Social -We care too much about what others think ABC -Activating Event -Belief -Consequence Born w/ potential to be rational or irrational -Irrational thinking is exacerbated by culture and social groups

Precursors to BT

Pliny the Elder: -Used aversion therapy Treatment of Victor of Aveyron: -Treated with modeling, shaping, and reinforcement Pavlov: Classical conditioning John B. Watson: -Created behaviorism -Little Albert Experiment Jones: Combined modeling and exposure to treat boy who feared rabbits Mowrer and Mowrer: bell and pad to treat bed-wetting Thorndike and Skinner: -Operant conditioning -Reinforcement or punishment

Addressing Freedom

Point out instances in the moment Correct "Can't" to "Won't" Inquire about Patient's role Encourage ownership Correct inability to wish Reduce impulsivity Help patients understand that *Alternatives exclude*- learn to tolerate the uncertainty that an alternative decision might have been a better decision

PERMA model

Positive emotion Engagement Relationships Meaning Achievement

Racism in early psychology

Problematization- process by which groups are made into a problem to be studied; reinforced in-group and out-group bias Eugenics- targeted many groups that were deemed as "unfit"; targeted people of color and those with disabilities

Other systems (CT)

Procedures used in cognitive therapy are similar to psychoanalytic method -Conscious interpretation vs unconscious Psychoanalysis, psychodynamic psychotherapy, and cognitive therapy assume that behavior can be influenced by beliefs that one is not immediately aware of. However, cognitive therapy maintains that the thoughts contributing to a patient's distress are not deeply buried in the unconscious. Cognitive therapy is highly structured and usually short term, typically lasting from 12 to 16 weeks for the treatment of most psychiatric disorders. The therapist is actively engaged in collaboration with the patient -Psychoanalytic is long term and unstructured Cognitive therapy and rational emotive behavior therapy (REBT) share an emphasis on the primary importance of cognition in psychological dysfunction, and both see the task of therapy as changing maladaptive assumptions and the stance of the therapist as active and directive -REBT theory states that a distressed individual has irrational beliefs that contribute to irrational thoughts and that when these are modified through direct disputation, they will disappear and the disorder will clear up. The cognitive therapist helps the patient translate interpretations and beliefs into hypotheses, which are then subjected to empirical testing se they arc irrational. A profound difference between these two approaches is that cognitive therapy maintains that each disorder has its own typical cognitive content or cognitive specificity. The cognitive profiles of depression, anxiety, and panic disorder are significantly different and require substantially different techniques. REBT, on the other hand, does not conceptualize disorders as having cognitive themes but instead focuses on the musts, shoulds, and other imperatives presumed to underlie all disorders. Within behavior therapy are numerous approaches that vary in their emphasis on cognitive processes. At one end of the behavioral spectrum is applied behavioral analysis, an approach that ignores "internal events," such as interpretations and inferences, as much as possible. As one moves in the other direction, cognitive mediating processes are given increasing attention until one arrives at a variety of cognitive-behavioral approaches. At this point, the distinction between the purely cognitive and the distinctly behavioral becomes unclear. In contrast to behavioral approaches based on simple conditioning paradigms, cognitive therapy sees individuals as active participants in their environments, judging and evaluating stimuli, interpreting events and sensations, and judging their own responses.

Phases One Process

Process: -From the first session, clients are encouraged to reflect on their narrative centered on a specific experience or event that brought out their best. They are also encouraged to share anecdotes, accounts, and stories that show their strengths in tandem with their struggles—that is, express how they have successfully coped with or overcome challenges big or small. -The therapist empathically listens to presenting concerns of clients to establish and maintain a trusting therapeutic relationship. -Clients then assess their strengths through multiple resources (described in the next section) and set realistic goals that are relevant to their presenting problems and their well-being -The last step in the assessment of strengths is encouraging clients to develop practical wisdom

Multicultural Theories of Psychotherapy (MT)

Proponents of multicultural ~s~chotherapies ad~ocat~ for cultural sensitivity-that is, awareness, r~spe~t, and appre_ciatton for cultural d1ve:s1ty. Valuing diversity promotes a critical e~~mmat1on of e~tabhshed ~1sychother'.1peut1c models and assumptions because defin1t10ns of ~1ealth, illness, healing, _normaht~, and ,~lmt~rmality are culturally embedded Thus, multicultural psychotherapists examine their clients' as well as their own worldviews. The concept of worldview refers to people's systematized ideas and beliefs about the universe. When multicultural psychotherapists engage in self-examination, they explore their professional socialization and potential bias. They also examine the cultural applicability of their interventions and promote culturally relevant therapeutic strategies. Monocultural, dominant psychotherapies tend to be decontextualized, ahistorical, and apolitical. When they fail to examine the historical and sociopolitical contexts, mainstream psychotherapies ignore the role of power and privilege in people's lives. strengths. The emphasis on diversity leads multiculturalists to endorse interdisciplinary approaches. Indeed, unity through diversity is a multicultural maxim. Consequently, multicultural psychotherapists benefit from the contributions of sociology, anthropology, cultural and ethnic studies, humanities, arts, history, politics, law, philosophy, religion and spirituality, neuroscience, and many other disciplines. Accordingly, multicultural psychotherapists also are represented in diverse theoretical schools, including psychodynamic, cognitive-behavioral, rational-emotive, humanistic existential, Jungian, and various other combinations of dominant psychotherapies. Regardless of preferred theoretical approach, multicultural psychotherapists work to develop cultural competence.

Racism in modern psychotherapy

Psychiatric diagnoses used to combat civil rights movement - docile illnesses were seen as violent and prevalent in black men; ex: Schizophrenia Criminalization of mental health in America- vast majority of psychiatric beds are found in prison; people who are black are more likely to arrested and less likely to be offered actions that can keep them out of jail

Fantasy (freud)

Psychoanalytic theory: Fantasies play a crucial role in psychic functioning and the way they relate to external experience, especially their relationships with other people Freud: Fantasies are linked to instinctually derived wishes involving sexuality or aggression, and they served the function of a type of imaginary wish fulfillment- also helps to regulate self-esteem, and to master trauma

Carl Rogers

Psychoanalytically trained Followed client's lead instead of assuming "expert" role Influence by Otto Rank's nondirective therapy 1940- Rogers presents "Some Newer Concepts in Psychotherapy" 1957- Roger published classic paper on "necessary and sufficient conditions" 1987- death

Theory of Causality (CT)

Psychological distress is ultimately caused by many innate, biological, developmental, and environmental factors interacting with one another, so there is no single "cause" of psychopathology Depression, for instance, is characterized by predisposing factors such as hereditary susceptibility, diseases that cause persistent ncurochemical abnormalities, developmental traumas leading to specific cognitive vulnerabilities, inadequate personal experiences that fail to provide appropriate coping skills, and counterproductive cognitive patterns such as unrealistic goals, assumptions, or imperatives

Psychological Distress

Psychopathology is on the same continuum with normal behavior Psychological distress results from -Perceived threat -Maladaptive interpretations -Reduced cognitive and reasoning abilities

Cultural Self-Awareness (MT)

Psychotherapists can explore these issues through the following questions (adapted from Pinderhughes, 1989): • What is my cultural heritage? • What was the culture of my parents and ancestors? • With what cultural group(s) do I identify? • \'v'hat is the cultural meaning of my name? • What is my worldview? • What aspects of my worldview (values, beliefs, opinions, and attitudes) do I hold that are congruent with the dominant culture's worldview? Which are incongruent? • How did I decide to become a psychotherapist? How was I professionally socialized? What professional socialization do I maintain? What do I believe to be the relationship between culture and psychotherapy/counseling? • What abilities, expectations, and limitations do I have that might influence my relations with culturally diverse individuals? Other potential questions include: • How do my clients answer some of the questions above? • Are there differences between my answers and those of my culturally diverse clients? • How do I feel about these differences? • How do I feel about the similarities? To further their cultural self-awareness, psychotherapists can use Bennett's (2004) multicultural sensitivity development model. Bennett divided multicultural sensitivity development into ethnocentric and ethnorelative stages. The ethnocentric stages include the following. 1. Denial: Individuals deny the existence of cultural differences and avoid personal contact with culturally diverse people. 2. Defense: Individuals recognize other cultures but denigrate them. 3. Minimization: Individuals view their own culture as universal, and although they recognize cultural differences, they minimize them, believing that other cultures are just like theirs. The ethnorelative stages of developing multicultural sensitivity include the following. 1. Acceptance: Individuals recognize and value cultural differences without judging them. 2. Adaptation: Individuals develop multicultural skills; in other words, they learn to shift perspectives and move in and out of alternative worldviews, . . · 3. Integration: Individuals' sense of self expands to include diverse worldviews.

dynamic psychotherapy

Psychotherapy based on the idea that an individual may have conflicting conscious and unconscious motives and fears -Existential system: Awareness of Ultimate Concern--> Anxiety--> Defense Mechanism

Basic ideas (REBT)

Rational emotive behavior therapists don't believe a warm relationship between client and counselor is a necessary or a sufficient condition for effective personality change, although it is quite desirable Rational emotive behavior therapy uses role-playing, assertion training, desensitization, humor, operant conditioning, suggestion, support, and a whole bag of other "tricks." REBT holds that most neurotic problems involve unrealistic, illogical, self-defeating thinking and that if disturbance-creating ideas are vigorously disputed by logicoempirical and pragmatic thinking, they can be minimized REBT shows how activating events or adversities (A) in people's lives contribute to but don't directly cause emotional consequences (C); these consequences stem from people's interpretations of the activating events or adversities- that is, from unrealistic and overgeneralized beliefs (B) about those events Historically, psychology was considered a stimulus-response

Six stages of Practice (CT)

Recognize lack of control -Can be humbling -Looks at wandering mind Recognize patterns -Look at habitual patterns Refined awareness brings insight -Allows for insight Exceptional abilities emerge -Equanimity- maintaining equilibrium Transpersonal experiences emerge Stabilization

Acceptance-Based Behavioral Therapies

Refers to the development of the acceptance-based behavioral therapies, which emphasize the importance of accepting unwanted thoughts, feelings, and emotions rather than trying to control or directly change them. These treatments include acceptance and commitment therapy, mindfulness-based cognitive therapy, dialectical behavior therapy, and other related approaches. -Teaching clients to become more aware of what is most important to them and to begin to shift their behaviors to live in a way that is more consistent with their values. Mindfulness Treatments: -Acceptance and Commitment Therapy: Fostering acceptance and encouraging clients to become more aware of their values and take action -Dialectical Behavior Therapy: It was first developed to treat borderline personality disorder, although it is now used for a wide range of other problems, including eating disorders, substance-use disorders, and trauma-based problems

DIfferential Reinforcement of Alternate Behaviors (DRA)

Reinforcing an appropriate alternative to the problem behavior and extinguishing the problem behavior through extinction

Research: Cognitive Model and Outcome Studies (CT)

Research has tested both the theoretical aspects of the cognitive model and the efficacy of cognitive therapy for a range of clinical disorders. In terms of the cognitive model of depression, negatively biased interpretations have been found in all forms of depression: unipolar and bipolar, reactive, and endogenous. The cognitive triad, negatively biased cognitive processing of stimuli, and identifiable dysfunctional beliefs have also been found to operate in depression. The efficacy of cognitive therapy for depression has been demonstrated in numerous studies. For the anxiety disorders, a danger-related bias has been demonstrated in all anxiety diagnoses, including the presumed clanger of physical sensations in panic attacks, the distorted perception of evaluation in social anxiety, and the negative appraisals of self and the world in posttraumatic stress disorder (PTSD). Moreover, the cognitive specificity hypothesis, which states that there is a distinct cognitive profile for each psychiatric disorder, has been supported for a range of disorders In addition, cognitive therapy appears to lead to lower rates of relapse than other treatments for anxiety and depression Beck found hopelessness as a predictor for suicide A recent randomized controlled trial investigated the efficacy of a brief cognitive therapy treatment for those at high risk of attempting suicide by virtue of the fact that they had previously attempted suicide and had significant psychopathology and substance abuse problems. Results indicate that cognitive therapy reduced the rate of reattempt by 50% over an 18-month period

Theory of Psychotherapy (CT)

Rigorous scrutiny of perceptual-cognitive processes Awaken from the waking dream Recognize and reduce distortions Improve concentration, perceptual clarity, insight, compassion Process of psychotherapy -Visualization and Breath Meditation -Stages of Practice: *Humbling *Recognizing habitual patterns *Refined awareness unveils still deeper cognitive insights *Marked by emergence of a variety of exceptional abilities *Transpersonal experiences emerge, producing identification with others and compassionate concern for them *Peak experiences extend into plateau experiences and transient capacities mature into permanent capabilities Difficulties: -Emotional lability -Existential and spiritual challenges -Meditative difficulties -Reframing and reattribution are valuable

Origins of Existentialism

Sartre and Marcel: Developed the philosophy in the 1940's; credited with the term; Existence precedes essence- We aren't bound by anything and are bound by our decisions Kierkegaard: Analyzed anxiety and despair of people in a technological world Nietzsche: Looked at the power that resentment can have on emotional powers when mixed with guilt and hostility Binswanger: Case of Ellen West provided a debate amongst psychotherapeutic circles; first physician to combine psychotherapy to existentialism Rollo May: His books, which sought to reconcile existential ideas with psychoanalysis, became important texts of existentialism -Attributed anxiety to the fundamental clash between being and the threat of nonbeing Fromm: Focused on the human tendency to submit to authority as a way to defend against the existential terrors of free choice Yalom: Publishes the first textbook Existential Psychology (1980's)

Behavioral Activation

Scheduling of activities for more sources of positive reinforcement -Key to changing how one feels is changing what one does -Although life changes can lead to depression, unhelpful short-term coping strategies can keep people stuck in their depression -Figuring out what strategies are likely to be helpful for a particular client lies in understanding the events that precede and follow the client's behavior

Psychotherapy Integration

Schema therapy, developed by Jeffrey Young, focuses on modifying maladaptive core beliefs that are developed early in life and that can underlie chronic depression and anxiety as well as personality disorders. Another approach, mindfulness-based cognitive therapy, uses acceptance and meditation strategies to promote resilience and prevent recurrence of depressive episodes

14 Session Model

Sessions 1-3: orientation to PPT; client writes "positive introduction" of self; assess signature strengths; develop action plan to incorporate strengths Sessions 4-6: reappraisal of bitter memories; forgiveness; gratitude letter Session 7: feedback/ check-in Sessions 8-9: cultivate positive emotions and growth from trauma Sessions 10-11: communication skills and strengths of others Session 12: savoring Session 13: altruism; helping others Session 14: integrate treatment grains- the full life

Methods of Psychotherapy (BT)

Set treatment Select appropriate treatment Develop treatment contract

History of CT

Shamans --> -OG physicians Yoga and Meditative Practices --> Beginnings: -Axial Age: Pioneering of new techniques for training the mind -Buddhism -Confucianism -Aristotle and Socrates Became obvious that mental training is essential for psychological health, wisdom, and maturity Common Discoveries and Practices -Concentration and Focus -Insight and Wisdom -Love and Caring

Evidence of Treatment (CT)

Sheer amount of studies Wide array of demonstrated effects more than any other psychotherapy Demonstrates multiple exceptional abilities -Attention and concentration -Emotional maturity -Equanimity -Moral Maturity Support is found in most therapeutic applications

Evidence Base

Short term dynamic psychotherapy (<40 sessions) Long term psychoanalytic therapy

Reflections

Simple reflections- direct statement about what is heard Paraphrase- State our interpretations Reframe Amplified Reflection- Amplifies what we heard; can be seen as snarky Double-sided reflection- Can hold things on both sides

Racism in early psychotherapy

Slavery: created fake diagnoses that black people could not be independent -drapetomania: urge to escape slavery is an illness that can be solved with physical violence -diasthesia aethiopica: used to justify physical violence and keeping slaves captive Institutionalization

Shamanistic societies

Societies that were unscientific, but not found to be ineffective

Gordon Paul's Question

Some behavior therapists argue that the question we-should be asking is not whether a treatment works for a particular diagnosis but rather which treatment, by whom, is the most effective for a particular individual with a particular problem, and under what circumstances, as behavioral psychologist Gordon Paul (1967) famously asked several decades ago.

Primal Modes

Some modes, such as the anxiety mode, are primal, meaning they are universal and tied to survival. Other modes, such as conversing or studying, are minor and under conscious control. Although primal modes are thought to have been adaptive in an evolutionary sense, individuals may find them maladaptive in everyday life when they are triggered by misperceptions or overreactions. Primal modes include primal thinking, which is rigid, absolute, automatic, and biased. Nevertheless, conscious intentions can override primal thinking and make it more flexible. Automatic and reflexive responses can be replaced by deliberate thinking, conscious goals, problem solving, and long-term planning. In cognitive therapy, a thorough understanding of the mode and all its integral systems is part of the case conceptualization. This approach to therapy teaches patients to use conscious control to recognize and override maladaptive responses.

SMART goals

Specific, Measurable, Attainable, Realistic, Timely Increases the likelihood of reaching the goals Anticipates and plans for barriers to reaching the goals Reinforces continued success by setting a progressive series of goals

Congruence(Rogers)

State of wholeness and integration within the experience of the person Seen by Rogers as the hallmark for psychological adjustment and the antithesis of defensiveness an rigidity

Provide Affirmation

Statements of understanding Reframe Notice strengths Statements of hope

Problem Solving Training

Step 1: Define the Problem(s). Here the individual is taught to describe the problem as specifically as possible: "I have to drive my children to school and the car won't start" rather than "I'm having a terrible morning." If there are several problems, then the individual is encouraged to prioritize them and identify which ones are the most important. Step 2: Identify Possible Solutions. This stage is often referred to as brainstorming. At this step, the client should not worry about whether the proposed solutions are good or bad. Step 3: Evaluate the Solutions. This step involves examining the costs and benefits of each solution generated in step 2. Step 4: Choose the Best Solution(s). Sometimes this may include more than one option (e.g., sending the oldest child to school by taxi, and keeping the youngest child at home for the day). Step 5: Implementation. Problem-solving training may also focus on developing other related abilities, in- . eluding skills for challenging negative thinking, enhancing motivation, setting priorities, setting goals, managing time effectively, and improving organization. Problem-solving training has been used in the treatment of depression,_generalized anxiety disorder, social anxiety disorder, schizophrenia, couple distress, and other problems

secondary process

Style of psychic functioning associated with consciousness Logical, sequential, and orderly, and the foundation for rational, reflective thinking

defense mechanisms

Sublimation- We take conflicted emotions and put them into creative outlets Regression- revert to childlike behavior to avoid pain Repression- wall off the pain into the unconscious

Training (CT)

The Center for Cognitive Therapy, which is affiliated with the University of Pennsylvania Medical School, provides outpatient services and is a research institute that integrates clinical observations with empirical findings to develop theory The Beck Institute in Bala Cynwyd, Pennsylvania, provides both outpatient services and training opportunities The International Cognitive Therapy Newsletter was launched in 1985 for the exchange of information among cognitive therapists. The Academy of Cognitive Therapy, a nonprofit organization, was founded in 1999 by a group of leading clinicians, educators, and researchers in the field of cognitive therapy. The academy administers an objective evaluation to identify and certify clinicians skilled in cognitive ther apy, In 1999, the Accreditation Council for Graduate Medical Education mandated that psychiatry residency training programs train residents to be competent in the practice of cognitive-behavior therapy. The primary journals devoted to research in cognitive therapy are Cognitive Therapy and Research, the International Journal of Cognitive Psychotherapy, and Cognitive and Behavioral Practice. It has been such a major force in the Association for the Advancement of Behavior Therapy that the organization changed its name in 2005 to the Association for Behavioral and Cognitive Therapies (ABCT).

Current Status (MT)

The collcctivistic concept of unity through diversity achieved prominence during the 21st century. Multiculturalism promotes empowerment, change, and a transformative dialogue on oppression and privilege. Indeed, multicultural psychotherapists advocate for social justice action Currently, multicultural psychotherapists practice following three models: (1) a cultural adaptation of dominant psychotherapy, (2) ethnic psychotherapies, and (3) holistic approaches. Psychotherapists frequently combine these frameworks. Psychotherapy can be culturally adapted through the development of generic crosscultural skills or through the incorporation of culture specific skills (Lo & Fung, 2003 ). The generic term cultural competence refers to knowledge and skills required to work effectively in any cross-cultural clinical encounter. Psychotherapists working within the culture-specific skills level assimilate ethnic dimensions into mainstream psychotherapy. \'v'ithin this framework, therapists use culturally appropriate language to fit client's worldview and life circumstances. The dimension of persons refers to the therapeutic relationship. Metaphors relate to concepts shared by members of a cultural group. The dimension of content refers to a therapist's cultural knowledge (e.g., Does the client feel understood by the therapist?). Concepts examine whether the treatment concepts are culturally consonant with the client's context. The dimension of goals examines whether clinical objectives are congruent with clients' adaptive cultural values. Methods pertain to the cultural adaptation and validation of methods and instruments. Finally, Bernal and his associates defined context as clients' environment, including history and sociopolitical circumstances. In another example of culture specificity, Ricardo Munoz (Munoz & Mendelson, 2005) suggested culturally adapting CI3T through (1) involving culturally diverse people in the development of interventions, (2) including collectivistic values, (3) attending to religion or spirituality, (4) paying attention to the relevance of acculturation, and (5) acknowledging the effects of oppression on mental health. Notwithstanding Cl3T's evidence-based foundation, there is a dearth of empirical studies on the cultural validity of empirically supported treatments

Cultural Formulation and Analysis

The cultural formulation is a clinical tool for assessment and treatment included in the fourth edition of the American Psychiatric Association's (2000) Diagnostic and Statistical Manual (DSM-IV). The cultural formulation is a process-oriented approach that places diagnosis in a cultural context. Although the cultural formulation is a medical model that emphasizes pathology, its application increases psychotherapists' cultural awareness. The cultural formulation examines: 1. individual's cultural identity, 2. cultural explanations for individual illnesses, 3. cultural factors related to the psychosocial environment and levels of functioning, 4. cultural elements of the therapist-client relationship, and 5. overall cultural assessment for diagnosis and treatment (APA, 2000). The cultural formulation facilitates a cultural analysis. Like the explanatory model of distress, the cultural analysis uncovers the cultural knowledge people use to organize their behaviors and interpret their experiences

Phase Three Process

The final phase of PPT, which spans from session eight to session 14, focuses on restoring or fostering positive relationships (both intimate and communal). clients are likely ready to pursue meaning and purpose; strengths have broadened clients' self-concepts, and they have been able to deal with troubling memories, learn about forgiveness, and start to see the benefits of gratitude. Research strongly supports that a sense of meaning and purpose helps clients deal with psychological distress effectively, and the presence of a sense of purpose helps clients to recover or rebound from adversity as well as buffers against feelings of hopelessness and lack of control The final phase of PPT encourages clients to cultivate meaning by engaging in many processes such as strengthening close interpersonal and communal relationships by spotting strengths of loved ones; pursuing artistic, intellectual, or scientific innovations; or engaging in philosophical or religious contemplation

Precursors to CT

The phenomenological approach posits that the individual's view of self and the personal world are central to behavior. This concept originated in Greek Stoic philosophy and can be seen in Immanuel Kant's (1798) emphasis on conscious subjective experience The second major influence was the structural theory and depth psychology of Kant and Freud, particularly Freud's concept of the hierarchical structuring of cognition into primary and secondary processes. George Kelly (1955) is credited with being the first among contemporaries to describe the cognitive model through his use of personal constructs and his emphasis on the role of beliefs in behavior change. Cognitive theories of emotion, such as those of Magda Arnold (1960) and Richard Lazarus (1984), which give primacy to cognition in emotional and behavioral change, have also contributed to cognitive therapy.

Theory of Psychotherapy (CT)

The goals of cognitive therapy arc to correct faulty information processing and to help patients modify assumptions that maintain maladaptive behaviors and emotions. Cognitive and behavioral methods are used to challenge dysfunction,il beliefs and promote more realistic adaptive thinking. Cognitive therapy initially addresses symptom relief, but its ultimate goals are to remove systematic biases in thinking and modify the core beliefs that predispose the person to future distress. Cognitive therapy fosters change in patients' beliefs by treating beliefs as testable hypotheses to be examined through behavioral experiments jointly agreed on by patient and therapist. The cognitive therapist does not tell the client that the beliefs are irrational or wrong or that the beliefs of the therapist should be adopted. Instead, the therapist asks questions to elicit the meaning, function, usefulness, and consequences of the patient's beliefs. Lets patients take risks to promote change while not substituting positive beliefs for negative ones Cognitive change occurs at several levels: voluntary thoughts, continuous 'or automatic thoughts, underlying assumptions, and core beliefs. According to the cognitive model, cognitions are organized in a hierarchy, each level differing from the next in its accessibility and stability. The most accessible and least stable cognitions are voluntary thoughts. At the next level are automatic thoughts, which come to mind spontaneously when triggered by circumstances. They are the thoughts that intercede between an event or stimulus and the individual's emotional and behavioral reactions.

Initial Sessions (CT)

The goals of the first interview are to initiate a relationship with the patient, elicit essential information, and produce symptom relief. Building a relationship with the patient may begin with questions about feelings and thoughts about beginning therapy. Problem definition and symptom relief begin in the first session. Although problem definition and collection of background information may take several sessions, it is often critical to focus on a very specific problem and provide rapid relief in the first session. In the early sessions, then, the cognitive therapist plays a more active role than the patient Homework, at this early stage, is usually directed at recognizing the connections among thoughts, feelings, and behavior. For example, patients might be asked to record their automatic thoughts when distressed. During the initial sessions, a problem list is generated. Priorities are based on the relative magnitude of distress, the likelihood of making progress, the severity of symptoms, and the pervasiveness of a particular theme or topic.

Dimensions of Personality (CT)

The idea that certain clusters of personality attributes or cognitive structures are related to certain types of emotional response Found two major personality dimensions relevant to depression and possibly to other disorders: social dependence (sociotropy) and autonomy. Beck's research revealed that dependent individuals became depressed following disruption of relationships. Autonomous people became depressed after defeat or failure to attain a desired goal Research has also established that although "pure" ·uises of sociotropy and autonomy do exist, most people display features of each, depending on the situation. Thus, sociotropy and autonomy are styles of behavior, not fixed personality structures.

Freedom (Existentialism)

The idea that we live in a universe without an inherent design in which we are the artists of our own lives Thought is that the desire to escape the burden of this freedom allows dictators to rise up Requires the individual to confront their own destiny -"givens" in life...we can choose how we shall respond, how we shal live out our talents Requires responsibility and will -Living without taking responsibility is to live in bad faith Failures of willing give rise to pathology -Impulsivity -Compulsivity -Decisional panic

Beginnings (MT)

The interest in the other arrived in the mental-health fields during the 1940s and 1960s. Anthropologists and psychoanalysts collaborated on studying the relationship between culture and psyche. Proponents of these movements applied psychoanalytic analyses to social and cultural phenomena. Although the anthropological psychoanalytic orientations enriched the cultural and behavioral discourse, they failed to develop cultural theories that could be applied to psychotherapy Psychological and psychiatric anthropologists studied the effects of culture on mental health and gave birth to transcultural psychiatry. Similar to culturalism-the psychotherapeutic use of culture-specific folk healing-transcultural psychiatry and psychology advocated for the use of community and indigenous resources (clergy, teachers, folk healers, and other ethnic minority individuals) for mental-health treatment. The minority-empowerment movements furthered the development of multicultural psychotherapies. These movements examined the power and oppression dynamics between dominant group members and minorities. Known as identity politics, women's rights, black power, Chicano or brown power, and gay lesbian and bisexual movements highlighted the civil rights and needs of marginalized groups. Adherents of these movements raised consciousness and worked toward empowering marginalized groups in order to redress social and political inequities. The desire to understand the effects of oppression on mental health led some clinicians to examine the psychology of colonization. Frantz Fanon (1967) articulated the principles of the psychology of colonization in terms of the economic and emotional dependence of the colonized on the colonizer. He used the concepts of imperialism, dominance, and exploitation to examine the relationship between the colonizer and the colonized A major influence on multicultural psychotherapies is the education /or the oppressed model. Paulo Freire ( 1973) identified dominant models of education as instruments of oppression that reinforce and maintain the status quo and social inequities. He coined the term concientizacion or critical consciousness as a process of personal and social liberation. Reevaluation counseling (RC) is another influence in the emergence of multicultural psychotherapies. RC is an empowering co-counseling approach in which two or more individuals take turns listening to each other without interruption in order to recover MULTICULTURAL THEORIES OF PSYCHOTHERAPY 543 from the effects of racism, classism, sexism, and other type'> of oppression (Roby, 1998). Harvey jackins developed RC based on his belief that everyone has tremendous intellectual and loving potential but that these qualities have become blocked as a result of accumulated distress. Recovery involves a natural discharge process through which. the "counselor" encourages the "client" to discharge emotions (catharsis). Afterward, the "client" becomes the "counselor" and listens to the client. RC proponents are committed to ending racism at the individual, collective, and societal levels. Feminist therapy and multicultural therapies equally influence each other.

Phase Two Process (PPT)

The middle phase of PPT constitutes the fourth to eighth sessions and focuses on helping clients apply strengths adaptively through discussions on the nuances of navigating day-to-day hassles effectively and resolving or otherwise constructively addressing more significant adversities such as grudges, negative memories, and traumas. Clients are further taught to use their strengths in a calibrated and flexible way that could adaptively meet situational challenges The core of this middle phase of PPT is to help clients learn specific positive and meaning-based coping strategies to reinterpret open and negative memories that continue to trouble them

The Full Life (PPT)

The synthesis of components of PERMA and character strengths make up the full life in PPT Various components of well-being (PERMA) and character strengths are empirically distinguishable routes to happiness, but they are not at all incompatible. As a result, all can be pursued simultaneously, with each individually associated with life satisfaction. In addition, we adapt quickly to pleasure, and pleasure per se, especially sensory pleasure, clearly does not lead to happiness. In contrast, we adapt slowly to those activities that deeply engage us and are imbued with meaning. This is because, during engaging experiences, we are completely absorbed, and we are required to continuously adjust our relationship with the environment and with the challenge or task at hand. Throughout the entire course of therapy, clients are encouraged to keep a gratitude journal to describe three good things that happened to them during the course of each day. Most clients find this helpful to direct their attention deliberately toward good experiences, which are often otherwise missed in the hustle and bustle of daily life. By the end of therapy, clients learn habits of journaling daily positive experiences in written, visual, or interpersonal formats

Ethnocultural Transference and Countertransference (MT)

The therapeutic relationship is a fertile ground for the projection of conscious ar.d unconscious feelings, and every therapeutic encounter promulgates the projection of conscious or unconscious messages about the client's and the therapist's cultures. The examination of transference (clients' projections of feelings from previous relationships onto their therapists) and countertransference (therapists' reactions to clients' transference) helps to manage these processes. Multicultural psychotherapists examine transferential reactions through the initiation of a dialogue on cultural differences and similarities. During this dialogue, among others aims, they seek to: 1. suspend preconceptions about clients' race and ethnicity contexts; 2. recognize that clients may be quite different from other members of their racial or ethnic group; · 3. consider how racial or ethnic differences .between therapist and client may affect psychotherapy; 4. acknowledge that power, privilege, oppression, and racism might affect their interactions with clients; and 5. err on the side of discussion, particularly when in doubt about the role of race and ethnicity in treatment (Cardemil & Battle, 2003 ). Comas-Diaz and Jacobsen (1991) described several types of ethnocultural transference and countertransference within intra- and interethnic dyads. Some of the interethnic transferential reactions include: 1. overcompliance and friendliness (observed when there is a societal power differential in the client-therapist dyad); 2. denial (when the client avoids disclosing issues pertinent to ethnicity or culture); 3. mistrust, suspiciousness, 'and hostility ("What are this therapist's real motivations for working with me?"); and 4. ambivalence (clients in an interethnic psychotherapy may struggle with negative feelings toward their therapist while simultaneously developing an attachment to him or her). lntraethnic transference may transform a client's image of the therapist into one of several predictable roles: 1. the omniscient or omnipotent therapist-fantasy of the reunion with the perfect parent as promoted by the ethnic similarity; 2. the traitor-client exhibits resentment and envy at therapist's successes, which is equated with betrayal of his or her ethnoculture; 3. the autoracist-client does not want to work with a therapist of his or her own ethnocultural group because of projection of strong negative feelings onto the ethnoculturally similar therapist; and 4. the ambivalent-clients may feel at once comfortable with their shared ethnocultural background while at the same time fearing too much psychological closeness. Some interethnic dyad countertransferential reactions include: 1. denial of cultural differences-we are all the same; 2. the clinical anthropologist's syndrome=-excessive curiosity about clients' ethnocultural backgrounds at the expense of their psychological needs; 3. guilt-about societal and political realities that dictate a lower status for people of color; 4. pity-a derivative of guilt or an expression of political impotence within the therapeutic hour; 5. aggression; and 6. ambivalence-toward the client's culture, which may originate from ambivalence toward a therapist's own ethnoculture. Within the intra ethnic dyad, some of the countertransferential manifestations include: 1. overidentification; 2. an us-and-them mentality-shared victimization because of racial discrimination may contribute to therapist ascribing a client's problems as being solely the result of membership in a minority group; 3. distancing; 4. survivor's guilt-therapists may have the personal experience of escaping the harsh socioeconomic circumstances of low-income ethnic minorities, leaving family and friends in the process, and generating guilt-feelings that can impede professional growth and may lead to denying clients' psychological problems; 5. cultural myopia-inability to sec clearly because of ethnocultural factors that obscure therapy; 6. ambivalence-working through the therapist's own ethnocultural ambivalence; and 7. anger-being too ethno culturally close to a client may uncover painful and unresolved intrapsychic issues.

Therapeutic Relationship (CT)

The therapeutic relationship is collaborative. The therapist assesses sources of distress and dysfunction and helps the patient clarify goals The patient also shares responsibility by helping to set the agenda for each session and by doing homework between sessions. Homework helps therapy proceed more quickly and gives the patient an opportunity to practice newly learned skills and perspectives. The therapist functions as a guide who helps the patient understand how beliefs and attitudes interact with affect and behavior. The therapist is also a catalyst who helps devise corrective experiences that lead to cognitive change and skills acquisition. Thus, cognitive therapy employs a learning model of psychotherapy. The therapist has expertise in examining and modifying beliefs and behavior but does not adopt the role of either a passive expert or the arbiter of correct thinking. Therapist has warmth, is flexible, sensitive to patient's level of comfort, and elicits feedback from the patient at the end of each session Provides a rationale for each procedure used to demystify the process Collaborative Therapist as a guide and catalyst for change Emphasizes patient responsibility (10,080)

two-person psychology

The therapist and client are both co-participants that engage in an ongoing process of mutual influence at both conscious and unconscious levels What seems to be used today

classical psychoanalysis

The traditional (Freudian) approach to psychoanalysis based on a long-term exploration of past conflicts, many of which are unconscious, and an extensive process of working through early wounds.

Heinz Kohut

Theorist that placed an increasing emphasis on the role that the therapist' empathic stance plays as a mechanism of change in and of itself and the centrality of this process in repairing ruptures in the therapeutic relationship when they occur as a result of the therapist's inevitable lapes in empathy

object relations perspectives

Theorize that internal representation (internal objects) influence the way people perceive others, choose particular types of people to establish relationships with, etc Attachment theory: humans build internal working models of caregivers that allow them to maintain proximity

REBT (Rational emotive behavior therapy)

Theory that holds that when a highly charged emotional consequence (C) follows a significant activating event (A), event A may seem to but doesn't actually cause C- emotional consequences are largely created by B Goals: -Correct demandingness *Recognize should, oughts, and musts *Give up perfectionism -Develop high frustration tolerance *Accept reality, even when grim *Is the worst thing that could happen really as bad as I melodramatically fantasize it would be?

Rogerian hypothesis

Theory that individuals are most able to access their own creative resources when provided a relationship offered by a gentile, congruent therapist who is experiencing unconditional positive regard and warm acceptance and is emphatically receptive to the client's own perceived realities

Applications (CT)

Therapeutic Applications: Psychological (P) or Somatic (S) -Stress disorders (P) -Drug use (P) -Depression (P) -ADHD (P) -Contemplation for Youth (P) -Meditation Combination Therapies (P) -Cardiovascular system, more specifically, coronary artery disease (S) -Hormonal and Immune Effects (S) -Further Adjuvant Treatments (S) -Enhancing Well Being (S) Psychological Maturity -Meditation and yoga are now used to enhance performance in multiple areas, such as academics, sports, business, and military settings

Evidence base (Rogers)

Therapeutic factors- Environment and attitude in therapy Extra-therapeutic factors- Environment outside of therapy Core conditions -Congruence and unconditional regard tend to result with better outcomes

Theory of PT(REBT)

Therapeutic relationship: -Active -Directive -Confrontational Unconditional Acceptance: Appreciates ourselves and others as fallible -Self -Others -Life Demandingness -Causes distress -Temporary "solutions" provide relief, but doesn't fix demandingness Satisfaction of demands Distraction Magic and mysticism

Core beliefs (CT)

Therapy aims at identifying these absolute beliefs and counteracting their effects. If the beliefs themselves can be changed, the patient is less vulnerable to future distress. In schema therapy, these core beliefs are called early maladaptive schemas

Techniques (CT)

Therapy may be directed toward problem solving with an understanding of how these beliefs influence the patient. Core beliefs are explored in a similar manner and are tested for their validity and adaptiveness. The patient who discovers that these beliefs are not accurate is encouraged to try out a different set of beliefs Cognitive therapy also uses behavioral techniques such as skills training (e.g., relaxation, assertiveness training, social-skills training), role playing, behavioral rehearsal, and exposure therapy.

History of psychoanalytic perspectives

There is no one psychoanalytic theory of personality or treatment, but a host of different theories and treatment models that have developed over more than a century

Automatic thought

Thoughts generated from underlying assumptions. For example, the belief "I am responsible for other people's happiness" produces numerous negative automatic thoughts in people who perceive themselves as causing distress to others.

Streams of investigation

Thoughts of how the mind works emerged in the 19th century: -systematic, lab-bench empiricists -philosophers of nature -clinician researchers

The Necessary and Sufficient Conditions of Therapeutic Personality Change

Three essential conditions for Therapist: Congruence Unconditional positive regard Empathic understanding These conditions all create trust with the client Three conditions for Client: -Self concept -Locus of Evaluation -Experiencing These conditions can create trust

developmental psychology (DP)

Three levels of development: -Prepersonal No idea of social convention -Personal Only half grown and half awake. We get stuck in a "herd" mentality -Transpersonal We shifts to transcend and focus on wisdom Consensus trance/shared hypnosis: Our usual mental state is like living in a darkened cave "We are only half-grown and half-awake"

Mechanisms of Psychotherapy (CT)

Three mechanisms of change common to all successful forms of psychotherapy are (1) a comprehensible framework, (2) the patient's emotional engagement in the problem situation, and (3) reality testing in that situation. Cognitive therapy maintains that the modification of dysfunctional assumption leads to effective cognitive, emotional, and behavioral change. Patients change by recognizing automatic thoughts, questioning the evidence used to support them, and modifying cognitions. According to cognitive therapy, core beliefs are linked to cmonons; with affective arousal, those beliefs become accessible and modifiable. One mechanism of change, then, focuses on making accessible those cognitive constellations that produced the maladaptive behavior symptomatology For a variety of psychotherapies, what is therapeutic is the patient's ability to be engaged in a problem situation and yet respond to it adaptively

spontaneous remission of disorders

Tied to people suddenly getting better from disorder symptoms

Optimal therapy characteristics (REBT)

Time and Effort Symptom Reduction Lasting Results Generalizable

Cultural Competence (MT)

To become culturally competent, you need to: 1. become aware of your worldview, 2. examine your attitude toward cultural differences, 3. learn about different worldviews, and 4. develop multicultural skills (Sue et al., 1995). Likewise, culturally competent therapists develop the capacity to: 1. value diversity, 2. manage the dynamics of difference, 3. acquire and incorporate cultural knowledge irito their interventions and interactions, 4. increase their multicultural skills, 5. conduct self-reflection and assessment, and 6. adapt to diversity and to the cultural contexts of their clients. Because all therapeutic encounters are multicultural-everyone belongs to diverse cultures and subcultures-cultural competence enables psychotherapists to work effectively in most treatment situations Therapists should: -Value diversity -Manage dynamics of difference -Acquire and incorporate cultural knowledge into their interventions -Increase their multicultural skills -Conduct self-reflection and assessment -Adapt to diversity and cultural context of their clients

Current existential therapists

Today, therapists are centrally concerned with rediscovering the living person amid the dehumanization of modern culture; to do this, they engage in in-depth psychological analysis

Mechanisms of Psychotherapy (BT)

Traditional behaviorism views mechanisms according to learning principles More recent conceptualizations have begun to acknowledge cognitions Poor treatment compliance is associated with worse outcomes

Beginnings (PPT)

Traditional psychotherapy is deficit oriented -Publications about negative emotions > positive emotions -2004 was the first time that the DSM introduced a classification of strengths In her book Current Concepts of Positive Mental Health, Jahoda (1958) made a persuasive argument that well-being should be appreciated in its own right. Frankl (1963) noted that the primary human drive was not pleasure, but the pursuit of meaning. Since 1952, five editions of the Diagnostic Statistical Manual (DSM-5; American Psychiatric Association, 2013) have cataloged hundreds of symptoms associated with psychiatric disorders, but there was not a single and coherent classification of strengths until 2004 Since 1952, five editions of the Diagnostic Statistical Manual (DSM-5; American Psychiatric Association, 2013) have cataloged hundreds of symptoms associated with psychiatric disorders, but there was not a single and coherent classification of strengths until 2004

Cultural Trauma

Tragic historical examples of cultural disruptions, some of which have led to complete cultural disintegration

Aaron Beck

Trained in psychoanalysis Observes consistent biases in cognitive processing Develops theory of emotional disorders and cognitive model of depression

Treatment strategies (BT)

Two main methods: -Results of detailed functional analysis -Based on the client's diagnostic profile Exposure: Confronting instead of avoiding -In vivo exposure: exposure in real life -Imaginal exposure: exposure to feared mental imagery/ thoughts instead of an external object -Interoceptive exposure: purposely experiencing frightening physical sensations until they are no longer frightening- used with individuals with panic disorders -Exposure hierarchy: ranking of feared situations with difficult at the top Response Prevention: -Impulse control (nail biting) -Compulsive rituals (washing, checking, counting) -Safety behaviors undermine exposure Operant Conditioning Strategies Relaxation Training: -Slow diaphragmatic breathing -Guided mental imagery -Progressive relaxation: most effective for generalized anxiety disorder, high blood pressure, etc Modeling: We learn by following others Behavioral Activation: Scheduling of activities for more sources of positive reinforcement Social Skills Training: Use of modeling, corrective feedback, behavioral rehearsal, and other strategies to help clients to improve their abilities to communicate effectively and function better in social interactions -Looks at eye contact, body language, speech quality, etc Problem Solving Training

Cultural considerations (existentialism)

Ultimate concerns transcend culture--> Culture influences defenses--> Therapist must acknowledge and adapt

Death

Ultimate existential concern Core inner conflict Denial based defenses: -Specialness: If I do this, nothing bad will happen to me -Ultimate Rescuer: Someone believes that an omnipotent savior is watching over them to keep the individual safe

OCD

Uncertainty of safety (obsession) Sense of responsibility to take action (compulsion)

Unconditional Positive Regard (Rogers)

Unconditional acceptance and approval of a person by others

Goals of Therapy

Understand unconscious conflicts Identify defense mechanisms DIscover their destructive influence Develop other ways of coping Life cannot be lived without anxiety FInd tolerable levels and use them constructively

Cognitive Techniques (CT)

Verbal techniques are used to elicit the patient's automatic thoughts, analyze the logic behind the thoughts, identify maladaptive assumptions, and examine. the validity of those assumptions. Automatic thoughts are elicited by questioning the patient about those thoughts that occur during upsetting situations Maladaptive assumptions are usually much less accessible to patients than automatic thoughts. Some patients are able to articulate their assumptions, but most find it difficult. Decatastrophizing, also known as the what-if technique (Beck & Emery, 1985), helps patients prepare for feared consequences. This is helpful in decreasing avoidance, particularly when combined with coping plans Reattrihution techniques test automatic thoughts and assumptions by considering alternative causes of events. This is especially helpful when patients personalize or perceive themselves as the cause of events. It is unreasonable to conclude, in the absence of evidence, that another person or single factor is the sole cause of an event. Redefining is a way to mobilize a patient who believes a problem to be beyond personal control. Burns (1985) recommends that lonely people who think, "Nobody pays any attention to me" redefine the problem as "I need to reach out to other people and be caring." Decentering is used primarily in treating anxious patients who wrongly believe they are the focus of everyone's attention. After they examine the logic behind the conviction that others would stare at them and be able to read their minds, behavioral experiments are designed to test these particular beliefs Decentering is used primarily in treating anxious patients who wrongly believe they are the focus of everyone's attention. After they examine the logic behind the conviction that others would stare at them and be able to read their minds, behavioral experiments are designed to test these particular beliefs Decentering is used primarily in treating anxious patients who wrongly believe they are the focus of everyone's attention. After they examine the logic behind the conviction that others would stare at them and be able to read their minds, behavioral experiments are designed to test these particular beliefs

evidence-based practice

What therapists strive for -clinical expertise: developed over years in schooling and internships; developed over a decade -best research evidence: use with clinical expertise to interpret data and how to implement that for a patient -patient values -Implementation science: how well does it work? -Effectiveness trials

What to determine when giving a treatment to a patient?

What works? ...for whom? ....in what context? .....and why?

Cultural Considerations (CCAT)

Within- group differences can exceed between-group differences -Multiple groups -Evolving self concept -Uniqueness Therapists must: -Be aware of own biases -Challenge bias to achieve true empathic understanding -Have openness and appreciate all kinds of differences

Rupture and Repair

Working through a retraumatization and learn how to bring themselves into a relationship that is real

Three components of CCT

Your own reality within yourself, when we come together each person still makes their own reality, must be as full a person as you can by going through all these steps, with yourself, reality and values Through their experience, the private world of the individual, not fully conscious, symbolization is the process of becoming aware of them Internal frame of reference, each person has their own way of seeing the whole world Organismic valuing process, we develop our own value judgments

Freud's Structural Model

a diagram where the majority of the superego, the ego, and the id are located in the unconscious and only a small portion of the superego and ego are located in the conscious

medical apartheid

a history of abuse of medical experimentation on African Americans, who have served for centuries as unwilling and unwitting subjects

cognitive-behavior therapy

a popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior) Therapist's aim is to challenge the patient's core beliefs, which are believed to maintain dysfunction or psychopathology

relational psychoanalysis

a subfield of psychoanalysis that emphasizes internalized relationships with other people based on the influences of early formative relationships with parents and other attachment figures

Cultural Genogram

family therapy tool, genograms diagram a genealogical tree that highlights dynamics from a nuclear to an extended family perspective (McGoldrick et al., 1999). Genograms are particularly useful when psychotherapists compare their genealogy to their clients' and examine similarities as well as differences. Clinicians begin a cultural genogram with three or more generations of ancestors. If appropriate and if the information is unavailable, they invite clients to use their imaginations to summon up family information. To aid in this process, clients bring family photos to therapy sessions. This approach is useful when discussing racial differences and other types of physical characteristics. The following factors can be used in completing a cultural genogrmn (adapted from Comas-Diaz & Ramos Grenier, 1998; Hardy Lazloffy, 1995): • Individual and family culture(s) • Meaning of race: o identity and identification; and o significance of skin color, body type, hair texture, phenotype. • Meaning of ethnicity: o national origin, collective history, wars, conflicts with other ethnic groups; o languages spoken by client, family of origin, and current family; and o ethnocultural heritage. • Sexual orientation: o interaction of gender, ethnicity, race, class, and sexual orientation. • Family: o intact, blended, single parent, nuclear, extended, multigenerational, and so forth; and . o cultural meanings of family roles. • Adoption and foster parenting: o family of origin and multigenerational history; 0 assessment of non-blood-related extended family members; 0family life-cycle development and stages; 0family structure (nuclear, extended, traditional, intact, reconstituted); and 0gender and family roles. • Social class: -educational level; -financial history (e.g., Great Depression, culture of poverty, change in socioeconomic class); and -occupation and avocation. • Marriage: o common-law, civil law, religious, commitment ceremonies, same-sex unions, and so on; o gender roles; and o gender-specific trauma. • Relations (intimate, friends, comrades or padres, sister friends, etc.): o intracthnic and interethnic. • Migration: o history of (im)migration and generations from (im)migrations; and o patterns, reasons for migration. • Refugee experience • Refugee trauma • Acculturation: o assimilation, separation, marginalization, and integration. • Stress: o types of stress, o acculturative stress, o life stressors, o ecological stress (e.g., inner-city living), and o stress management. • Spirituality and faith: o spiritual assessment and o use of contemplative practices. • History and politics • Trauma: o political torture and repression; o history of slavery, colonization, holocaust, genocide, wars; and o history of human trafficking. • Sexual and gender trauma: o rape, incest, molestation, and harassment. • Meaning of differences: o individual, family, group, and community. Finally, multicultural assessments can be complemented with a poioer-differential analysis. Such analysis requires going beyond the power differential inherent in the psychotherapist-client dyad. It should include an analysis of the client's cultural group's social status compared with the practitioner's. This comparison entails the identification and challenge of internalized privilege and oppression

Feminist Identity development

feminist identity develops as (1) passive acceptance, (2) revelation, (3) embeddedness or emanation, (4) synthesis, and (5) active commitment.

Congruence (Rogers)

according to client-centered counseling, the necessary quality of a counselor being in touch with reality and other's perception of oneself

attachment theory

theory based on John Bowlby's work that posits that children are biologically predisposed to develop attachments to caregivers as a means of increasing the chances of their own survival

play therapy

an approach to treating childhood disorders that helps children express their conflicts and feelings indirectly by drawing, playing with toys, and making up stories

interpersonal psychoanalysis

another term for interpersonal therapy

reversal design

any experimental design in which the researcher attempts to verify the effect of the independent variable by "reversing" responding to a level obtained in a previous condition: encompasses experimental designs in which the independent variable is withdrawn

integral psychology

approach that addresses multiple psychological and somatic dimensions Multimodal interventions may be significantly more effective than psychotherapy alone

nomothetic approach

approach to personality that focuses on identifying general laws that govern the behavior of all individuals

idiographic approach

approach to personality that focuses on identifying the unique configuration of characteristics and life history experiences within a person

doll study (clark and clark, 1947)

asked kids to describe characteristics to white and black dolls; used as argument for ending segregation in schools

Logo therapy

therapy through meaning, will, freedom, and responsibility

Fugitive Slave Law

this law required that northern states forcibly returned escaped slaves to their owners Part of scientific racism

Evaluating the evidence base

challenges regarding evidence < importance of the evidence

Non-Directive Approach

clients are encouraged to freely find solutions to their problems instead of the therapist telling them what they should do.

nonspecific factors

clients' and therapists' personal qualities, the therapists' empathy, and the quality of the relationship

cure

deep transformative change across multiple domains of personality, character, and behavior

Rationalization

defense mechanism that offers self-justifying explanations in place of the real, more threatening, unconscious reasons for one's actions Ex: I must have failed my exam because my teacher hates me

Feminist Therapy

emphasizes the role of social, political, and economic stresses facing women as a major source of their psychological problems

Feminist Therapies

encourage young women to pursue their own values rather than blindly adopting prescribed social roles

Cultural Identity Development

following Gehrie's (1979) assertion, multicultural psychotherapists view the self as an internal representation of culture. For instance, being a member of an oppressed minority group influences identity development. The identify formation of people of color involves both personal identity and cultural-racial-ethnic group identity The minority identity development theories offer a lens for understanding how individuals process and perceive the world. Indeed, the ethnic and racial identity stage affects beliefs, emotions, behaviors, attitudes, expectations, and interpersonal style. More specifically, minority identity development stages include: 1. conformity-individuals internalize racism and choose values, lifestyles, and role models from the dominant group; 2. dissonance-individuals begin to question and suspect the dominant group's cultural values; 3. resistance-immersion-individuals endorse minority-held views and reject the dominant culture's values; 4. introspection-individuals establish their racial ethnic identity without following all cultural norms, beginning to question how certain values fit with their personal identity; and 5. synergistic-individuals experience a sense of self-fulfillment toward their racial ethnic- cultural identity t having to categorically accept their minority group's values.

collaborative empiricism

g and providing feedback, and thereby demystifying how therapeutic change occurs. The therapist and patient become co-investigators, examining the evidence to support or modify the patient's cognitions. As in scientific inquiry, interpretations or assumptions arc treated as testable hypotheses. Empirical evidence is used to determine whether particular cognitions serve any useful purpose. Prior conclusions are subjected to logical analysis.

free association

in psychoanalysis, a method of exploring the unconscious in which the person relaxes and says whatever comes to mind, no matter how trivial or embarrassing Therapist interprets: -Manifest content = surface material -Latent content = deeper level

interpretation

in psychoanalysis, the analyst's noting supposed dream meanings, resistances, and other significant behaviors and events in order to promote insight

transference

in psychoanalysis, the patient's transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent)

Resistance

in psychoanalysis, the tendency for an individual to resist change or act in a way that undermines the therapeutic process Defense processes can manifest against the therapy itself

intrapsychic conflicts

inner mental struggles resulting from the interplay of the id, ego, and superego when the three subsystems are striving for different goals

constructs

internal attributes or characteristics that cannot be directly observed but are useful for describing and explaining behavior

ICD

international classification of diseases DSM but with disorders

MBSR (mindfulness-based stress reduction)

involves a structured program of mindfulness meditation, yoga and mindful practices, and group discussion.

common factors approach

modern approach to eclecticism focusing on factors seen as the source of success

Variety of Concepts (MT)

multicultural psychotherapists promote cultural resilience-a set of strengths, values, and practices that enhances the coping mechanisms and adaptive reactions of clients of color to trauma and oppression Within this framework, multicultural psychotherapists encourage clients of color to develop cultural consciousness, a process that helps clients increase their psychocultural awareness. Likewise, psychotherapists aim to develop multicultural consciousness during and beyond the clinical hour. Multicultural consciousness refers to therapists' internalization and incorporation of cultural competence into their everyday activities and into every aspect of their behavior Equally important, multicultural consciousness fosters the development of cultural intelligence, which is the understanding of the impact of culture on individuals' behavior. Cultural intelligence requires inductive and analogical reasoning because individuals need these forms of thinking to approach and understand a new context without being constrained by previous experiences and preconceived ideas

Who can we help? (MT)

multiculturalists share similarities with all therapists (by virtue of being therapists), with some therapists (by belonging to a particular theoretical orientation), and with no other therapist (because of their unique personal and cultural experiences). Multicultural clinicians engage in diverse therapy formats, including individual, family, and group. In addition, some use community interventions such as network therapy. Multicultural psychotherapies apply to everyone because they emphasize a person-in context model.

aversive racism

people who appeared nonprejudiced in self-report measures often have generally negative attitudes toward blacks. Known as aversive racism, this phenomenon showed that both liberal and conservative whites discriminate against African Americans (and probably against other visible people of color) in situations that do not implicate racial prejudice as a basis for their actions

person-centered perspective

people are basically good, and given the right environment their personality will develop fully and normally

Character Strengths (PPT)

posits that whereas symptoms and their severity help therapists understand the stress, sadness, anger, and anxiety of clients, character strengths such as gratitude, hope, love, kindness, and curiosity helps them understand the ways in which clients can be good, sane, and high functioning. Hence, assessing strengths along with symptoms is critical for a balanced and holistic clinical practice, as well as understanding that psychotherapy is as much about cultivation of wellness as it is about alleviation of distress. We argue that psychotherapy is one of the most important venues to build strengths because of the following: ● Fixing weaknesses yields remediation, whereas nurturing strengths produces growth and improves well-being. ● Repairing or fixing weakness does not necessarily make clients stronger or happier. ● Using strengths increases clients' self-efficacy and confidence in ways focusing on weakness cannot. ● Strengths offer ways for clients to be the individuals they often want to be—kind, humorous, industrious, curious, creative, and grateful. ● Strengths essentially come from being good, not feeling good. Trite feel-good statements such as "You can do anything if you work hard enough" and "The sky's the limit" are ineffectual stratagems. In contrast, strengths are built through specific, realistic actions The patterns of strengths individuals possess have tremendous variation. Through rituals, societal institutions attempt to cultivate these character strengths, which are morally desired traits of human existence. Character strengths (e.g., kindness, teamwork, zest) are distinguished from talents and abilities. Athletic prowess, photographic memory, perfect pitch, manual dexterity, and physical agility are examples of talents and abilities. Strength use varies by context, so there is no perfect mean; however, positive psychologists accept what Aristotle referred as the golden mean—the right combination of strengths applied to the right degree in the right situation

Denial

psychoanalytic defense mechanism by which people refuse to believe or even to perceive painful realities.

Displacement

psychoanalytic defense mechanism that shifts sexual or aggressive impulses toward a more acceptable or less threatening object or person, as when redirecting anger toward a safer outlet ex: Barney's chain of screaming

primary process

raw or primitive form of psychic functioning that begins at birth and continues to operate unconsciously throughout the lifetime no distinction between past, present, and future

single-case experimental design

research tactic in which an independent variable is manipulated for a single individual, allowing cause-and-effect conclusions but with limited generalizability

racial microaggressions

subtle insults directed at people of color and often done nonconsciously

context-dependent stochastologicals

tangle of variables internal and external to the person that intertwine with job stresses, financial concerns, troubled children, angry spouses or in-laws, difficult colleagues, bad weather, life-threatening illness, contested insurance claims, and the forgotten baggage of personal history and past defeats

Termination

the act of ending something made collaboratively by client and therapist and marks the end of a treatment that has been helpful and satisfying

Comorbidity

the co-occurrence of two or more disorders in a single individual complicates the diagnostic coding of disorders and patients for purposes of validating therapy for them

Who Can We Help? (PPT)

the core exercises that constitute PPT (e.g., exploring and using signature strengths, three blessings journal, the gratitude letter or visit, and active-constructive responding) have been widely used with nonclinical samples in life and executive coaching, education, and organizations The Internet offers the potential to disseminate information about positive psychology and PPT exercises to a broad audience in an accessible and affordable manner. One way to expand this influence of PPT is to reach out to "normal" people who may not have exhibited clinical symptomatology but who do need help to develop skills to improve their well-being. PPT can also help a wide range of psychologically disturbed individuals

dodo bird verdict

the finding that most forms of therapy are effective and few significant differences exist in effectiveness among standard therapies

Actualizing Tendency (Rogers)

the force for growth and development that is innate in all organisms When given the chance, we are gonna strive to be the best version of ourselves

Intersectionality

the interconnected nature of social categorizations such as race, class, and gender as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage.

locus of evaluation

the place of judgement's origin, its source; whether the appraisal of an experience comes more from within the individual (internal) or from outside sources (external)

intersubjectivity

the process by which two participants who begin a task with different understandings arrive at a shared understanding Stephen Mitchell argues that it is at the heart of the therapeutic process

Soul Wounding

the product of sociohistorical oppression, ungrieved losses, internalized oppression, and learned helplessness

object relations theory

the psychodynamic theory that views the desire for relationships as the key motivating force in human behavior

therapeutic alliance

the relationship between therapist and client that develops as a warm, caring, accepting relationship characterized by empathy, mutual respect, and understanding emphasized by Ralph Greenson

Golden Mean

the right combination of strengths applied to the right degree in the right situation

Recovery Oriented Care

treatment that elicits and cultivates the positive elements of a person's life—such as his or her assets, aspirations, hopes, and interests—at least as much as it attempts to ameliorate and decrease symptoms

empirically supported therapies (ESTs)

treatments for psychological disorders whose effectiveness has been validated by controlled experimental research

Existential Theory

ultimate concerns -->anxiety--> defenses

existential dilemma

who am i, why am i here, what is my purpose?