Clinical Psychology

Psychological Interventions and Medical Costs

APA concluded that research on psychotherapy outcomes has demonstrated that courses of psychotherapy reduce overall medical utilization and expense ex. Chiles, Lambert, and Hatch meta-analysis of research conducted between 67-97 -indicated that participation in psychological interventions by patients undergoing surgery, patients with a history of medical over-utilization, and patients receiving treatment for substance misuse or other psychological disorder usually resulted in a medical cost offset --found that 90% of the studies included in their analysis reported evidence of a medical cost offset and that the average cost savings attributable to a psychological intervention was 20%

Extended Family Systems Therapy (AKA intergenerational and transgenerational family thearpy)

Bowen derived this approach from work with children with schizophrenia and their families, which led his conclusion that the transmission of certain emotional processes from one generation to the next is responsible for the development of schizophrenia in a family member Differentiation: both intra- and interpersonal -intrapersonal aspect: person's ability to distinguish between their own feelings and thoughts --ability makes it possible for the person to separate their own emotional and intellectual functioning from the functioning of others -interpersonal aspect: person with low level of differentiation becomes "emotionally fused" with other family members Emotional Triangles: when a family dyad experiences tension, it may recruit a third family member to form an emotional triangle which helps alleviate tension and increase stability -ex. a husband and wife may reduce conflict between them by becoming overinvolved with one of their children - likelihood that an emotional triangle will develop increases as the levels of differentiation of family members decrease Family Projection Process: refers to the parents' projection of their emotional immaturity onto their children, which causes the children to have lower levels of differentiation Multigenerational Transmission Process: an extension of the family projection process and refers to the transmission of emotional immaturity from one generation to the next -happens when the child most involved in the family's emotional system becomes the least differentiated family member, and as an adult, chooses a spouse or partner who has a similar level of differentiation --the couple then transmits an even lower level of differentiation to one of its children ---process continues in subsequent generations and eventually results in the development of severe symptoms in a child Bowen believed that increasing differentiation in one family member facilitates greater differentiation in other family members Therapists often see only 2 family members in therapy - usually the parents - or the individual family member who is most capable of increasing their level of differentiation Primary goal of therapy is to increase each family member's differentiation, and several strategies are used to achieve this goal: -begins with an assessment that includes constructing a genogram that depicts family relationships and important life events for at least 3 generations and is used to help family members understand intergenerational patterns of functioning -during therapy, therapists ask questions that are designed to defuse emotions and help family members identify how they contribute to family problems -also teach family members how to interact with their families-of-origin in ways that alter triangulated relationships -therapists assume the role of coach and stay connected with family members but remain neutral and avoid becoming involved in the family's emotional processes -to reduce emotional reactivity, they have family members talk directly to them rather than to each other

Existential Therapies

Derived from existential psychology and developed by several psychiatrists/ologists including Irvin Yalom, Rollo May, and Viktor Frankl emphasize personal responsibility and choice and based on assumption that each person must ultimately define their existence view psychological disturbances as result of an inability to resolve conflicts that arise when facing 4 ultimate concerns of existence: -death -freedom -isolation -meaninglessness Distinguish between 2 types of anxiety: -normal (existential anxiety): in proportion to an objective threat, doesn't involve repression, and can be used constructively to identify and confront the conditions that elicited it and motivate positive change -neurotic anxiety: disproportionate to an objective threat, involves repression, and keeps people from reaching their full potential primary goal of therapy is to help clients lead more authentic lives by assisting them in taking charge of their life, helping them choose for themselves the values and purposes that will define and guide their existence, and supporting them in actions that express these values and purposes consider an authentic therapist-client relationship to be the most important therapeutic tool but may use other techniques such as questioning, interpretation, and reframing

Psychodynamic psychotherapies

Freudian psychoanalysis, Jun's analytical psychology, Adler's individual psychology, and object relations approaches

Healthy Cultural Paranoia

Ridley proposed that an ethnic minority client's unwillingness to disclose personal information to a White therapist may be due to one of 2 types of paranoia Functional paranoia: unhealthy psychological condition that involves pervasive suspicion and distrust -ethnic minority client with this is unwilling to disclose personal info to an ethnic minority or a White therapist Healthy Cultural Paranoia: involves suspicion and distrust, but it's a normal reaction to prejudice and discrimination -ethnic minority client with a healthy cultural paranoia is willing to self-disclose to an ethnic minority therapist but unwilling to self-disclose to a White therapist unless certain conditions are met --therapist discusses meaning of the cultural paranoia with the client and encourages the client to distinguish between when it is and not safe to self-disclose

Autoplastic vs Alloplastic interventions

autoplastic interventions: focus on making changes in the client so they they can successfully adapt to the environment -ex. strategies aimed at helping them gain insight into their problems or change their behavior Alloplastic interventions: focus on altering the environment or situation to fit the client's needs, desires, or other attributes -ex. removing oneself from a stressful situation (ex changing jobs)

Telepsychology and Evidence-Based Psychotherapy

benefits: decreases patients' and providers' costs, increases access to psychotherapy, and reduces stigma and embarrassment that some people have when receiving psychotherapy at treatment facilities -research found that in most cases, technology-delivered evidence-based practices provides roughly equivalent outcomes for members of diverse populations and a variety of disorders a. Anxiety disorders: evidence that telehealth is effective for treating individual anxiety disorders but also for treating comorbid anxiety and mood disorders --Berryhill did a review of effectiveness of psychotherapy, most often CBT - for treating panic disorder with agoraphobia, GAD, and SAD through telehealth - found sig improvement in anxiety symptoms, with controlled studies finding no sig differences between telehealth and in person --another study compared telehealth CBT to in person CBT and found they to be similarly effective for reducing comorbid anxiety and depression and improving quality of life b. PTSD: most studies evaluating use of telehealth for treating PTSD found it to be comparable to face-to-face in terms of effectiveness -one study found that trauma-focused therapies in person and telehealth were similar in terms of reduction of PTSD, attendance and dropout rates, client satisfaction, and therapist fidelity to treatment protocols --studies included in their review did not provide entirely consistent results with regard to the therapeutic alliance ---therapists providing telehealth said they didn't have trouble developing rapport with clients, but some reported barriers to developing a therapeutic alliance like the inability to detect nonverbal communications c. MDD: Berryhill found that most studies reported stat sig decreases in depressive symptoms following telehealth with no stat differences between tele and in person groups receiving the same intervention -also evidence that telehealth is useful for alleviating the insomnia and chronic pain that often accompany depression -while a study evaluating the effectiveness of telephone-administered CBH found it to have a lower attrition rate than in-person CBT had, other studies have found that attrition rates for other modes of telehealth vary, depending on the population and type of intervention d. Bulimia Nervosa: research found that it has beneficial effects but isn't necessarily as effective as in-person treatments -ex. Mitchell compared telehealth to in-person delivered versions of manual-based CBT for BN - overall results showed that 2 versions had similar attrition rates and that both produced beneficial effects on outcome measures following treatment --some differences: patients getting in-person CBT had non-sig higher rates of abstinence from binge eating and purging and sig greater reductions in eating disordered cognitions and depression -Zerwas compared manualized version of CBT group therapy for BN via internet chat group and the same treatment delivered via traditional face-to-face group therapy --found that patients in both groups experienced a decrease in bine eating and purging and comorbid symptoms of depression and anxiety by the end of treatment but some differences: immediately after treatment ended, patients with F2F therapy had a greater decrease in abstinence rates and anxiety symptoms but the gap between the 2 groups on these measures narrowed at the 12-mo follow-up, indicating that the pace of recovery was slower for patients who got therapy via the internet

Efficacy and effectiveness research

empirical research evaluating psychotherapy outcomes can be categorized as efficacy research/effectiveness research Efficacy research studies: known as clinical trials and maximize internal validity by maximizing experimental control -ex. participants randomly assigned to groups in these studies and therapists use treatment manuals to ensure that treatment is provided in the same way to all participants Effectiveness research study: maximize external validity by providing therapy in naturalistic clinical settings both approaches have strengths and weaknesses and a useful strategy for evaluating treatment outcomes is to first conduct an efficacy study to determine a treatment's effectiveness in well-controlled conditions and then conduct an effectiveness study in "real world" settings to determine its generalizability, feasibility, and cost-effectiveness

Cultural Encapsulation

explains the inability of some mental health professionals to work effectively with members of different cultural backgrounds culturally encapsulated mental health professionals are insensitive to cultural differences and believe that their own cultural assumptions about what constitutes mental health or normality applies to people from all cultural backgrounds

Culturally Competent Psychotherapy

guidelines for working with members of several culturally diverse groups are below: African Americans: -consider the client's cultural identity, level of acculturation, and worldview -keep in mind that racism and other environmental factors may be contributors to the client's presenting problems -be aware that the client's extended kinship network is likely to include nuclear and extended family members, friends, members of their church and community -know that roles within African American families are often flexible and that male-female relationships tend to be egalitarian -empower the client by, for example, helping the client acquire the problem-solving and decision-making skills they need to control their own life interventions: African American clients usually prefer an egalitarian therapist-client relationship and a time-limited, problem-solving approach -Boyd-Franklin recommends using a multisystems approach which involves intervening in numerous systems and at multiple levels that include the individual, their immediate and extended family, non-blood relatives and friends, church and community services, and social service agencies American Indians: -consider the client's cultural identity, level of acculturation, and worldview -identify possible environmental contributors (e.g., discrimination, poverty, acculturation conflicts) to the client's presenting problems -be aware that American Indians often adhere to a collateral social system that incorporates the family, community, and tribe -recognize that cooperation, sharing, and generosity are important cultural values and that the interests of the family and tribe take priority over the interests of the individual -be aware that American Indians are likely to regard wellness as depending on the harmony of mind, body, and spirit and illness as the result of disharmony -eep in mind that American Indians tend to place more emphasis on nonverbal than verbal communication, consider listening to be more important than talking, and view direct eye contact as a sign of disrespect and a firm handshake as a sign of aggression -foster a collaborative therapeutic relationship and build trust by demonstrating familiarity with and respect for the client's culture and admitting any lack of knowledge Interventions: collaborative, problem-solving, client-centered approach that avoids highly directive techniques and incorporates American Indian values and traditional healers is usually preferred -LaFronboise, Trimble, and Mohatt recomment using network therapy, which helps empower clients to cope with life stresses by mobilizing relatives, friends, and tribal members to provide support and encouragement Hispanic/Latino Americans: -consider the client's cultural identity, level of acculturation, and worldview -identify possible environmental contributors (e.g., discrimination, poverty, acculturation conflicts) to the client's presenting problems -determine the client's beliefs about the nature of their presenting problems and be aware that Hispanic Americans often express psychological symptoms as somatic complaints -consider how a client's religious and spiritual beliefs might inform assessment, diagnosis, and treatment decisions -keep in mind that Hispanic/Latino Americans tend to emphasize family welfare over individual welfare -be aware that Hispanic/Latino American families may be patriarchal and stress machismo (male dominance) and marianismo (female submissiveness) -adopt a formal style (formalismo) in the initial therapy session but a more personal style (personalismo) in subsequent sessions Interventions: likely to prefer CBT, solution-focused therapy, family therapy, and group therapy -therapy may be most effective when it incorporates culturally congruent techniques like cuento therapy (use of folktales to present models of adaptive behavior and dichos (use of proverbs and idiomatic expressions to help clients express their feelings) Asian Americans: -consider the client's cultural identity, level of acculturation, and worldview -identify environmental factors that may be contributors to the client's presenting problems -be aware that differences in acculturation within families may be a source of conflict -determine the client's beliefs about the contributors to his or her presenting problems and be aware that Asian Americans often have a holistic view of mind and body and express psychological problems as somatic symptoms -be aware that Asian American families tend to be hierarchical and patriarchal, adhere to traditional gender roles, and emphasize family needs over individual needs -keep in mind that a fear of losing face and shame are powerful motivators for Asian Americans and may affect their willingness to discuss personal problems and express emotions -maintain a formal style during the course of therapy -be aware that, for Asian American clients, periods of silence and avoidance of eye contact are expressions of respect and politeness. Interventions: likely to prefer CBT and other brief structured goal-oriented, problem-focused approaches that focus more on the family than the individual -also likely to expect the therapist to be a knowledgeable expert who gives advice and suggests specific courses of action while also encouraging their participation in identifying goals and solutions to their problems LGBTQ: men and women are 2x more likely to have a mental disorder in their lives (especially anxiety, depression, and substance misuse) than heterosexual men and women -also have unique concerns that may be a target of therapy --coming out and internalized heterosexism ---most LGB individuals report being aware they were different than others during childhood, but median age for being aware of sexuality is between 13-15 - some studies found the more wider they disclosed their identity, the greater their self-esteem and positive affectivity and lower their anxiety, other studies found that disclosure to students/staff associated with greater in-school victimization but also higher levels of self-esteem and decreased depression --internalized heterosexism (internalized homophobia): internalization of negative messages by LGBTQ about their own identity - identified as a component of minority stress and linked to anxiety, depression, increased risk for suicide, alcoholism, and other substance misuse -Be aware of the effects of stigmatization and heterosexism on the lives of LGB individuals. -Recognize that same-sex attractions and behaviors are normal variants of human sexuality but avoid adopting a "sexual orientation blind" perspective that ignores or denies the unique experiences of LGB individuals. -Consider how your own attitudes toward and knowledge of LGB issues might impact your assessment, diagnosis, and treatment of lesbian, gay, and bisexual clients. -Distinguish issues related to sexual orientation from those related to gender orientation, and be aware that lesbian, gay, and bisexual individuals may act in gender conforming or gender non-conforming ways. -Recognize the effects of intersectionality on the lives of LGB individuals - i.e., the effects of such factors as race/ethnicity, culture, gender, age, class, and disability and the interaction of these factors with sexual orientation. Experts stress of combining EBP with culturally competent services - for LGBTQ clients, means providing affirmative therapy (integration of knowledge and awareness by the therapist of the unique development and cultural aspect of LGBTQ individuals, therapist's own self-knowledge, and translation of this into effective and helpful therapy skills at all stages) --ex. when using CBT with someone, important to distinguish between maladaptive thoughts and thoughts that reflect a normal response to stigmatization they have experienced Older Adult Clients: with exception of neurocognitive disorder, the rates of mental health disorders are lower among older adults than their younger and middle-aged counterparts -many older adults experience mental health problems (anx/dep most common) and their symptoms may differ from younger adults --ex. with depression, older adults more likely to complain about physical and cognitive symptoms than emotional distress and to report irritability, insomnia, weight loss, and other symptoms associated with anxiety -Consider how your own attitudes and beliefs about aging might impact your assessment and treatment of older adults. -Be aware that the heterogeneity among older adults surpasses that seen in other age groups, and recognize how gender, age, race/ethnicity, sexual orientation, and other factors may affect the experience and expression of psychological problems of older adults. -Be familiar with normal biological changes associated with increasing age (e.g., changes in sensory acuity and cognitive functioning) and be able to distinguish between normative changes and changes due to physical illness or medications. -Be aware that older adults respond favorably to a variety of types of psychotherapy but that some interventions have been found to be particularly effective for older adults with certain disorders (e.g., cognitive-behavior therapy and reminiscence therapy for depression). -Acquire the knowledge and skills needed to make culturally sensitive adaptations to interventions that increase their effectiveness for older adults --ex. modifying an intervention process and/or content (slowing pace of therapy, increasing number of sessions/decreasing frequency, accommodating heating loss, addressing physical illness/grief/cog decline and other problems that are experienced more often by older than younger adults) Treatment: research found that effects of psychotherapy are comparable for older and younger adults but that older adults may respond more slowly to therapy and benefit most when treatment is tailored to their cognitive, sensory, and physical needs

Diagnostic Overshadowing

initially used to describe the tendency of mental health professionals to attribute all of the problems of people who have received a diagnosis of intellectual disability to that diagnosis and overlook other problems since then, the term has been applied to other client characteristics -ex. exhibiting diagnostic overshadowing when they assume that the presenting problems of gay clients are due to the clients' sexual orientation without considering other explanations

Brief therapies

interpersonal psychotherapy, solution-focused therapy, therapy based on the transtheoretical model, and motivational interviewing

Beck's Cognitive-Behavior Theory

originally developed as an intervention for depression and is now considered an evidence-based treatment not only for depression but also for bipolar disorder, generalized anxiety disorder, anorexia nervosa, bulimia nervosa, schizophrenia, obsessive-compulsive disorder, PTSD, and a number of other disorders based on the assumption that psychological disturbance is due largely to maladaptive cognitive schemas, automatic thoughts, and cognitive distortions: -(a) Cognitive schemas: core beliefs that develop during childhood as the result of experience and certain biological factors such as biological reactivity to stress. --Schemas are enduring, can be maladaptive or adaptive, and are revealed in automatic thoughts. --proposed that different disorders are associated with different maladaptive schemas, which are also known as cognitive profiles. ---ex. the cognitive profile for depression consists of negative beliefs about oneself, the world, and the future. -(b) Automatic thoughts: verbal self-statements or mental images that come to mind spontaneously when triggered by circumstances and intercede between an event or stimulus and the individual's emotional and behavioral reactions --can be positive or negative. ---Negative automatic thoughts are characterized by a distortion of reality, emotional distress, and/or interference with the pursuit of life goals and can contribute to psychological distress ----Practitioners of CBT often have clients record negative automatic thoughts outside therapy in a Dysfunctional Thought Record (DTR) whenever they feel their mood is worsening. When using a DTR, the client records the event or situation that led to an unpleasant emotion, the automatic thoughts that preceded the emotion, the type of emotion and its intensity on a scale from 0 to 100, an alternative rational response to the automatic thought, and the outcome (the emotion and any change in behavior elicited by the rational response). -(c) Cognitive distortions are systematic errors in reasoning that often affect thinking when a stressful situation triggers a dysfunctional schema that, in turn, affects the content of automatic thoughts. -Common distortions include arbitrary inference, selective abstraction, dichotomous thinking, personalization, and emotional reasoning: --Arbitrary inference involves drawing negative conclusions without any supporting evidence. --Selective abstraction involves paying attention to and exaggerating a minor negative detail of a situation while ignoring other aspects of the situation. --Dichotomous thinking is the tendency to classify events as representing one of two extremes - for example, as a success or a failure. --Personalization involves concluding that one's actions caused an external event without evidence for that conclusion. --emotional reasoning is reliance on one's emotional state to draw conclusions about oneself, others, and situations. The primary goals of CBT are to correct faulty information processing and to help patients modify assumptions that maintain maladaptive behaviors and emotions Practitioners of CBT adopt an active, structured approach and use a variety of cognitive and behavioral techniques to achieve these goals. -Cognitive techniques include redefining the problem, reattribution, and decatastrophizing -behavioral techniques include activity scheduling, behavioral rehearsal, exposure therapy, and guided imagery (which is used to facilitate relaxation and decrease anxiety and pain). An essential feature of CBT is its reliance on collaborative empiricism, which is a collaborative therapeutic alliance between the therapist and client in which they become coinvestigators as they examine the evidence to accept, support, reevaluate, or reject the client's thoughts, assumptions, intentions, and beliefs Another feature is the use of Socratic dialogue, which involves asking the client questions that are designed to clarify and define the client's problems, identify the thoughts and assumptions that underlie those problems, and evaluate the consequences of maintaining maladaptive thoughts and assumptions.

Postmodernism influence on family therapy

recent approaches to family therapy are influenced by postmodernism which challenges the basic premises of general systems theory, including the premise that there are universal laws that govern systems and can be discovered by scientific research these approaches adopt a constructivist or social constructionist perspective and assume that there are multiple viewpoints and realities view family therapy as a shared process where the therapist forms a collaborative relationship with the family and helps family members identify alt ways of interpreting and resolving problems

Common factors in psychotherapy

research has found that different psychotherapy approaches have similar beneficial effects Norcross and Lambert attribute 30% fo variability in psychotherapy outcomes to patient contributions, 12% to therapeutic alliance, 8% to the treatment method, 7% to therapist characteristics, 3% to other factors, and 40% to unexplained variance

Therapeutic factors of group therapy

therapeutic factors that are responsible for the effects of group therapy: -group cohesiveness -instillation of hope -universailty -altruism -imparting info -development of socializing techniques -corrective -recapitulation of the primary family group -interpersonal learning -imitative behavior -catharsis -existential factors group cohesiveness considered to be the analogue of the therapeutic alliance of individual therapy, is viewed as a precondition for the other therapeutic factors, and has been most consistently found to be a strong predictor of positive group therapy outcomes

Positive psychology

about valued subjective experiences: well-being, contentment, and satisfaction (in the past); hope and optimism (for the future); and flow and happiness (in the present) important characteristic is emphasis on using scientific methods to evaluate its theories, concepts, and interventions -ex. researchers investigated positive emotions by evaluating effectiveness of interventions aimed at increasing happiness and have investigated positive health by studying how positive emotions contribute to and sustain physical health Seligman's PERMA model: Positive emotions: experiencing pleasure, hope gratitude, love, and other positive emotions Engagement: how truly engaged in situations/tasks, characterized being being in a state of "flow" (totally immersed in an activity accompanied by a high level of joy and sense of fulfillment) Relationships: having positive and meaningful interpersonal relationships Meaning: being dedicated to a cause that's bigger than oneself Accomplishment-achievement: striving to better oneself and accomplish one's goals

Evidence-Based Practice and Culturally Adapted interactions

Evidence-based practices: the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences Empirically supported treatments: slightly differ from above, refer only to treatments that have been found to be effective by scientific research that meets certain criteria Culturally adapted interventions: involve the systematic modification of an evidence-based treatment (EBT) or intervention protocol to consider language, culture, and context in such a way that it is compatible with the client's cultural patterns, meaning, and values -adaptations may include incorporating content that's culturally appropriate and relevant (ex. issues related acculturation, racism, and religion and spirituality) and/or altering the format and delivery of treatment so that it's culturally compatible (ex. delivering the treatment in a client's native language, adopting a culturally compatible interpersonal time, and including indigenous healers in treatment delivery) Adaptations of EBTs has created a fidelity-adaptation dilemma that requires psychotherapists to determine.to what degree they will adopt the standardized top-down approach that demands fidelity in its implementation and the idiographic bottom-up approach that demands sensitivity and responsiveness to each person's unique needs some research has concluded that evidence shows that culturally adapted interventions provide benefit to intervention outcomes, but this added value is more apparent in the research on adults than on children and youths -studies have found that adaptations are more effective when they involve adding features to an intervention than when they involve replacing a component of an intervention and that culturally adapted interventions are more beneficial for clients who have the greatest need for them --ex. clients who are not fluent in English and clients with low levels of acculturation

Working alliance

Greenson was teh first to describe the therapeutic relationship as consisting of 3 components: -Working alliance -Real relationship -Transference-countertransference of these, working alliance has been studied most extensively working alliance is the relatively non-neurotic, rational relationship between patient and analyst which makes it possible for the patient to work purposely in the analyytic situation studies have identified the working alliance as a core common factor across all types of psychotherapy and have found a strong one to be a sig predictor of successful psychotherapy outcomes

High- vs Low-Context Communication

Hall (76) distinguished between 2 communication styles: High-context communication: relies heavily on group understanding, nonverbal messages, and the context in which the communication occurs and is characteristic of several cultural minority groups Low-context communication: relies on the verbal message, is independent of the context, and is characteristic of the White (mainstream) culture problems can arise in therapy when the therapist and the client have different communication styles -ex the fact that African Americans may communicate more by high-context cues has led many to characterize them as nonverbal, inarticulate, and unintelligent

Internalized Racism and Colorism

Internalized racism (internalized racial oppression): happens when a person accepts society's negative beliefs and stereotypes related to their own racial group Colorism: form of internalized racism and also known as color consciousness -refers to discrimination within a racial group based primarily on skin hue or color and may also include other physical characteristics such as hair texture and eye color --in US and some other countries, this often involves preferences for lighter skin over darker skin within a community of color ---use of skin-lightening products by people of color is a manifestation of colorism

Mindfulness-Based Interventions

Mindfulness refers to moment-to-moment awareness of one's experience without judgment has been incorporated into several therapeutic approaches including ACT and DBT and is the core strategy of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). MBSR was originally developed to make mindfulness meditation available and accessible in a Western medical setting while remaining true to the essence of Buddhist teachings -It's used to help people cope with stress, pain, and illness and consists of an eight-session group program that focuses on teaching participants several mindfulness meditation practices including awareness of breathing, yoga, and sitting and walking meditation. MBCT combines elements of MBSR and CBT. -It was originally developed as a method for treating recurrent depression and research has confirmed that it's an effective treatment not only for depression but also for a number of other conditions including anxiety, chronic pain, and insomnia. -The primary goal of MBCT is to enable clients to become self-aware, so they can learn to de-centre from distressing thoughts, feelings, bodily sensations and behaviours. - It incorporates psychoeducation, mindfulness meditation practices, and cognitive-behavioral techniques and, like MBSR, usually consists of an eight-session group program. Based on their meta-analysis of research on mindfulness-based interventions, Khoury and his colleagues (2013) have concluded that they're effective for treating both psychological disorders and physical/medical conditions but are more effective for psychological disorders, especially depression, anxiety, and stress. -There's no clear consensus about the mechanisms that are responsible for the effectiveness of mindfulness-based interventions, but several mechanisms have been proposed and received some research support. Holzel and her colleagues (2011) conclude that the primary mechanisms are attention regulation, emotion regulation, body awareness, which is awareness of one's internal states, and decentering, which is also known as reperceiving and is the ability to separate oneself from one's thoughts and emotions and view them objectively as transient mental events.

Credibility and Gift Giving

Sue and Zane propose that credibility and gift giving are important when working with Asian American and other non-Western clients Credibility: refers to the client's perception of the therapist as trustworthy and is determined by the therapist's ascribed and achieved status -ascribed status: position or role assigned to the therapist by the client's culture --ex. age and gender are characteristics that contribute to a therapist's credibility in some cultures -achieved status: the therapists expertise --ex. therapist's experience working with members of the client's culture Gift giving: refers to the direct benefits that the client perceives they receive from therapy -include providing the client with reassurance and a sense of hope, normalizing the client's feelings, and using interventions that reduce the client's depression or anxiety they note that direct benefits must be given as soon as possible in therapy to help establish achieved credibility and reduce premature termination from therapy by demonstrating the relationship between therapy and the alleviation of the client's problems

Jung's Analytical Psychology

accepted some aspects of Freudian theory but rejected others believed that behavior is driven by both positive and negative forces, personality continues to develop throughout the lifespan, and that behavior is affected by the past and the future divided unconscious aspect of the psyche into the personal and collective unconscious -personal unconscious: person's own forgotten/repressed memories -collective unconscious: memories shared by all people and are passed down from one generation to the next --contains archetypes: universal thoughts and images that predispose people to act in similar ways in certain circumstances ---expressed in myths, symbols, and dreams and include the persona, shadow, hero, and anima and animus primary goal is to bring unconscious material into consciousness to facilitate the process of individuation -happens primarily during the second half of life and is the process where a person becomes a psychological in-dividual, a separate, indivisible unity of whole techniques used to achieve goal include dream interpretation and the analysis of transference, which Jung viewed as being due to the projection of elements of the personal and collective unconscious

Worldview

affects how we perceive and evaluate situations and how we derive appropriate actions based on our appraisal worldview impacted by culture and can be described by locus of control and locus of responsibility ICIR (internal locus of control and internal locus of responsibility): people believe they are in control of own outcomes and responsible for their own successes and failures IC-ER: believe they could determine their own outcomes if given the chance but that others are responsible for keeping them from doing so EC-ER: believe they have little or no control over their outcomes and aren't responsible for them EC-IR: believe they have little control over their own outcomes but tend to take responsibility for their own failures IC-IR is characteristic of mainstream American culture while other 3 are characteristic of some minority cultures difference in therapist's and client's worldviews can affect therapeutic relationship -ex. clients who have IC-ER worldview are likely to be most challenging for a White therapist who has an IC-IR worldview because these clients are likely to view the therapist and therapy as sources of oppression and to be reluctant to self-disclose, to want to take an active role in therapy, and to seek action and accountability from a more privileged therapist

Communication theory

another major contributor to family therapy Bateson and colleagues at the Mental Research Institute proposed that certain types of repetitive patterns of communication and interaction produce problematic behavior -linked development of schizophrenia to double-bind communication --happens when a person receives 2 contradictory messages from a family member and is not allowed to comment on the contraindication Bateson also distinguished between symmetrical and complementary interactions: -symmetrical interactions: reflect equality and occur when the behavior of one person elicits a similar type of behavior from the other person --can escalate in intensity and become a "one-upmanship game" -complementary interactions: reflect inequality and occur when behavior of one person complements the behaviors of another person --common pattern is for one person to assume dominant role while the other person assumes a subordinate role -problems occur when interactions between family members are exclusively symmetrical or complementary

Rational Emotive Behavior Therapy (Ellis) (REBT)

attributes psychological disturbances to irrational beliefs, which tend to be absolute (or dogmatic) and are expressed in the form of 'must's,' 'should's,' 'ought's,' 'have to's,' etc. and lead to negative emotions that largely interfere with goal pursuit and attainment -ex. "I must do well on all of the important projects I take on; if not, I'm an inadequate person" and "You must take care of me when I need you to do so; if not, you're not a good person" Ellis uses an A-B-C-D-E model to explain psychological disturbance and the process of change in therapy: -A is an activating event -B is the client's irrational belief about that event -C is the emotional or behavioral consequence of that belief -D is the therapist's use of techniques that dispute the client's irrational belief -E is the effect of these techniques, which is the replacement of the irrational belief with a more rational one. Practitioners of REBT use a variety of cognitive, behavioral, and emotive techniques, including active disputation of irrational beliefs, rational-emotive imagery, systematic desensitization, and skills training. Research has found that REBT is an effective treatment for depression, anxiety, conduct problems, anger, and several other disorders and conditions

Structural Family Therapy (Minuchin)

based on assumption that a family member's symptoms are related to problems in the family's structure and identifies subsystems and boundaries as important aspects of a family structure: -subsystems: smaller units of the entire family system and are responsible for carrying out specific tasks (ex. parental subsystem is family members who care for the children) -boundaries: implicit and explicit rules that determine the amount of contact that family members have with each other - differ in terms of degree permeability and exist on a continuum --at one end, boundaries are overly diffuse and lead to enmeshed relationships, at the other end, boundaries are overly rigid and lead to disengaged relationships - midway between the.2 are clear boundaries that let family members have close relationships while allowing each member to maintain a sense of personal identify Identified 4 rigid family triads - boundary problems that help parents obscure or deny their conflicts: a. stable coalition: happens when one parent and a child form an inflexible alliance against the other parent b. unstable coalition: known as triangulation and occurs when each parent demands that the child side with them c. detouring-attack coalition: happens when parents avoid the conflict between them and blame the child for their problems d. detouring-support coalition: happens when parents avoid their own conflict by overprotecting the child maladaptive behaviors are due to a dysfunctional family structure that causes the family to repeatedly respond inappropriately to developmental and situational stress primary goals of therapy are used to alleviate current symptoms and change the family structure by altering coalitions and creating clear boundaries Therapy focuses on promoting behavior change rather than insight and consists of three overlapping phases: a. joining: used by a therapist to establish a therapeutic alliance with the family and relies on 3 techniques: -mimesis involved adopting the family's affective, behavioral, and communication style -tracking involves adopting the content of the family's communications -maintenance entails providing family members with support b. therapist's next task is to evaluate the family's structure to make a structural diagnosis and identify appropriate interventions -includes constructing a family map that depicts the family's subsystems, boundaries, and other aspects of the family's structure c. therapist then uses reframing, unbalancing, boundary making, enactment, and other interventions to achieve therapy goals -reframing: relabeling a problematic behavior so it can be viewed in a more constructive way -unbalancing: used to alter hierarchical relationships and happens when a therapist aligns with a family member whose level of power needs to be increased -boundary making: used to alter the degree of proximity between family members -enactment: involves asking family members to role-play a problematic interaction so the therapist can get information about the interaction and then encourage family members to interact in an alternative way

Person-Centered therapy (Rogers) (client centered therapy)

based on assumption that all people have an innate drive toward self-actualization, which motivates them to achieve their full potential the drive toward self-actualization can be thwarted when a person experiences incongruence with their self-concept and experience -ex. when parents provide child with love and acceptance only when the child behaves in certain ways people often respond to incongruence defensively by distorting or denying their experiences which, in turn, leads to psychological maladjustment primary goal is to help the client become a "fully functioning person" who isn't defensive, is open to new experiences, and is engaged in the process of self-actualization -provide clients with 3 facilitative (core conditions): -empathy: understanding their perspective and communicating that to them -unconditional positive regard: valuing and accepting the client as a person -congruence: being genuine, authentic, and honest

Milan Systemic Family Therapy

based on assumption that the family as a whole protects itself from change through homeostatic rules and patterns of communication patterns of communication are referred to as family games, and family games associated with problematic behaviors are rigid, involve power struggles between family members, and are known as "dirty games: primary goal is to alter the family rules and communication patterns that are maintaining problematic behavior -involves providing the family with info that challenges family games and helps family members develop communication patterns that increase the family's ability to adapt to change distinguished from other family therapies by its use of a therapeutic team and five-part therapy sessions (pre-session, session, intersession, intervention, and post-session) and gaps between therapy sessions of 4-6wks strategies include hypothesizing, neutrality, circular questioning, positive connotation, and family rituals -hypothesizing: continual interactive process of speculating and making assumptions about the family situation --first hypotheses are based on info obtained in the initial telephone interview, and hypotheses are modified during therapy as new info about the family's functioning is acquired -neutrality: therapist's interest in the family's situation and acceptance of each family member's perception of the problem circular questioning: involves asking each family member the same question to identify differences in perceptions about events and relationships and uncover family communication patterns --ex. might ask each member, when mom is depressed, what does dad do? -positive connotation: type of reframing that helps family members view a symptom as beneficial because it maintains the family's cohesion and well-being --purpose is to change the family's perception of a symptom from an individual family member's illness to, instead, a behavior that's voluntarily controlled and well-intentioned and involves the entire family system -family rituals: activities that are carried out by family members between sessions and are designed to alter problematic family games --ex. when parents are competitive in their control of children's behaviors or family events, the therapist might instruct the mother to make all family decisions on odd-numbered days and the father to make family decisions on even-numbered days

Strategic family therapy (Haley)

based on assumptions that struggles for power and control in relationships are core features of family functioning and that a symptom is a strategy that is adaptive to a current social situation for controlling a relationship when all other strategies have failed -also assumes that power and control are determined primarily by hierarchies within a family and that maladaptive family function is often related to unclear or inappropriate hierarchies primary goal of therapy is to alter family interactions that are maintaining its symptoms -to achieve this, strategic family therapists assume an active role and use a variety of strategies that are aimed at changing behavior rather than instilling insight -initial session is highly structured and consists of four stages: --(brief) social stage: therapist welcomes the family and observes the family's interactions --problem stage: therapist elicits each family member's view is the family problem and its causes --interactional stage: family members discuss their different views of the family's problem, and the therapist observes how family members interact when addressing the problem --goal-setting stage: therapist helps family members agree on a definition of the family's problem and concrete therapy goals that target the problem during subsequent sessions, therapist uses a combo of straightforward and paradoxical directives -straightforward directives: instructions to engage in specific behaviors that will change how family members interact -paradoxical directives: help family members realize that they have control over problematic behavior or use the resistance of family members to help them change in the desired way --prescribing the symptom: involves instructing family members to engage in the problematic behavior, often in an exaggerated way --restraining: involves encouraging family members not to change or warning them not to change too quickly --ordeal: unpleasant task that a family member is asked to perform whenever they engage in the undesirable behavior

Reality therapy (Glasser '65)

based on choice therapy, which proposes that people have 5 basic innate needs (love and belonging, power, fun, freedom, and survival) and that the ways the person chooses to fulfill their own needs determine whether they have a success or failure identify success identity: when chooses to fulfill needs responsibly (positive, constructive ways that don't infringe on the rights of others) failure identity: when a person chooses to fulfill their needs irresponsibly (in negative, destructive ways that infringe on the rights of others and don't always help the person get what they want) primary goal is to replace the client's failure identity with a success identity by helping the client assume responsibility for their actions and adopt more appropriate ways to fulfill their needs Strategies summarized by WDEP system: -ask clients about their Wants and needs -determine what the client is Doing to foster awareness of their behaviors -encourage the client to Evaluate their own behaviors -help the client create a Plan of action (kind of a weak acronym in my opinion)

Acceptance and Commitment Therapy

based on the assumptions that psychological pain is both universal and normal and is part of what makes us human and that psychological inflexibility causes psychological problems and is characterized by a rigid dominance of psychological reactions over chosen values and contingencies in guiding action distinguishes between clean and dirty pain: -Clean pain is also known as clean discomfort and refers to natural levels of physical and psychological discomfort that are inevitable and cannot be controlled. -Dirty pain is also known as dirty discomfort and refers to the emotional suffering that's caused by attempts to control or resist clean pain. The main goal of ACT is to increase psychological flexibility, which involves addressing six core processes that foster acceptance, mindfulness, commitment, and behavior change and counter the processes that contribute to psychological inflexibility: -Experiential acceptance counters experiential avoidance and is the active and aware embrace of private experiences without unnecessary attempts to change their frequency or form -Cognitive defusion counters cognitive fusion and is the ability to distance oneself from one's thoughts and feelings and view them as experiences rather than reality. -Being present counters attentional rigidity to the past and future and involves being in contact with whatever is happening in the present moment. -Awareness of self-as-context counters attachment to the conceptualized self. It's the ability to view oneself as the context in which one's thoughts and feelings occur rather than as the thoughts and feelings themselves. -Values-based actions counter unclear, compliant, or avoidant motives and depend on the ability to use one's freely chosen values to guide one's behaviors. -committed action counters inaction, impulsivity, and avoidant persistence and refers to a commitment to continue to act in ways consistent with one's values in the future, even when faced with obstacles. Interventions target these six processes and include metaphors, mindfulness strategies, and experiential exercises. ACT is considered to be an evidence-based treatment for a number of conditions including chronic pain, psychosis, depression, anxiety disorders, and obsessive-compulsive disorder.

Gestalt Therapy

based on the assumptions that: a. people are motivated to maintain a state of homeostasis, which is repeatedly disrupted by unfulfilled physical and psychological needs b. people seek to get something from the environment to satisfy their unfulfilled needs in order to restore homeostasis Neurosis (maladjustment) happens when there's a persistent disturbance in the boundary between the person and the environment that interferes with the person's ability to fulfill needs Boundary disturbances: -Introjection: when people adopt believes, standards, and values of others without evaluation or awareness -Projection: when people attribute undesirable aspects of themselves to other people -Retroflection: when people do to themselves what they'd like to do to others -Deflection: when people avoid contact with the environment -Confluence: when people blur the distinction between themselves and others consider gaining awareness of one's current thoughts, feelings, and actions to be the curative factor in therapy Strategies used to increase awareness: -Dream work: client role-play parts of their dream that represent disowned parts of the client's personality -Empty-chair technique: client interacts with opposing aspects of their personality (ex. top dog and underdog) or to resolve "unfinished business" with a significant person in the client's past or present in contrast to psychodynamic therapists, Gestalt therapists don't foster or interpret a client's transference but, instead, help the client distinguish between their "transference fantasy" and reality

Eysenck Psychotherapy Outcome Research

best known for conclusions about intelligence and personality proposed that intelligence is due primarily to heredity, with about 80% of variability in IQ scores being due to genetic factors his personality theory also stresses the role of heredity and distinguishes between 3 major personality traits: extroversion, neuroticism, and psychoticism Also known for controversial conclusions about effectiveness of psychotherapy - based on his review of 24 empirical studies that reported treatment outcomes for "neurotic" patients who participated in psychoanalytic or eclectic psychotherapy -because studies didn't include no-treatment control groups, he used other studies to estimate the spontaneous remission rates of neurotic patients who received custodial care in an inpatient facility or medical care from a physician --based on this data, concluded that 44% of patients who participated in psychoanalytic psychotherapy, 64% of patients who participated in eclectic psychotherapy, and 72% of patients who didn't participate in psychotherapy experienced an improvement in symptoms ---proposed that results not only showed that psychotherapy is ineffective but that it may have actually caused detrimental effects since the average recovery rates for psychotherapy patients were lower than average spontaneous remission rate for patients who didn't receive psychotherapy his conclusions were challenged by advocates of psychotherapy for teh methodological flaws -ex. patients not randomly assigned to groups, criteria for recover were questionable - found that different criteria produced recovery rate of 83% for patients who participated in psychotherapy vs 30% for patients who didn't receive psychotherapy

Racial Microaggressions

brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional that communicate hostile, derogatory, or negative racial slights and insults toward POC a. Microassaults: explicit racial derogations that are usually intentional and meant to hurt the intended victim. -include name-calling and explicit discriminatory acts and are most similar to what is referred to as "old-fashioned" racism b. Microinsults: verbal and nonverbal messages that are insensitive to or demean the person's racial or ethnic background -ex. implying that an African American employee was hired only because of affirmative action c. Microinvalidations: communications that exclude, negate, or nullify the psychological thoughts, feelings, or experiential reality of a person of color -ex. complimenting an Asian American employee who was born in the US on their "good English"

Emotionally Focus Therapy

brief, evidence-based treatment that integrates principles of attachment theory, humanistic-experiential approaches, and systems theory originally developed by Greenburg and Johnson ('88) as a treatment for couples but has since been applied to families and individuals --(emotionally focused therapy and emotion-focused therapy are sometimes used interchangeably but that the 2 differ, with the laster referring to various therapies that emphasize emotion as the target of change based on assumptions that: -a. emotions are essential to the organization of attachment behaviors and influence how people experience themselves and their partners in intimate relationships -b. the attachment needs of partners are essentially healthy and adaptive but problems arise when needs are enacted in the context of attachment-related insecurities -c. relationship distress is maintained by the ways in which interactions between partners are organized and by the dominant emotional experiences fo each partner practitioners assume that helping partners express and deal with their emotions is the fastest and most effective way to solve problems, and primary goal of therapy is to expand and restructure the emotional experiences partners have with each other so they can develop new interactional patterns and experience attachment security within their current relationship therapy involves 3 stages: -assessment and cycle de-escalation, changing interactional positions and creating bonding events, and consolidation and integration

Etic vs Emic Perspective

can adopt wither perspective when working with clients from different cultural backgrounds emic perspective: psychologist believes that behavior is affected by culture, and as a result, psychological theories and interventions that apply to members of one culture may not apply to members of other cultures etic perspective: psychologist believes that behavior is similar across cultures and that the same psychological theories and interventions are appropriate for everyone, regardless of their cultural background

Narrative Family Therapy

consider a person's problems as arising from and being maintained by, oppressive stories which dominate the person's life - view these stories as being socially constructed -also assume that the problem - not the person - is the problem --problem is not internal to the person but is something that exists outside the person ---ex. instead of saying that a family member is depressed, a narrative family therapist would say that depression sometimes causes problems for the person Primary goal is to replace problem-saturated stories with alt stories that support more satisfying and preferred outcomes -process varies somewhat among practitioners but generally involves the following stages: --a. meeting family members involves getting to know them separate from their problems by asking them about their interests and everyday activities --b. listening involves paying attention to what family members say to identify dominant discourses and unique outcomes, which are also known as sparkling moments and are experiences that are not consistent with problem-saturated stories --c. separating family members from their problems involves externalizing the problems --d. enacting preferred narratives involves identifying alt stories that lead to more satisfying realities and identities --e. solidifying involves strengthening alt stories by, ex. writing letters of support to family members and expanding the family's network of social relationships to include people who will support its new stories therapist assumes the role of collaborator and uses questions and other techniques to help family members identify current stories and construct alt, healthier ones -ex. externalizing questions: used to help clients view their problems as being outside themselves (ex. asking a family member what his anger tells him to do) --opening space questions: help family members identify unique outcomes (ex. asking family. members if there have ever been times when conflicts didn't control their lives) -other interventions include therapeutic letters, therapeutic certificates, and definitional ceremonies --therapist writes therapeutic letters to family members to reinforce their emerging alt stories --therapeutic certificates are given to family members toward the end of therapy to acknowledge their accomplishments --definitional ceremonies provide family members with opportunities to tell others how they overcame their problems and celebrate the changes they've made in their lives

Atkinson, Morton, and Sue's Racial/Cultural Identity Development Model (R/CID)

distinguishes between five stages of identity development: 1. Conformity: -People have either neutral or negative attitudes toward members of their own minority group and other minority groups -positive attitudes toward members of the majority group -accept negative stereotypes of their own group and consider the values and standards of the majority group to be superior -prefer a therapist from the majority group and view a therapist's attempts to help them explore their cultural identity as threatening. 2. Dissonance: As the result of exposure to information or events that contradict their worldview, people in this stage question their attitudes toward members of their own minority group, other minority groups, and the majority group. -they're aware of the effects of racism and are interested in learning about their own culture -may prefer a therapist from the majority group but want the therapist to be familiar with their culture, and they're interested in exploring their cultural identity. 3. Resistance and Immersion: -People in this stage have positive attitudes toward members of their own minority group, conflicting attitudes toward members of other minority groups, and negative attitudes toward members of the majority group. -unlikely to seek therapy because of their suspiciousness of mental health services --When they do seek therapy, they're likely to attribute their psychological problems to racism and prefer a therapist from their own minority group. 4. Introspection: During this stage, people question their unequivocal allegiance to their own group and are concerned about the biases that affect their judgments of members of other groups. -They've become comfortable with their cultural identity but are also concerned about their autonomy and individuality. -may prefer a therapist from their own minority group but are willing to consider a therapist from another group who understands their worldview, and they're interested in exploring their new sense of identity 5. Integrative Awareness: -People are aware of the positive and negative aspects of all cultural groups. -They're secure in their cultural identity and are committed to eliminating all forms of oppression and becoming more multicultural. -Their preference for a therapist is based on similarity of worldview, and they're most interested in strategies aimed at community and societal change.

Helm's White Racial Identity Development (WRID) Model

consists of two phases - abandonment of racism and defining a nonracist White identity. -Each phase includes three statuses, and each status is characterized by a different information processing strategy (IPS) that people use to think about race-related issues. 1. Contact: characterized by a lack of awareness of racism and satisfaction with the racial status quo -usually have had limited contact with people from racial minority groups and may describe themselves as being colorblind. -IPS: obliviousness. 2. Disintegration: transition to this status when they become aware of contradictions that create race-related moral dilemmas (ex. a conflict between the belief that all people are created equal and their unwillingness to live in an integrated neighborhood) These dilemmas cause confusion and anxiety. -IPS: suppression and ambivalence. 3. Reintegration: attempted to resolve the dilemmas of the previous status by believing that Whites are superior to minority group members and blaming minority group members for their own problems. -IPS: selective perception and negative out-group distortion. 4. Pseudo-Independence: transition to this status when faced with an event that makes them question their beliefs about Whites and members of minority groups. -characterized by a superficial tolerance of minority group members that may be accompanied by paternalistic attitudes and behaviors that perpetuate racism. -IPS: reshaping reality and selective perception. 5. Immersion-Emersion: search for a personal meaning of racism and an understanding of what it means to be White and to benefit from White privilege. -IPS: hypervigilance and reshaping. 6. Autonomy: develop a nonracist White identity, value diversity, and can explore issues related to race and racism without defensiveness. -IPS: flexibility and complexity. a White therapist's identity status impacts their effectiveness when working with clients from minority groups. -a progressive therapist-client relationship is optimal for the development of a positive therapeutic alliance and occurs when the therapist has a more integrated and flexible racial identity than the client has. Evidence for the impact of White identity status has been provided by several studies, including research showing that White therapists with higher racial identity statuses also have higher levels of multicultural counseling competence

White Privilege

consists of unearned benefits that are conferred upon White individuals based solely on skin color and are inaccessible to racial/ethnic minorities McIntosh proposes that most White people are unaware of their race-related privileges because they are maintained by denial ex. going shopping without being followed/harassed by staff, see race widely represented on TV, can arrange to protect their children most of the time from people who might not like them, are never called upon to speak for members of their own racial group macro level: systemic and consists of the benefits, rights, and immunities that Whites have within institutions -ex. more favorable educational opportunities and housing conditions, better health care, and higher salaries micro level: primarily intrapsychic and interpersonal and includes a sense of entitlement and social validation of Whiteness proposed that it has substantial negative economic, political, and social costs for racial/ethnic minorities but also have some negative consequences for Whites -ex. distorted beliefs about race and racism, limited exposure to people of different races and ethnicity, irrational fear of people of different races and ethnicity --White privilege can interfere with a White therapist's ability to develop multicultural counseling competencies

Transdiagnostic treatments

designed to address a range of diagnoses that not onlly share symptoms but also biological, psychological, and environmental mechanisms that increase the risk for and maintain those symptoms premise underlying transdiagnostic treatments is that the commonalities across disorders outweigh the differences and that targeting the commonalities may have a number of important benefits compared to diagnosis-specific approaches ex. treatments can reduce the cost and amount of time associated with training psychologists to deliver numerous diagnosis-specific interventions and they're better suited than single-diagnosis treatments for addressing comorbidities some treatments (a) combine evidence-based strategies that are applicable to disorders within a single diagnostic category, while others (b) combine strategies that are applicable to disorders from different categories -ex. of b is the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders - an emotion-focused, cognitive-behavioral intervention for anxiety, depression, and related disorders --views neuroticism as the core characteristic shared by these disorders and focuses on mechanisms associated with neuroticism, including defecits in emotion regulation and avoidance of intense emotional experiences ---treatment consists of 8 modules: motivational enhancement, psychoeducation, emotional awareness, cognitive flexibility, emotion avoidance, interoceptive exposures, emotional exposures, and relapse prevention --preliminary research found that UP produces substantial short-and long-term improvement in the symptoms of both principal and comorbid disorders as well as the underlying mechanisms associated with those disorders

Minority Stress Theory

developed by Meyer to explain the increased risk for mental health problems among sexual-minority individuals proposes that sexual-minority individuals experience chronic stressors related to their stigmatization that increase their vulnerability to mental health problems theory also distinguishes between proximal and distal minority stress processes -proximal: happen within the person and include concealment, fear of rejection, and internalized heterosexism -distal: external to the person and include, verbal/physical harassment, prejudice, and discrimination theory has been applied to other stigmatized minority groups and to physical health and other outcomes

Caplan's Model of Prevention

distinguished between 3 types of preventions: a. Primary prevention: goal is to reduce the occurrence of new cases of a mental or physical disorder -preventions are aimed at an entire population or group of individuals rather than specific individuals, and the population or group may or may not be restricted to people who are known to be at elevated risk for the disorder --ex. public education program about depression and suicide, school-based program for fifth graders to prepare them for the transition to middle school, and a prenatal care for low-income mothers b. Secondary prevention: goal is to reduce the prevalence of a mental or physical disorder in the population through early detection and intervention -aimed at specific individuals who have been identified as being at elevated risk for the disorder --ex. providing tutoring to elementary school students who are beginning to have academic difficulties and using a screening test to identify individuals at risk for depression and then providing identified individuals with counseling are secondary preventions c. Tertiary prevention: goal is to reduce the severity and duration of a mental or physical disorder -target people who have already received a diagnosis of a mental or physical disorder and include relapse prevention and rehab programs --ex. social skills training for patients with schizophrenia, halfway houses, and Alcoholics Anonymous

Gordon's Model of Prevention

distinguishes between universal, selective, and indicated prevention Universal preventions: aimed at entire populations or groups that aren't restricted to people who are at risk for a disorder -ex. drug abuse prevention program for all high school students in a school district Selective preventions: aimed at people who have been identified as being at increased risk for a disorder to to their biological, psychological, or social characteristics -ex. drug abuse prevention program for adolescents whose parents have a substance use disorder Indicated preventions: are for individuals who are known to be at high-risk because they have early or minimal signs of a disorder -ex. drug abuse prevention program for adolescents who have experimented with drugs is an indicated prevention The Institute of Medicine expanded Gordon's model to create a continuum of care model that includes prevention, treatment, and maintenance -in this model the 3 preventions are restricted to people who haven't received a dx of a mental/physical disorder --treatment strategies are aimed at people who have received a diagnosis, and maintenance strategies are for people who have received treatment for a disorder and focus on preventing chronicity or relapse and/or providing rehab

Sellers, Smith Bynum, Rowley, and Chavous's Multidimensional Model of Racial Identity

does not describe sequential stages of identity development but, instead, proposes that a person's racial identity may vary across time and situations. -developed for African American individuals and defines African American racial identity as the significance and qualitative meaning that individuals attribute to their membership within the Black racial group within their self-concepts Also distinguishes between four dimensions of racial identity: -Racial salience: the extent to which a person's race is a relevant part of his/her self-concept at a particular point in time and in a particular situation. --ex. race may become more salient for a person when they witnesses or experiences discriminatory behavior or is the only African American in a restaurant, classroom, or other social setting. -Racial centrality: the extent to which a person normatively defines themselves in terms of race and is affected by the importance of race to the person relative to other identities such as gender and religion. --ex. for some African American women, gender may be more important than race for their identities while, for others, the opposite may be true. ---In contrast to salience, centrality is relatively stable across situations. -Racial regard includes private and public regard. --Private regard refers to the extent to which a person feels positively or negatively toward African Americans and how positively or negatively they feel about being an African American. --Public regard refers to the extent to which a person feels that others view African Americans positively or negatively. ---Private and public regard are not necessarily related and a person can have, for example, negative private and public regard or positive private regard and negative public regard. -Racial ideology: refers to a person's beliefs and opinions about the ways African Americans should live and interact with society. --(a) nationalist ideology: view the African American experience as being unique and believe African Americans should control their own destinies with minimal input from other groups. --(b) oppressed minority ideology: emphasize the similarity of the oppression experienced by African Americans and members of other minority groups, and they're interested in forming coalitions with other groups. --(c) assimilationist ideology: emphasize similarities between African Americans and the rest of American society and believe that African Americans should work within the system to change it. --(d) humanist ideology: emphasize the similarities of all humans, give race low centrality, and are more concerned with issues facing the human race such as peace, poverty, and climate change. a person's ideology may depend on the context -ex. believe that African Americans should patronize African American-owned businesses as often as possible (nationalist ideology) but also think that African Americans should have more social contact with White individuals (assimilationist ideology) propose that the four dimensions of racial identity can help clarify why individuals respond to similar situations differently. --ex. two African American adults with similar regard and ideology may act differently in the same situation because race has high salience for one person in that situation but low salience for the other person.

Caplan 4 types of mental health consultation

each type consists of a triad that includes a consultant, a consultee (therapist or program administrator), and a client or program 1. Client-Centered Case Consultation: focuses on a particular client of the consultee who is having difficulty providing the client with effective services (ex. having trouble identifying an appropriate treatment) -consultant's goal is to provide the consultee with a plan that will benefit the client 2. Consultee-Centered Case Consultation: focuses on the consultee with the goal of improving their ability to work effectively with current and future clients who are similar in some way (ex. with TBI, specific minority group, etc.) -goal is to improve the consultee's knowledge, skills, confidence and/or objectivity -several factors contribute to a consultee's lack of objectivity: ex. theme interference - happens when a consultee's biases and unfounded beliefs interfere with their ability to be objective when working with certain types of clients Program-Centered Administrative Consultation: involves working with program administrators to help them clarify and resolve problems they're having with an existing mental health program -goal is to provide administrators with recommendations for dealing with the problems they've encountered in developing, administering, and/or evaluating the program Consultee-Centered Administrative Consultation: focuses on improving the professional functioning of program administrators so they're better able to develop, administer, and evaluate mental health programs in the future Mental health consultations differs from collaboration in several ways -ex. consultant has little or no direct contact with a consultee's client and is not responsible for the client's outcomes --collaborator usually has direct contact with the client and shares responsibility for the client's outcomes

Functional Family Therapy

evidence-based treatment for at-risk adolescents (ex. conduct disorder, substance use disorder) and their families incorporates elements of structural, strategic, and behavioral family therapy, and is based on the assumption that problematic behaviors within a family serve important relationship functions (i.e. regulate interpersonal connections and relational hierarchies) primary goal is to replace problematic behaviors with nonproblematic behaviors that fulfill the same relationship functions -therapy normally involves 8-30 sessions over a 3-6mo period and consists of 3 stages: -engagement and motivation stage: emphasis is on forming a therapeutic alliance with family members and helping family members reduce feelings of hopelessness and negativity, increase positive expectations for change, and develop a family-focused understanding of its presenting problems --techniques used during this stage include joining and reframing --once family members are engaged and motivated, next stage begins -behavior change: immediate and long-term behavioral goals are identified and an individualized treatment plan for the family is implemented --techniques used in this stage include training in parenting, communication, problem-solving, and coping skills -generalization stage: the focus is on linking family members to community resources and helping them generalize their acquired skills to new problems and situations and identify ways to avoid relapse

Multisystematic Therapy

evidence-based treatment that was originally developed for adolescent offenders at risk for out-of-home placement and their families but has subsequently been adapted for adolescents with other serious clinical problems including psychiatric disturbances, substance abuse, and childhood maltreatment based on Brofenbrenner's (04) ecological model which views individuals as being embedded in and influenced directly and indirectly by mx systems focuses on the specific individual, family, peer, school, and social network variables that contribute to a youth's presenting problems, and on interactions between these factors linked with the presenting problems includes nine treatment principles that are applied using an analytic process that structures the development, implementation, and evaluation of the treatment plan -core principles are finding the fit between identified problems and their broader systemic context; focusing on positive and strengths; increasing responsibility; being present-focused, action-oriented, and well-defined; targeting behavior sequences; using developmentally appropriate interventions; encouraging continuous effort; stressing evaluation and accountability; and promoting generalization therapy is provided in the family's home and in community settings where problems occur interventions derived from strategic and structural family therapy, behavior therapy, and CBT and target factors that are driving problem behaviors -ex. assessment might indicate that the drivers of an adolescent's daily marijuana use (and targets of treatment) are a high level of family conflict, low parental monitoring of the adolescent's behavior and ineffective discipline, the adolescent's poor social skills and friendships with peers who use drugs, opportunities for the adolescent to use drugs at school, and availability of drugs in the adolescent's neighborhood therapy is delivered by multidisciplinary team that's tailored to the adolescent's and family's problem behaviors -for someone with academic, conduct problems, frequent use of marijuana/cocaine, and a recent arrest for cocaine possession ---team may consist of a caseworker, family therapist, substance abuse counselor, and 2 other people who will work with the adolescent in their school and neighborhood

Smith, Glass, and Miller research

first to use meta-analysis to combine results of studies that compared the outcomes of patients who received psychotherapy to the outcomes of patients in either a no-treatment control group or an alternative (non-therapy) treatment group included 475 studies and produced a mean effect size of .85 -average patient who received psychotherapy was better off than 80% of patients who didn't receive it (mean outcome store for those who participated in psychotherapy was .85 SD above the mean outcome score for people who didn't get psychotherapy) --in normal distribution, 84% of scores are below a standard deviation of 1.0 and 80% are below a SD of .85

Personal construct therapy (Kelly '63)

focuses on how people construe (perceive, interpret, and anticipate) events -proposes that there are alt ways of doing so and that people can change the way they construe events to alleviate undesirable behaviors and outcomes construing involves the use of personal constructs (bipolar dimensions of meaning like fair/unfair, friend enemy) that arise from a person's experiences and may operate on an unconscious or conscious level practitioners consider the therapist and the client to be partners who work together to help the client identify and replace maladaptive personal constructs -ex. Kelly developed fixed-role therapy to help clients try out alt personal constructs --involves having the client role-play a fictional character that is described by the therapist and construes events in alt ways

Stress Inoculation Training

focuses on improving the ability of clients to deal better with ongoing and future stressful situations by teaching them effective coping skills. It consists of three phases. 1. conceptualization/education phase: clients provided with information about stress and its effects and are encouraged to view stressful situations as problems-to-be-solved 2. skills acquisition and consolidation phase: clients learn a variety of cognitive and behavioral coping skills which may include relaxation, self-instruction, and problem-solving. 3. application and follow-through phase: clients use newly acquired coping skills, first in imagined and role-playing situations and then in real life situations.

Solution-Focused Therapy

focuses on solutions to problems instead of the etiology and nature of problems therapists adopt a goal-directed collaborative approach and use several types of questions to help clients identify treatment goals and personal strengths and resources that will help them achieve those goals a. miracle question: helps establish the focus of treatment as the future (rather than past and present) and identify treatment goals -ex. if miracle happened and problem was solved, how would you know that a miracle occurred? b. Exception questions: used to help clients identify times when their problems didn't exist or were less intense -ex. can you think of a time in the past 2 weeks when you and your partner did not argue? c. Scaling questions: help clients evaluate their current status or their progress towards achieving their goals -ex. on scale from 1 to 10, how stressed are you now? each therapy session is structured and involves asking questions, providing feedback, and assigning a task to complete before the next session -ex. formula first session task is assigned at end of the first session and requires clients to identify something in their lives that they want to continue

Interpersonal Psychotherapy (ITP)

focuses on the interpersonal factors that contribute to a client's current symptoms based on medical model and views depression and other mental disorders as treatable mental illnesses Primary goals are symptom relief and improved interpersonal functioning Developed as a treatment for acute depression but modified to treat BD, eating disorders, and several other disorders Three stages of therapy: a. initial stage: therapist determines the client's diagnosis and the interpersonal context of the client's symptoms -information used to identify the primary problem that will be the focus for treamtment --ex. for depression, problem areas are interpersonal role disputes, interpersonal role transitions, interpersonal deficits, and grief -during this stage, clients are assigned the "sick role" in order to allow them to to be ill without blaming themselves for their symptoms and to view their illnesses as temporary and treatable b. middle phase: therapist uses a variety of strategies to address the problem area identified in the initial stage -common strategies include encouragement of affect, role-playing, communication analysis, and decision analysis c. final stage: therapist addresses issues related to termination and relapse prevention

Troiden's Model of Homosexual Identity Development

gay and lesbian identity development are most fully realized when self-identity, perceived identity, and presented identity coincide distinguishes between four stages: 1. Sensitization: occurs during childhood and is characterized by feeling different from same-sex peers. -ex. Young girls may feel that they're not feminine or pretty and are more independent and aggressive than other girls are -ex. young boys may say they're less interested in sports and less aggressive than other boys and are more interested in art, reading, and other solitary activities. 2. Identity Confusion: begins in middle or late adolescence when individuals start to feel sexually attracted to individuals of the same sex and suspect that they're gay or lesbian. -This suspicion leads to uncertainty and anxiety which they attempt to alleviate with denial, avoidance, repair (attempting to change), redefinition (viewing homosexual feelings as a phase), or acceptance. 3. Identity Assumption: The transition occurs when the person begins to accept a gay or lesbian identity -usually between 19 and 21 years of age for males and between 21 and 23 years of age for females. -Individuals in this stage seek out social and sexual relationships with gays or lesbians and disclose their sexual orientation to gay and lesbian peers and adults and to some heterosexual family members and friends. 4. Identity Commitment: People in this stage have internalized a gay or lesbian identity, accepted homosexuality as a way of life, and are comfortable disclosing their sexual orientation to heterosexual individuals including family members, friends, and coworkers.

Formative phases of group therapy

groups usually experience 3 overlapping formative stages: 1. initial orientation, hesitant participation, search for meaning, and dependency stage: members are concerned with clarifying the nature and purpose of the group and depend on the leader for structure, acceptance, and answers to their questions --interactions between members often focus on describing symptoms and previous treatments and involve giving and seeking advice 2. conflict, dominance, and rebellion stage: members compete for power and control and attempt to establish a pecking order -members tend to be critical of each other and some may become hostile and resentful toward the therapist as they become aware that they're not going to be the therapist's "favorite child" 3. development of cohesiveness: conflict between group members decreases, and cohesiveness increases as members begin to trust each other and the therapist -members may reveal teh real reason why they have come to therapy and show concern when a member is absent or drops out of therapy -development of cohesiveness marks the beginning of a mature group that can deal effectively with the concerns and problems of group members

Cross's Black Racial Identity Development Model

has been revised several times original model was known as the Nigrescence Model (Cross, 1971) and distinguished between five stages: 1. Pre-Encounter: People idealize and prefer White culture. They have negative attitudes toward their own Black culture and may view it as an obstacle and source of stigma. 2. Encounter: People question their views of White and Black cultures as the result of exposure to events that cause them to become aware of the impact of racism on their lives. These individuals are interested in learning about and becoming connected to their own culture. 3. Immersion-Emersion: People reject White culture and idealize and become immersed in their own culture. 4. Internalization: During this stage, defensiveness and emotional intensity related to race decrease. People in this stage have a positive Black identity and tolerate or respect racial and cultural differences. 5. Internalization-Commitment: People have internalized a Black identity and are committed to social activism to reduce all forms of oppression. Cross reduced the number of stages to four by combining the internalization and internalization-commitment stages. Cross and Vandiver then changed its name to the Black Racial Identity Development Model and reduced it to three stages, with each stage including multiple identity subtypes. 1. Pre-encounter stage - includes assimilation, miseducation, and self-hatred subtypes 2. Immersion-emersion stage - consists of intense Black involvement and anti-White subtypes 3. internalization stage - consists of Black nationalist, biculturalist, and multiculturalist subtypes.

Humanistic and existential psychotherapies

humanistic: person-centered and Gestalt Existential: reality therapy, positive psychology, and personal construct theory humanistic and existential are sometimes categorized jointly as therapies but differ in important ways as well similarities: both focus on here-and-now and adopt a phenomenological orientation (prioritize a client's subjective experience over objective reality) -also reject the medical model and use of clinical labels and, consequently, concentrate on a client's internal qualities and perspective rather than the client's symptoms differences: -humanistic emphasizes growth and acceptance and helps clients become more fully-functioning and self-actualizing -existential emphasizes freedom and responsibility and helps client confront the anxieties that arise from the awareness of one's existential condition and cultivate authentic engagement with their world

Motivational Interviewing

incorporates concepts and principles of person-centered therapy, transtheoretical model, Bandura's concept of self-efficacy, and Festinger's notion of congitive dissonance assumes that interventions are most effective when they match the client's stage of change, considered most useful for people in the precontemplation or contemplation stage primary techniques are expressing empathy, supporting self-efficacy, developing a discrepancy (helping clients see the difference between their behaviors and goals), and rolling with resistance (decreasing client resistance by avoiding arguments and power struggles) distinctive characteristic is the use of questions, reflections, affirmations, and other strategies to elicit and reinforce a client's "change talk" (statements that move the client toward making positive changes in behavior

Conjoint Family Therapy (Satir) (AKA human validation process model)

influenced by humanistic psychology and communication and experiential approaches to family therapy family systems seek a state of balance, with family problems arising when balance is maintained by unrealistic expectations, inappropriate rules and roles, and dysfunctional communication Four dysfunctional communication styles: -placating: involves agreeing with or capitulating to others due to fear, dependency, and a desire to be loved and accepted -blaming: involves accusing, judging, and bullying others to avoid taking responsibility and to hide feelings of vulnerability and worthlessness -computing: taking an overly intellectual and rational approach to avoid becoming emotionally engaged with others -distracting: involves changing the subject and making inappropriate jokes to distract attention and avoid conflict Congruent (or leveling) style: functional style that's characterized by congruence between verbal and nonverbal messages, directness and authenticity, and emotional engagement with others Primary goal is to enhance the growth potential of family members by increasing their self-esteem, strengthening their problem-solving skills, and helping them communicate congruently Satir viewed the therapist's "use of self" as the most important therapeutic tool and proposed that therapists have mx roles when working with clients including facilitator, mediator, advocate, educator, and role model -also used several techniques to achieve therapy goals including family sculpting (involves having each family member to take a turn positioning other family members in ways that depict their view of family relationships) and family reconstruction (type of psychodrama that involves role-playing 3 generations of the family to explore unresolved family issues and events)

Self-Instructional Training

initially developed to teach problem-solving skills to children with high levels of impulsivity but has since been applied to other populations and problems. It consists of five stages: 1. initial cognitive modeling stage: children observe a model perform a task while the model verbalizes instructions aloud. 2. overt external guidance stage: children perform the same task while the model verbalizes the instructions. 3. overt self-guidance stage in which children perform the task while verbalizing the instructions aloud themselves. 4. faded overt guidance stage: children perform the task while whispering the instructions. 5. covert self-instruction stage: children perform the task while repeating the instructions subvocally. The instructions used by the model and children while performing the task address four skills: 1. identifying the nature of the task 2. focusing attention on the task and the behaviors needed to complete it 3. providing self-reinforcement that sustains appropriate behavior 4. evaluating performance and correcting errors.

Transtheoretical Model

integrates concepts and strategies from multiple therapeutic approaches and is based on the assumption that strategies are most effective when they match the person's stage of change Six stages of change, and primary goal of the first 5 stages is to help the client advance to the next stage: a. Precontemplation: clients have no intention of taking action to change their behaviors in the next 6 months -may be in denial about their problems or may have made multiple unsuccessful attempts to change and believe that change is impossible -likely to resist advice of change interventions but may benefit from consciousness raising, dramatic relief (experiencing and expressing emotions), and environmental reevaluation (examining how the environment affects their behavior) b. Contemplation: clients plan to change in the next 6mo but they're ambivalent about changing, which may make it difficult for them to transition to the next stage -benefit from self-reevaluation in addition to the strategies that are useful for individuals in the precontemplation stage c. Preparation: clients plan to take action within the next month -useful strategies for these people support their decision to change and include self-reevaluation and self-liberation (believing that change is possible and making a commitment to change) d. Action: clients in this stage are taking action to change their behaviors -effective strategies for these clients include contingency management, stimulus control, and counterconditioning e. Maintenance: client's transition to this phase when they have maintained the desired behavior change for 6 months -primary focus of treatment is relapse prevention which involves the same strategies useful for people in the action stage f. Termination: clients in this stage are confident that their risk of relapse is low Motivation to change is affected by 3 factors: -decisional balance: strength of the person's beliefs about the pros and cons of changing --is most important as a determinant of motivation during the contemplation stage -self-efficacy: refers to the confidence the person has about their ability to change and avoid relapse --important determinant of whether a person transitions from the contemplation to the preparation stage and then from the preparation and the action stage -temptation: intensity of the urge to engage in the undesirable behavior and is usually the strongest during the first few stages of change

Howard and Colleagues study

investigated relationship between duration of psychotherapy and its outcomes Developed 2 models to describe this relationship: a. dosage model (dose-effect model): states that there's a predictable relationship between number of therapy sessions and the probability of measurable improvement in symptoms -predicts that 50% of therapy clients can be expected to exhibit a clinically significant improvement in symptoms by 6 to 8 sessions, 75% by 26 sessions, and 85% by 52 sessions b. phase model: proposes that psychotherapy outcomes can be described in terms of 3 phases: --initial remoralization phase: occurs during the first few sessions and is characterized by an increase in hopefulness --remediation phase: happens during the next 16 sessions and involves a reduction in symptoms --rehabilitation phase: involves unlearning troublesome, maladaptive, habitual behaviors and establishing new ways of dealing with various aspects of life (ex. problematic relationship patterns, faulty work habits, and trouble-causing personal attitudes) implication of this model is that different outcomes measures should be used during different phases of therapy -i.e. measures of subjective well-being during the remoralization phase, the severity and frequency of symptoms during the remediation phase, and life functioning during the rehab phase

Economic Evaluation

involves using info about program costs and benefits to inform decision-making Cost benefit analysis: used to compare the costs and benefits of one or multiple interventions -costs and benefits are both expressed in monetary terms --ex. compared individual placement and support (IPS) and standard vocational rehab for helping people with severe mental disorders obtain employment - when costs of implementing interventions and their benefits (as measured by expected earnings) were compared, IPS produced a greater net benefit Cost-effectiveness analysis: used to compare the costs and benefits of two or more interventions when benefits can't be expressed as monetary values --ex. used this to compare cost and benefits of IPS and standard vocational rehab, with benefits being measured as percent or participants who worked for at least 1 day during the follow-up period, percent of participants who dropped out of the program, percent of participants who had to be readmitted to the hospital ---IPS found to be more effective than vocational rehab for all 3 benefits Cost-utility analysis: used to compare the costs of 2 or more interventions on quality-adjusted life-years (QALYs) which combines measures of gain in the health-related quality and quantity (duration) of life --ex. one study compared costs and benefits in terms of QALYs of three treatments for depression, cognitive therapy, rational-emotive behavior therapy, and fluoxetine (Prozac) ---results indicated that CT and REBT both had greater cost-utility than Prozac but didn't differ significantly from each other

Stepped Care

model of healthcare delivery with 2 fundamental features: 1. recommended treatment within a stepped care model should be the least restrictive of those currently available, but still likely to provide significant health gain 2. stepped care model is self-correcting, which means that the results of treatments and decisions about treatment provision are monitored systematically and changes are made ('stepping up') if current treatments aren't achieving significant health gain primary goals are to increase the efficiency of health care services and the accessibility of effective treatments through better allocation of scarce mental health resources Several models of stepped care: some apply to specific disorders, while others are non-specific and can be applied to various disorders and conditions Commonly cited models for depression usually include 4 steps that are similar to these: 1. Assessment and Monitoring: evaluating the patient's symptoms and "watchful waiting" which is appropriate for patients with minor depressive symptoms and involves monitoring their symptoms 2. Interventions requiring minimal practitioner involvement: include psychoed about symptoms and course of depression, treatment options, and signs of relaps -bibliotherapy as a preventative technique for patients who at high risk for depression or are experiencing an increase in symptoms as an adjunct to other treatments -computer-based interventions that track patients' symptoms and use multimedia with interactive components designed to help patients cope with depression and anxiety 3. Interventions requiring more intensive care and specialized training: may include group therapy, individual psychotherapy, and/or medication -some models identify group psychotherapy and brief individual psychotherapy as initial choices for this step followed by long-term psychotherapy with or without antidepressant medication for patients who don't adequately respond to group or brief individual thearpy) 4. most restrictive and intensive forms of care: step for patients with severe depressive symptoms and consists of voluntary or mandated inpatient care

Foundations of Family therapy

most approaches have their roots in general systems theory and cybernetic therapy General systems theory: originally used by biologists to describe the functioning of living and non-living systems -predicts that all systems consist of interacting components, are governed by the same general rules, and have homeostatic mechanisms that help them maintain a state of stability and equilibrium Cybernetic theory: concerned with the mechanisms that regulate a system's functioning and distinguishes between negative and positive feedback loops -negative feedback loops: resist change and help a system maintain the status quo -positive feedback loops: amplify change and disrupt the status quo

Inclusion and Exclusion Considerations for Group therapy

most effective for people who are highly motivated, active, psychologically minded and self-reflected, who seize opportunities for self-disclosure within the group, and who have an adequate capacity for interpersonal relationships group therapy is contraindicated for people who are actively experiencing suicidal ideation, who are delusional and likely to incorporate the group into their delusions, or who pose a threat to group members because they're unable to control their aggressive impulses -in addition, people with antisocial personality disorder do well in groups that are homogeneous with regard to dx but should ordinarily not be included in heterogeneous groups

Group therapy characteristis

one factor to consider is the size of the group -optimal size depends on type of group and its purpose --in general, recommended size for an adult outpatient group ranges from 7-10 members ---when group has less than 7 members, interactions are limited and when it has more than 10, it's hard to involve everyone in the session -also evidence that, the larger the size of a therapy group, the lower its cohesiveness and the higher the dropout rate another factor is whether or not it will be open or closed: -closed: begin with a desired number of members and, if any members drop out, they aren't replaced --have specific goals and meet for a predetermined number of sessions --advantages: associated with greater group cohesiveness -open: maintain the same number of members for their duration by replacing members who drop out --usually have broader goals than closed groups do and meet indefinitely ---advantages: benefit from the energy and new input provided by new members

Tight vs. Loose Cultures

refers to the strength of a culture's social norma and tolerance for deviant behaviors Tight cultures: have strong social norms and low tolerance for deviant behaviors -greater conformity to social norms, tendency to engage in risk avoidance behaviors, and a preference for stability Loose cultures: have weak social norms and high tolerance for deviant behaviors -greater willingness to act in ways that deviate from social norms and engage in risk-taking and innovative behaviors and a greater openness to change tightness-looseness is related to the ecological and human-made challenges that nations and states have historically encountered -ex. those with a history of high population density, greater vulnerability to natural disasters and disease, and scarcity of resources are likely to become tight because they need strong norms and punishments for deviant behaviors to ensure their survival --while nations and states without these challenges survive with weaker norms and acceptance of deviant behaviors Gelfand and colleagues looked at 33 nations and 50 states --Pakistan, Malaysia, and India as three "tightest" countries and Estonia, Hungary, and Israel as the three "loosest" countries --Mississippi, Alabama, and Arkansas were the three "tightest" states and California, Oregon, and Washington were classified as the three "loosest" states people living in tight states have higher levels of conscientiousness and lower levels of openness to experience than individuals living in loose states, while the opposite is true for those living in loose states

Freudian psychoanalysis

reflects a deterministic and pessimistic view of human nature that views current psychological problems as being due to unconscious unresolved conflicts that arose during childhood assumes that these conflicts cause anxiety and are the result of the divergent demands of the 3 aspects of personality: a. id: present at birth and its life (sexual) and death (aggression) instincts are the primary source of psychic energy --operates according to the pleasure principle and seeks immediate gratification of its instinctual needs using unconscious irrational means b. ego: develops about 6mo and operates according to the reality principle --it also seeks to at least partially gratify the id's instincts it attempts to do so in realistic rational ways c. superego: last aspect of personality to develop --represents the internalization of society's values and standards and acts as the conscience --attempts to permanently block (rather than gratify) the id's instincts proposes that when the ego is unable to resolve a conflict between the id and superego using rational means, it resorts to a defense mechanism -defense mechanisms deny or distort reality and operate on an unconscious level --includes repression, denial, reaction formation, projection, and sublimation ---repression is the basis of all other defense mechanisms, is involuntary, and involves keeping undesirable thoughts and urges out of conscious awareness ---denial is an immature defense mechanism that involves refusing to acknowledge distressing aspects of reality, includes: ignoring, distorting, and rejecting reality ---reaction formation involves defending against an unacceptable impulse by expressing its opposite ---projection involves attributing an unacceptable impulse to another person ---sublimation involves channeling an unacceptable impulse into a socially desirable (and often admirable) behavior -occasional use of defense mechanisms is adaptive but repeated reliance on them keeps a person from resolving the conflicts that are causing anxiety main psychoanalysis goals are to make the unconscious conscious and to strengthen the ego so that the behavior is based more on reality and less on instinctual cravings and irrational guilt -primary technique is analysis of client's free associations, dreams, resistance, and transference, and the process of analysis consists of 4 steps 1. Confrontation: helping clients recognize behaviors they've been unaware of and their possible cause 2. Clarification: brings cause of behaviors into sharper focus by separating important details from extraneous material 3. Interpretation: involves explicitly linking conscious behaviors to unconscious processes 4. Repeated Interpretation: leads to catharsis (experience of repressed emotions) and insight into the connection between unconscious material and current behavior and then to working through (gradual process where client accepts and integrates new insights into their life)

Adler's Individual Psychology

rejected some aspects of Freudian theory -replaced Freud's sexual instincts with an innate social interest and desire for social connectedness and adopted a teleological approach that emphasizes the effects of future goals on current behavior proposed that people are motivated by feelings of inferiority that arise during childhood in response to real or imagine inadequacies and by striving for superiority to overcome inferior feelings style of life: describes ways that people strive for superiority and proposed that a person's style of life develops during early childhood -people adopted a healthy style of life when their goals reflect not only concerns for personal achievement but also for the well-being of others -people adopted a mistaken (unhealthy) style of life when their goals focus on overcompensating for feelings of inferiority and reflect a lack of concern about the well-being of others --from this perspective, neurosis, psychosis, addiction, and other problems are manifestations of a mistaken style of life primary goal is to replace the client's mistaken style of life with a healthier, more adaptive one by helping the client overcome feelings of inferiority and develop a stronger social interest -strategies to achieve this include identifying early recollections, dream analysis, and having clients act "as if" they're already the people they want to be

Utilization of Mental Health Care

research has found that utilization rates of mental health care services vary, depending on clients' gender, age, sexual orientation, and race/ethnicity 2018 National Survey of Drug Use and Health found that utilization rates were higher for female adults than for male adults -found that, for all adult respondents, utilization rates were highest for respondents ages 26 to 49 followed by, in order, those 50 and older and those ages 18 to 25, which is consistent with the results of yearly surveys conducted since 2002 studies generally find that sexual minority men and women utilize mental health care services at higher rates than sexual majority (heterosexual) men and women do -National Health Interview Surveys: sexual minority men and women were 2-4x more likely than heterosexual men and women to have talked with a mental health professional in the past year -Hughes found that lesbians in their sample were more likely than heterosexual women to report being in recovery or having received treatment for alcohol-related problems -Koh and Ross found that lesbians more likely than heterosexual women to seek therapy for depression 2018 National Survey of Drug Use and Health indicated that among all adult survey respondents, the use of outpatient mental health services in the past year was highest for respondents who identified themselves as belonging to 2 or more racial groups and lowest for respondents who identified themselves as Asian -for inpatient mental health services, use was highest for those who identified themselves as American Indian or Alaska Native and lowest for those who identified themselves as Asian National Survey of Drug Use and Health in 2015 collected data on use of mental health services by individuals ages 18+ -found that annual average use of outpatient mental services from 2008-12 were highest for respondents reporting two or more races, followed by, in order, those who identified themselves as being Black or African American, two or more races, Hispanic American, White, or Asian

Effects of Age, Gender, and Socioeconomic Status on Psychotherapy Outcomes

research investigating effect of these on psychotherapy hasn't produced entirely consistent results, but best overall conclusions are that they have little or no impact on outcomes and that apparent differences are due to other factors ex. Nordberg found that, when initial severity of symptoms was controlled, client age explained essentially none of the variance in psychotherapy outcomes also, while some studies have linked low socioeconomic status to premature termination, there's evidence that this relationship is due to transportation difficulties and other factors

Client-Therapist Matching

results of research investigating the effects of client --therapist matching in terms of race and ethnicity vary, depending on the outcome measure and clients' race or ethnicity Cabral and Smith: meta-analysis produced effect size of .32 for the impact of matching on clients' perceptions of their therapists, but an effect size of only .09 on measures of therapy outcome Sue et al. found that racial ethnic matching reduced premature termination rates for Asian, Hispanic, and European American clients but not for African American clients and that matching was associated with improved treatment outcomes only for Hispanic American clients Comas-Diaz: found that their review of the research indicated that clinicians' cultural competence, compassion, and worldview were more important than ethnic matching between client and clinician

Evidence-Based Couple and Family Therapies

the best couple and family treatments are those that are "based on both science and the accumulated clinical knowledge of experienced practitioners in order to most accurately identify both the efficacy (reliability) and utility (contextual efficacy) of clinical procedure" Three levels of evidence: Level 1: evidence-informed interventions that are supported by pre-existing research (ex. common factors research) or are linked to evidence-based treatment models --have not been evaluated themselves and/or haven't been evaluated for specific populations or problems --ex. Gottman's marital therapy and structural family therapy at at this level Level II: consists of promising interventions that have preliminary evidence of their effectiveness but have not been replicated for specific populations or problems --ex. insight-oriented marital therapy and attachment-based family therapy are in this category Level III: consists of evidence-based interventions that are supported by systematic high-quality research that shows they are effective for the clinical problems they are designed to treat --divided into 4 categories: ---category 1: evidence of an interventions efficacy and effectiveness when compared to no treatment (absolute efficacy) - all interventions included included must, at a minimum, meet the criteria for this category ----ex. brief structural family therapy and integrative behavioral couple therapy ---category 2: evidence of an intervention's efficacy and effectiveness compared to alt treatments (relative efficacy) ----ex. behavioral marital therapy and parent management training are examples of interventions in this category ---category 3: evidence of the efficacy and effectiveness of an intervention's model-specific change mechanisms (verified mechanisms of action) ----ex. behavioral couples therapy and family psychoeducation interventions for schizophrenia ---category 4: evidence that the intervention has beneficial outcomes for specific client populations, for specific clinical problems, and for different service delivery systems (contextual efficacy) ----ex. multisystemic therapy for adolescent problem behaviors and behavioral couples therapy for alcohol and substance abuse disorders

Object relations theory

view behavior as being primarily motivated by a desire for human relationships and they focus on the impact of early relationships between a child and primary caregivers (objects) on the child's future relationships object constancy: development of mental representations (introjects) of the self and objects that allow the person to value an object for reasons other than its ability to satisfy the individual's needs Development of object constancy takes place during three stages: -normal autistic stage: happens during the first few weeks of life, infants are totally self-absorbed and unaware of external environment -normal symbiotic stage: infants become aware of external environment but are unable to differentiate themselves from their caregivers -separation-individuation stage: begins at about 5mo and continues until the child is about 3, consists of 4 substages where object constancy gradually develops: differentiation, practicing, rapprochement, and beginning object constancy Narcissism, BPD, personality disorder, and other psychiatric disorders are often due to problems during the separation-individuation process that cause a pervasive failure of object constancy Primary goal is to provide clients with a corrective reparenting experience in order to replace the client's maladaptive introjects with more adaptive ones and therby improve their current relationships -therapists provide clients with empathic acceptance and use a number of psychoanalytic strategies in therapy including the analysis of resistance and transference

Acculturation

when members of a minority group are in contact with a majority group, so they can adopt one of 4 acculturation strategies that represent different combos of retention/rejection of their own minority culture and the majority culture a. Integration strategy: retain their own minority culture and adopt the majority culture b. Assimilation strategy: reject their own minority culture and adopt the majority culture c. Separation strategy: retain their own minority culture and reject the majority culture d. Marginalization strategy: reject their own minority culture and the majority culture