Motivational interviewing, Narrative Therapy, CH 8 - Cognitive-Behavioral Theory and Therapy, Clinical chapter 12, Psychoanalytic Therapy and CBT, CLINICAL INDIVIDUAL TEST ONE: Ch ONE Systems, Ecological, Ecosystems; Ch TWO CBT, CLINICAL INDIVIDUAL:...

Describe what the focus should be in motivational interviewing

*Person-centered* vs. disordered or disease -centered approach

Flooding (actual) and Implosion (imagined)

- in phobias, exposure to feared stimuli without the possibility of avoidance.

Components of CBT

1) Problem-oriented focus 2) Collaborative therapeutic relationship (therapist gives advice and feedback) 3) Socratic questioning 4) Use of structuring, psycho-education, and rehearsal to enhance learning 5) eliciting and modifying automatic thoughts 6) uncovering and changing schemas 7) Behavioral methods to reverse patterns of helplessness, self-defeating behavior, and avoidance

Initial Stage of Therapy (3 things)

1) Transference is attended to 2) Interpretations of patient's statements and behaviors 3) Confrontation of resistance to treatment

narrative- First goal is to what 2 things

1. Identify 2. Personify problem

Inferential

A characteristic of psychodynamic psychotherapy referring to the clinician's reliance on deduction or conjecture rather than empirical or directly observable info

Displacement

A defense mechanism in which the ego displaces an id impulse toward a safer target

Reaction Formation

A defense mechanism in which the ego forms a reaction against the id impulse, resulting in behavior opposite of the original id impulse

Projection

A defense mechanism in which the ego projects an id impulse onto other people

Sublimination

A defense mechanism in which the ego redirects the id impulse in such a way that the resulting behavior actually benefits others

Repression

A defense mechanism in which the ego represses conscious awareness of conflict between id and superego

Brief Psychodynamic Psychotherapy

A more efficient and increasingly common version of psychodynamic psychotherapy, typically lasting about 6 months or less

Insight

A primary goal of psychodynamic psychotherapy; making the unconscious conscious

Time-Limited Dynamic Psychotherapy (TLDP)

A specific, contemporary form of psychodynamic psychotherapy in which the therapist makes efforts to form a "corrective" relationship with the client that doesn't follow the same unconscious "script" as the client's previous problematic relationships

Interpersonal Therapy (IPT)

A specific, manualized, contemporary form of psychodynamic psychotherapy that emphasizes interpersonal relationships and has received empirical support for the treatment of depression

Free Assocation

A therapy technique in which psychodynamic psychotherapists simply ask clients to say whatever comes to mind without censoring themselves at all

Object Relations

A variation of psychodynamic psychotherapy deemphasizing internal conflict and instead emphasizing relationships between internalized "objects"

Self-Psychology

A variation of psychodynamic psychotherapy emphasizing parental roles in the child's development of self, with special attention paid to the meaning of narcissism at various points, including in therapy

Ego Psychology

A variation of psycohdynamic psychotherapy emphasizing the adaptive tendencies of the ego over the pleasure-based drive of the id

Define action:

Action to change Praise any desire action This is where you want the patient to be Want to get people into the action stage I walked my dog .5 mile/day this week Praise them for anything action oriented

Define contemplation:

Ambivalent about change Patient is assessing barriers Giving up enjoyed behavior causes feelings of loss despite a perceived gain, e.g., time, expense, hassle, the "I know I need to doc..." They consider pros and cons, go back and forth, consider it easier to not change EX: I'd love to quit smoking but I enjoy it, I need more sleep but I need to study, should eat better but always busy I know I need to do something but etc.

Psychodynamic Psychotherapy

An approach to psychotherapy deriving from the theories of Sigmund Freud, the primary goal of which is to make the unconscious conscious

Dreams

An important means by which the client's unconscious material is communicated, and a common focus of interpretation

Working through

An often lengthy component of psychodynamic therapy in which interpretations are reconsidered and reevaluated again and again

Projection

Attributing an unacceptable internal impulse to an external source (vs displacement). Ex: A man who wants to cheat on his wife accuses his wife of being unfaithful.

Denial

Avoiding the awareness of some painful reality Ex: A patient with cancer plans a full-time work schedule despite being warned of signi cant fatigue during chemotherapy.

reciprocal determinism

Bandura-idea that cognitions, behavior, personal factors - emotions, motivations, physiology, and physical-AND social-environmental factors are interactive.

Splitting

Believing that people are either all good or all bad at different times due to intolerance of ambiguity. Commonly seen in borderline personality disorder. Ex: A patient says that all the nurses are cold and insensitive but that the doctors are warm and friendly.

ecological environment

Brofenbrenners "concieved as a set of nesting structures, each inside the next like a set of Russian dolls. Innermost level is immediate setting containng the developing person. The next step, however, already leads us off the beaten track for it requires looking beyond single settings to the relations between them. HUMAN DEVELOPMENT CANNOT BE SEEEN IN ISOLATION BUT MUST BE VIEWED WITHIN THE CONTEXT OF THE INDIVIDUAL'S RELATIONSHIP WITH THE ENVIRONMENT. EACH INDIVIDUAL'S ENVIRONMENT IS UNIQUE THE PERSON'S DEVELOPMENT IS PROFOUNDLY AFFECTED BY EVENTS OCCURRING IN SETTINGS IN WHICH THE PERSON IS NOT EVEN PRESENT. Example: in a family, there may be forces affecting parental subsystem that trickle down to affect the children w/o the children even knowing them. Like if parent is stressed at work and displaces frustrations at home by yelling at kid, you can see that outside environments can exert pronounced effect on child development

What is cognitive dissonance?

Change or not change, part of us wants to , part doesn't

Resistance

Client behavior that impedes discussion or conscious awareness of selected topics or emotions

What should do to empower the pt?

Complex clinical skill—Making the Patient Your Partner by Gordon and Edwards. Understand the person's perspective and experience. Empower the patient.

What is important for change to occur?

Confidence

Reinforcement intervals most susceptible to extinction

Continuous Reinforcement, Fixed Ratio Reinforcement, and Fixed Interval Reinforcement

Schema

Core beliefs that act as templates for information processing. Act as shortcuts for interpreting information.

Resistance

Defensive process within the therapy relationship where patient impedes test of exploration and inquiry

Countertransference

Doctor projects feelings about formative or other important persons onto patient (eg, patient reminds physician of younger sibling).

anomie

Durkheims term fro individuals who are unable or unwilling to fit into society through compliance with the normative expectations of the group, and thus fail to fulfill expected roles. To a SW, it describes situations where there is a severe disruption in the goodness of fit between an individual and their social context; this creates a DYSFUNCTION

Is motivational interviewing helpful?

Effective way of talking to a patient about changing his/her behavior

How do you understand the patients motivaton?

Elicit patient's reason for change, not yours. Ask why they want to make a change vs. telling them to change.

Undoing

Erasing an unacceptable behavior in the past by adopting acceptable behavior in the present (superstition) or by atonement or confession Ex: Woman was robbed when she went out the front door so now she only leaves through the back door.

***** What are the 4 basic principles of motivational interviewing?

Express empathy Develop discrepancy Roll with resistance Support self-efficacy Express empathy Discrepancy is very important, Pros and cons, if you make that change you'll like how you feel, it is social but you also say you're worried about your health or your baby, listen to patient, feed it back, "yeah, but" "yeah, but" "roll with the resistance" they don't want to make change, don't keep confronting the issue, roll with the resistance, patient will begin saying why they need to quit not why you want them to Support self-efficacy, like they don't need you for the rest of their life, they know what to do, how to, confidence to do it, importance to do it

Idealization

Expressing extremely positive thoughts of self and others while ignoring negative thoughts Ex: A patient boasts about his physician and his accomplishments while ignoring any flaws

Acting Out

Expressing unacceptable feelings and thoughts through actions. Ex: A surgeon throws a tantrum in the operating room because the last case ran very late.

adaptation

Germain's ecosystem ids ______________, life stress, coping, power, and human relatedness as important concepts for understanding the nature of the interactions of person-in-environment.

power

Germain: used by dominant groups to influence subordinate groups through trasactions in which resources are either provided or withheld; abuse of this causes both social and technological pollutions and be a source of tension in person-in-environment interactions; affect whole segments of population not just ind., abuse can occur at any systemic level including families

coping

Germain; requires both problem-solving and the ability to regulate negative feelings. The outcome of these factors leads to increased self esteem, which helps diminish negative feelings caused by a particular stressor; for a person to properly do this, they have to partially block out negative feelings so that hope is maintained and problem solving can begin. As problem solving proceeds, self esteem is elevated, hope is strengthened, and defenses can relax. When people feel their resources are tapped, this ability is reduced and maladaptive defenses can predominate

equilibrium, homeostasis

Germains Adaptation as it relates to ____________ would provide a short list of choices, whereas to achieve _______________, the system whould have a more extensive list of options from which to choose.

What are some motivational interviewing strategies?

Get a conversation going—express empathy through reflective listening. Develop a discrepancy between a patient's goals and their current behavior. Avoid argument and direct confrontation and roll with resistance rather than opposing it directly. Support self-efficacy and optimism.

Shaping

Getting a desired behavior by rewarding closer and closer approximations to the behavior

What is the role of the physician in making these changes?

Helping pt understand their health to help make changes Motivation of pt (exercise, diet, medications, stress management) Lifestyle changes to manage long term illness

What is motivational interviewing?

Important skill for primary care physicians. Used to help motivate patient's commitment to change. A different way to interview that involves listening very carefully to your patient. A patient-centered way of being with a patient.

open, closed

In SW, an ________ system is functional and a ___________ closed one is dysfunctional

Anal Stage

In psychodynamic psychotherapy, the second of the psychosexual developmental stages, and the stage from which issues of control may emerge

"Blank Screen" role

In psychodynamic psychotherapy, the therapist role in which little personal info is revealed to facilitate transference

Allegiance Effects

In psychotherapy outcome research, the influence of researchers' own biases and preferences on the outcome of their empirical studies

What is more powerful motivation to change, extrinsic or intrinsic?

Intrinsic ie from within Extrinsic reward has to be associated with the action otherwise regression will occur but intrinsic is much better

Regression

Involuntarily turning back the maturational clock and going back to earlier modes of dealing with the world (vs fixation). Ex: Seen in children under stress such as illness, punishment, or birth of a new sibling (eg, bedwetting in a previously toilet-trained child when hospitalized).

What is the importance of motivational interviewing?

Is about reducing risk for the patient. How their problem behavior is in conflict with important goals or values they have. Empathy with a goal. Supports self-efficacy. If they believe they can change, more likely to do it. Is optimistic, supportive and helpful.

Identification

Largely unconscious assumption of the characteristics, qualities, or traits of another person or group. Ex: A resident starts putting his stethoscope in his pocket like his favorite attending, instead of wearing it around his neck like before.

Systems

Ludwig von Beranlanffy; originator of form of this theory used in sw; Used social systems from Emile Durkheim's early study and Work of Talcott Parsons;

Unconscious

Mental activity occurring outside our awareness

Founders of Narrative Therapy

Michael White and David Epston

What does research show with regards to motivational interviewing?

More effective than confrontation and advice Quick and powerful (often 4 visits/sessions) Leads to greater adherence, retention Produces clinically significant results Is long lasting and can be combined with other approaches

ecosystems perspective

NINE assumptions of this theory are: - there is underlying general order in the world - social ordering is a constant and dynamic process - all human social behavior is purposive - all forms of social orgs. display self-maintaining and development characteristics - all social orgs are greater than the sum of their parts - well-being is natural state of all humans and human social org.- STRENGTHS PERSPECTIVE - all forms of social org. can be characterized and studied as social systems - social relationship is fundamental unit of all social systems - helping process seen in professional SW is formalization of natural socia l process

Define maintenance and relapse prevention:

New behavior over the long haul to be maintained Recycle through the stages of change before it becomes established Maintenance: if they have done an action for about 6 months then you're moving into maintenance, if they've done it 3 months they're moving towards it If exam question: 6 months of action is now maintenance. ex: Dieting for weight loss doesn't work because they cannot sustain the drastic diet over time Need to think if it is something they can sustain, something realistic Relapse's occur because they cannot sustain the change See this a lot in substance use, been sober for months/year then they have a break up or a death/trauma relapse Understand the cycles so you can identify where they are then the goal is to get them to action and maintenance phase

Define precontemplation:

Not considering change. In denial, doesn't apply to me personally, e.g., obese person who has been repeatedly unsuccessful. "My grandma was 90 and overweight, people in my family don't get heart disease, I won't take medications so don't prescribe them"

Transference

Patient projects feelings about formative or other important persons onto physician (eg, psychiatrist is seen as parent).

What is the issue with patients?

People don't follow physicians' advice and recommendations. More than 80% don't follow advice to change health behavior. 50% don't follow long-term medication regimes. 20-30% don't complete short-term medication regimes.

Describe the 6 stages of change

Precontemplation: no intention to change Contemplation: intend to change in next 6 months, may procrastinate Preparation: intends to take the action within next month Action: has changed behavior for less than 6 months Maintenance: has changed behavior for more than 6 months

Define preparation:

Preparing to make a specific change May experiment with small changes, e.g., decreasing drinking Preparation: Pro's outweigh the con's, start to do specific things Something small to get their foot in the water I have a babysitter so I can work out Preparing for the change I am going to go a different way to work to bypass McDonald's Telling you what they can do to prep for action

Rationalization

Proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame. Ex: After getting red, claiming that the job was not important anyway.

What is the expectancy theory?

Pt has to be: - motivated to change (must be *important* to them) -*confident* they can change

Emotional reasoning

Reasoning from how you feel without using any evidence

Displacement

Redirection of emotions or impulses to a neutral person or object (vs projection). Ex: A teacher is yelled at by the principal. Instead of confronting the principal directly, the teacher goes home and criticizes her husband's dinner selection.

What does not work to change pt behavior?

Repeated education Trying to persuade them to change

Reaction Formation

Replacing a warded-off idea or feeling by an (unconsciously derived) emphasis on its opposite (vs sublimation). Ex: A patient with libidinous thoughts enters a monastery.

What is the main goal of motivational interviewing?

See where pt is in the stages of change Help them move forward Help them maintain Support and empower them Do not force them to change

Isolation of affect

Separating feelings from ideas and events Ex: Describing murder in graphic detail with no emotional response.

Mature Defense Mechanisms

Sublimation, Altruism, Suppression, Humor

Defense Mechanisms

Techniques used by the go to manage conflict between the id and superego

Disassociation

Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress. Patient has incomplete or no memory of traumatic event. Ex: A victim of sexual abuse suddenly appears numb and detached when she is exposed to her abuser.

meaning-making

The __________- _________ function of humans directly influences the ways individuals experience the viccissitudes or change of circumstances across the life span AND the capacities enable humans to reconstruct the past, redefine the present, and creatively construe a future of possiblities.

Manifest Content

The actual plot of the dream as remembered by the dreamer, which represents the latent content

cause, effect, dynamic,

The ecosystem perspective views individuals as the ______________ and ____________ of their situation. Since situations are ___________, each change causes a reactive change in the larger system

Oral Stage

The first of the psychosexual developmental stages, and the stage from which issues of dependency may emerge

ecological environment, systems theory, ecological systems perspective

The juxtaposition of Brofenbrenner's _________ _________ with von Bertanlanffy's _____________ ____________ leads to ____________ ____________ ____________ which examines transactional relationships between systems.

What is the righting reflex?

The more you push the patient, the more they will resist change. It is the principle that people resist change to keep the status quo. Example: you try not to be anxious which makes you more anxious We want to help people but by forcing them to do stuff they will resist

Superego

The part of the mind that establishes rules, restrictions, and prohibitions

ID

The part of the mind that generates and seeks immediate satisfaction for all the pleasure-seeking, selfish, indulgent, animalistic impulses

Ego

The part of the mind that manages conflict between id and the superego and also meets the demands of reality

Sigmund Freud

The pioneer of the psychodynamic approach to clinical psychology

private, inner

The predominant focus of cognitive methods are on the ________,___________ experience of the individual.

Dream Work

The process of converting the latent content of a dream to its manifest content

Latent Content

The raw, unconscious thoughts and feelings represented by a dream

Transference

The tendency of clients to form relationships with therapists in which they unconsciously and unrealistically expect the therapist to behave like important people from the client's past

Interpretation

The therapists attempt to formulate and discuss with the client a hypothesized connection between unconscious material and client behavior

Phallic Stage

The third of the psychosexual stages, and the stage from which issues of self-worth may emerge

Conscious

Thoughts a person is currently aware of. Marked by secondary process thinking (rational, logical, time-oriented).

genogram, ecomap, and social network map

Three specific tools to acquire full dynamics of person in environment interaction in systems are the

strengths

Through Germain's ecosytems perspective , it is not necessary to know the order to facilitate systemic change, change becomes possible through the identification of the system's ______________

Countertransference

Transference by the therapist toward the client

Somatization

Turning an unacceptable impulse or feeling into a physical symptom Ex: Man who is anxious about a new job gets a headache before work.

Fixation

Unsuccessful resolution of the psychological tasks of a particular developmental stage

Intellectualization

Using facts and logic to emotionally distance oneself from a stressful situation. Ex: In a therapy session, patient diagnosed with cancer focuses only on rates of survival.

Reinforcement intervals most resistant to extinction

Variable Ratio Reinforcement and Variable Interval Reinforcement

Freudian Slips

Verbal or behavioral mistakes determined, according to psychodynamic psychotherapists, by unconscious motivations

Response Acquisition

When the conditioned response is acquired or learned

When does relapse occur?

When they're not engaging in healthy behavior

What can a pt response to your advice show?

Where they are in the process You begin with simple advice and see if they take it to heart, their response will tell you where they are in the process, some people change w/ advice from Dr. some do not.

Should you say to the pt "you are free to refuse"?

Yes 5 words make compliance rates jump from 10% to 47% Explore ambivalence: Reasons not to change; reasons to make a change.

twenty, twenty

__________ years ago, more than ___________ distinct varieties of CBT were id'd by Mahoney and Lyddon. It has continued to be expanded, enhanced, and elaboratec, resulting in a variety of conceptualizations of human distress and treatment models.

cognitivism, behaviorism

_____________ emerged during mid to late fifties when ____________ was strongly challenging psychoanalytic theory. Impact of cognitive movement was revolutionary in conceptualizing human functioning and change interventions

Aversive Conditioning

a pleasurable but maladaptive behavior (e.g. paraphilia or addiction) is paired with an aversive stimulus (e.g. electric shock) so that the two become associated.

31. CBT is: a. Agenda driven. b. Not supported by empirical research. c. Accepted as empirically valid for virtually all cultural groups. d. Being quickly overtaken by behavioral approaches. e. Dominated by the life-span developmental perspective.

a. Agenda driven.

27. Key similarity(ies) between Beck's cognitive therapy and Ellis's REBT is/are: a. Cognition is at the core of human suffering, and the therapist's job is to help clients modify distress-producing thoughts. b. Cognition is at the core of human suffering, and therapists must coach clients in changing their behaviors. c. Maladaptive behavior is at the core of human suffering, and therapists must help clients modify distress-producing behaviors. d. Maladaptive behavior is always a function of early childhood trauma. e. Deep cognitive schemas are a product of early childhood experiences.

a. Cognition is at the core of human suffering, and the therapist's job is to help clients modify distress-producing thoughts.

29. Which of the following is Beck's cognitive model of psychopathology? a. Cognitive distortions are triggered by external or internal events and produce automatic thoughts. These automatic thoughts are maladaptive and linked to core beliefs or core schema. b. Activating events trigger maladaptive behaviors, which, in turn, trigger maladaptive cognitions, which trigger future activating events. c. Negative self-talk generates anxiety, which is subsequently directed inward toward the self. This results in further negative self-talk that degrades into a negative spiral. d. Negative irrational beliefs are natural, but can get out of control and spiral into deeper and deeper irrational beliefs until it's virtually impossible to change those beliefs without intensive psychotherapy. e. Both a and c are consistent with Beck's cognitive therapy model.

a. Cognitive distortions are triggered by external or internal events and produce automatic thoughts. These automatic thoughts are maladaptive and linked to core beliefs or core schema.

7. Which phrase best describes Aaron Beck's cognitive therapy approach? a. Collaborative empirical analysis of ongoing cognitions. b. Rational argument to overcome irrational thought. c. Self-talk to guide adaptive behaviors. d. Reciprocal feedback from the environment, analyzed cognitively. e. None of these is a good description.

a. Collaborative empirical analysis of ongoing cognitions.

41. Which technique might be most useful with clients who hold on to maladaptive thoughts despite the fact that other, more reasonable interpretations exist? a. Generating alternative interpretations. b. False interpretations technique. c. Stress inoculation training. d. Collaborative interviewing. e. Guessing the thought.

a. Generating alternative interpretations.

10. Social learning theory emphasizes two main cognitive processes: a. Human learning is observational in nature, and reciprocal interactions can occur between the individual's behavior and environment. b. Punishment and extinction. c. Life and death. d. The belief or interpretation of a stimulus, and the potential modification of such beliefs. e. None of the above.

a. Human learning is observational in nature, and reciprocal interactions can occur between the individual's behavior and environment.

18. Consistent with cognitive appraisal theory, research shows that individuals with anxiety disorders are likely to: a. Overestimate the chances of a negative event occurring. b. Pay very little attention to negative incidents or cues. c. Minimize the significance of negative events. d. All of the above. e. Only a and c.

a. Overestimate the chances of a negative event occurring.

24. The purpose of Rational Emotive Behavior Therapy (REBT) is to help substitute a(n) ______________________, which will result in more positive and more comfortable consequent feelings. a. Rational belief (rB) for a current irrational belief (iB). b. Irrational belief (iB) for a rational belief (rB). c. Maladaptive thought for a irrational belief (iB). d. Rational belief (rB) for a maladaptive thought. e. None of the above.

a. Rational belief (rB) for a current irrational belief (iB).

4. Ellis identified five bedrock components of this theory. Which of the following is NOT one of these five bedrock components? a. Therapists should follow their clients' lead in identifying irrational thoughts. b. People dogmatically adhere to irrational thoughts and ideas. c. Irrational ideas cause people distress and misery. d. These ideas can be boiled down to a few basic categories. e. Therapists can teach clients how to give up their misery-causing irrational beliefs.

a. Therapists should follow their clients' lead in identifying irrational thoughts.

19. The stimulus-organism-response theory postulates that: a. There is a conscious thought between an external event and a particular emotional response. b. Behavior is a function of its consequences. c. Thought has no influence on response. d. All of the above. e. Both a and b are true.

a. There is a conscious thought between an external event and a particular emotional response.

26. The goal of collaborative empiricism is: a. To help clients discover inaccurate or maladaptive thoughts. b. To establish ground rules for CBT. c. To help the client discover what his or her dreams mean. d. To help the client analyze his or her emotional state. e. To use standardized assessment procedures to track treatment outcomes/

a. To help clients discover inaccurate or maladaptive thoughts.

14. Observational learning can also be referred to as: a. Vicarious learning. b. Modeling. c. Rational learning. d. None of the above. e. Both a and b.

a. Vicarious learning.

Extinction

after repeated presentation of conditioned stimulus in absence of the unconditioned stimulus leads to eventual disappearance of the conditioned response

social systems

all receive input from the environment, engage in processes, and generate outputs; each serves a function; the family, for instance socializes and and cares for its members- an essential process for family system is communication

Classical Conditioning

associative learning; Conditioned response is elicited by a learned stimulus

33. After the first session, Margarita's therapist suggests that she write down whatever thoughts come into her mind when she is feeling a strong emotion. This is an example of which technique? a. Thinking in shades of gray. b. Cognitive self-monitoring using a thought record. c. Emotional resistance. d. It could be any of the above. e. None of the above.

b. Cognitive self-monitoring using a thought record.

25. In Socratic questioning, the therapist asks questions that help clients focus on: a. Rational thoughts. b. Idiosyncratic and maladaptive thoughts. c. Maladaptive behaviors. d. Psychopathology. e. Both b and c.

b. Idiosyncratic and maladaptive thoughts.

12. Which statement is true about self-efficacy? a. It is the same as self-esteem. b. It is more specific than self-esteem in that it focuses on an individual's belief or confidence in performing specific skills. c. Along with collaborative empiricism, it's one of Aaron Beck's most important cognitive concepts. d. It has very little influence on client behavior and therefore is mostly irrelevant to counseling. e. Lower self-efficacy is associated with positive self-talk.

b. It is more specific than self-esteem in that it focuses on an individual's belief or confidence in performing specific skills.

1. How would you characterize the relationship that existed between behavior therapists and cognitive therapists in the 1970s? a. After initial tension between the cognitive and behavioral types, they quickly formed an alliance. b. Many behaviorists were unhappy with the idea of considering cognition as a focus of therapy. c. The cognitive types (introspectionists) preceded the behaviorists and resisted their unification. d. Behaviorists welcomed cognitive therapists into their professional organizations. e. Cognitive therapists saw themselves as different and therefore distanced themselves from behavior therapists.

b. Many behaviorists were unhappy with the idea of considering cognition as a focus of therapy.

30. What was the original name of Donald Meichenbaum's therapeutic approach? a. Rational psychotherapy. b. Self-instructional therapy. c. Cognitive therapy. d. Rational Emotive Behavior Therapy. e. Rational Emotive Therapy.

b. Self-instructional therapy. .

6. Which early approach to psychotherapy is seen as a predecessor of modern rational or cognitive approaches to therapy? a. S. Freud's psychoanalytic approach. b. A. Freud's ego psychology. c. Adler's individual psychology. d. Rogers's nondirective counseling. e. B. F. Skinner's applied behavior analysis.

c. Adler's individual psychology.

34. In CBT, the general purpose of a case formulation is to: a. Help practitioners identify their own cognitive distortions and how those distortions might adversely affect treatment outcomes. b. Identify a single maladaptive or irrational core belief so that you, the therapist, can work to eliminate that belief. c. Help practitioners develop a treatment plan that comprehensively addresses individual client issues. d. Identify underlying psychodynamics that are contributing to maladaptive client behavior patterns. e. Provide a medical diagnosis that assures the practitioner that there will be insurance reimbursement potential.

c. Help practitioners develop a treatment plan that comprehensively addresses individual client issues.

21. At its core, Rational Emotive Behavior Therapy (REBT) involves: a. Mostly listening and reflection. b. Analysis of rational emotions versus irrational emotions. c. Identifying irrational ideas and disputing them. d. Dream analysis. e. Self-talk designed to facilitate a positive coping response.

c. Identifying irrational ideas and disputing them.

13. Factor(s) that can improve self-efficacy is/are: a. Incentives. b. Positive feedback. c. Knowledge and skills. d. Successful performance accomplishment. e. All of the above.

c. Knowledge and skills.

40. Albert Ellis thinks that the therapeutic relationship is: a. The responsibility of the client. b. The responsibility of B. F. Skinner. c. Minimally important to therapeutic success. d. Moderately important to therapeutic success. e. Extremely important to therapeutic success.

c. Minimally important to therapeutic success.

38. Identify the cognitive distortion based on the following scenario: Susie sees Alice in the hallway at school and says hello. Alice doesn't reply, or even look up for that matter. Susie believes that she must have done something to cause Alice to be angry with her. a. Mind reading. b. Overgeneralization. c. Personalization. d. Dichotomous or polarized thinking. e. Labeling and mislabeling.

c. Personalization.

8. Which phrase best describes Donald Meichenbaum's therapy approach? a. Collaborative empirical analysis of ongoing cognitions. b. Rational argument to overcome irrational thought. c. Self-talk to guide adaptive behaviors. d. Reciprocal feedback from the environment, analyzed cognitively. e. None of these is a good description.

c. Self-talk to guide adaptive behaviors.

39. Which of the following is the best description of the technique of thinking in shades of gray? a. An art therapy technique emphasizing the transfer of emotional material to calmer, shades of gray. b. A self-instructional technique designed to help clients cope by encouraging them to think about what is happening, rather than responding emotionally. c. Taking a client's automatic thoughts, assumptions, or conclusions about a specific performance and placing them on a concrete, measurable scale. d. Countering the client's selective abstraction with concrete abstraction. e. None of the above.

c. Taking a client's automatic thoughts, assumptions, or conclusions about a specific performance and placing them on a concrete, measurable scale.

22. In Ellis's A-B-C model the "A" refers to: a. The actual behavior and actual emotion derived from the individual's belief. b. The activating physiological trigger. c. The activating event. d. The individuals' activities linked to their beliefs. e. The attenuation of individual behavior, emotion, and cognition.

c. The activating event.

36. The purpose of vertical descent (used in CBT) is to: a. Hypnotize the client. b. Develop trust in the therapeutic relationship. c. Uncover underlying core beliefs. d. Develop a problem list. e. Both b and d.

c. Uncover underlying core beliefs.

thermostat

classic example of system feedback and response; input and output; input is sensors reading room temp and output is furnace adjusting this; room temp read in a continual feedback loop that regulates it

metacommunication

communication about communication

Ecological environment

concept part of systems credited Uri Bronfenbrenner; didn't like Von Bertalanffy's systems model because of the single dimension cause and effect relationship between social units in the environment; He didn't think it fully explained complex dynameic that occur within social systems; he called these additional environmental factors in human social systems the

Describe collaboration in motivational interviewing

conversation to strengthen a person's motivation and commitment to change

17. The essence of cognitive theory can be summarized in one sentence that Ellis attributed to Epictetus: a. "People are disturbed by things that cannot be understood." b. "People are disturbed by things, not by what they think." c. "People are disturbed by emotions caused by response." d. "People are disturbed not by things, but by the view which they take of them." e. "People naturally find negative emotions disturbing, and it will cause them to think and behave irrationally."

d. "People are disturbed not by things, but by the view which they take of them."

23. The ABCs in REBT are: a. Antecedent, behavior, consequence of behavior. b. Antecedent, belief, consequence of behavior. c. Activating event, behavior, consequent feeling. d. Activating event, belief, consequent feeling. e. Actual thought, behavior, cognition.

d. Activating event, belief, consequent feeling.

32. What's helpful about the CBT process of generating a problem list? a. It gives therapists a chance to show interest in and compassion for client problems. b. As clients describe their problems, cognitive and behavioral antecedents and consequences are identified and initial hypotheses are generated. c. As therapists utilize Socratic questioning to explore problems, clients become oriented to the CBT process. d. All of the above are true. e. Only a and c are true.

d. All of the above are true.

28. Beck's cognitive triad includes which of the following? a. Negative evaluation of self. b. Negative evaluation of the world or specific events. c. Negative evaluation of the future. d. All of the above. e. Only a and c.

d. All of the above.

37. Suppose a client has this automatic thought about his therapist: "This is the best therapist I've ever known. He's incredible. He's so insightful." What type of cognitive distortion would Beck most likely consider this to be? a. Mind reading. b. Overgeneralization. c. Personalization. d. Dichotomous or polarized thinking. e. Labeling and mislabeling.

d. Dichotomous or polarized thinking.

20. Albert Ellis's Rational Emotive Behavior Therapy (REBT) labels clients' thoughts that cause distress and misery as: a. Crazy-making. b. Rational thinking. c. Trigger thoughts. d. Irrational thoughts. e. Maladaptive thoughts.

d. Irrational thoughts.

3. What are the three original and primary forms of cognitive therapy or cognitive-behavioral therapy (CBT) described in the textbook? a. Self-instructional training, problem-solving therapy, behavioral activation. b. Stress inoculation training, cognitive therapy, narrative therapy. c. Reality therapy, logotherapy, interpersonal psychotherapy. d. Rational Emotive Therapy, cognitive therapy, self-instructional training. e. Transactional analysis, schema therapy, cognitive therapy.

d. Rational Emotive Therapy, cognitive therapy, self-instructional training.

11. One of Albert Bandura's most important social learning theory concepts is: a. Anger management. b. Reflective listening. c. Unconditional positive regard. d. Self-efficacy. e. Reciprocal determinism.

d. Self-efficacy.

16. Chelsea comes to therapy to stop her compulsive hair-pulling. However, she has very little confidence in her ability to do so. Which statement is true about Chelsea? a. She is highly likely to be successful in her effort to stop her hair-pulling behavior. b. She suffers from low self-esteem. c. She has low self-instructional focus. d. She has low self-efficacy in terms of her ability to stop pulling her hair. e. She is unlikely to work well with a therapist who uses collaborative empiricism.

d. She has low self-efficacy in terms of her ability to stop pulling her hair.

2. What factors did Judith Beck identify as her reasons for specializing in cognitive therapy? a. She identified her core schema as linked to her father's cognitive therapy teachings. b. She noted that she has never developed the skills to make her competent to practice using any other approach. c. She's uncomfortable using any approach that her father didn't invent. d. She views it as the most humane, effective, and quickest way to alleviate suffering. e. Judith Beck doesn't use cognitive therapy.

d. She views it as the most humane, effective, and quickest way to alleviate suffering.

15. According to observational learning theory, which scenario would likely occur when Jane sees her older brother in pain after placing his hand on a hot stove? a. She would make fun of him. b. She would place her hand on the hot stove. c. She would encourage him to do it again. d. She would refrain from putting her hand on a hot stove. e. She would be completely unaffected by this event because she needs to directly experience positive reinforcement or punishment to have it cause any changes in her behavior.

d. She would refrain from putting her hand on a hot stove.

congruence

degree to which message and message about messag agree with eachother; incongruence causes anxiety and confusion

Overgeneralization

drawing a sweeping conclusions from a single incident and applying it to related and to unrelated situations

42. Rosen and Davison (2003) published an article advocating a shift away from: a. CBT. b. Gestalt therapy. c. Randomized controlled trials as the gold standard of treatment outcomes. d. Pharmacological interventions for psychiatric disorders. e. Empirically supported treatment lists, and instead work toward treatment principles.

e. Empirically supported treatment lists, and instead work toward treatment principles.

5. What was the original name of Albert Ellis's therapeutic approach? a. Self-instructional therapy. b. Cognitive therapy. c. Rational Emotive Behavior Therapy. d. Rational Emotive Therapy. e. None of the above.

e. None of the above.

Like behavior therapy, CBT is based on learning theories. However, CBT goes beyond classical and operant conditioning and includes: a. Social learning theory. b. Choice theory. c. Cognitive appraisal theory. d. Only a and b. e. Only a and c.

e. Only a and c.

35. When the therapist provides information to clients about the nature of their problems, this is called: a. Psychobabble. b. Psychoneurology. c. Psychodynamics. d. Psychopharmacology. e. Psychoeducation.

e. Psychoeducation.

Preconscious

easily accessible memories not presently in one's awareness

Magnification/ minimization

exaggerating the negative and minimizing the positive (blowing things out of proportion or shrinking their importance)

feedback

exchange of info between system and environment is regulated by this process; method of evaluation used to determine whether the system's outputs are consonant with the perceived outcomes or goals that the system has established for itself

narrative- Externalizing problem purpose

for people to see the problem as not personal but as a common enemy, Dad is seen as someone who is not depressed, but Depression convinces Dad to stay home.

human relatedness, competence, self-direction, and self-esteem

four attributes that exist in all cultures regardless of how the particular culture defines them; they undersocore our need to understand the cultural values that contribute to the makeup of each client system

outcomes

goals that the system has established for itself

Imperatives (should or must statements)

having an over- precise idea of how you and others should behave, and overestimating the consequences of how bad it would be not to meet these expectations

cybernetics

interdisciplinary approach that grew in part from structural functionalism and interest in understanding how systems create and use processes to regulate themselves

mezzosystem

intermediate size system; groups, support networks, and extended families

Positive Punishment

introduction of an aversive stimulus reduces the likelihood of a behavior reoccurring

Positive Reinforcement

introduction of stimulus results in increased behavior

Problem saturated stories

it is the problem in narrative therapy, their stories affect how they see themselves and the world

macrosystems

large systems; communities and organizations

CBT

leading evidence-based methodology for several reasons: it lends itself to research, is applicable to a number of problems and disorders, and has been used for long enough to build a broad base of research. Numbers of those using CBT may exceed adherants to several other approaches

open systems

living organisms form; they exchange matter with environment

Mind-reading

making (negative) assumptions about the way in which others think about you when there is no evidence for this

Repression

most basic defense mechanism upon which all other defense mechanisms are based. It allows us to avoid knowing or distracts us from something.

constitional self

narrative -plastic and continuously deconstructed and constructed through interactions

Dominant Cultural Discourses

narrative therapy - sociocultural norms that can become internalized and have a controlling effect on ones story of oneself. These norms are personified such as expectations for men, african americans, women

Dominant Story

narrative therapy- Person holds a dominant narrative that shape his behavior and identity

example of unique outcome in quesiton

narrative- can you remember a time when Depression did not take over your life?

Theraputic certificates

narrative- clients create them, announces their victory over the problem which they show to others and review when they feel the effect of the problem reasserting itself.

Unstoried competencies

narrative- competenticies the client possesses that are not part of his dominant story and therefore are not expressed until the dominant story is reconstructed

Unique outcomes or sparkling events

narrative- events that exemplify clients preffered outcome rather than his problem saturated stories instances when client does not experience the problem for which he seeks therapy these are highlighted in therapy to counteract problem saturated stories

Landscape of action questions

narrative- gather info about times in their life the person was able to resist the externalized problem and its effect on their lives. This gives us the unique outcome or sparkling event

example of landscape of action question

narrative- give me an example when anxiety did not tell you that you should not kiss your wife?

leagues

narrative- groups of people who are overcoming the same problem

Landscape of meaning question

narrative- questions to help clients consider to new or more heroic self view

theraputic letters

narrative- therapist documents clients competencies with respect to overcoming the problem and acknowleding the sparkling events

example of landscape of meaning question

narrative- what do you think it says to about you to not get in your Pattern and you engage with your wife?

Mapping relative influence

narrative-asking about the effect of the problem on relationships and the effect of the relationships on the problem.

Theraputic stance

narrative-neither direct nor inderect

life stress

normal tension; Germain says encompasses both the external and internal or conscious and unconscious experience of stress, both emotional and physiological elements. What is perceived stressful varies across age, gender, culture, physical, and emotional states, past experience, and the perceived and actual nature of the environment. TWO PEOPLE MAY HAVE DIFFERENT REACTIONS TO THE EXACT SAME ENVIRONMENTAL EXPERIENCES

ecomap

one of the three systems tools; this one identifies clients current social context by using circle to rep different factors affecting the client and by id'ing other systems that have an interface with the client system; one of a family can id exosystem. Each org. is depicted by a circle, client ids nature and flow of energy direction between orgs and self; gives client better understanding of his or her situation and ultimately reveal strategies for dilemma resolving

genogram

one of the three systems tools; this one provides a historical overview of a family that is similar to a family tree; useful for obtaining a sense of the clients historical milieu by describing as many familial relationships as the client likes. Client involvement in identification and characterization of their family is a great advantage to assessment. HIstorical patterns an emerge that better equip client to develop strategies for behavior change

social network map

one of three systems tools; used along with social network grid to id and engage client in defining their social supports. consists of cocentric rings with client in center; client asked to id supports and place them on map while quantifying the amount of support recieved through closer placement to self; social supports important for well-being, emotional integration, social integration, opportunity for nurturance, reassurance of worth, and assistance

negative entropy

or negentropy; opposite of entropy; system is importing more than exporting; STATE of system growth and healthy; steady state achieved through this process of ordering and growth

systems

organization theory that looks at interactions between systems

system

organized whole made of components that interact in a way distinct fromthe interacton with other entities and which endures over some period of time

Biofeedback

person is given ongoing feedback about physiological information which serves as a reinforcer to help person control visceral changes when paired with relaxation techniques. Effective in hypertension, headaches, chronic pain, fecal incontinence, and temporomandibular joint pain.

Carol Germain

person responsible for adapting two theoretical models, systems and ecological to social work through biopsychosocial development of ind. and families witin cultural, historical, communal, and societal contexts- perspective that requires us to look as well at all events in a person's life. She says the nature of relationships between systems is not linear but circular, each system affecting the other through reciprocal interaction over tithisme

Systematic Desensitization

phobias developed through classical conditioning can be unlearned by exposure to fear-provoking stimulus while pairing it with a relaxing stimulus to induce a relaxation response.

Catastrophizing

predicting the future negatively without considering alternative outcomes

Personalization

relating external events to yourself when there is no basis for making such a connection

Negative Reinforcement

removal of an aversive stimulus results in and increase in a behavior

Habituation

repeated stimulation results in decreased response

Sensitization

repeated stimulation results in increased response

Id

represents raw, uncontrolled sexual and aggressive drives. Works according to the pleasure principle

Super-Ego

represents the internalized values of civilization as expressed by our parents' "No!" Also known as one's conscience

Ego

represents the mediator of the Id, Super-Ego and Reality. Functions on the reality principle through defense mechanisms to minimize anxiety and maintain psychic equilibrium

Unconscious

repressed thoughts and feelings outside of awareness. Marked by primary process thinking (primitive, wish fulfillment, pleasure seeking, non-rational, no concept of time)

tangible

resources are things like food and money that contribute to physical maintenance of system

intangible

resources are things like information; knowledge or energy that passes through given system's boundary determines its permeability, or growth factor

equilibrium

sense of being in balance;

microsystem

small size social systems; individuals and couples

homeostasis

state of variable balance where the limits to maintaining balance are more flexible

boundary

system term that defines what makes that particular system unique; can be partially defined by norms and customs; some are clearly defined; some are not; For instance if person is the system; this is their shell, skin, or physical being

energy, boundary

systems grow through exchange of _______between system and its environment- only possible if _________, or defining factor possesses permeability

organizing

systems is not a theory but a method of _____________ info that the worker can use with other theories. I.e. pscyhoanalytic, CBT,

goal attainment

systems term that describes when a system determines and prioritizes its goals, then obtains and mobilizes resources in directed actioni to achieve them

closed system

systems that are isolated from their environment; example: ethnic minority community that has limited access to the majority cultural institutions due to active discrimination against its members

Discounting the positive

telling yourself that positive experiences/ qualities do not count

steady state

term Von Bertanffy used to describe a system that is working properly; form of dynamic equilibrium achieved through process of ordering and growth

adaptation

term in system which describes the dynamic process of which a given system responds to the demands of and pressures of external forces and conditions; way in which a system is able to bring in resources from outside environment, and involves reciprocal interactions and exchanges between the system and environment which results in both being changed

latency

term in systems that describes a pattern maintenance or system state in which the system is invested in maintaining and transmitting its norms and values

integration

term in systems that describes the coordination and orchestration of the systems internal components

double-bind

term in systems when an individual is placed in a no-win situation through contradictory instructions or expectations; told to kiss mom, but mom demos rejecting behaviors

systems

terms in this theory are open and closed systems, entropy, boundary, homeostasis, inputs, outputs, and feedback

permeable

the more ___________the boundary, the greater the extent of interaction the system has with its environment leads to greater openness

Operant Conditioning

trial-and-error learning; involves positive and negative reinforcement

psychoanalitic and behaviorism

two schools of thought that can be discerned in the various CBT methods

Token economy

use of tokens to increase positive behaviors. Useful with children or people who are psychotic, autistic, or intellectually disabled

All or nothing thinking

viewing a situation in only two categories rather than on a continuum (e.g. oversimplifying events or beliefs as good/ bad or as right/wrong)

Ecological environment, biopsychosocial, systems

when concept of _____________ _____________ is introduced into the formula of human dvlpment, result is complex matrix for defining behavior that includes "here and now" AND historical, cultural, factors with family, and bio concerns, hence the _____________________ nature of ecological systems. _____________ , as an organizational method can begin to introduce order to the complexity by lending it conceptual clarity

entropy

when systems are exporting more than importing; system closes to protect itself, but systems depend on openness to function and survive; too much of this is causes a state of disorder that is called

narrative- Allows clients a voice in the process of their treatmentn

yes

Narrative therapy is very aware of political and cultural narratives?

yes,

Narrative therapy is based on the post-modern constructionist belief on reality?

yes, there is no absolute reality, reality is constantly being constructed

Do narrative therapist avoid diagnosis and labels?

yes, they view the problems that people bring to therapy within larger social and political context