LISW Exam
Stacked or complex question
A question that contains multiple parts and may confuse or be unclear to a client, or make the client uncertain which part to answer first
Retroflection
Consists of turning back onto ourselves what we would like to do to someone else or doing to ourselves what we would like someone else to do to or for us.
Oral Stage (Erikson Psychosocial Stage)
First Stage. Critical to the child's development of trust versus mistrust
Supervisors
Have only interdepartmental authority and invariably have an assignment of discrete scope and authority
Psychodynamic Therapists (Psychodynamic Therapies)
Neoanalysts or neo-Freudians (neo meaning after or new)
Evidence-Based Family Therapies (Systems)
New generation of empirically tested family therapies: -Functional family therapy -Multidimensional family therapy -Multisystemic therapy
Theory of Personality
Freud-He viewed personality from six different perspectives: Topographic, dynamic, genetic, economic, structural, and adaptive.
Psychosexual Stages
Freudian chronological phases of development, beginning in infancy. Oral, Anal, Phallic
Gestalt Therapy
Fritz Perls. Works to assist people to become deeply aware of themselves and their bodies.
Field theory
Gestalt Therapy is based on, which, simply put, asserts that the organism must be seen in its environment, or in its context, as a part of the consulate changing field.
Emotion Regulation
Includes identifying emotions, identifying obstacles to changing emotions, reducing vulnerability, and increasing positive emotions.
Life-style
Includes the connecting themes and rules of interaction that give meaning to our actions. Lifestyle is often described as our perceptions regarding self, others, and the world.
Ratio Measures Cont.
Income; Number of Children, Number of Sessions, etc. On a ratio scale, 10 is two points higher than 8 and is also two times greater than 5. Ratio numbers can be added and subtracted, and because the numbers begin at an absolute zero point, they can also be multiplied and divided (so ratios can be formed between the numbers).
Stereotyping
Incorrect when addressing an entire group of people-especially when applied to a whole group of people, stereotyping is often incorrect. Such blanket stereotyping is often subconscious, influencing one's choice even when one is unaware of doing it.
Reinforcement
Increasing or strengthening of a behavior
Independent Variable
Independent (predictor - X) variable - belief that this variable may produce some variation of the dependent variable. Social work intervention
Operationalization Concepts
Indicators: a single question is used to measure a concept (i.e.: What is your total income?) Item: a single indicator of a variable Scales and Indexes: the sum or average of several questions is used to measure the same concept (i.e.: The Beck Depression scale) Improved Validity Improved Reliability Increased Level of Measurement
The remedial model of group therapy focuses on
Individual change. The group acts as a means of change to assist individual goals
Hallmarks of EBP
Individualized assessment (strengths, needs, values, preferences of client) Well-formulated question (database query) Well-executed search of research literature Deciding its applicability to clients Considering the evidence together with the values and preferences of the client.
The stages of change: Action Stage (4)
Individuals are taking step to modify their behaviors to solve their problems
Fictional Finalism (Psychodynamic Therapies)
Individuals create their own fictional goals for living and act as if their personal goals are the final purpose for life. Fictional finalist reflects the fact that psychological events are determined not so much by historical circumstances as by present expectations of how one's future life can be completed.
The stages of change: Preparation Stage (3)
Individuals intend to take action immediately and report some small behavioral changes
Inductive Logic
Inductive Method Theories are developed from the analysis of research data (observation) (qualitative).
Erikson: School Age (age 6-12 years)
Industry versus inferiority. Child needs to expand understating of world, continue to develop appropriate gender-role identity, and learn the basic skills required for school success. Basic tasks is to achieve an sense of industry, which refers to setting and attaining personal goals. Failure to do so results in a sense of inadequacy.
Potential Advantages of Standardized Scales
Information about reliability and validity Structured, so information less likely to be missed Often efficient, simple to use, inexpensive, readily available, and take little time to administer, score, and interpret
12 assumptions important for testing and assessment: Various sources of data enrich and are part of the assessment process.
Information from several sources usually should be obtained in order to make an accurate and informed decision. For example, the idea of portfolio assessment is useful.
Archetypes (Psychodynamic Therapies)
Inherited predispositions or models on which similar things are patterned. Developed by Jung.
Phases of Existential Counseling
Initial Phase: Therapists assist clients in identifying and clarifying their assumptions about the world Middle Phase: Clients are assisted in more fully examining the sources and authority of their present value system Final phase: Focuses on helping people take what they are learning about themselves and put it into action. Transformation is not limited to what takes place during the therapy hour.
Practicalities of Narrative Therapy (Constructivist)
Initially introduced in family therapy. Used in therapy for children, adults, couples, families, and communities. Length can be considerable. 50-minute sessions. No rigid boundaries.
Friedrich Nietzsche
Like Kierkegaard, he emphasized the importance of subjectivity. Set out to prove that the ancient definition of humans as rational was entirely misleading.
3 Multicultural Pioneers
Lillian Comas-Diaz, Stanley Sue, Beverly Greene
Sampling frame
List of all elements in the population
Introjection (Psychodynamic)
Literal incorporation of objects into the mind.
Effectiveness of Adlerian Therapy
Little controlled empirical research. Four studies on Adlerian therapy. Results slightly better then placebo. Found as effective as client-centered therapy and psychoanalytic therapy.
Practicalities of Existential Therapy
Little written on particulars (e.g., schedules, fees, formats, training). Flexible length decided by patient (from one 50- minute session/week to extended hours). No formalized criteria for becoming an existential therapist. Therapist gives honest and authentic opinion. Major alternatives are easier to conduct as briefer therapy.
Locus of Change
Locus of change is between people, not inside patient's mind.
IPT is not
Long-term Open-ended About past relationships Intrapsychic Cognitive/behavioral Achieving insight Identifying defenses Curing the problem
Sociopolitical Forces in Gender-Sensitive Therapies
Modern psychotherapy created by White men in their own image and according to their own values. Rise of feminism (commitment to equal social, economic, and political rights for men and women) in the 60s and 70s. Gilligan's In A Different Voice illuminated sexist bias in psychology research and practice. Women denied equal rights and an equal voice in mental health care. No single person responsible for feminist treatment; a collaborative effort.
Therapeutic Processes: IPT
Short-term, present-oriented therapy. Therapist should not address additional problems, but remain focused on primary problem. No ideological hesitation to use medication.
Disorder of thought
Schizophrenia
Life instincts
Serve the purpose of the survival of the individual and the human race; they are oriented toward growth, development, and creativity.
Non-Probability Sampling: Quota sampling
Set a quota for # elements to choose from sub-populations with certain characteristics Similar to stratified random sampling, except sample isn't chosen randomly from each sub-population Same problem as with matching in research design: not feasible to use more than a couple of characteristics for quotas
Types of Patterns
Several pattern types may emerge during the baseline period such as a: Stable line: a line that is relatively flat with little variability; Trend: an ascending or descending line; Cycle: depicts a problem that is cyclical in nature.
Primary risk factor for PTSD
Severity of exposure. Other factors to consider with PTSD are psychiatric symptoms, child abuse and previous multiple events, to name a few. While some factors are known, not as much is known about what affects the course of PTSD over time. However, a good social support system can be a positive factor in how a client deals with PTSD.
Libido
Sexual energy
Adler Birth Order: The Only Child
Shares some characteristics of the oldest child. May not learn to share or cooperated with other children. Will learn to deal with adults well. Is often pampered by parents and may become dependently tied to them.
Adolescent Stage (Erikson Psychosocial Stage)
Third Stage. Brings the Massive challenge of developing ego identity versus ego diffusion. Young adults are to use their maturing ego processes if they are going to move toward intimacy rather than laps into isolation.
Bargaining
Third stage of grief. Characterized by "if only" and "what if" questions
Ordinal Example
What is the level of measurement for the variable, "political ideology", measured as "Very Conservative", "Conservative", "Moderate", "Liberal" and "Very Liberal"?
Conceptualization in Practice Example
What observations or images should we associate with the concept "substance abuse"? -slurred speech? -An AA Group? -College students drinking at a party
Experimental (Evaluative) Research
What services help the homeless? What information do you need to know the answer to that questions
Basic Questions of Cognitive Restructuring
What's the evidence? What's another way of looking at it? So what if it happens?
Encouragement
entails showing faith in people, expecting them to assume responsibility for their lives and valuing them for who they are
Assertion Training
People have the right (but not the obligation) to express themselves.
Theory of Personality: Ideal self (Psychodynamic Therapies)
Represents the perfect person we might strive to become.
In Vivo Flooding
Consists of intense and prolonged exposure to the actual anxiety-producing stimuli.
Albert Ellis
"Grandfather of CBT"
3 Cs of Behavior Therapy
1. Counterconditioning 2. Contingency management 3. Cognitive-behavior modification
Reality Therapy (Existential)
Emphasizes a lack of responsibility as the central concern.
Questions Social Science Research Can Answer
Exploratory Descriptive Explanatory Experimental
Creator of Person Centered Therapy
Carl Rogers
Phobias are best treated by
CBT
Antecedent Events
Cue or elicit a certain behavior
Interpersonal Conflicts
Intimacy and sexuality, Communication, Hostility, Control of others
Delusional Disorder
Involves non-bizarre delusions
Isolation (or fundamental aloneness)
Is another condition of life that brings anxiety.
Mixed Methods
Mixed methods is using both qualitative and quantitative methods in the same study
Analysand
Patient
Reinforcement
Strengthens a behavior
Expenses
The costs incurred for organizational operations
Theories of personality and psychopathology
tell us what needs to be changed
Denial
"Closing one's eyes" to the existence of a threatening aspect of reality Denial of reality is perhaps the simplest of all self-defense mechanisms. It is a way of distorting what the individual thinks, feels, or perceives in a traumatic situation. This mechanism is similar to repression, yet it generally operates at the preconscious and conscious levels.
Holding Environment
"Good enough" mothering. Such an environment makes the child feel taken care of, protected, understood and loved.
Threats to Internal Validity Example
"Ice Cream Sundae Therapy (IV) decreases anxiety levels (DV) for at-risk 4th Graders 1. History - ICST is for only 1 hour per week, what if all the 4th graders in the therapy also had really conflicted and dysfunctional families that they lived with? 2. Maturation - Makes a difference if ICST is for 2 weeks or two years. 3. Testing Effects - ICST measures are collected every three weeks. 4. Instrumentation - does not change over time. 5. Dropout - do you think some might stop coming? 6. SRTM - might have extreme measurement scores. 7. Selection - biased? 8. Diffusion/Initiation - practitioners communicate in the school?
Research Questions/Hypotheses Examples
"Juvenile offenders are more likely to come from poor families " (hypothesis) "What is it like to be homeless?" (question) "There is a difference in mental health diagnosis for adolescent males and females" (hypothesis)
There are four primary ways to measure reliability
(1) The first type of reliability is called test-retest reliability. -This refers to the consistency of test scores over time. -It is measured by correlating the test scores obtained at one point in time with the test scores obtained at a later point in time for a group of people. -A primary issue is identifying the appropriate time interval between the two testing occasions. -The longer the time interval between the two testing occasions, the lower the reliability coefficient tends to be.
There are four primary ways to measure reliability
(2) The second type of reliability is called equivalent forms reliability. -This refers to the consistency of test scores obtained on two equivalent forms of a test designed to measure the same thing. -It is measured by correlating the scores obtained by giving two forms of the same test to a group of people. -The success of this method hinges on the equivalence of the two forms of the test.
There are four primary ways to measure reliability
(3) The third type of reliability is called internal consistency reliability. -It refers to the consistency with which the items on a test measure a single construct. -Internal consistency reliability only requires one administration of the test, which makes it a very convenient form of reliability. -One type of internal consistency reliability is split-half reliability, which involves splitting a test into two equivalent halves and checking the consistency of the scores obtained from the two halves. -The measure of internal consistency that we emphasize in the chapter is coefficient alpha. (It is also sometimes called Cronbach's alpha.) The beauty of coefficient alpha is that it is readily provided by statistical analysis packages and it can be used when test items are quantitative and when they are dichotomous (as in right or wrong). -Researchers use coefficient alpha when they want an estimate of the reliability of a homogeneous test (i.e., a test that measures only one construct or trait) or an estimate of the reliability of each dimension on a multidimensional test. You will see it commonly reported in empirical research articles. -Coefficient alpha will be high (e.g., greater than .70) when the items on a test are correlated with one another. But note that the number of items also affects the strength of coefficient alpha (i.e., the more items you have on a test, the higher coefficient alpha will be). This latter point is important because it shows that it is possible to get a large alpha coefficient even when the items are not very homogeneous or internally consistent.
There are four primary ways to measure reliability
(4) The fourth and last major type of reliability is called inter-scorer reliability. -Inter-Scorer Reliability refers to the consistency or degree of agreement between two or more scorers, judges, or raters. -You could have two judges rate one set of papers. Then you would just correlate their two sets of ratings to obtain the inter-scorer reliability coefficient, showing the consistency of the two judges' ratings.
Exploratory Research Example
* "One shot case study"; "After only"; "One Group Post Test Only" * No correlation studied * No control for internal validity There is a total absence of control in this type of study. We don't know what the students were like before they entered the MSW or BSW program. We don't know if graduating MSW or BSW students were just as educated about social work when they entered the program as they were when they graduated from the program. Additionally, we have nothing to compare this group of persons to. We don't know how different this group of MSWs' & BSWs' scores would be compared to a comparable group of persons who did not enter the MSW or BSW program.
Beneficence
- Do not harm - Maximize benefits while minimizing harms
Threats to External Validity: Reactive or Interaction effect
- possibility that pre-testing alters the subjects' reaction to the experimental variable. In other words, a pretest might increase or decrease the respondent's sensitivity or responsiveness to the experimental variable and thus make the results obtained for a pre-tested population unrepresentative of the effects of the experimental variable for the universe (not pre-tested) from which the experimental respondents were selected. The pretest can actually act as a stimulus to change whatever is being measured. For example, if you're studying weight, and the first time you weigh me, I am decidedly overweight, I may freak out and try to lose weight before you weigh me the second time. This could occur even without your therapy (the intervention) for weight control. Similarly, when a researcher sits in a classroom and observes the discipline the teacher uses with her students, the teacher's use of discipline may change because there is an observer in the room.
Effectiveness of Systemic Therapies
-20+ meta-analyses show couple and family therapies are effective; average ES = .65 -Positive effects remain but taper over time. -No difference in effectiveness among different systemic therapies. -No consistent outcome differences between individual and family therapy; "for now, a tie."
Description of conditions in SSD
-A clear, detailed description of the conditions of measurement (location, time of day, observer training), the dependent variable ( have a clear operational definition) and the nature of the treatment (clear description of treatment) is needed to strengthen internal and external validity.
12 assumptions important for testing and assessment: Psychological traits and states exist.
-A trait is a relatively enduring (i.e., long lasting) characteristic on which people differ; a state is a less enduring or more transient characteristic on which people differ. -Traits and states are actually social constructions, but they are real in the sense that they are useful for classifying and organizing the world, they can be used to understand and predict behavior, and they refer to something in the world that we can measure.
Relevant validity evidence based on relations to other variables.
-Convergent evidence—validity evidence based on the relationship between the focal test scores and independent measures of the same construct. The idea is that you want your test (that your are trying to validate) to strongly correlate with other measures of the same thing. -Discriminant evidence—evidence that the scores on your focal test are not highly related to the scores from other tests that are designed to measure theoretically different constructs. This kind of evidence shows that your test is not a measure of those other things (i.e., other constructs).
Sampling error
-Differences between characteristics of population and sample -More sampling error = less representative sample = low generalizability
Probability Sample
-Every element has an equal chance of being chosen for the sample -Chosen using random sampling
Hierarchy of design categories and design subtypes
-Experimental (evaluative) Classic Experimental Design Posttest-only Control Group Design Solomon Four-Group Design -Explanatory (often uses the designs above) -Descriptive ("quasi-experimental") One Group pre/post-test Design Static Group Comparison Design Time Series Design -Exploratory ("non-experimental") Case Study ("one shot"; "after only"; "one group") Cross-Sectional Survey Design Longitudinal Case Study Design (trend; panel; cohort)
12 assumptions important for testing and assessment: Various approaches to measuring aspects of the same thing can be useful.
-For example, different tests of intelligence tap into somewhat different aspects of the construct of intelligence.
12 assumptions important for testing and assessment: Psychological traits and states can be quantified and measured.
-For nominal scales, the number is used as a marker. For the other scales, the numbers become more and more quantitative as you move from ordinal scales (shows ranking only) to interval scales (shows amount, but lacks a true zero point) to ratio scales (shows amount or quantity as we usually understand this concept in mathematics or everyday use of the term). -Most traits and states measured in education are taken to be at the interval level of measurement.
12 assumptions important for testing and assessment: Tests and other measurement techniques have strengths and weaknesses.
-It is essential that users of tests understand this so that they can use them appropriately and intelligently. -In this chapter, we will be talking about the two major characteristics: reliability and validity.
12 assumptions important for testing and assessment: Assessment can provide answers to some of life's most momentous questions.
-It is important that the users of assessment tools know when these tools will provide answers to their questions.
12 assumptions important for testing and assessment: Testing and assessment benefit society.
-Many critical decisions are made on the basis of tests (e.g., teacher competency, employability, presence of a psychological disorder, degree of teacher satisfactions, degree of student satisfaction, etc.). -Without tests, the world would be much more unpredictable.
Assessment Measures
-Neurocognative Disorders • Clinician Rated Adult Measure • Parent Rated Child Measure • Clinician Rated Psychosis Measure • WHODAS 2.0 36 item
Non-probability sample
-No random sampling -Elements do not have equal chance of being chosen for the sample
12 assumptions important for testing and assessment: Present-day behavior sampling predicts future behavior.
-Perhaps the most important reason for giving tests is to predict future behavior. -Tests provide a sample of present-day behavior. However, this "sample" is used to predict future behavior. -For example, an employment test given by someone in a Personnel Office may be used as a predictor of future work behavior. -Another example: the Beck Depression Inventory is used to measure depression and, importantly, to predict test taker's future behavior (e.g., are they a risk to themselves?).
Relevant validity evidence based on relations to other variables.
-Putting the ideas of convergent and divergent evidence together, the point is that to show that a new test measures what it is supposed to measure, you want it to correlate with other measures of that construct (convergent evidence) but you also want it NOT to correlate strongly with measures of other things (divergent evidence). You want your test to overlap with similar tests and to diverge from tests of different things. In short, both convergent and divergent evidence are desirable. -Known groups evidence is also useful in demonstrating validity. This is evidence that groups that are known to differ on the construct do differ on the test in the hypothesized direction. For example, if you develop a test of gender roles, you would hypothesize that females will score higher on femininity and males will score higher on masculinity. Then you would test this hypothesis to see if you have evidence of validity.
Steven Hayes in Third Wave Therapies
1948-present Raised in California during the 1960s in heyday of hippie counterculture. Combined interest in Eastern philosophy with psychological science. Focused on one of cognitive therapy's components: cognitive distancing. Developed ACT in part from his own panic disorder.
12 assumptions important for testing and assessment: Test-related behavior predicts non-test-related behavior.
-The goal of testing usually is to predict behavior other than the exact behaviors required while the exam is being taken. -For example, paper-and-pencil achievement tests given to children are used to say something about their level of achievement. -Another paper-and-pencil test (also called a self-report test) that is popular in counseling is the MMPI (i.e., the Minnesota Multiphasic Personality Inventory). Clients' scores on this test are used as indicators of the presence or absence of various mental disorders. -The point here is that the actual mechanics of measurement (e.g., self-reports, behavioral performance, projective) can vary widely and still provide good measurement of educational, psychological, and other types of variables.
Treatment in SSD
-The treatment condition is a period of time during which the experimental manipulation is introduced and the DV continues to be observed and recorded. Both the baseline and treatment phases of the study need to be long enough to achieve stability in the DV.
The Basic Principles of Motivational Interviewing
-Therapists practicing MI strive to experience the world from the client's perspective without judgment or criticism -MI is designed to evoke and explore both discrepancies and ambivalence -Reluctance and change is viewed as a normal and expected part of the therapeutic process -Practitioners operating from an MI orientation support clients' self-efficacy, mainly by encouraging them to use their own resources to take necessary ac tons that can lead to success in changing. -When clients show signs of readiness to change through decreased resistance to change and increased talk about change, a critical phase of MI begins.
12 assumptions important for testing and assessment: Various sources of error are always part of the assessment process.
-There is no such thing as perfect measurement. All measurement has some error. -We defined error as the difference between a person's true score and that person's observed score. -The two main types of error are random error (e.g., error due to transient factors such as being sick or tired) and systematic error (e.g., error present every time the measurement instrument is used such as an essay exam being graded by an overly easy grader). (Later when we discuss reliability and validity, you might note that unreliability is due to random error and lack of validity is due to systematic error.)
12 assumptions important for testing and assessment: Testing and assessment can be conducted in a fair and unbiased manner
-This requires careful construction of test items and testing of the items on different types of people. -Test makers always have to be on the alert to make sure tests are fair and unbiased. -This assumption also requires that the test be administered to those types of people for whom it has been shown to operate properly.
Scales of Measurement: Interval Scale
-This scale or level of measurement has the characteristics of rank order and equal intervals (i.e., the distance between adjacent points is the same). It does not possess an absolute zero point. -Some examples are Celsius temperature, Fahrenheit temperature, IQ scores. -Here is the idea of the lack of a true zero point: zero degrees Celsius does not mean no temperature at all; in a Fahrenheit scale, it is equal to the freezing point or 32 degrees. Zero degrees in these scales does not mean zero or no temperature.
Baseline in SSD
-baseline refers to a period of time in which the target behavior (dependent variable) is observed and recorded as it occurs without a special or new intervention.
Repeated measurement in SSD
-used to see pattern of change in the DV over time (control for the normal variation that is expected within short time interval) -need to be sure that you are measuring the same way each time, have a clear operational definition (control for extraneous variables)
The Oral Stage (1)
0-18 months of ago. Characterized by a focus on the oral pleasure (sucking, eating, oral exploration of items, etc.)
AB Design
1 baseline and 1 treatment phase Ex. Kid having trouble working on school work (i.e. staying on task), the treatment is setting up a reinforcement contingency that gives him a dollar for every minute he stays on task Problems: Limited control over threats to internal validity No control for extraneous variables - that is changes in the DV could be caused by numerous things
Mahler's symbiotic stage of development occurs during which months of infant life?
1 to 5 months after birth. During the symbiotic stage, the child becomes aware of the need-satisfying object (mother) as a separate being.
Measurement Reliability Definition
1. Consistency of measurements 2. Likelihood of repeatable measures over time. 3. Extent to which you can rely on the accuracy and stability of the results obtained. Measurement reliability is a measure's ability to yield consistent results each time it is applied. The quality of the measurement method that suggests the same data would have been collected each time in repeated observations of the same phenomenon. This speaks to the accuracy or precision of a measuring instrument.
Seven Key Characteristics of Behavior Therapy
1) BT is based on the principle and procedures of the scientific method. 2) Behavior is not limited to overt actions a person engages in that we can observe; behavior also includes internal processes such has cognitions, images, beliefs, and emotions 3) BT deals with the client's current problems and the doctors influencing them, as opposed to an analysis of possible historical determinants 4) Clients involved in BT are expected to assume an active role by engaging in specific actions to deal with their problems 5) This approach assumes that change can take place without insight into underlying dynamics and without understanding the origins of a psychological problem 6) Assessment is an ongoing process of observation and self-monitoring that focuses on the current determinants of behavior, including identifying problem and evaluating the change; assessment informs the treatment process. 7) Behavior tx interventions are individually tailored to specific problems experienced by the client.
Albert Bandura's Four Areas of Research
1) The power of psychological modeling in shaping thought, emotion, and action 2) The mechanisms of human agency, or the ways people influence their own motivation and behavior through choice 3) People's perceptions of their efficacy to exercise influence over the events that affect their lives 4) How stress reactions and depressions are caused.
PCP (Rogers) beliefs
1) The therapist must relate in a genuine manner 2) The therapist must relate with unconditional positive regard 3) The therapist must relate with accurate empathy
Freud postulated that two major aspects shaped personality development
1) natural growth and maturation through five stages of psychosexual development. 2) The degree of success an individual experiences in overcoming anxieties, conflicts, and frustrations, and in avoiding pain.
3 Key ways cognitive theory parted from Freudian theory
1) the personality is a holistic entity, and not a component system (i.e., not separated into id, ego, and superego components); 2) social motivation, rather than sexual drive, shapes most behavior; and 3) conscious thoughts and beliefs are far more significant than unconscious motivations.
Practicalities of Communication/Strategic in Systemic Therapy
1- to 11⁄2-hour sessions. Better if whole family is present, but can work with the couple subsystem. Sessions often videotaped. One-way mirrors frequently used. Insurance billing forces identification of one patient but only for reimbursement.
Action-Oriented Programs
1-5% participation rates. ≥20% of people are ready for action. High drop out rates. Small impact on populations with unhealthy behaviors.
How significance Testing Works
1. A statement of the null hypothesis: 2. Setting the level of risk (alpha level): 3. Selection of the appropriate test statistic: 4. Computation of the test statistic value: 5. Determining the critical value necessary: 6. Comparison of obtained and critical values: If the obtained studied value (i.e., p = .08) is more than the critical (alpha) value (p < .05), the null hypothesis is accepted and research hypothesis is rejected If the obtained studied value (i.e., p = .03) does not exceed the critical (alpha) value (p > .05), the null hypothesis is rejected and the research hypothesis is accepted
Treating the family together
1. Allows us to observe and understand the family dynamics. If family members are missing there are often important elements of the family's functioning that we won't know about. The folks that are there will describe situations involving other people, but only from their own perspective. Interaction patterns that are present in the home will not be present in session when an important member is missing. 2. Allows the worker to make a more objective assessment. The more viewpoints we have the more accurate picture we're going to form. 3. Allows us to see the true patterns of interaction as closely as we can to how they really are. much more accurate than hearing about family functioning
Early and Glen Maye - strengths approach strategies - more than just positive reframing
1. Build on the family's strengths and desires to meet each other's needs 2. Work collaboratively with family members and base work on folks' current patterns of helping themselves 3. Help the family formulate a vision of what things will be like when things get better - help them connect to a positive vision of the future 4. Boost family involvement through activities 5. Environmental modification - helping elements of the environment come to meet the needs of the family - could mean educating, opening doors, building bridges 6. Model high expectations for family involvement and success
Phases of CBM in BT
1. Conceptualizing the problem 2. Trying on the conceptualization 3. Modifying cognitions and producing new behavior
Cognitive Triad of Depression
1. Events are interpreted negatively. 2. Depressed individuals dislike themselves. 3. Future is appraised negatively.
What makes a research question "good"?
1. Feasibility: Can you start and finish an investigation of your research question with the resources that you can obtain and in the time that is available? 2. Social Importance: Will an answer to your research question make a difference in the social world, even if that is only in terms of helping people understand a problem they consider important? 3. Scientific Relevance: Does your research question help to resolve some contradictory research findings or a puzzling issue in social theory? (King, Keohane, & Verba, 1994)
Jansen and Harris - three primary goals at the beginning of the intervention process:
1. Get a picture of the family's interaction and the relationship between the family and the presenting problem and their interaction 2. Get the family's consent to start the process- this means that various family members need to agree to begin 3. Set the process in motion - help them feel like the process has begun - begins with the family members knowing that the worker understands the problem. This increases hope and willingness, confidence in the process - decreases rejection and hesitation
Measurement Validity & Reliability
1. If there is no measurement reliability, then there is no measurement validity! 2. The ceiling for measurement validity is set by the level of measurement reliability! 3. If you have measurement validity, then you have measurement reliability!
5 Axioms of Communication in Systemic Therapy
1. It is impossible not to communicate. 2. Communication implies commitment and defines relationships; both report and command elements. 3. Relationships are contingent on how a communication is punctuated or ended. 4. Communication both verbal and nonverbal. 5. Communications are symmetrical (either side can lead the communication) or complementary (one side leads).
5 P's for Resuming Contact In Systems
1. Prepare. 2. Persevere. 3. Practice "foot in the door" technique. 4. Provide positive reinforcement. 5. Promote urgency.
Transtheoretical Model: 3 Core Dimensions
1. Processes of change (how people change) 2. Stages of change (when people change) 3. Levels of change (what people change)
Conceptualization Steps
1. Select the most important variables to study; 2. State exactly what is meant by each variable; 3. Specify how each variable is to be measured; 4. State the value categories or values that each variable can assume.
Counterconditioning Techniques in BT
1. Systematic desensitization Progressive relaxation to inhibit anxiety response. 2. Assertiveness training Assertion inhibits passivity and aggression in relationships. 3. Sexual arousal Relaxation and arousal inhibit sexual anxiety. 4. Stimulus control Rearrange environment and triggers.
Types of Reliability Measurements
1. Test-retest 2. Internal consistency 3. Alternate (parallel) forms 4. Inter-observer (inter-rater)
Hypothesis Testing
1. Testing of the Independent Variable (IV) on the Dependent Variable (DV). A Research Hypothesis, not a Question. 2. Testing the Hypothesis Relationship (cause) Explanatory or Experimental Design level. 3. Findings support for the Hypothesis Statistical Significance - Yeah!!
Layers/Levels of Psychopathology (Experiential)
1. The phony, 2. the phobic, 3. the impasse, 4. the implosive, and 5. the explosive.
Statistical Significance IS NOT Proof that:
1. The relationship was not caused by the influence of some other variable: Moderator variable; or, Mediator variable. 2. The relationship was not caused by design flaws; 3. The relationship is necessarily a strong one; 4. The relationship is a valuable, meaningful (practical), or a previously unknown one; 5. The relationship absolutely could not have been produced by sampling error; 6. The variables are related to the same degree within the population from which the sample was drawn.
Two Meanings of Systemic Therapies
1. Therapy modality or format (like individual therapy and couple therapy). 2. Treatment content or goal (what is discussed or intended).
Mean - Options to help minimize the "outlier affect"
1. Trimmed mean Not using the top 5% and bottom 5% of the distribution: 2 40 45 46 52 52 55 59 60 61 61 63 64 66 66 66 67 69 70 259 Mean for n = 20 is 66.2 Trimmed mean for n = 18 is 53.1 Median is 61
Erikson's psychosocial stage of identity versus role confusion (stage 5)
12 to 18 years of age. Adolescence requires development of personal "identity" and self-integration, the absence of which results in role confusion.
The Genital Stage (5)
12 years of age and above. Characterized by genital acceptance, and mature sexual feelings.
Genital Stage
12+. Genital primacy. Sexual intimacy and reproduction. In Freudian Theory, an individual does not progress to the genital stage without at least some conflict between instinctual desires and social restraints.
Brief IPT
12- to 16-week duration Weekly face-to-face Present-oriented Focus on recovery (not character change) Provides protection against reemergence of symptoms.
Developmentally, the capacity to thrown objects and walk backwards and sideways emerges during which age range
15-17 months
The Anal Stage (2)
18 months to 3 years of age. Characterized by a focus on the canal experience of elimination and resolved once sphincter control is mastered
An Early Existential Therapist: Ludwig Binswanger
1881-1966 Became existential after reading Heidegger's Sein und Zeit (Being & Time). Medical director of the Sanatarium Bellevue in Switzerland. Emphasis on direct, immediate experience and its meaning.
Fritz Perls (Experiential)
1893-1970 Received MD in Berlin. Studied at the Vienna Institute of Psychoanalysis and analyzed by Wilhelm Reich. Established New York Institute for Gestalt Therapy in 1946. Difficult to separate Fritz from Gestalt techniques. Built Gestalt Training Center in British Columbia in 1970 and died soon after.
Carl Rogers
1902-1987 Restricted, inexpressive family life. Ph.D. in clinical psychology from Columbia. Founder of psychotherapy research. Evolved from nondirective to client- centered to person-centered. Applied his system to education, politics, and international conflicts.
An Early Existential Therapist: Medard Boss
1903-1991 Heavily influenced by Freud. Integrated ideas of Heidegger with methods of Freud. Wrote Daseinanalysis & Psychoanalysis in 1963. Professor of psychoanalysis at University of Zurich.
An Early Existential Therapist: Rollo May
1909-1994 Trained in theology and clinical psychology. Studied with Alfred Adler. Contracted TB when completing Ph.D. Found meaning in adversity.
Albert Ellis (Cognitive Therapy)
1913-2007 First demonstrated rational-emotive therapy (RET) in 1957. Goal: Maximize pleasure and minimize pain. Changed name RET to rational-emotive behavior therapy (REBT). A charismatic, prolific, and controversial figure.
Joseph Wolpe in BT
1915-1997 Psychoanalytic in his early years. Used deep relaxation to inhibit anxiety. Reported success with 90% of clients. Major and controversial figure in the establishment of behavior therapy.
Aaron Beck
1921-present Originally trained in psychoanalytic tradition. Approach heavily rooted in empiricism. Developed popular instruments, including Beck Depression Inventory and Beck Anxiety Inventory. Beck and Ellis did not collaborate, but approaches are very similar.
Multimodal Therapy: Arnold Lazarus (Integrative)
1932-present Born, raised, and educated in South Africa. Originally trained in behavioral tradition. Introduced multimodal therapy in 1973. One of most influential psychologists. Continues to expand horizons of therapeutic practice.
Paul Wachtel in Integrative
1940-present Ushered in sophisticated attempts at theoretical integration. Trained in psychoanalytic therapy and then incorporated behavioral and systemic. His system began as effort to portray behavior therapy as foolish, superficial, and possibly immoral.
Marsha Linehan (Third Wave)
1943-present Developed DBT for chronically suicidal and borderline personality disorder. Principles drawn from CBT with acceptance and mindfulness. Prefers DBT be characterized as expanded behavior therapy. Rooted partially in her own troubling experiences and meditation training.
Anal Stage
2-3 years of age. Anus, bowels. Active self-soothing and self-mastery; passive submission. Urges to play with their anus brings conflict with societal rules. Involves all kinds of power struggles Deals with the inability to recognize and express anger.
Inference and Alternative Explanations: Design Flaw
2. Design Flaw Sampling bias - systematic distortion and not representative of the population. * Can correct through random sampling methods. b. Measurement error (reliability and validity) Systematic error Mistakenly assuming that what is being measured can be assumed synonymous with variable of interest. Random error Measurement bias Cultural bias
Measures of Variability (Variation): Interquartile Range
2. The interquartile range is the difference between the first and third quartile, and avoids the problem created by outliers. Calculate with the following recipe: a. Put the data in numerical order (array); b. Divide the data into two equal high and low groups at the median (if the median is a data point, include it in both the high and low groups); c. Find the median of the low group. This is called the first quartile (Q1; 25%); d. The median of the high group is called the third quartile (Q3; 75%); e. Now the interquartile range (IQR) is the distance (or difference) between them. IQR = Q3 - Q1
Measure of Central Tendency: Median
2. The median, the point that divides the distribution in half, should be computed from ungrouped data - like a highway median strip. Must be used for at least ordinal level of measurement - why? Unlike the mode, the median does not always coincide with an actual value in the set. The median is not synonymous with the value of the middle case in the array; although it does work out that way for arrays with odd number of values.
Therapeutic Processes in Multicultural Therapy
3 perspectives: Cultural relativism Cultural universality Cultural adaptation Consciousness raising: Understanding how culture has oppressed and shaped self-views. Catharsis: Expressing healthy anger and recognizing that anger is normal and justified. Choosing: Channeling new-found liberation and pride.
Multiple baseline design types
3 types -Across participants Same settings and behavior, but different participants -Across behaviors Same participant and setting, but different behaviors -Across settings Same participants and behavior, but different settings
The Phallic Stage (3)
3-6 years of age. Characterized by a focus on the genitals
Phallic Stage
3-6 years. Genitals. Oedipus and electra conflicts; identification with same-sex parent; ambivalence of love relationships Deals with the inability to fully accept one's sexuality and sexual feeling, and also to difficulty in accepting oneself as a man or woman.
Threats to Internal Validity: Testing Effects
3. Testing effects - the effects of taking a test upon the scores of a second testing. In other words, when subjects are exposed to a measurement device more than once. The effects of taking the test can have an effect on the score of the second test—score better but may actually feel the same or know the same information. People usually do better the second time that they take a test. IQ test scores often improve 3-5 points and personality tests tend to show "better judgment." Also, anonymous tests often have different results than confidential tests. In confidential tests, respondents often try to respond in a more socially desirable manner than they did the first time. Example: Taking a pre-test about anxiety may have made participants more anxious during the day then they normally would have been.
Measure of Central Tendency: Mean
3. The mean, or arithmetic average, takes into account the values of each case in the distribution it is the sum of all of the values ÷'d by the total # of the values. Must be interval or ratio level measurements. Should not be computed for ordinal level - why? Uses all values in the array. Mean uses all of the values whereas the median uses only some of them - the ones in the center or middle of the array. Mean can promote accuracy or distortion depending on whether the distribution is symmetrical or skewed (our next course topic).
Measures of Variability (Variation): Variance
3. The variance is the average squared deviation of each case from the mean. It takes into account all the scores to determine the spread.
Threats to Internal Validity: Instrumentation
4. Instrumentation - changes in the calibration of a measuring instrument or changes in the observers or scorers used may produce changes in the obtained measurements. In other words, the way in which variables are measured may change in systematic way during experiment, resulting in measurements being done differently—getting better at it; recognizing things previously missed. If a researcher is observing class participation, he/she may become more blasé about his/her observations between times one and two. If a researcher is interviewing families, his/her familiarity with the instrument may improve between times one and two, and, therefore, he/she may change slightly the way he/she presents the instrument to the families. Or, there may be actual changes between the instruments used, for example, a move from DSM-IV to DSM-5.
Measures of Variability (Variation): Standard Deviation
4. The standard deviation is the square root of the variance. This tells us what degree the values cluster around the mean. This is the preferred measure of variation, especially when a variable is normally distributed (next course topic). The variance and standard deviation are calculated via your software programs or hand calculators ("s" button
Freud's psychoanalytic theory incorporated the structural theory of personality development. Freud believed that personality development is completed by:
5 years of age.
Alternating treatments in SSD
5. Know the critical features of the alternating treatments design. Critical features 2 or more treatments presented Treatment phases are rapidly alternated In a pseudo random fashion Generally a baseline phase (not required) Advantages No treatment withdrawal Faster comparison of treatments Variable data is okay Problems Artificiality Interference between treatment phases Treatments must sufficiently differ
Latency Stage
6-11 years. Repression of pregenital forms of libido; learning shame and disgust for inappropriate love objects A time for ego development and learning the social rules of being a citizen.
The Latency Stage (4)
6-12 years of age. Characterized by the onset of sexuality within socially acceptable bounds, and terminating at the onset of puberty.
Multiple baseline design
6. Know the critical features of the multiple baseline design. Critical features More than one baseline recorded during the same time period for different lengths of time Introduce treatment in one condition at a time Sequentially in order of baseline stability No withdrawal or reversal Avoids any associated problems Must have overlap in terms of setting, researchers used, participants used, etc. to detect potential extraneous variables otherwise it is simply a series of stacked AB designs
The original Social Security Act was passed in 1935. It was a federal trust fund that was intended to primarily provide "old age and survivors" benefits. To be eligible for full benefits, an individual born before 1960 must have attained the age of:
65. Those born after 1960 are eligible for full benefits at 67
Differences in motor skills between males and females become most evident during which age range
7-11 years of age. Girls' fine motor skills advance more than boys at this age.
Changing Criterion Design in SSD
7. Know the critical features of the changing criterion design. Critical features Uses the same, behavior, participant, and setting Baseline phase Shows experimental control by demonstrating that changes in the DV occur only when the criterion changes Considerations Length of phase Considerable variation for control purposes Size of incremental change Considerable variation for control purposes # of phases More = better
Analysis of SSD
8. Know how single subject designs are most commonly analyzed. Visual analysis most common Assess trends and levels between adjacent phases Level - value of DV Trend - direction of the level of DV Increasing, decreasing, stable, variable
Therapeutic Relationship in Existential Therapy
A "being-together." A process of change and a source of content. Honesty Patient responsible for patient; therapist not responsible for patient.
Transference
A Freudian term that describes a client's placing feelings for another onto the counselor.
Intermittent
A behavior is reinforced from time to time.
Social Skills Training
A broad category that deals with an individual's ability to interact effectively with others in various social situations; it is used to help clients develop and achieve skills in interpersonal competence.
Cognitive Restructuring
A central technique of cognitive therapy that teaches people how to improve themselves by replacing irrational beliefs with a rational beliefs.
Emotional attachment
A change in tone in therapy likely means that the client has significant emotional attachment to what is being said. At such times, the counselor should pay additional attention to what the client is saying and make a point to explore the situation.
Anamnesis (Psychodynamic Therapies)
A client's earliest recollections that will give a picture of whether the client felt encouraged or discouraged to compensate for inferiority feelings in a socially constructive lifestyle.
Multimodal Therapy
A comprehensive, systematic, holistic approach to behavior therapy developed by Arnold Lazarus.
Concept
A concept is a mental image that summarizes a set of similar observations, feelings, or ideas.
Task Centered
A social worker who focuses on diagnoses and intervention on a specific problem is practicing from this framework
Self-confidence in worker
A counselor should possess and exhibit self-confidence, which assists in setting boundaries and maintaining professional distance. Self-confidence also makes it less likely that he counselor will fall into the habit of trying to please the client rather than say what needs to be said.
Empathy
A deep and subjective understanding of the client with the client. Is not sympathy.
Rationalization
A defense mechanism
Splitting (Psychodynamic)
A defensive attempt to deal with being overwhelmed by more powerful parents.
Boundary Crossing
A departure from commonly accepted practice that could potentially benefit a client. Ex: Attending a client's wedding and could benefit them.
Actualizing Tendency
A directional process of striving toward realization, fulfillment, autonomy, and self-determination.
Field
A dynamic system of interrelationships
Older Americans Act of 1965
A federally administered act which provides, among other things, for certain nutrition programs, senior centers, legal services, transportation, home repair, and home health care assistance. The services that are authorized under the act provide access to certain state resources which help elderly individuals live in the community without institutionalization.
Anxiety
A feeling of dread that results from repressed feelings, memories, desires, and experience that emerge to the surface of awareness. It can be considered as a state of tension that motives us to do something.
Eye Movement Desensitization and Reprocessing (EMDR)
A form of exposure therapy that entails assessment and preparation, imaginal flooding, and cognitive restructuring in the tx of individuals with traumatic memories.
Mindfulness
A fundamental skill in DBT and is considered the basis for other skills taught.
Social Interest (Psychodynamic Therapies)
A healthy style of life reflects a social interest in all human beings. A healthy personality is aware that a complete life is possible only within the context of a more perfect society.
Aspirational Ethics
A higher level of ethical practice that addresses doing what is in the best interest of clients.
Motivational Interviewing (MI)
A humanistic, client- centered, psychosocial, directive counseling approach that was developed by William R. Miller and Stephen Rollick in the early 1980's. MI has defined as "a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and solve ambivalence." MI therapists avoid arguing with clients, avoid assuming a confrontational stance, reframe resistance as a healthy response, express empathy, and listen reflectively.
Hypotheses
A hypothesis is a tentative statement about empirical reality, involving a relationship between two or more variables May be based on Theory Literature Experience
Privileged Communication
A legal concept that generally bars the disclosure of confidential communications in a legal proceeding.
DSM IV Contd
A major change at this time was the removal of Spitzer, and the appointment of Allen Francis as the new chairman. Francis established a task force of several hundred mental health professionals. Francis also made an effort to include women, minorities, psychologists, clinical social workers and professional counselors. He sought to adhere to a more rigid empirical approach and the stated primary objective was to move beyond expert consensus.
Persona
A mask, or public face, that we were to protect ourselves
Sublimation
A mature ego defense that allows us to channel the id's energy into more acceptable substitute activities. Defense: Diverting sexual or aggressive energy into other channels Uses: Energy is usually diverted into socially acceptable and sometimes even admirable channels. Ex: Diverted into athletics.
Evaluation of Measures - Validity
A measure may be reliable, but that does not make it valid. Measures may be valid, but not if they are not reliable. We can measure head size with accuracy, but that tells us nothing about intelligence. Validity indicates whether and how well it measures what is intended to be measured (systemic error).
Systems and Postmodern Approaches: Postmodern Approaches
A number of key figures are associated with the development of these various approaches to therapy. Steve de Shazer and Insso Kim Berg are the co-founders of solution-focused brief therapy. Michael White and David Epston are the major figures associated with narrative therapy. Social constructionism, solution-focused brief therapy, and narrative therapy all assume that there is no single truth; rather, it is believed that reality is socially constructed through human interaction. These approaches maintain that the client is an expert in his or her own life.
Systems and Postmodern Approaches: Family Systems Therapy
A number of significant figures have been pioneers of the family systems approach, including Alfred Adler, Murray Bown, Virginia Satir, Carl Whitaker, Salvador Minuchin, Jay Haley, and Cloe Maddens. This systemic approach is based on the assumption that the key to changing the individual is understanding and working with the family.
Confluence
A person does not know who is doing what to whom because the boundaries between self and others are too vague.
Retroflection
A person who treats him/herself as he actually wanted to treat other persons or objects. Prolonged and/or intense retroflection can lead to depression and even self-destructive behavior.
Style of Life (Psychodynamic Therapies)
A person's particular feeling of inferiority influences the style of life that person chooses for becoming superior.
Causal Mechanism
A plausible process by which the cause is believed to have led to the effect Process can be direct or through intervening (mediating) variables
Client-centered Therapy (Person-centered)
A process of expanding consciousness or awareness through the therapist bringing about more effective information processing in clients.
Participant Observation
A qualitative method for gathering data in which natural social processes are studied as they happen in the field rather than a laboratory (ethnography common type) Field is relatively undisturbed Observing and interacting with subjects in the course of their normal activities; Avoid the structured settings; Context is better understood.
What is Qualitative Research?
A qualitative research study is often multi-method in its focus; involves an interpretive, naturalistic approach, to answering research questions Emphasis on the use of non or semi-structured & naturalistic observations, interviews, narrative dialogues (or stories), and existing documents STILL HIGHLY RIGOROUS METHODS!!
Negative punishment
A reinforcing stimulus is removed following the behavior to decrease the frequency of a target behavior (such as deducting money from a worker's salary for missing time at work)
Scientific Method
A series of sequential steps used in the research process Logical, systematic Purpose: to ensure that research results are Real (true) Replicable Transparent
Boundary Violations
A serious breach that harms the client and is therefore unethical. This takes the practitioner out of the professional role.
Tarasoff regulations specify a duty to warn if
A serious threat of physical violence is made, the threat is made against a specifically name individual(s) and, 3) the threat is also made in context of clinician-patient relationship
Case Manager
A social work case manager actually arranges for the provision of services for a client, based upon proper needs assessment and evaluation. Then the SW case manager monitors the services provided, and secure alternate resources and services as dictated by changes in the client's status.
Hypothesis
A statement that postulates the relationship between the IV and DV; a tentative statement that predict what we expect to find about the way variables may covary Stated in either present or future tense, never in the form of a question
Meta-analysis
A statistical technique that quantitatively combines the results of many different studies.
Acculturation
A subordinate culture emulating a dominant one. Every society has one culture within that is dominant. Subordinate cultures will sometimes attempt to emulate the dominant culture as a means of gaining greater acceptance within the society. Acculturation refers to such emulation and the degree to which an individual associates himself with the dominant culture.
Minority groups are best described as
A subset of individuals with differing characteristics. Feelings of marginalization, harassment, and/or oppression are insufficient criteria for minority status. Rather, minority groups are identified in a primary social population as individuals possessing unique physical, social, and/or cultural characteristics.
Sample
A subset of the population
CAGE is an acronym for
A substance abuse screening. Cut Down, Annoy, Guilt, and Eye Opener
Personality perspective
A supervisor may approach a staff supervision experience from the perceptive of specific traits and characteristics that appear to influence the practice situation.
Meta-Analysis
A systemic evaluation of the results of several independent studies
Catching oneself (Psychodynamic Therapies)
A technique that encourages clients to think about catching themselves "with their hands in the cooke jar." They should try to actually catch themselves in the process of ac ting out a destructive behavior. Clients can learn to anticipate a situation and to turn their attention to more constructive consequences.
Confrontation
A technique used to confirm the social worker's guess and to reveal and bring to consciousness the client's real goal or intentions of a behavior or statement.
paradoxical directive
A therapeutic technique where the individual is asked to do exactly what the problem behavior is.
Frotteurism
A type of paraphilia, or sexual disorder, in which an individual gains sexual enjoyment by touching genitalia to a non-consenting or unsuspecting individual
Goal attainment Scaling (GAS)
A well-respected tool used or measuring program treatment outcomes. It is a client-specific technique that links treatment goals and outcomes with scaled points, making for a flexible evaluation tool
Positive punishment
An aversive stimulus is added after the behavior to decrease the frequency of a behavior (such as time-outs).
Effectiveness of Third-Wave Therapies
ACT consistently outperforms no treatment and wait-list controls across disorders, but similar outcomes as alternative treatments. DBT produced an average ES of .58 vs. no treatment and is a "treatment of choice" for borderline personality disorder. MBCT shows promise.
Standardized Scales
Administration of the same items to different people using the same administration and scoring procedures Availability of reliability and validity data Measurement of client problems in terms of concepts with general relevance (e.g., marital satisfaction, depression)
Major Characteristics in BT
Abnormal behavior is acquired and maintained by same principles as normal behavior. Continuous assessment focuses on current determinants of behavior. Focus on thoughts, feelings, and actions. Treatment is specified, replicable, and tailored to people. Outcomes should generalize to real-life and be maintained over time.
Processes of Change (Medium Level)
Abstraction: Change processes. Ex: Consciousness raising, counterconditioning
Process of Change: (Low Level)
Abstraction: Clinical techniques, Ex: two-chair technique, self-monitoring
Processes of Change (High Level)
Abstraction: Global theories. Ex: Psychodynamic, Gestalt, behavioral
Leading Third-Wave Therapies
Acceptance and commitment therapy (ACT) Dialectical behavior therapy (DBT) A bit on other therapies, such as mindfulness-based cognitive therapy.
Competence in Code of Ethics
According to the ethical principles of the NASW, social workers are expected not only to practice within their area of expertise but also to add to the knowledge base of the field
Importance of Diagnosis and Treatment Planning: Accountability
Accountability: - Clients - Insurers - Agencies - Other Providers - Courts - Utilization review
Death instincts
Accounts for the aggressive drive. At times, people manifest through their behavior an unconscious wish to die or to hurt themselves or others.
Transtheoretical
Across theories-model reduces the therapeutic morass to a manageable number of processes of change.
REBT's Theory of Personality: ABC in CT
Activating (A) events lead to Beliefs (B) about activating events, which lead to Emotional Consequences (C) A→B→C
Cognitive Therapy Similarities
Active, directive, time-limited, present-centered, problem-oriented, collaborative, structured, and empirical.
Practicalities of Structural Therapy (Systemic Therapy)
Active, short-term treatment. Format fallows function of therapy, usually conjoint sessions. Restructure seating as a function of restructuring family. Booster sessions are natural and economical.
Reaction Formation
Actively expressing the opposite impulse when confronted with a threatening impulse By developing conscious attitudes and behaviors that are diametrically opposed to disturbing desires, people do not have to face the anxiety that would result if they were to recognize these dimensions of themselves. Individuals may conceal hate with a facade of love, be extremely nice when they harbor negative reactions, or mask cruelty with excessive kindness.
Therapeutic Processes in Exposure Therapy
Adaptive information processing (AIP) model Counterconditioning via desensitization, distancing, and cognitive restructuring. Consciousness raising and catharsis operate, but not as central mechanisms.
Organizational perspective
Addresses policy, procedure, and organizational goals and objectives.
Immediacy
Addressing what is going on between the client and therapist, is highly valued in this approach
Individuo-social Conflicts
Adjustment vs. transcendence, Impulse control
Individuo-social conflicts
Adjustment vs. transcendence, impulse control
Individual psychology
Adler's theoretical approach because he wanted to avoid reductionism. Adler emphasized the unity and indivisibility of the person and stressed understanding the whole person in the context of his or her life.
Fictional Finalism
Adlerian term. Refers to an imagined life goal that guide a person's behavior.
Phenomenological
Adlerian's attempt to view the world from the client's subjective frame of reference.
Private Logic
Adlerian. The concepts about self, others, and life that constitute the philosophy on which an individual's lifestyle is based. Involves our convictions and beliefs that get in the way of social interest and that do not facilitate useful, constructive belonging.
Therapeutic Relationship in Integrative
Affirmative and active relationship required. "You don't go far in neutral." Viewed as both a precondition of change and a process of change. Centrality of non-pejorative, therapeutic communication.
Net assets
After accounting all revenue and expenses, are often referred to as the business' bottom line
Therapeutic Processes in CT
After symptoms begin to subside, treatment shifts to underlying cognitions. Identification of problematic schemas and their remediation. Successful clients pass through stages: Become aware of thinking. Recognize what thoughts are awry. Substitute accurate for inaccurate judgments. Receive feedback on effectiveness of change.
Age of individuals when selecting members for group therapy
Age is often a significant factor with most groups. However, age may be a consideration in certain populations, such as among teenagers, where age has particular status
Prior to 1996, The TANF Program (Temporary Assistance for Needy Families) was known as
Aid for Families with Dependent Children (AFDC). The legislated change in 1996 was to transform AFDC into a temporary program designed to move recipients into the workforce.
Distress Tolerance
Aimed at helping individuals to calmly recognize emotions associated with negative situations without becoming overwhelmed by these situations.
Pleasure principle
Aimed at reducing tension, avoiding pain, and gaining pleasure, the id is illogical, amoral, and driven to satisfy instinctual needs.
Supportive Therapy (Psychodynamic)
Aims to strengthen the patient's coping, provide encouragement, and prevent regression.s
Supportive Therapy
Aims: strengthen patient's coping, provide encouragement and reassurance, prevent regression. Therapist reinforces patient's adaptive behaviors to reduce intrapsychic conflicts. Mixture of both exploratory/expressive and supportive interventions
Identify the two of the most prominent cognitive theorists:
Alfred Adler and Albert Ellis.
Ideal self
Alfred Adler theorized that individuals begin to form an idea of the "ideal self" around the age of 6. The individual then works towards achieving that ideal self, choosing behavior that will aid in reaching the ideal.
Actualization (Person-centered)
All humanity has but on basic motivational force, a tendency toward actualization.
Peer supervision model
All members participate equally. They are responsible for their own work but meet periodically to share experiences and offer professional advice on each other's cases.
Population
All people (or agencies, communities, states, countries, etc.) that you wish your study to generalize to
Id
All the untamed drives or impulses that might be likened to the biological component.
Organismic Valuing (Person-centered)
Allows us to value positively those experiences perceived as maintaining or enhancing our lives and to value negatively those experiences that would negate our growth
Individualized Rating Scale (IRS)
Also known as a "target complaint scale," a "self-anchored scale," and an "individual problem rating scale" Tailor-made for each client Example: Intensity of anxiety today (1) Little or no anxiety (2) Some anxiety (3) Moderate anxiety (4) Strong anxiety (5) Intense anxiety
Descriptive Analysis
Also known as data reduction Reduce large amounts of data without losing overall meaning Some sacrifice necessary Descriptive summaries of measurements of entire populations: Parameters At sample level: statistics Are preliminary for inferential analysis
1. Counterconditioning in BT
Also known as reciprocal inhibition. Learning the healthy opposite of the problem behavior. Based on respondent conditioning. Follows directly from the work of Pavlov. Techniques include systematic desensitization, assertiveness training, and stimulus control.
Ordinal Measures
Also mutually exclusive; With a fixed order (rank ordered); Indicates rank and nothing more, so numbers assigned have no numerical properties; Ranks orders are not equal interval scales;
DSM II Contd
Also, in response to criticisms, "Reaction" was removed and "Reactive" was added. This was influenced by the dominant rationale of 20th century psychiatrists and psychoanalysts. A new change was inevitable due to the controversy of the 1970s which was related to homosexuality and mental illness. After protests and threats of lawsuits, homosexuality was removed by VOTE in the 1974 printing of the seventh edition of the DSM II
Inference and Alternative Explanations: Rival Hypothesis
Although you might conclude the relationship found between (or among) variables is also present in the population, there are two alternative explanations: 1. Rival Hypothesis - some other variable(s), unknown, may cause the relationship (or strength of the relationship found).
A disease characterized by a diffuse atrophy of the brain
Alzheimer's
Source of DSM
American Psychiatric Association. Was first published in 1952 and has been revised several times since. It provides standard criteria for diagnosing mental disorders and, although attracting controversy from time to time, is still the standard used.
Culture-Bound Syndromes in Multicultural Therapy
Amok: In Malayan culture, sudden, wild homicidal aggression. Anorexia nervosa: In Western cultures, preoccupation with thinness and refusal to eat. Ataques de nervios: In Caribbean cultures, impulsivity, dissociation, and anxiety. Susto: In Central American cultures, loss of soul causing depression and somatic symptoms. TKS: In Japanese culture, intense fear of offending other people through social awkwardness. Windigo: In Algonquin Indians, anxious, agitated and convinced of bewitchment.
Positive Ethics
An approach taken by practitioners who want to do their best for clients rather than simply meet minimum standards to stay out of trouble.
Normal Anxiety
An appropriate response to an event being faced. This kind of anxiety does not have to be repressed, and it can be used as a motivation to change.
Autonomous Ego (Psychodynamic Therapies)
An ego that functions independently of the id drives. These involve the individual's adaptation to reality and mastery of the environment.
Analytical Psychology
An elaborate explanation of human nature that combines ideas from history, mythology, anthropology, and religion.
Enuresis
An elimination disorder characterized by inappropriate voiding of urine
Confidentiality
An ethical concept, and in most states it is the legal duty of therapists not to disclose information about a client.
Ludwig Binswanger
An existential analyst, Binswanger proposed a holistic model of self that addresses the relationship between the person and his or her environment. He used a phenomenological approach to explore significant features of the self, including choice, freedom, and caring.
Delving into the past
An exploration process, rather than in intervention in itself
According to Albert Bandura's social learning theory, an antecedent event is best described as
An external event occurring immediately prior to specific behavior.
Dream Analysis
An important procedure for uncovering unconscious material and giving the client insight into some areas of unresolved problems.
Transference
An interactive process between patient and therapist.
Boundaries in Systemic Therapy
An organized family has clearly marked boundaries. Disengaged families have rigid boundaries. Enmeshed families have diffuse boundaries. Dysfunctional families respond to demands for change in pathological ways.
Idiographic explanation
An outcome for a specific person or a particular event is thought to be due to a series of earlier events, thoughts, actions, or conditions. Used to explain what is, rather than to predict what might happen under certain conditions Usually used with a single person or event
Treatment Manuals
Analogous to a flight plan or a road map, training will ensure competence in appropriate therapist stances and technique.
Secondary data analysis
Analysis of existing data that results in findings beyond those done for the original study
Select Rating Scale Anchors
Anchors define numbers Individualized or general anchors can be used General anchors allow comparability and averaging across targets Individualized anchors may be more relevant and meaningful to clients Higher numbers should represent more of the dimension measured
The theory of defense mechanisms was developed by
Anna Freud. These defense mechanisms constitute irrational and unconscious efforts to protect the ego from anxiety and distress by means of reality distortion, denial, or avoidance.
Descriptive Research: One-Group Pre-Test - Post-Test Design
Another example of this would be if UT gave all MSW students a final, comprehensive examination upon their entry into the MSW program and again gave all MSW students a final, comprehensive examination upon their graduation from UT. The observations would be the pretest and posttest, and the intervention would be the MSW coursework. In this design, we still have one major problem - we have nothing to compare this group of persons to. We don't know if something other than the intervention is responsible for the changes between the pretest and posttest scores. We still cannot establish causation with this research design. One can establish time-order and correlation with this design, but it does not take into account other factors (besides the independent variable) that could have caused a change between the pretest and the posttest.
Intrapersonal Conflicts
Anxieties and defenses, Self-esteem problems, Personal responsibility
Intrapersonal conflicts
Anxieties and defenses, self-esteem problems, and personal responsibilities
Therapeutic Processes in BT
Anxiety can be unlearned through counterconditioning. Do the opposite of the problem and the problem will disappear (reciprocal inhibition).
Theory of Psychopathology in BT
Anxiety is a response of sympathetic nervous system. Anxiety is cause of most behavioral disorders. Anxiety can be conditioned to any stimuli. Thoughts associated with threatening stimuli can elicit anxiety.
Behavior Therapists
Behavior therapists vary in both theory and technique. Learning theory is core, but differences on what version (Pavlov's, Hull's, Skinner's, Mowrer's, or other). Treatment must be validated under controlled conditions.
Deinstitutionalization
Changes in policy and law that led to the release of many disabled patients who would have otherwise remained in institutional settings
Counterconditioning
Changing our behavior to the stimuli
Stimulus Control
Changing our environment to the stimuli
Concepts
Concepts are ideas, words or images that have shared meaning Examples: -Age - Homelessness - Athlete - Politics
Theory of Psychopathology in Exposure Therapy
Anxiety is conditioned response controlled by two factors: respondent learning and operant learning. Conditioning accounts for acquisition and extinction of fear. Conceptualizes pathology in terms of both behavioral and emotional processing.
Medications to treat Bipolar Disorder
Anti-convulsants, antidepressants (SSRIs, MAOIs, and tricyclic antidepressants (less likely to be used)), antipsychotics, calcium channel blockers (including blood pressure medications, and Benzodiazepines. Even electroconvulsive therapy has been successfully utilized
Theory of Psychopathology in Integrative
Anxiety is core — common emphasis of both psychoanalysts and behaviorists. Bridges can be built to connect the chasms that separate them. Cyclical psychodynamics: Powerful conflicts can be understood as both cause and effect. Vicious self-perpetuating cycles maintain psychopathology.
Summarizing Univariate Distributions
Any set of measurements has two important properties: 1. The Central Tendency (or typical value)! 2. The Spread (variability) about that value!
Universal programs
Are available without any restrictions or eligibility criteria
Educational groups
Are formed to provide education, information, and essential skills
Behavioral and Cognitive approaches
Are practice approaches based on theoretical orientations and not frameworks.
Oedipus and Electra Complexes
Arise during the phallic stages of development, but do not constitute specific developmental stages themselves.
Paradoxical Theory of Change (Gestalt)
Arnie Beisser suggested that authentic change occurs more from being who we are than from trying to be who we are not.
Incongruence (Person-centered)
As some experiences are distorted or denied, there is incongruence between what is being experienced and what is symbolized as part of a person's self-concept.
Internal Validity Factors
Ascertaining the internal validity within your study is a judgment call, including a review of the following factors: 1. History - did any other events occur during the time of the research that impacted the results? 2. Maturation - passage of time 3. Testing effects - repeated measure given and learned from/affecting the participants 4. Instrumentation - changes in the measurement devises used over time 5. Experimental mortality (Dropout) 6. Statistical Regression toward the Mean - extreme scores on an original measure (test) will tend to become less extreme upon re-measurement (rock on with in-class therapy for coins) 7. Selection - biases resulting in differential selection of respondents for the comparison groups. 8. Diffusion or initiation or Intervention - practitioners communicate with each other; or client learns about the information.
Not an effective active listening technique
Asking questions while the client is telling his/her story
Construct Validity Example
Assess how well an instrument measures a concept by comparing that concept to other variables. For example, If I am measuring marital satisfaction, and I want to assess the validity of how I measured satisfaction, I could compare the level of marital satisfaction to the level of domestic violence. I already know that as satisfaction increases, violence decreases. If I do not see this pattern in my data, I may question the way I am measuring marital satisfaction.
Descriptive Research: Static Group Comparison Design
Assesses an outcome (dependent) variable for two groups only after the intervention (IV). Two groups may or may not be similar in comparison. Example - Group therapy treatment for parents referred because of abusing their children. We would hope to show the treated group scored better on a standardized measure of abuse than the untreated parents. This would show a correlation, but would not allow us to infer that the difference between the two groups was caused by the intervention. Reason for this is selection bias. Without pretests, we have no way of knowing whether the scores of the two groups would have differed as much to begin with.
Descriptive Research Levels
Assesses correlation Controls for causal time order Does not account for: history; maturation; testing; and statistical regression. Example - Study measures social work activism before and after taking a social work advocacy course in school. Can we say the course caused the increased advocacy? No. Students could have matured; or events changed the students' ways during the course (history).
The first stage of treatment is generally agreed to be
Assessment.
Importance of Diagnosis and Treatment Planning: Assessment
Assessment: - Diagnostic Knowledge - Treatment Planning - Intervention - Delivery of Services
Criteria for establishing causality
Association Time order Non-spuriousness Plausible causal mechanism Context
Solution-Focused Therapy: Personality & Psychopathology in Constructivist
Assumption: People are healthy and competent. Psychotherapy can enhance lives by focusing on solutions rather than problems. Real causes of psychopathology can never be known. Knowing the cause of a problem does not mean you have the cure. Solution-focused, not problem-oriented.
Interval Levels of Measurement
At the interval level of measurement, numbers represent fixed measurement units but have no absolute zero point. Intervals between are equal. Your text uses the example of temperatures measured with the Fahrenheit scale. The temperature can definitely go below zero, as indicated in this weather forecast for Fargo, ND.
Ordinal Measures Cont.
At this level, you specify only the order of the cases (logical rank order), in "greater than" and "less than" distinctions. A common ordinal measure used in social service agencies is client satisfaction. You may ask clients to indicate whether they are "very satisfied," "satisfied," dissatisfied," or "very dissatisfied" with a particular service. A client who responds "very satisfied" is clearly more satisfied than a client who responds "dissatisfied" - but not twice as satisfied or 2 units more satisfied.
Undoing
Atoning for unacceptable desires or actions
Ego
Attempts to organize and mediate between the id and the reality of dangers posed by the id's impulses. Has contact with the external world of reality. It is the executive that governs, controls, and regulates the personality.
4 Selfish Goals for Attaining Superiority
Attention seeking, Power seeking, Revenge taking Declaring deficiency or defeat
Projection
Attributing to others one's own unacceptable desires and impulses This is a mechanism of self-deception. Lustful, aggressive, or other impulses that are seen as being processed by "those people out there, but not by me"
Core Constructs of Personality in Existential Therapy
Authenticity, Existential anxiety (Nonbeing, Meaninglessness, Isolation and loneness), Finiteness, Existential givens, Intentionality
Revised Diagnoses: Autism
Autism Spectrum Disorder This is likely one of the most significant (and controversial) diagnostic changes in the DSM- 5. It includes the disorders formerly known as: Autistic Disorder, Asperger's Syndrome, Pervasive Developmental Disorder, and Childhood Disintegrative Disorder.
Erikson: Early Childhood (age 1-3 years)
Autonomy versus shame and doubt. A time for developing autonomy. Basic struggle is between a sense of self-reliance and a sense of self-doubt. Child needs to explore and experiment, to make mistakes and and to test limits. If parents promote dependency, child's autonomy is inhibited and capacity to deal with world successfully is hampered.
Precontemplators
Avoid reading, talking, and thinking about the behavior that needs to be changed. The least confident about ability to take action. Most resistant to public policy changes. Feel pressured by others to take action, but have developed defenses. About 40% of people are in precontemplation.
BASIC I.D. (Integrative)
B = Behavior A = Affect S = Sensation I = Imagery C = Cognition I = Interpersonal relationships D = Drugs/biology
Cognitive Behavioral Approaches
Behavior Therapy Cognitive Behavior Therapy Rational Emotive Behavior Therapy Reality Therapy
Operant Conditioning is associated with
Behavior Therapy. Associated with the work of BF Skinner, who theorized that an individual's behavior will be repeated if it is positively reinforced. On the other hand, behavior that is punished (or does not elicit a reaction) will be eliminated
Functional Assessment (or behavior analysis)
Behavior Therapy. To identify the maintaining conditions by systematically gathering information about situational antecedents (A), the dimensions of the problem behavior (b), and the consequences (C) of the problem.
Research questions: empirical
Based on direct or indirect observation, experience, or experimentation
Categories of Statistical Analysis
Based on number of variables in analysis Based on primary purpose
End goals (daily goals) (Experiential)
Based on our biological needs, which are limited to hunger, sex, survival, shelter, and breathing. The social roles we adopt are the means-whereby we fulfill our end goals.
Relational Model
Based on the assumption that therapy is an interactive process between client and therapist.
Systematic Desensitization
Based on the principle of classical conditioning, is basic behavioral procedure developed by Joseph Wolpe, one of the pioneers of BT. Clients imagine successively more anxiety-arousing situations at the same time that they engage in a behavior that competes with anxiety.
Myers-Briggs Type Inventory
Based upon Jung's notions of psychological types. AN instrument for measuring a person's preferences, using four basic scales with opposite poles. The four scales are: 1) extraversion/introversion, 2) sensate/intuitive, 3) thinking/feeling, 4) judging perceiving
ABA Design
Baseline (A) - Treatment (B) - Baseline (A) (withdrawal) The withdrawal strengthens the relationship between the IV and DV Ex. Kid having trouble working on school work (i.e. staying on task), the treatment is setting up a reinforcement contingency that gives him a dollar for every minute he stays on task Problems: Doesn't completely control for extraneous variables (but more evidence!) Irreversibility Some IVs can't be withdrawn Some behaviors can't be reversed Ethical and legal issues Sequence effects
ABAB Design
Baseline - Treatment - Baseline - Treatment Increases the confidence in the treatment effect Better controls for extraneous variables Ex. Kid having trouble working on school work (i.e. staying on task), the treatment is setting up a reinforcement contingency that gives him a dollar for every minute he stays on task Problems Irreversibility (same as in ABA) Sequence effects
Theory of Personality:
Basic motivating force is actualization. We are born with: -actualizing forces that motivate us. -valuing processes that regulate us. We create our subjective world. Acquire conditions of worth. Need for unconditional positive regard.
Bibliotherapy (Psychodynamic Therapies)
Becoming more aware of one's lifestyle and disorder can be accelerated by reading books written by others, a process known as Bibliotherapy.
Physical contact with clients
Before engaging in physical contact with a client, the social worker should take into account the possible psychological, social and cultural ramifications of such contact. Taking ac client's and or a pat on the back can be interpreted differently depending upon client and situation. Clear boundaries should be set for such conduct.
Narrative Analysis
Begins with the lived experiences of individuals as told in stories May be a biography, autobiography, life history, oral history Analyze "whole story" of a single participant and assign a "genre" to the narrative What is the overall meaning, structure, focus of the story? More holistic look at each case than finding similarities in themes across cases Often the purpose of the research is to reveal the underlying mechanisms that account for social relations and to empower less powerful people. Purpose of research is to change the world
Reaction Formation
Behaving the opposite of what one truly desires that develops at first as a reaction to being very cleaning neat, as the parents demand, rather than expressing anal desires to be messy
Representative Techniques (Integrative)
Behavior: Positive/negative reinforcement, counterconditioning, extinction. Sensation: Tension release, sensory pleasuring. Imagery: Coping images, change in self-image. Cognition: Cognitive restructuring, heightening awareness, education. Interpersonal relationships: Modeling, assertion, developing social skills. Drugs/biology: Identifying medical illnesses, exercise, psychotropic medications.
3. Cognitive-Behavior Modification in BT
Behaviorism was established as a radical alternative to mentalist theories. Conditioning replaced cognition as the critical determinant of human behavior. Cognition gradually reintroduced in treatment of human disorders. Most behavior therapists now incorporate cognitive techniques.
A supervisor's role involves
Being a role model, recruitment and orientations, day-to-day management, staff training, education and development, staff assessments and reviews, provide support and counsel to staff, evaluating the program for ongoing improvement, advocating for staff and program needs
Main Qualities of Self-Disturbing Philosophies in CT
Beliefs are rigid and dogmatic (e.g., musturbatory thinking). Beliefs generate unrealistic and over- generalized attributions (e.g., catastrophizing).
Jean-Paul Sartre
Believed that humans are even more free than earlier existentialists had believed. Our values are what we choose. The failure to acknowledge our freedom and choice results in emotional problems.
Aaron T Beck
Believes clients can assume an active role in modifying their dysfunctional thinking and thereby gain relief from a range of psychiatric conditions
Impasse (Experiential)
Below the Phobic layer, the most critical level of psychopathology that is the very point at which we are stuck in our own maturation. The impasse is the point at which we are convinced that we have no chance of survival because we cannot find the means of within ourselves to progress when environmental support is withdrawn.
Free association
Beneficial in gaining non-censored insight into a client's thoughts and feelings
Bereaved vs. mourning
Bereavement is a state of being, specifically a change in status. Mourning refers to behavior associated with bereavement (crying and choice of isolation)
Practicalities of IPT
Best conducted by those with favorable attitude toward short-term treatment and no attachment to theoretical system. IPT typically 12-16 weeks in duration. Therapist adheres to treatment manual. Disposed toward cost-efficient formats and combining therapy with medication.
Effectiveness of Emotion-Focused Therapy in Experiential
Better than no treatment and placebo. Randomized clinical trials (RCT) show: EFT more effective than person-centered for depression. EFT equally effective as cognitive- behavioral for depression. Addition of emotion-focused to Rogerian therapy improves outcome.
Motivational Discrepancy (Person-centered)
Between present behaviors (real self) and desired goals (more ideal self). Evidence indicates that such discrepancy provides motivation that triggers behavior change.
New Diagnoses: BED
Binge Eating Disorder Symptoms include regularly eating unusually large amounts of food in a discrete period of time. Individuals with this disorder feel unable to control their binge eating. It is often done privately and accompanied by negative feelings (e.g. guilt, self- loathing, disgust, etc.). Their binge eating is not followed by an inappropriate attempt to compensate (e.g. exercising excessively or purging) as is commonly seen in Bulimia Nervosa or Anorexia Nervosa. Prior to the DSM-5, individuals with this binge eating pattern have been diagnosed with Eating Disorder NOS (not otherwise specified).
Disorder of mood
Bipolar
Oral Stage
Birth to 1. Mouth, thumb. Developmental challenge-passive incorporation of all good through mouth; autoerotic sensuality. Parents who are either too depriving or too indulgent can make it difficult for a child to mature beyond the oral stage. Deals with the inability to trust oneself and others, resulting in the fear of loving and forming close relationships and low self-esteem.
DBT Theory of Psychopathology (Third Wave)v
Borderline personalities are products of genetic and social abnormalities. BPD has biological predisposition for heightened reactivity to emotionall stimuli. BPD individuals especially vulnerable to invalidation of their emotions and thoughts via punishing, ignoring, and trivializing communications.
Edna Foa in Exposure Therapy
Born in Israel in 1937. Spent most of education and career in behavior therapy. Collaborated with colleagues in examining exposure therapy for anxiety disorders. Premier proponent of prolonged exposure (PE) with response prevention (RP).
Median or Mean
Both the median and mean are used to summarize the central tendency of quantitative variables. To decide which to use, consider these issues: Level of measurement: The median can be used with ordinal data; but, the mean requires interval or ratio level data the mode should be used for nominal level data. Shape of variable's distribution: The mean and median will be the same when the distribution is perfectly symmetric (Chapter 4). When the distribution is not symmetric, the mean is pulled in the direction of extreme values, but the median is not affected in any way by extreme values. Purpose of the statistical summary: If the purpose is to report the middle position, then the median is the appropriate statistic. If the purpose is to report a mathematical average, the mean is the appropriate statistic.
Supportive-Expressive Therapy (Psychodynamic)
Brief Psychodynamic treatments. Systemized by Lester Luborsky. Assists patients in identifying the recurrent themes in their lives that have negatively impacted their relationships with other people. Two main components: providing support in an understanding relationships (supportive) and simulating insight via clarifications and interpretations (expressive).
Reports of Superior Outcomes of Certain Treatments are Misleading in Integrative
Bruce Wampold notes 3 reasons: 1. Comparative therapy studies ignore therapist effects and overestimate treatment effects. 2. Comparison treatments are often not bona fide; lack of structural equivalence. 3. Purported outcome differences are often due to allegiance effect (researcher's favorite).
Positive Psychology
Building strengths rather than focusing solely on problems. Identifying patients' character strengths and virtues. Helping organizations and communities develop resilience, justice and optimism. Psychotherapists will simultaneously treat psychopathology and promote growth.
According to Freud's Theory, what is one way an individual can control the influence of the subconscious
By thinking before acting
Roll with resistance (Person-centered)
By using energy in the current/the client to steer the interaction
Empathetic mirroring
By which the self-object fully accepts the embryonic grandiose self.
Effectiveness in CT
CT is as or more effective than no treatment and placebo. CT is as or more effective as other treatments for depression, anxiety, panic, PTSD, eating disorders, chronic pain. Not limited to individual psychotherapy (e.g., couple and group therapy). CT with homework is more effective than therapy without.
Advantages of IRS's
Can be completed by clients, practitioners, relevant others, or independent evaluators Tailored to individual clients Easy to administer and score, and so can be used frequently What are some disadvantages?? Can be used with most clients Can be used to measure intensity of targets Can be used to measure thoughts and feelings sensitivity to change
Overt Behavior
Can be observed by others, at least theoretically e.g., time spent with child or spouse, time spent interacting by nursing home residents, number of completed Tx tasks, number of times a parent compliments his or her child
Existential Analysis (Daseinanalysis)
Can be viewed as an intermediate step between psychoanalysis proper and contemporary humanistic existentialism.
Unconditional Positive Regard
Can best be achieved through empathetic identification with the client. A deep and genuine caring for the client as a person, or a condition.
Discrete Variable
Can only take finite number of values Eg. Siblings (no 1.2 siblings)
Homework
Carefully designed and agreed upon and is aimed at getting clients to carry out positive actions that induce emotional and attitudinal change.
Played no role in the development of the objects relation theory
Carl Jung. He is known as the founder of analytical psychology
Person-centered
Carl Rogers' person-centered therapy seeks to guide the client in finding his or her own way toward self-growth. Reflection, as demonstrated in the example, is a common Rogerian technique. It is crucial that a counselor possess the three key factors of positive regard, congruence and empathy, which are vital to the counselor-client relationship
Causality
Cause: an explanation for some characteristic, attitude, behavior, occurrence Nomothetic Idiographic
Measures of Central Tendency: Mode
Central tendency is usually summarized with one of three statistics: 1. The mode, the most frequent value in a distribution, is the least often used as it easily gives a misleading impression: mnemonic - mode = most. If the mode occurs twice, then the distribution is called bimodal. Can be used for all four levels of measurement. May not be effective in describing what is typical in the distribution of a variable
Therapeutic Relationship in Gender Sensitive Therapies
Characterized by 2 Es: empowerment and egalitarianism. Empowerment: Therapist helps instill power, both social and individual, in client. Egalitarianism: Comparatively equal relationship between therapist and client. Treatment goals are mutually generated.
Narcissistic Personality
Characterized by a grandiose and exaggerated sense of self-importance and an exploitive attitude toward others, which serve the function of masking a frail self-concept.
Somatization disorder
Characterized by complaints regarding several organ systems involving different body sites and functions, rather a single body organ.
Therapeutic, or working, alliance (Psychodynamic)
Characterized by conscious collaboration and explicit consensus, in contrast to the unconscious distortion of the relationship between therapist and client.
Therapeutic Relationship in Exposure Therapy
Characterized by empathy, trust, and safety. Clinicians communicate respect for client courage, but not during active processing. Safe haven created through rapport, teaching relaxation, "stop signal."
Dementia
Characterized by slow and persistent escalation of symptoms over an extended period of time
The hurried child
Children who are pressured to grow up too quickly. Termed by David Elkind. He believed that children are pushed to grow up too fast, pushed too hard to succeed in life, and not allowed to fully experience their childhoods.
Non-Probability Sampling: Purposive sampling
Choose key informants from population for your sample Key informants are chosen to represent various parts of the population Often used for qualitative research
Convenience sampling
Choose whomever is easy to get Used for preliminary research, or some agency evaluations Problem: sample might not be very representative of population
Experiential Therapies
Class of psychosocial treatments in humanistic tradition. Core construct and central axis of change is experiencing. Personality is understood in terms of potentials for inner experiencing. Many variants of experiential therapies, but most popular and researched is emotion-focused.
Three Experimental Design types:
Classic Experimental Design Posttest-only Control Group Design Solomon Four-Group Design
A social worker sees clients through a court-ordered treatment program. In treating reluctant involuntary clients, the most difficult issue is:
Client ambivalence about the need for treatment
De-reflection (Existential)
Client are instructed to ignore that which they are obsessed with by directing their awareness toward more positive aspects of life.
Phases of EMDR in Exposure Therapy
Client history, Preparation, Desensitization, Installation, Body scan, Closure
Subpoena records
Client still must sign a written release
Illogical thinking and resistance
Clients can be nervous and confused in relating information during a therapy session. However, when the information being omitted is of significant relevance, it is more likely an issues of illogical thinking or even possible resistance to therapy.
Narrative Therapy in Constructivist
Clients construct their past by stories they tell in the present. Past can be changed by constructing new narratives or stories. "Reality" is our stories. Narrative therapists are antirealists: There is no objective reality behind our stories.
Therapeutic Processes in Exposure Therapy
Clients given clear rationale for treatment. Taught anxiety coping skills. Prolonged exposure. Given homework. Maintenance sessions as needed.
Genetic in theory of personality
Concerns the origin and development of psychic phenomena through the oral, anal, phallic, latency, and genital stages
Cases for Diagnosis Sheet Contd
Clinical Formulation/Diagnostic Impression: (rationale for diagnoses) • Principal/Primary Diagnosis and clinical syndromes (decide which diagnosis is primary or principal. Provisional can also be used). • Psychosocial Stressors and Developmental Functioning (This is the section where the previous Axis IV and V is handled.
Process Research (Person-centered)
Concerns the interactions between client and therapist, whereas outcome research tracks the success of effectiveness of therapy.
Latent Content of Dreams
Consists of hidden, symbolic, and unconscious motives, wishes, and fears.
Common medications for treating Schizophrenia
Clozaril, Haldol, Loxitane, Mellaril, Prolixin, Risperdal, Stelazine, Thorazine, and Zyprexa.
Dementia, mild, due to head trauma
Cognitive impairment (an IQ of 70 or lower) after the age of 18
Exploratory Research Cohort/Panel Studies
Cohort study - pool of potentials does not change, but specific cases selected for study will differ during different stages of data collection. Panel study - same group of participants would be studied over time (increases causal-type findings); goal is to know whether individuals in a population have changed over time. Difficulties include expense; attrition; and subject fatigue.
James Bugental
Coined the term "existential-humanistic" psychotherapy, and he was a leading spokesman for this approach. The therapist's primary task involved helping clients to make new discoveries about themselves in the living moment, as opposed to merely talking about themselves.
Therapeutic Relationship in CT
Collaborative empiricism: Shared mission to determine dysfunctional thoughts and pursue better ones. Client is active partner. Therapist provides support and direction; however, empathy is not sufficient. Therapist engenders responsible dependency in client.
Research Risks
Colleagues e.g., plagiarism, inadequate credit to contributors, taking advantage of privileged information Public-at-large and society e.g., distrust resulting from deception in the conduct or reporting of research Participants e.g., undesirable effects such as physical, psychological, or legal harm
Decoding
Communication is a two-part process, involving both the sending and receiving of information. This remains true, regardless of the method of communication involved (verbal, written, symbolic, body language, etc.). The recipient of any communication is required to record the information in order to perceive, understand, and respond to the information that was received.
All aspects of the helping relationship depends upon
Communication. Beyond therapeutic skill, academic knowledge or other counseling-related factors, the basic ability to connect with another individual is a crucial first step
Four Systemic Therapies
Communication/strategic therapy, Structural therapy Bowenian therapy, Evidence-based family therapy
Verifying Validity
Compare observations to a standard (criterion validity) Compare observations to other measured variables, if predicted relationships
Verifying Validity of IRS's
Compare to a standard (criterion validity) Compare to other measured variables (construct validity) Determine whether expected changes occur (sensitivity to change, construct validity)
Core values of social work
Competence, dignity of the individual, integrity, importance of human relationships, service, and social justice
Multimodal Theory of Psychopathology (Integrative)
Complex interplay of genetic endowment, social- learning history, and physical environment. Most disorders emanate from perceived associations (cognitive) rather then actual conditioning (behavioral). Occam's razor: The simplest explanation is often the best. A precise explanation of psychopathology is not required to remedy it.
Brief Therapy
Concentrates on small changes that are necessary and is also known for its focus on solutions and treatment
Some Dimensions Along Which Standardized Scales Differ
Concept measured - uni-dimensional or multidimensional (has subscales) Reliability and validity Perspective - client self report, clinician report, etc. Structure (type of items) Reverse scored items Type of respondent (e.g., client) Time, effort, training needed to administer, score, and interpret Reading level
Action or behavioral therapies
Conditional stimuli (Experiential level: counterconditioning; environmental level: stimulus control) Contingency control (Experiential level: reevaluation; Environmental level: contingency management)
An ethical principle
Confidentiality
Tarasoff vs. Regents of the University of California (1976) in regards to HIV
Confidentiality can be broken, in the situation of a client having HIV/AIDs and not disclosing to partner: 1) the HIV infection is known, 2) unprotected sex (or sharing of needles) is occurring, 3) the behavior is actually unsafe, 4) the client refuses to modify his behavior even after being counseled regarding the harm, 5) if HIV transmission will likely occur
The limits of confidentiality
Confidentiality is a critical issues in social work, but there are limits, and a client should be made aware of those limits.
Intrapersonal Conflict
Conflicts are competing forces within the person, such as a conflict between desires to be independent and fears of leaving home.
According to Freud's structural theory of personality development, mental disturbances and psychological maladjustments are primarily the result of
Conflicts between the id, ego, and superego. These three elements of an individual's personality must be unified and work together smoothly for optimum mental health.
DSM III-R
Confrontation with Feminists resulted in the removal of "Paraphilic Rapism, Self- defeating Personality Disorder" & "Premenstrual Dysphoric Disorder" (PMDD). "Ego-Dystonic Homosexuality" was removed even though Spitzer admitted that homosexuality was not included or removed based on empirical grounds. It became an issue because of heterosexual biases.
Topographic in theory of personality
Conscious vs. unconscious modes of functioning
Awareness or Insight Therapies
Consciousness Raising (experiential level: feedback; environmental level: education) Catharsis (Experiential level: corrective emotional experiences; Environmental level: dramatic relief) Choosing (Experiential level: self-liberation; environmental level: social liberation)
Therapeutic Process in Systems
Consciousness raising Choosing Counterconditioning Contingency management
REBT's Therapeutic Processes in CT
Consciousness raising (aware of irrational thinking patterns) Counterconditioning (replace irrational thinking with rational thinking) Contingency management (rearrange reinforcements to support behavior changes)
DBT Therapeutic Processes (Third Wave)
Consciousness raising (focus on present without judging) Choosing (clients become mindful and accept distressing events) Counterconditioning (effective skills when changing behavior and mindfulness when accepting situation) Dialectic between behavior change and radical acceptance
ACT Therapeutic Processes (Third Wave)
Consciousness raising (present- moment focus) Choosing (committed action) Catharsis Counterconditioning (mindfully observe and accept rather than fight)
Therapeutic Processes: Experiential
Consciousness raising regarding phony games and roles; liberation from maya. Cathartic explosion of breaking out of neurosis (obtained after consciousness raising). Therapists show confidence in client by pressing ahead when client doubts own ability. Therapists cannot let client shift responsibility for progress.
Processes of Change in Systemic Therapy
Consciousness raising: Aware of rules for communicating and relating. Choosing: Straight directives and paradoxical techniques. Catharsis: Satir's emphasis on feelings. Counterconditioning: Haley's emphasis on power and ordeal therapy.
Experiential Processes
Consciousness raising: Increasing awareness Dramatic relief: Emotional arousal Self reevaluation: Self reappraisal Environmental reevaluation: Social reappraisal Social liberation: Environmental opportunities and advocacy
Therapeutic Processes in Constructivist
Consciousness raising: More conscious of problem exceptions; solution talk (not problem talk); miracle question raises awareness. Choosing: If it works, don't fix it. Choose to do more of it. If it works a little, choose to build on it. If nothing seems to be working, choose to experiment. Approach each session as if it is the last.
Elements of Hypothesis
Consistency of Conceptualization, Relevance to Problem Completeness, Specificity, Potential for testing
Stages of Change
Constellation of individual's attitudes, intentions, and behaviors related to readiness to change problem. A temporal dimension unfolding over time. 5 stages: precontemplation, contemplation, preparation, action, maintenance. If change is unsuccessful, then recycle (relapse) back into stages. If change is complete and stable, then termination.
Constructivist Therapies
Constructivism: one cannot attain knowledge of reality that is objective or independent of knower. Constructivism ≠ nihilism; real things exist, but we cannot access reality outside of language. Constructivism vs. empiricism Clients cannot be reduced to universal principles to explain personality or pathology. Part of postmodern movement.
EBP and measurement integrates knowledge gained from research with
Consumer values and clinical expertise. Used to make decisions about when and how to interact with clients. Evidence is gathered about what treatment may work best with particular clients and is administered appropriately.
Practicalities of Feminist Therapy in Gender Sensitive Therapies
Consumer-oriented: Clients encouraged to shop around for therapist. Lower-cost sessions common. Empowered consent regarding risks and benefits of psychotherapy. Non-hierarchical leadership to group treatment and community organizations. Mostly, but not always, women therapists. Length of treatment determined by patient. Treatment length increases when client decides to pursue more ambitious goals. Feminist consciousness takes considerable time. Successful feminist action takes even longer.
Unconscious Mind
Containing thoughts and ideas that are hidden from awareness
Conscious Mind
Containing thoughts and motivations which hare already in full awareness, and thus can readily be manipulated, accessed, and otherwise utilized
Preconscious Mind
Containing thoughts beyond active awareness, but which can easily be accessed and recognized
Collective unconscious (Psychodynamic Therapies)
Contains primordial archetypes inherited from our past that record common experiences repeated over countless generations. Developed by Jung.
Manifest content
Content that is conscious
Types of Variables
Continuous Discrete
Heteronomy (Person-centered)
Control by others and the environment, to autonomy, or inner control
Single system designs (SSD) are most appropriate in what environment?
Controlled environment
Construct Validity (continued)
Convergent construct validity - if measure is correlated with another measure (then will have a positive correlation). Discriminant construct validity - if measure is not correlated with variables that is should not be correlated (negative correlation). Usually reported in correlations: -1.0_______________________0______________________+1.0 Correlations larger than .30 (positive or negative) find these measures "fit or hang" together. Correlations larger than .60 (positive or negative) are considered very strong.
Striving for Superiority (Psychodynamic Therapies)
Core motive of the human personality. Means striving to live a more perfect and complete life and gives power to human drives. To rise above what we currently are rather than attain social distinction.
Values Imposition
Counselors directly attempting to define a client's values, attitudes, beliefs, and behaviors. It is possible for counselors to impose their values either actively or passively.
Processes of Change
Covert or overt activities that people engage in to alter emotion, cognition, behavior, or relationships. Systems of psychotherapy differ on what to change (content), but tend to agree on how to change (processes). Change processes with most use/ agreement are consciousness raising and therapeutic relationship.
Culture is created by humans
Created through socialization rather than inherited. It's also influenced by various factors, including proximity to the community. Although racial issues influence a culture, it is not restricted by race. An individual's environment has the greater effect.
Psychoanalytic Therapy
Credited to Franz Alexander and his colleagues at the Chicago Institute of Psychoanalysis. Alexander and colleagues argued that orthodox analysis has been developed by Freud to serve as a scientific means of gathering knowledge about neuroses, as well as means for treating neuroses.
Generalized Anxiety Disorder
Criteria for GAD specifies excessive worry about a number of events or activities as opposed to an isolated fear or concern. Persists in spite of any specific location or activity
Validity and Reliability of Observational Research
Criterion Validity Compare results with other method results. Behavior of observed person Revealing behavior of observed that reflects badly. Inter-rater (inter-coder) reliability Coding or observing consistently. Reactivity Presence of researcher influences on observed.
Kairos (Existential)
Critical choice points and momentous opportunities for deciding whether to risk changing a fundamental aspect of existence.
Empowerment theory
Critical review of attitudes and belief about self and one's sociopolitical environment Validation of one's experience Increased knowledge and skills for self care, critical thinking and action Action taking for personal and political change
According to NASW, the policies, behaviors, and attitudes works well with people regardless of race, religion, class, or cultural is formally referred to as
Cultural Competence
Theory of Personality in Multicultural Therapy
Culture is a major determinant of personality. Culture is constellation of human knowledge, belief and behavior passed down from earlier generations. No single theory of personality for multicultural treatment. We require multiple perspectives rooted in particular cultures.
Ego Psychology
Deals with both the early and the later developmental stages, for the assumption is that current problems cannot simply be reduced to repetitions of unconscious conflicts from early childhood. Ego psychology does not deny the role of intrapsychic conflicts but emphasizes the striving of the ego for mastery and competence throughout the human life span. Part of classical psychoanalysis with the emphasis placed on the vocabulary of id, ego, and superego, and on Anna Freud's identification of defense mechanisms
Finiteness (Existential)
Death reflects the finiteness of our time and creates anxiety.
DSM III Contd
DSM III The controversy over homosexuality though, was again at the forefront. As chairman, Spitzer wanted to retain the diagnosis for homosexuals, as it was thought that they experience distress over their sexual orientation and therefore were disordered. The diagnosis of "Ego-Dystonic Homosexuality" thus appeared in the DSM III.
Thematic Analysis
Data collection/analysis may be led by previous research/theory Describes themes in the data, some common patterns without creating a grand theory May still organize data from "in vivo" to higher order themes, often start with a predetermined codebook and build from there Similar coding technique to grounded theory, different outcome
Sources for Qualitative Research
Data from case studies Personal experiences of people Interviews with people Introspections Life stories Observations Historical interactional & visual texts Pictures videos
A-B Comparison of Data
Data from the baseline phase (A) is compared to data from the intervention phase (B). To infer that in intervention is effective, that is improvements in the dependent variable (stated problem goal) are attributed to the intervention and not some rival explanation such as history or maturation, look for shifts in the trend or pattern of data coinciding with shifts between baseline (A) and intervention (B) phases.
Qualitative data analysis
Data not as numbers But as words, notes, video from interviews, focus groups, observations Generally subjective Not designed to test hypotheses They arrive at hypotheses Needs to be transcribed Meaningful content may be embedded in noise (superfluous words, social greetings etc) Needs to be isolated, quantified to degree possible Involves content analysis and coding
Secondary Data
Data originally collected by another researcher for a study Administrative data: Agency files Surveillance data collected by the government (e.g., crime data, hospital admissions, traffic fatalities, medicare billing)
Conceptualization Example
Decisions about how to define a concept reflect the theoretical framework that guide researchers. For example, do we define "poverty" by: -an absolute standard? -a relative standard? -a subjective standard?
Deductive Logic
Deductive Method Researcher begins with a theory, then derives one or more hypotheses from it for testing (quantitative).
Self Psychology
Deemphasized id impulses in early relationships. Development of ideal situation through mirroring and idealizing.
Repression
Defense: threatening or painful thoughts and feelings are excluded from awareness. Uses: One of the most important Freudian processes, it is the basis of many other ego defenses and neurotic disorders. Freud explained repression as an involuntary removal of something from consciousness. It is assumed that most of the painful events of the first 5 or 6 years of life are buried, yet these events do influence later behavior.
Regression
Defenses: Going back to an earlier phase of development when there were fewer demands. Use: In the face of severe stress or extreme challenge, individuals may attempt to cope with their anxiety but clinging to immature and inappropriate behaviors.
Identification
Defenses: Identifying with successful causes, organizations, or people in the hope that yo will be perceived as worthwhile. Uses: Can enhance self-worth and protect one from a sense of being a failure
Compensation
Defenses: Masking perceived weaknesses or developing certain positive traits to make up or limitations. Uses: This mechanism can have direct adjustive value, and it can also be an attempt by the person to say "don't see the ways in which I am inferior, but see me in my accomplishments."
Introjection
Defenses: Taking in and "swallowing" the values and standards of others Use: Positive forms of introjection include incorporation of parental values or the attributes and values of the therapist (assuming that these are not merely uncritically accepted).
Early Recollections
Defined as "stories of events that a person says occurred (one time) before he or she was 10 years of age."
Malingering
Defined as feigning symptoms to gain some external benefit, e.g., disability benefits.
A social assessments report should include
Demographic facts, social data, and social work data assessment and interpretation
Ivan Pavlov
Demonstrated classical conditioning, with the idea that if an unconditioned stimulus and response are paired often enough, the conditioned stimulus will produce an unconditioned response (behavior) on its own.
Dependent Variable
Dependent (criterion - Y) variable - assigned to the variable you are most interested in explaining/knowing more about. The Outcome Variable "Child's developmental success"
Most common lifetime disorder
Depression. Some people may have one major episode, while others experience it as a recurring problem throughout their life
Denial
Derives from having to finally close one's eyes and go to sleep as a way of shutting out the unmet oral needs.
Albert Bandura
Explored social learning theory and the prominent role of observational learning and social modeling in human motivation, through, and action.
Categories of Statistical Analysis Based on the primary purpose
Descriptive analysis Raw data (scores) is summarized To communicate salient characteristics of data set May involve compiling graphs, tables, descriptive summaries of measurements Easier to comprehend and interpret when compared to data from each case
Common Factors in Integrative Therapy
Determine the core ingredients that different therapies share. Goal: Create more parsimonious and efficacious treatments based on commonalities. Commonalities account for more outcome than unique factors that divide the therapies. Occupy an intermediate level of abstraction, between concrete technique and global theories.
Generally, the first thing the social worker should do in treating the client
Determine the goals for treatment.
Therapeutic Relationship in Systemic Therapy
Develop an atmosphere conducive to congruent communication. Empathy and positive regard are important. Therapist is in charge and in control. Therapist uses direct and indirect techniques to control relationship.
Irvin Yalom
Developed an existential approach to psychotherapy that addresses four given of existence" or ultimate human concerns: freedom and responsibility, existential isolation, meaninglessness, and death.
Cognitive Therapy (CT)
Developed by Aaron Beck as a result of research on depression. CT perceives psychological problems as stemming from commonplace processes such as faulty thinking, making incorrect inferences on the basis of inadequate or incorrect information, and failing to distinguish between fantasy and reality.
Individual Psychology (Psychodynamic Therapies)
Developed by Adler to underscore the importance of studying the total individual in therapy.
Social Learning Approach (Social-Cognitive Approach)
Developed by Albert Bandura and Richard Walters is interactional, interdisciplinary, and multimodal.
Analytical Psychology (Psychodynamic Therapies)
Developed by Carl G. Jung
Logotherapy
Developed by Frankl. Means "therapy through meaning."
Emotion-Focused Therapy (EFT)
Developed by Leslie Greenberg and is related to Gestalt Therapy. Entails the practice of therapy being informed by understanding the role of emotion in psychotherapeutic change. Blends the relational aspects of the person-centered approach with the active phenomenological awareness of experiments of Gestalt Therapy.
Bowen Family Systems Therapy
Developed by Murray Bowen (1913- 1990). Initially applied to schizophrenic families at NIMH. Dramatically applied to his own family. A cerebral and deliberate approach.
Character Analysis (Psychodynamic Therapies)
Developed by Wilhelm Reich as an alternative to classical psychoanalysis.
Interpersonal Psychotherapy (IPT)
Developed in early 1970s by Gerald Klerman and colleagues. Originally intended as treatment for depression. Established in the research heritage. Myrna Weisssman and John Markowitz updated treatment manual after Klerman's death.
Benefits of Focus Groups
Developing hypotheses; Developing survey questions; Investigating the meaning of survey results; Quickly assessing a range of opinions.
Growth groups
Developing personal potential
Adjustment Disorders
Diagnosed differently in children an adults
Senile
Diagnostically, the term senile is only an indicator of age 65 or older
Types of Variables
Dichotomous Binary Dummy Variable
Nominal Measures Example
Did you receive the intervention or not? How did you hear about the agency: telephone book ad; Mailing to home; Other.
Beck's Cognitive Therapy vs. Ellis's REBT
Different terminology. CT emphasizes empiricism to greater extent than REBT. CT relies more on evidence to alter beliefs while REBT focuses more on philosophical conversion. CT is more structured, REBT less so. CT is less confrontational than REBT.
Bowen's Theory of Psychopathology (Systems)
Differentiation of self is ability to be objective and controlled about emotional matters. Emotional illness arises when individuals unable to differentiate from their families of origin (fusion). Fusion results in undifferentiated family ego mass. Fusion leads to triangulation. The child closest to parents is most likely to develop pathological symptoms. Emotional cutoffs are efforts to cope with unresolved attachments to families of origin. Family projection process Multi-generational transmission process
Stage 4 of Group Development
Differentiation. Group members display opinions and differing views more readily
Existential confrontation (Existential)
Differs from psychoanalytic confrontation in that existentialist reveal their own experience of the pa tent and do not just reflect that patient's experience.
Threats to Internal Validity: Diffusion or Initiation of Intervention
Diffusion or Initiation of Intervention Practitioners communicate with each other; or client learns about the information. For example, if one member of the Ice Cream Sundae Therapy treatment group shared her ice cream with a member of the control group.
Displacement
Directing energy toward another object or person when the original object or persons is inaccessible. Displacement is a way of coping with anxiety that involves discharging impulses by shifting from a threatening object to a "safer target." For example, the meek man who feels intimidated by his boss comes home and unloads inappropriate hostility onto his children.
Research Hypotheses: Directional
Directional - provide a tentative statement on exactly how the IV impacts the DV Positive - as the IV goes up (or down) the DV goes up (or down) "Increased drug use increases depression" "Decreased drug use decreases depression" Negative (inverse) - as one variable goes up, the other goes down; and, as one variable goes down the other variable goes up. "Increased drug abuse will decrease depression" "Decreased drug abuse will increase depression"
Exposure Therapies
Directly confront feared stimuli and activate intense emotions. Particularly useful in treatment of anxiety and trauma. Two exposure therapies in chapter: Exposure (Edna Foa) Eye movement desensitization and reprocessing (EMDR) (Francine Shapiro) Designed to treat fears and other negative emotional responses to introducing clients, under carefully controlled conditions, to the situations that contributed to such problems.
Specific Methods with Involuntary Clients in Constructivist
Discover what client wants. Define what will satisfy the referring person. Talk in terms of solutions, not problems. Find past and recent successes. Determine what will repeat exceptions. Ask about the next steps in achieving goal. Ascertain how others will scale progress. Assist client in establishing sufficient treatment.
Francine Shapiro in Exposure Therapy
Discovered deliberate eye movements made her thoughts less distressing. Founder of EMDR and EMDR Humanitarian Assistance Program. Controversial early on for restricting EMDR training.
Qualitative Data
Discrete categories, usually designated by words or labels, and non-numerical differences between categories May be words, phrases, long quotations or whole narratives Type of data used depends on design and data analysis technique used
Administering Standardized Scales
Discuss confidentiality issues Discuss importance of accuracy Explain relevance of the measure Provide clear instructions, answer questions, and don't rush Take care in how you respond Be sensitive to educational, social, and cultural background
Maximizing Reliability and Validity of IRS's
Discuss confidentiality issues with clients Present with confidence Discuss importance of accuracy with clients Collect only relevant information Minimize difficulty of recording Clearly define what is to be done Record as soon as possible after event Use information Don't inadvertently encourage reports of improvement
Theory of Psychopathology: Experiential
Disruption of maturation can cause 5 levels of psychopathology: phony, phobic, impasse, implosive, and explosive. Maya is phony level created to protect us from threatening aspects of our selves or world. Unhealthy people refuse to accept they have attributes of both poles of life and lose their ability to flow through the gambit of emotions.
New Diagnoses: Disruptive Mood Dysregulation Disorder
Disruptive Mood Dysregulation Disorder (listed under Depressive Disorders) The addition of this diagnosis will hopefully reduce the number of children misdiagnosed with Bipolar Disorder, who are subsequently prescribed heavy duty drugs as part of their treatment. Prominent symptoms of DMDD include: a persistent, irritable mood and frequent, major anger outbursts or tantrums. Some healthcare providers are concerned about this diagnosis, arguing that the symptoms aren't necessarily abnormal and shouldn't warrant a mental health diagnosis. Opponents to this new addition also argue that these symptoms may also be caused by several other psychiatric disorders.
Dissemination and implementation (Person-centered)
Dissemination refers to spread the evidence based treatment to professionals and the public; it's out there. Implementation refers to practitioners using the treatment and thereby altering their clinical behavior-it's actually implemented.
Panic disorder symptoms
Dizziness, shortness of breath, palpitations, profuse sweating, tingling, hyperventilation, etc.)
Archetypes
Do not originate in the world of the senses, but exist independently of that world and are known directly by the mind. Jung believed that the archetypes arise spontaneously in the mind, especially in times of crisis.
Therapeutic Core Conditions
Do not vary according to client type. Exist over some period of time, constructive personality change will occur.
Evaluation of Measures - Validity Types-Content Validity
Does the measure cover the full range of meaning? Does it provide an adequate sample of all the content or elements of the phenomenon being measured? Useful when a great deal is known about the variable being measured. i.e. a weekly quiz in a research methods course fairly assesses the chapter's content. This is judged by experts. For example, does an instrument designed to measure depression ask questions about depressed mood, difficulty sleeping, not taking pleasure in activities, weight gain or loss... Face validity (the "duh" test) Does the test "look valid" to the examinees who take it, the administrative personnel who decide on its use, and other technically untrained observers. If it looks like a duck, and quacks like a duck, it is probably a duck. Does the test appear to superficially measure a given variable? Content validity requires more rigorous statistical tests than face validity, which only requires an intuitive judgment.
Anal Personality
Dominated by holding-on tendencies
Working alliance
Done to help the patient work in the face of potential terror and resulting defensiveness.
Ice breaker exercises
Done to make member comfortable in the group setting. In most new groups, the counselor has the responsibility to create a comfortable atmosphere conducive to free expression. A variety of exercises may be used to accomplish this, and such endeavors.
The fundamental premise of Freud's psychoanalytic theory is that human behavior is best understood as arising from:
Drives and unconscious motivations
The Freudian terms cathexis and anti-cathexis refer to forces collectively known as:
Driving forces.
Developmental Model I: Perry's stages of ethical development
Dualists: True believers who view world in polar, dichotomous terms. Multiplists: True bettors who accept diversity and uncertainty, but favor a single theory. Relativists: True eclectics who embrace pluralism and see validity as issue-specific. Committed: Accept relativism but committed to mastering and improving a particular theory.
Therapeutic Relationship in Constructivist
Each relationship is unique, not predetermined by clinician's theory. Little can be generalized from one client to another. Therapist gently guides clients into constructing new, more liberating stories. Therapists contribute to the "reality" of a story by narrative empathy.
Adaptation
Eco-systems theory (also known as life model theory) postulates that all individuals experience adaptation by which they attempt to achieve a "goodness of fit" to their physical and social environment. Ex: blended family adapted to revising roles, rearranging the home as needed, and altering schedules and activities to accommodate each other
Errors in causal reasoning
Ecological fallacy: thinking that group results apply to each and every individual Reductionism: thinking that an individual's results apply to an entire group
Germain and Gitterman are best known for their work on what theory?
Ecological systems. Best known for their work on the Life Model of Ecological Systems Theory, which is based on the premise that there is a mutual, interdependent relationship between people and their environment.
Adlerian Goals for Bibliotherapy (Psychodynamic Therapies)
Educate by filling in psychological knowledge and gaps. Encourage by reading inspirational materials Empower by reviewing goal formation and attainment Enlighten by increasing self- and other-awareness Engage with the social world through modeling and social mentoring Enhance by reinforcing specific lifestyle changes addressed in psychotherapy.
Effectiveness of MST in Systems
Effective and cost-effective in treatment of conduct disorders. Effective to include parents in treatment. No convincing evidence MST outperforms other systemic therapies. Not suited for all patients and contexts.
Effectiveness of Exposure Therapy
Effective in treating PTSD, OCD, specific phobias, and social phobia Only small % of clients experience symptom exacerbation. Low relapse rates. Treatment of choice for many anxiety disorders.
Type of evaluation addresses processes and outcome, which enables staff to measure the three E's of:
Effort, efficiency and effectiveness. Effort refers to the resources used in carrying out the program. How well the program uses those resources reach its intended results speaks to "efficiency." Finally, "effectiveness" refers to how well the goals of the program were reached.
Dual (or multiple) relationships
Either sexual or nonsexual, occurs when counselors assume two (or more) roles simultaneously or sequentially with a client.
Community Feeling
Embodies the feeling of being connected to all of humanity-past, present, an future- and to being involved in making the world a better place. Those who lack this community feeling become discouraged and end up on the useless side of life.
Gemeinschaftsgefuhl (Psychodynamic Therapies)
Embraced by the ideal person. The social interest that allows us to contribute to the common welfare. Social interest is not just an idealistic or inspirational value; it is also a pragmatic goal that produces mental health in life.
Shame-attacking exercises
Emotional disturbance related to the self is often characterized by feelings of shame, guilt, anxiety, and depression.
Therapeutic Relationship in Multicultural Therapy
Empathy, regard, and collaboration are foundation. Relationship can be challenging if therapist is of different race and ethnicity. Meaning of "therapist" varies by culture. Racial/ethnic matching of therapist and patient may be preferred. Therapist adapts to cultural preferences. Therapist is advocate: Empowers client for social change.
Ego Psychology (Psychodynamic Therapies)
Emphasis on the ego and its functioning
Object Relations (Psychodynamic)
Emphasize relationships between the self and other people as the major organizing principle in people's lives.
Ego Psychology (by Heinz Hartmann)
Emphasizes the ego structure of the personality, and the behavioral patterns and perceptions by which individuals adapt to their social environment. Ego psychology postulates that adaptation is a process of mutual exchange between an individual and the surrounding environment.
Existential Analysis
Emphasizes the subjective and spiritual dimensions of human existence.
Personality & Psychopathology in Constructivist
Empirical theories of personality can be oppressive and even destructive. Empiricism tells clients who they are. Narrative therapist asks clients who they are. Narrative therapists reject theories of personality and psychopathology. Narrative therapy helps construct new stories and new meanings.
Evidence-Based Practice
Empirically supported treatment. The integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.
Dialectical Behavior Therapy (DBT)
Employs behavioral and cognitive behavioral techniques, including a form of exposure therapy in which the client learns to tolerate painful emotions without enacting self-destructive behaviors.
Subjective Empathy
Enables practitioners to experience what it is like to be the client
Mahler's Autistic Stage (1)
Encompasses the first month and is characterized by total self absorption and a lack of response to external stimuli
Object-Relations Theory
Encompasses the work of a number of rather different psychoanalytic theories. Their emphasis is how our relationships with other people are affected by the way we have internalized our experiences of others and set up representations of others within ourselves.
Purposes of Single Subject Design
Encourage social work practitioners to assess the case as objectively as possible, and to monitor these changes in the client targets and/or situation over time; Evaluate whether changes actually have occurred in targeted client events; Evaluation concerns whether the practitioners' intervention could be causally linked to these observed changes; To enable practitioners to compare the effectiveness of different interventions; Can be built into every social work practitioners' practice with each and every case/situation.
Theory of Personality: Experiential
End-goals based on biological needs of hunger, sex, survival, shelter, and breathing. Humans spend inordinate energy pursuing social means as end-goals, and proving to others that our social end-goals are relevant. Maturation entails realizing others do not exist to serve you and you do not exist to serve them. Childhood experiences can limit maturation. Mature people discover new means of achieving end-goals.
Benefit of "culture match"
Enhanced insight into the client's situation. A SWer of the same culture as the client can help to put the client at ease and also offer additional insight into the client's situation. However, being of the same culture does not ensure greater level of counseling skill
Dynamic in theory of personality
Entails the interaction and conflict among psychic forces
Therapeutic Processes in BT
Environmental contingencies shape, maintain, and extinguish behavior. Behavior modification systematically controls contingencies to shape behavior. Change the contingencies and the behavior will change.
In thinking specifically with PIE, which is most likely to create social functioning difficulties
Environmental unresponsiveness. Transitions in life, relationship problems and environmental unresponsiveness are three common PIE situations likely to cause social functioning difficulties
Crisis
Equivalent to a turning point in life when we have the potential to move forward or to regress.
Psychosocial Stages (Psychodynamic Therapies)-Erikson
Erik Erikson broadened Freud's psychosexual stages to psychosocial stages that being in infancy and extend through life to old age. The life cycle is described in terms of eight discrete crisis periods.
One of the earliest theorists to address human development from a total lifespan perspective
Erik Erikson. He developed the psychosocial theory of human behavior and personality, which addresses psychosocial stages of development from birth to senior years.
Psychosocial Stages
Erik son's basic psychological and social tasks, which individuals need to master at intervals from infancy through old age.
Upon first meeting a client, a social worker should begin by taking the following steps (in this order)
Establish rapport, summarize legal and ethical obligations, complete a service contract, and assess the client
Ego Psychology/Analysis in Psychodynamic
Established by Hartmann, Kris, Loewenstein, Erikson, Rappaport. Assumes ego is separate from the id. Postulates that ego has conflict-free spheres (autonomous ego). Psychosocial (not psychosexual) stages Later stages are as important as early stages.
Acceptance
Fifth stage of grief. Characterized by an acknowledgement of reality and a belief. in eventual recovery.
Ego Psychology/Analysis
Established by Hartmann, Kris, Loewenstein, Erikson, Rappaport. Assumes ego is separate from the id. Postulates that ego has conflict-free spheres (autonomous ego). Psychosocial (not psychosexual) stages-Later stages are as important as early stages.
Evaluation Responsibiliites
Ethical guidelines of practice + Provide demonstrable help Demonstrate that no harm is done Involve the client in the consideration of evaluation of their situation Involve the client in the identification and measurement of targets and goals Minimize the extent to which evaluation intrudes on the intervention process Stop evaluation when harmful to client Ensure confidentiality within legal and ethical limitations, and clarify the limitations of confidentiality Balance the costs and benefits of evaluating practice Demonstrate sensitivity and respect for the client's individuality, especially in regard to ethnicity, race, socio-economic status, sexual orientation, and gender Consider using a Client Bill of Rights
Types of Qualitative Research
Ethnography Case Studies Life History Focus Groups MANY types of qualitative research Like quantitative, each has its own implications for all aspects of research design ALL REQUIRE RIGOR in methods
Assessment
Evaluating the relevant factors in client's life to identify themes for further exploration in the counseling process.
Can we practice without evaluating our practice?
Evaluation is an inherent part of practice - most often it occurs inside our heads We all evaluate our practice--the question is how best to do it - tacit and explicit vs. tacit only
Consequences
Events that maintain a behavior in some way, either by increasing or decreasing it.
Castration Anxiety
Eventually causes the son to repress his desire for his mother, repress his hostile rivalry toward his father, and identify with his father's rules, in the hope that if he acts as his father would have him act, he can avoid castration.
There are three main methods of collecting validity evidence.
Evidence Based on Content Content-related evidence is based on a judgment of the degree to which the items, tasks, or questions on a test adequately represent the domain of interest. Expert judgment is used to provide evidence of content validity. -To make a decision about content-related evidence, you should try to answer these three questions: -Do the items appear to represent the thing you are trying to measure? -Does the set of items underrepresent the construct's content (i.e., have you excluded any important content areas or topics)? -Do any of the items represent something other than what you are trying to measure (i.e., have you included any irrelevant items)?
There are three main methods of collecting validity evidence.
Evidence Based on Internal Structure Some tests are designed to measure one general construct, but other tests are designed to measure several components or dimensions of a construct. For example, the Rosenberg Self-Esteem Scale is a 10 item scale designed to measure the construct of global self-esteem. In contrast, the Harter Self-Esteem Scale is designed to measure global self-esteem as well as several separate dimensions of self-esteem. -The use of the statistical technique called factor analysis tells you the number of dimensions (i.e., factors) that are present. That is, it tells you whether a test is unidimensional (just measures one factor) or multidimensional (i.e., measures two or more dimensions). -When you examine the internal structure of a test, you can also obtain a measure of test homogeneity (i.e., how well the different items measure the construct or trait). -The two primary indices of homogeneity are the item-to-total correlation (i.e., correlate each item with the total test score) and coefficient alpha (discussed earlier under reliability).
There are three main methods of collecting validity evidence.
Evidence Based on Relations to Other Variables This form of evidence is obtained by relating your test scores with one or more relevant criteria. A criterion is the standard or benchmark that you want to predict accurately on the basis of the test scores. Note that when using correlation coefficients for validity evidence we call them validity coefficients.
Statistical Significance
Evidence, based upon mathematics & the rules of probability, that the relationship between variables in a research sample is very unlikely to have been produced by sampling error. In hypothesis testing, this means obtaining an outcome that permits rejection of the null hypothesis.
Exploratory Research: Cross Sectional Survey Design
Examine the plausibility of parent-child discord as a cause of childhood behavioral disorders by administering two measures to children at the same point: one assesses the degree of parent-child discord; and the second assesses whether the child has a behavioral disorder. If so, then it is plausible, but does not control for any interval validity concerns.
Experimental (Evaluative) Research Levels: Classic Experimental Design Example
Example - An assessment of life history story telling intervention to alleviate depression in a nursing home where you work. We would use a table of random numbers to systematically assign each resident who agrees to participate and for whom the intervention is deemed appropriate to an experimental group (receives the treatment) and a control group (does not receive the treatment). Observations of depression would be taken and analyzed. Controls best for interval validity. If improvement was caused by history or maturation, then experimental group should not show improvement more than control group. Random assignment controls for statistical regression or comparable groups. Does not control for testing. If we think a pretest would impact the results, then we would go to the:
Government sponsored social service policies can be categorized as:
Exceptional eligibility program, selective eligibility programs, and universal programs
Categories of Problems in BT
Excess - excessive response (e.g., washing hands 30 times a day) Deficits - lack of response (e.g., rarely interacting with people) Inappropriateness - responses inappropriate to situation (e.g., flashing others)
New Diagnoses: Excoriation Disorder
Excoriation Disorder Individuals who compulsively pick their skin for no apparent reason, such as the presence of an underlying medical condition, may be given this new diagnosis. This disorder, sometimes called dermatillomania, is included in the Obsessive-Compulsive and Related Disorders" chapter in DSM-5.
Type 1 & 2 Errors: Explanation
Explanations for these errors: 1. Very non-representative samples. 2. Using the wrong statistical test . Controls for these errors: 1. Selecting a smaller p value but that increases Type II errors. 2. Using larger sample sizes good for I and II. 3. Replicating the study good for I and II, but impractical.
Experiential and Relationship-Oriented Therapies
Existential Therapy Person Centered Therapy Gestalt Therapy
Natalie Rogers (PCT)
Expanded the theory by developing person-centered expressive arts therapy in groups.
Self-liberation
Experiential level of choosing that involves experiencing anxiety inherent in being responsible for which alternative is followed.
Threats to Internal Validity: Experimental Attrition
Experimental Attrition (mortality; dropout) - differential dropout of subjects from the experimental and control groups - may not be equivalent groups at post testing. Persons often drop out of studies before they are finished; some of them may die. This can affect your conclusions.
The most rigorous form of program outcome evaluation
Experimental evaluation. This approach uses experimental and quasi-experimental processes, including the effects of independent variables on an identified dependent variable, to test for causality as related to program efficiency. Only approach that actually tests program performance in a scientifically rigorous way.
Quantitative Example
Exploring how ACT (Assertive community treatment) affects rates of institutionalization for people with mental illness... Are rates of clients' use of institutional settings—both hospitals and jails—reduced after treatment by an ACT team? Do clinicians' and clients' perspectives about clients' improvement in selected treatment areas differ? What factors predict declines in admission to an institution?
Therapeutic Relationship in Exposure Therapy
Exposure therapist acts like an effective, firm parent. Clients' trust of therapist allows them to stay in presence of feared stimuli. Therapist models confidence.
Principles of MI (Person-centered)
Express empathy (reflective listening), Develop discrepancy (between client's deeply held values and current behavior), Roll with resistance (reflection rather than confrontation), Support self-efficacy (actively conveying the message that the client is capable of change)
Four Principles of MI in PCT
Express empathy, Develop discrepancy, Roll with resistance, Support self-efficacy
Criteria of Problem Statements
Express or explore a relationship between two or more variables Clearly stated and unambiguously, typically in question form (i.e., asks a question) Problem and problem statement imply possibilities of empirical testing Only one relationship per question- do not "double barrel" your questions
Theory of Psychopathology in Multicultural Therapy
Expression and manifestation of pathology are often culturally determined. Psychopathology is behavior that predominant culture consensually deems unusual or maladaptive. Etiology is mix of biology, culture, and psychology. Impact of race/ethnicity usually due less to biological vulnerability and more to social inequality.
Effectiveness of Brief Psychodynamic Therapies
Extensively studied in controlled research. Cognitive-behavioral researchers find more impressive results for CBT. Psychodynamic researchers find more impressive results for psychodynamic therapy (allegiance effect).
External Validity Definition
Extent to which the study's results hold across different study settings, procedures and participants. If a study possesses external validity, its results will generalize to the larger population.
"Situational Control" when working with minority groups
Factors that influence the client's life- "regardless of how much control a client has over his or her choices, he or she is still influenced by situational factors, which should be considered in any counseling setting.
Validity and Reliability of Observational Research
Factors that may reduce validity: The observed not having anonymity - can change behavior; Expectations of the researcher - biased perceptions; Condition of observer - fatigue, stress, etc.
Genograms and ecomaps are used to structure and explore a client's
Family and social relationships
Specific treatment approaches, such as the communications approach, the structural approach, the social learning approach, and the narrative approach are associated with
Family therapy
Narrative Approach
Family therapy approach that suggests that behavior changes occur when family members produce alternate narratives, stories, or scenarios with improved endings by which to focus their energies and beliefs in a more positive way.
B.F. Skinner
Father of the behavioral approach of psychology. Was a determinist; he did not believe that humans had free choice. He acknowledged that feelings and thoughts exist, but he denied that they caused our actions.
Inferiority Complex (Psychodynamic Therapies)
Feelings of inferiority can arise subjectively felt psychological or social weaknesses as well as from actual bodily impairments.
Systems and Postmodern Approaches
Feminist Theory Postmodern Approaches Family Systems Therapy
Effectiveness of Multimodal Therapy (Integrative)
Few controlled studies performed; supportive but not definitive RCTs. Eclecticism uses research-proven techniques for each problem. Difficult to evaluate effectiveness of eclectic treatments because of their variations, but in general, they show effectiveness.
Rational Emotive Behavior Therapy (REBT)
First of the CBT therapies. Basic assumption is that people contribute to their own psychological problems, as well as specific symptoms, by the rigid and extreme beliefs they hold about events and situations.
DSM II
First official changes of the DSM to place in 1968. - The rationale for the DSM II was to conform to the now published edition of the International Classification of Diseases (ICD). It continued to reflect the influence of Psychoanalysis - The DSM and DSM II were very similar to one another. In that symptoms were conceptualized as reflecting underlying internal causes. - One significant change: the number of diagnoses were increased from 106 to 182. There were 7 editions of the DSM II Published.
Carl Rogers: Four Period of Development of the Approach
First period: Nondirective counseling which provided a powerful and revolutionary alternative to the direction and interpretive approach to therapy then being practiced. Second period: Renamed his approach "client-centered therapy" to reflect emphasis on the client rather than on non directive methods. This period was characterized by a shift from clarification of feelings to a focus on the phenomenological world of the client. Third period: Addressed the necessary and sufficient conditions of therapy. Becoming one's experience. Fourth phase: Developed person-centered approach
Denial
First stage of grief. A defense mechanism to escape the awful reality of a loss
Normal Autism (Psychodynamic)
First stage of the development of self by Margaret Mahler. Comes in the first few months of life. In this primary, undifferentiated state, there is neither self nor object. Fixation at this stage results in the severe pathology of primary infantile autism, which is characterized by a failure of attachment to objects and a failure of mental organization due to a lack of self-image.
Adlerian Therapy
Flexible and innovative, Conjoint family sessions Multiple-therapist approach, Advocate time-limited treatment Workshops for parenting and couples, Pro bono work
Remedial groups (psychotherapy groups)
Focus on personal growth, such as anger management
Self-help groups
Focused on behavioral changes (i.e., AA)
Task group
Focuses on accomplishing a singular goal
Emotion-Focused Couples Therapy in Experiential
Focuses on construction of emotional experience and interpersonal drama of couple. Emphasizes two client capacities: Attachment bond Emotions Goal: Help couples become increasingly aware of negative interactions and overcome them by establishing secure attachments.
Support groups
Focuses on coping with common problems (i.e., bereavement, etc.), but with less of an emphasis on learning and skill development
Strategic family therapy
Focuses on family rules and behavioral patterns. This approach suggests that persistent behavioral dysfunction and faulty family rules are at the heart of most family problems. Intervention is supplied by the social worker actively choosing to engage the family in ways that will highlight problematic behavioral patterns. In this way, the family becomes more aware of problematic patters of interaction, after which the social worker can assist family in choosing more functional behaviors and interactive patterns.
Situational perspective
Focuses on issues and issue resolution
Phenomenological Method (Existential)
Focuses on the immediacy of experience, the perception of experience, and observation with a minimum of priori biases.
12 assumptions important for testing and assessment: Assessment can pinpoint phenomena that require further attention or study.
For example, assessment may identify someone as having dyslexia or low self-esteem or at-risk for drug use.
Context
For whom, when, and under what conditions does this effect occur? Moderating variables
According to Piaget, a child developed capacity for abstract thinking during which developmental stage?
Formal operational. (11-15 years of age) is characterized by adult-like thinking, including abstract thinking (also known as hypothetical thinking)
3 Systems that Contribute to Well-being of Individuals
Formal, informal, and societal
Cultural proficiency
Formally refers to the degree of skill one possesses in managing these differences effectively. To work well in diverse settings, professionals must possess sufficient cultural proficiency to avoid compromising the mental or emotional well-being of those with diverse backgrounds.
Precursors to Constructivist Therapies
Found in many theoretical orientations, including psychoanalytic and behavioral. George Kelly 's personal construct therapy: Seeing humans as curious, amateur scientists who actively construct their worlds. Roy Schafer's new conceptualization and language for psychoanalysis: A constructivist position that emphasized the narrative tradition.
Structural Therapy (Systemic Therapy)
Founded by Salvador Minuchin (1922- present). Created to treat delinquents as systemic issue rather then individual problem. Initial focus on delinquency and anorexia nervosa. Influential and pragmatic approach.
Psychodynamic Approaches: Adlerian Therapy
Founder: Alfred Adler Key Figure: Following Adler, Rudolf Dreikurs is credited with popularizing this approach in the US. This is a growth model that stresses assuming responsibility, creating one's own destiny, and finding meaning and goals to create a purposeful life. Key concepts are used in most other current therapies.
Experiential and Relationship-Oriented Therapies: Person-centered therapy
Founder: Carl Rogers, Key Figure: Natalie Rogers This approach was developed during the 1940's as a non directive reaction against psychoanalysis. Based on a subjective view of human experiencing, it places faith in and gives responsibility to the client in dealing with problems and concerns.
Psychodynamic Approaches: Psychoanalytic Therapy
Founder: Sigmund Freud A theory of personality development, a philosophy of human nature, and a method of psychotherapy that focuses on the unconscious factors that motivate behavior. Attention is given to the events of the first 6 years of life as determinants of the later development of personality.
Cognitive Behavioral Approaches: Reality Therapy
Founder: William Glasser. Key Figure: Robert Wubbolding. This short-term approach is based on choice theory and focuses on the client assuming responsibility in the present. Through the therapeutic process, the client is able to learn more effective ways of meeting her or his needs.
Experiential and Relationship-Oriented Therapies: Gestalt Therapy
Founders: Fritz and Laura Perls. Key Figures: Miriam and Erving Polster. An experiential therapy stressing awareness and integration; it grew as a reaction against analytic therapy. It integrates the functioning of body and mind.
Mid-Adulthood (Erikson Psychosocial Stage)
Fourth Stage. Involves the ego energies in creating a lifestyle that brings a sense of generativity, creating something of worth with one's life lest of sense of stagnation stake over.
Despair (depression)
Fourth stage of grief. Characterized by feeling the overwhelming sadness of a loss
Existential Vacuum
Frank calls the meaninglessness of life can lead to emptiness and hollowness
Paradoxical Intention (Existential)
Frankl encourages clients to adopt an attitude of self-detachment and humor toward themselves and to intend to do the very thing they are dreading. With this paradoxical intention, clients find that the way they anticipated acting is rarely the way they will in fact act.
Methods for Recording (Quantifying) Behavior
Frequency recording Duration recording Interval recording
When and How Often to Complete Standardized Scales
Frequently enough to detect important changes, but not so frequently that it is burdensome In general about once per week Predesignated times
Instincts
Freud believed that basic dynamic forces motivating personality were Eros (life and sex) and Thanatos (death and aggression). These complementary forces are instincts that possess a somatic basis but are expressed in fantasies, desires, feelings, thoughts and most directly, actions.
Neurosis
Freud believed that the basis of neurosis was sexual conflict-or, more specifically, the conflict between the id's instinctive desires and society's retribution for the direct expression of those desires
Id
Freud divided the psyche into three parts-id, ego and superego-with the id being responsible for basic drives. Unable to take "no" for an answer, the id is ruled by the pleasure principle.
The subconscious mind
Freud empahsized the role of the subconscious in people's lives and felt that it was connected to behavior. Freud believed that by bringing subconscious issues into conscious awareness, he could enhance understanding of an individual's behavior.
Deductive Reasoning
From the more general to the more specific. Sometimes this is informally called a "top-down" approach. We might begin with thinking up a theory about our topic of interest. We then narrow that down into more specific hypotheses that we can test. We narrow down even further when we collect observations to address the hypotheses. This ultimately leads us to be able to test the hypotheses with specific data -- a confirmation(or not) of our original theories.
The Elderly Nutrition Program, Food Stamps, School Lunch Program, and Women, Infants and Children (WIC) programs are funded how?
Funded federally and state administered
Operating support
Funds derived from other sources besides the sale of goods and services (i.e., donations, grants, etc.).
Question Formulation Process
Gathering information Categorizing ideas and questions Selecting research questions/creating problem statements Constructing operational definitions of the concepts and variables represented in the question
2 Forms of REBT in CT
General or inelegant: Synonymous with cognitive-behavior therapy (CBT). Specialized or elegant: Adheres more to Ellis's formulations.
Generalizability
Generalizability in a single subject design is an issue of external validity. Will the findings apply to different settings, clients, or communities? The following three sequential replication strategies can be used to enhance the external validity of single subject design: Direct replication: the same procedures are repeated by the same researchers with different clients Systematic replication: the experiment is repeated in different settings with different providers Clinical replication: different interventions are combined into a clinical package to treat multiple problems
Sample generalization
Generalizability refers to the extent that research can tell us about people or things that were not actually studied.
Adler Birth Order: Oldest Child
Generally receives a good deal of attention, and during the time she is the only child, she is typically somewhat spoiled as the center of attention. Tends to be dependable and hardworking and strives to keep ahead.
Punishment
Generally thought as decreasing behavior
Continuous Reinforcement
Generally used initially and means that a behavior is reinforced or promoted each time it happens
Erikson: Middle age (35-60 years)
Generativity versus stagnation. There is a need to go beyond self and family and be involved in helping the next generation. This is a time of adjusting to the discrepancy between one's dream and one's actual accomplishments. Failure to achieve a sense of productivity often leads to psychosocial stagnation.
Freud's final stage of personality development
Genital Stage. Lasts from age 12 until death. Freud believed that during this time people seek positive relationships that continue through career, family, etc.
Intervention where the focus is on becoming aware of the inner and outer self, as proper awareness is all that is needed to produce change. Indeed, individuals innately possess all the necessary tools for change if their awareness regarding the need for change is adequate.
Gestalt Approach. The social worker is more of a facilitator than a traditional therapist. The goals of this intervention are three-fold: 1) to increase self-awareness of key behaviors; 2) to identify and develop alternate behaviors; and, 3) to own and take responsibility for all behavioral choices.
Choice Theory (Existential)
Glasser. Choice is really the main process of change. Form of reality therapy. Therapeutic change is the result of responsible choice based on the awareness of the hurt that one has been creating.
The term schemas, according to Jean Piaget, is used to refer to
Goal-oriented strategies for learning. Piaget offers a theory focused on cognitive development. The theory explores how individuals learn by organizing their thoughts and knowledge as they explore their environment
Practicalities of Multicultural Therapy
Goal: Develop network of change agents that will reverberate throughout client's life. Frequently involves contact with families, communities and indigenous healers. Use of translators is controversial and often contraindicated. Pre-treatment preparation clarifies expectations and defines comfortable role for client, typically leading to lower dropouts and better outcomes.
Therapeutic Processes: Existential
Goal: Increase congruence between self and experience. Combination of consciousness raising and corrective emotional experience. Therapists control the process of therapy, but not the content. Use facilitative conditions (genuineness, positive regard, empathy).
Therapeutic Processes (Systems)
Goal: Increase differentiation of self from family emotional system. Detriangulate family members. Change produced in one triad will cause change in all family triangles. Consciousness raising Choosing
Structural Therapeutic Processes (Systemic Therapy)
Goal: Restructure families to free members to grow and relate. Changing family structure involves changing rules for relating and boundaries. Consciousness raising: education, reframing. Choosing or social liberation: System creates more alternatives for healthy responding.
Goals in treatment planning
Goals should be specific, realistic and measurable. It's not enough simply to state that a relationship needs to be improved. Goals should address specific ways to improve a relationship should be specific, realistic, and measures (to determine progress)
The key features and/or benefits of a not-for-profit (non-profit) organization, as compared with a for-profit organization include:
Greater control over assets and revenue. Non-profit organizations have far less common over assets, resources, and revenue.
Self-Psychology
Grew out of the work of Kohut that emphasizes how we use interpersonal relationships (self-objects) to develop our own sense of self.
Classical Psychoanalysis
Grounded on id psychology, and it holds that instincts and intrapsychic conflicts are the basic factors shaping personality development (both normal and abnormal) Therapeutic change requires an extended period of "working through" old patterns in the safety of the therapeutic relationships.
Experiments
Grow out of the interaction between client and therapist, and they emerge within this dialogic process.
Oral Traits
Gullible, overly optimistic, and cocky
Organismic needs (Experiential)
In a healthy natural existence, our daily life cycle would be an open, flowing process of organismic needs emerging into awareness.
Hartmann vs. Freud
Hartmann believed that children are born with both ids and egos. Therefore, Hartmann felt that children have the rudimentary capacity to begin rationally considering the need for mediation demands between themselves and their environment
Maintenance
Has overtly changed behavior. Consistent success for ≥ 6 months. "Keep moving forward!" Reaping rewards of change, but also realize relapse is common.
Shadow
Has the deepest roots and is the most dangerous and powerful of the archetypes. It represents our dark side, the thoughts, feelings, and actions that we intend to disown by projecting them outward.
Games in IPT
Have overt social meanings and covert psychological meanings. Complex series of ulterior transactions progress to a psychological payoff. Psychological payoff are feelings such as guilt, depression, or anger. Examples: Kiss off, Kick me.
Higher risk of attempting suicide
Having had thoughts about suicide in the past, a history of behavior in one's family and a history of high mobility
Viktor Frankl
He believed that the essence of being human lies in searching for meaning and purpose. He believed that love is the highest goal to which humans can aspire and that our salvation is through love. Developed Existential therapy in Europe and credited with bringing it to US.
Arnold Lazarus
He is a pioneer in clinical behavior therapy and the developer of multimodal therapy which his comprehensive, systemic, holistic approach to behavior therapy.
Federal Title XIX of The Social Security Act
Health care providers may not bill Medicaid patients for any service costs. The health care provider must accept Medicaid as payment in full.
Psychic determinism
Held that just as there is no event in the physical universe without its cause, so there is no mental event or mental state without its cause.
Therapeutic Processes in Systemic Therapy
Help individuals and systems to communicate clearly and constructively. Changing communication changes relationships and power dynamics.
Therapeutic Processes 1 in Existential Therapy
Help individuals see themselves capable of directing their lives through active choice. Encourage clients to enter into an authentic, equal therapeutic relationship. Binswanger, Boss, and May draw heavily on psychoanalytic techniques.
Ego-Defense Mechanism
Help the individual cope with anxiety and prevent the ego from being overwhelmed. Rather than being pathological, ego defense are normal behaviors that can have adaptive value provided they do not become a style of life that enables the individual to avoid facing reality.
Latent content
Hidden meaning of events
Ratio Measures
Highest level of measurement; Mutually exclusive categories; Rank order; Equal spacing between categories; and, An Absolute Zero point! If a measure is zero on a ratio scale, then there is a basis for saying that some object has none of the property being measured Can perform all arithmetic operations
Manic episodes after 40
Highly unusual and more likely would be due to a medical condition or, perhaps a substance abuse issue
Two common factors in BPD
Highly variable mood and impulsive behavior
Threats to Internal Validity: History
History- the specific events occurring between the first and second measurement (in addition to the experimental variable.) For example, If I was measuring the anxiety level of all of the people in the waiting room on Wednesday. At 8am I measured all of the participants level of anxiety, at 9am I gave half the group a sachet of lavender and at noon I measured their level of anxiety again. If there was a bomb threat in the hospital at 10am, the anxiety level of all research participants would have been impacted by it. For history to be a plausible rival hypothesis, it should have occurred to most of the persons in the study. The longer the time period between observations, the greater threat history is. If you're doing a pre- and posttest within a 1 day period, history is not much of a threat. However, if you're doing a pre-and posttest within a 1-year period, history is a much greater threat. because more things can happen within that time period.
New Diagnoses: Hoarding Disorder
Hoarding Disorder Serious hoarding behavior affects a significant percentage of the population. Previously regarded as a symptom or subtype of Obsessive-Compulsive Disorder (also a symptom of Obsessive-Compulsive Personality Disorder), it will now be listed as a separate, distinct disorder. The primary symptom is the inability (or persistent difficulty) to discard or give up possessions, regardless of their actual value. Historically, compulsive hoarding has been a difficult behavior to treat successfully.
Structural Change (Psychoanalysis)
Hopes to impact fundamental personality organization.
Self-Interest (Psychodynamic Therapies)
Hostility is the worse expression of the belief that self-interest is of higher value than social interest.
Interpreting Reliability Coefficients
How big does a reliability coefficient need to be (regardless of type) to be considered "acceptable"? range is from 0.0 to +1.0 We want coefficients to be positive (0.0 to 1.0) We want coefficients to be as large as possible (closest to 1.0) Test-retest Reliability = .89 Interpretation - test is reasonably consistent over time. Goal is to be above .80. Parallel forms reliability = .12 Interpretation - test does not seem to be very consistent over different forms, low coefficient. Internal consistency reliability = .24 Interpretation - test does not seem to be one-dimensional in that these items are not consistently measuring the same thing.
Qualitative Example
How do case management providers develop therapeutic alliances in everyday practice? How do case management providers manage adherence problems in everyday practice?
Effect size (ES)
How the results of meta-analyses are typically presented.
4 Major Therapeutic Factors in Integrative
Hubble, Duncan, & Miller: Client factors Harnessing client competence, tapping client's resources. Relationship factors Fostering therapeutic alliance, embracing client's theory. Hope and expectancy Facilitating hope. Models and techniques Selecting methods that provide structure and fit client.
2. Contingency Management in BT
Human behavior is controlled by its consequences. Skinner the influential theorist Reinforcements and punishments impact the probabilities of maladaptive behavior and development of new responses. Behavior chain is foundation for modifying contingencies.
Adler's view of human nature
Humans are motivated primarily by social relatedness rathe than by sexual urges; behavior is purposeful and goal-directed; and consciousness, more than unconsciousness, is the focus of therapy.
Effectiveness of Transtheoretical Model (TTM)
Hundreds of studies on stages of change and processes of change. Early research conducted on addictions; now applied to dozens of disorders. RCTs on smoking cessation, stress, bullying, and multiple health behaviors. Stage-matched treatments outperform conventional treatments.
Adler Birth Order: The Youngest Child
I always the baby of the family and tends to be the most pampered one. Because of being pampered or spoiled, he may develop helplessness into an art for and become expert at putting others at his service.
Effectiveness of IPT
IPT is more effective than no treatment and placebo. Effective for treatment of mood and eating disorders. Tends to be most effective in combination with medication. Combination treatment has lower relapse likelihood.
After identifying a specific behavior that a client wishes to change, the next priority for a social worker using a behavioral (behavior modification) approach is to:
Identify and evaluate the antecedents and consequences of the behavior
Feminist Theory of Personality in Gender-Sensitive Therapies
Identity is influenced by prevailing environment, including social learning and gender roles. Gender roles and discrimination influence cognitive structures and behavior patterns. Differences between gender due in part to women primarily raising children (Chodorow). Children bombarded with messages of gender expectations. Gender roles deeply ingrained in personality.
Erikson: Adolescence (age 12-18 years)
Identity versus role confusion. A time of transition between childhood and adulthood. A time for testing limits, for breaking dependent ties, and for establishing a new identity. Major conflicts center on clarification of self-identity, life goals, and life's meaning. Failure to achieve a sense of identity results in role confusion.
Designs for Monitoring Subjects
If a baseline phase is not possible, client monitoring can take place with a B or a B-A design. A B design has only an intervention phase. In a B-A design, an intervention period is followed by a period of no intervention.
Contingency Management
If behavior changes are made by modifying the contingencies in the environment
Inter-rater reliability
If individuals are used to code a respondents level of a variable, you want to measure the degree of correspondence between how the two raters score that individual. 70 to 80% correlation is desired.
Unconditional Positive Regard (Person-centered)
If the clinician can demonstrate unconditional positive regard for the client, then the client can begin to become accurately aware of pervasively distorted or denied experiences because they threatened a loss of positive regard from significant others.
Insight
If the patient has cognitive and affective awakening about aspects of themselves that were previously hidden-then some analysts have some evidence for the validity of their interpretations. Understanding translated into constructive action-the motivation that operate in a client's life.
Independent Variable example
If you want to know how X impacts Y X is your independent variable: It is the variable that impacts the dependent variable: "How does IV drug use impact domestic violence?" IV drug use is the Independent Variable
Midlife Crisis
Implies difficulty with midlife transition, but the terms are often used interchangeably. Whether midlife transition is seen as a time of crisis of not, however, it is a time of assessing one's progress toward personal goals and readjusting to the fewer years left.
Selective eclecticism
Implies several possibilities but generally refers to blending more than one theory and/or being more open to treatment options. In this example, three types of therapy are represented-Rogerian, REBT, and Freudian
Competence model of supervision
Implies that an individual performs a supervisory role because of specific training and experience.
Accurate empathetic understanding
Implies that the therapist will sense client's feelings as if they were his or her own without becoming lost in those feelings.
Authenticity
Implies that we are living by being true to our own evaluation of what is a valuable existence for ourselves; it is the courage to be who we are.
Holistic concept
Implies that we cannot be understood in parts; rather, all aspects of ourselves must be understood in relationship.
Hawthorne Effect
Improvements in performance is assumed to be due to increases in morale, novelty, and esteem that people experience from having others attend to them. (Used in study at factory with workers).
DSM III
In 1980 the third edition of the DSM (DSM III) was published. The reason was to retain conformity with the newest edition of the ICD. It also reflected a significant paradigm shift from a theoretical model to a medical model. Also, the number of diagnoses increased from 182 to 265. In response to criticisms, attempts were made to make this DSM a data-driven and multi-axial system, focusing on symptoms rather than causes.
DSM III-R (Revisions)
In 1983, Robert Spitzer and the task force began working on another major revision. In 1987, the third edition-revised of the DSM was published. The purpose for revision at this time was to increase reliability and validity of the classifications. While revisions were intended to be few, several diagnostic categories were renamed, reorganized & significant changes were made to diagnostic criteria.
DSM IV
In 1988, the work on the DSM IV began and in 1994, the fourth edition of the DSM was published. The rationale was again to retain conformity with the new ICD 9 and. In the published edition, a detailed system of diagnostic criteria, and changes to axis IV where significant and the number of diagnoses was increased from 292 to 365.
Undifferentiated
In Bowen family systems theory, "differentiation of self" is a major concept. Clients are either "differentiated" (indicating the ability to separate thoughts from feelings) or "undifferentiated" (unable to separate feelings from thoughts).
Multiple Treatment Designs
In a multiple treatment design, the nature of the intervention changes and each change represents a new phase of the design. For example, the intensity of the intervention may change over time or the actual intervention may change over time.
Confrontation
In analytic confrontation, the therapist makes sure patients are aware of the particular actions or experiences being analyzed. Therapists can encourage clients to look at certain incongruities, especially gaps between their verbal and nonverbal expressions.
Deductive/Inductive Reasoning in Conceptualization
In deductive research, conceptualization helps to translate portions of an abstract theory into specific variables that can be used in testable hypotheses. In inductive research, conceptualization is an important part of the process used to make sense of related observations.
Experimental and Quasi-Experimental Designs
In order to infer causality you must show: 1. A statistical association between independent and dependent variables; 2. The IV must precede (occur prior in time to) the DV; 3. The relationship between the IV & DV must not be spurious (due to a 3rd variable). This requires control to reduce other possible explanations for the effects. In other words, we want to know whether the change (or variation) in the DV is really produced (caused) by the IV - experimental validity. OR If something else produces the change, or some part of the change (variability) - that is known as extraneous variability. This Requires "Control"
Intersubjective (or relational) Evolution
In psychoanalysis, functionally means that it has progressed from a one-person psychology to a two-person psychology. The therapist is always as much a participant in the interaction as the patient.
Transmuting internalization
In self-psychology, the process by which positive objects are integrated into an internalized self-structure. The process by which the grandiose self internalizes (or "transmutes") ideals, goals, and values from the self-object.
DSM & Politics
In the late 1960s, the standard practice of Medical Insurance companies was to request a DSM diagnosis before providing reimbursement. In a landmark case in 1988 the U.S. Court of appeals ruled against Blue Shield for its refusal to pay clinical psychologists unless billed through a Physician. Blue Shield representatives pleaded with Spitzer to standardize the DSM III so that insurers could separate the so-called legitimate mental illnesses from non psychiatric problems, and more importantly, legitimate providers from all others.
Team supervisor
In the term service-delivery approach, all team members share in the responsibility for making decisions about the services offered. However, there is a team leader who acs as a supervisor, and whenever there is dissent among the members, the team leader has the final say
Transference relationships
In which their clients will make projections onto them. The transference relationship is a cornerstone of psychoanalysis.
Delusions
Inaccurate beliefs held by an individual. These delusional beliefs are overwhelmingly contraindicated by known reality.
Natural Crises
Include: marriage, the birth of a child, or the natural death of a loved one. Are often less likely to produce severe distress than those crises that may be viewed as outside the expected human experience (such as violent crime and natural disasters).
Lifestyle Analysis (Psychodynamic Therapies)
Includes a summary of the client's family constellation. The order of birth, the gender of siblings, the absence of a parent, and the feelings of which child was favored are all crucial factors in a family constellation that can be interpreted as influencing the lifestyle.
Defense Mechanisms
Inner controls that restrain sexual and aggressive impulses from being expressed in uncontrollable outbursts. For defenses to work, the person must remain unconscious of the very mechanisms being used to keep sexual and aggressive impulses from coming into awareness.
Erikson: Preschool age (age 3-6 years)
Initiative versus guilt. Basic task is to achieve a sense of competence and initiative. IF children are given freedom to select p personally meaningful activities, they tend to develop a positive view of self and follow through with their projects. If they are not allowed to make their own decisions, they tend to develop guilt over taking initiative. They then refrain from taking an active stance and allow others to choose for them.
Id Psychology
Instincts and intrapsychic conflicts are the basic factors shaping personality development (both normal and abnormal)
Types of Contingency Management in BT
Institutional control, Self-control, Mutual control or contracting, Therapist control, Aversive control
EBP
Integration of best research evidence with clinical expertise and patient culture, preferences, and characteristics. Aim: Improve effectiveness and enhance public health. What is designated as EBP will increasingly determine what therapies are reimbursed, taught, funded, and promoted
Erikson: Later life (age 60+)
Integrity versus despair. If one looks back on life with few regrets and feels personally worthwhile, ego integrity results. Failure to achieve ego integrity can lead to feelings of despair, hopelessness, guilt, resentment, and self-rejection.
Intelligence Tests
Intelligence has many definitions because a single prototype does not exist. Although far from being a perfect definition, here is our definition: intelligence is the ability to think abstractly and to learn readily from experience. -Although the construct of intelligence is hard to define, it still has utility because it can be measured and it is related to many other constructs.
Stanford-Binet Scale
Intelligence scale that was the first test of child intelligence to be developed. It evaluates levels of cognitive development rather than overall development.
Task-Centered Approach
Intended to be structured as a short-term intervention. The treatment process typically takes place during 6-12 sessions, with the total treatment interval not generally exceeding several months
Prolonged Exposure
Intensive (direct and immediate) vs. gradual (slow and incremental exposure) Imaginal (imagining fear stimuli) vs. in vivo (actual place or tactile material) Total vs. partial response prevention
Threats to External Validity
Interaction effects of selection biases and the experimental variable. It could be possible that the effects the researcher finds are specific to the population of persons whom he sampled to make his experimental and control groups. Unrepresentative samples - cannot generalize to larger population if sample is not representative of that group of people. Many subjects in SW research are volunteers or coerced (offer of extra credit, etc.). How representative are these people?
Adler (Psychodynamic Therapies)
Interest in common people was expressed by his commitment to avoid technical jargon and to present his work in a language readily understood by nonprofessionals.
Ethnography
Interested in examining shared patterns of behavior, beliefs, and language. Focuses on an entire cultural group Extended observations of a culture-sharing group. Study the meaning of the behavior, language and interactions among members of the group Analyze data for a description of the culture-sharing group, themes that emerge from the group, and an overall interpretation. Formulate a detailed description of the group. Then develop theme analysis of patterns or topics that describe how the cultural group works and lives. In-depth participant observation, field methods
Internal Validity
Internal validity - questions whether the intervention (independent variable) caused, can explain, or is the reason the change is observed in the dependent variable. In other words, how confident are you that the independent variable and not some other variable (explanation) is the reason for the observed change.
ICD
International Statistical Classification of Diseases and Related Health Problems. Primarily provides a way to classify diseases and medical symptoms.
4 Major Interpersonal Problems: IPT
Interpersonal losses (e.g., loss of a loved one) Disputes (incompatible expectations of a relationship) Transitions (e.g., loss of job) Deficits (trouble forming and maintaining relationships)
Problems of Interpretation
Interpretation becomes difficult when you are unable to obtain clear patterns in either the baseline or intervention phase. Some of these problems include: Widely discrepant scores in the baseline: may be difficult to determine any pattern during baseline; No immediate change apparent in the intervention phase: difficult to interpret change that takes place several weeks into the intervention; Improvement during the baseline period: improvement begins before start of intervention phase.
What practice decisions?
Intervene or not? Continue an intervention? Modify an intervention? Change to a new intervention? Discontinue intervention altogether?
Interventions (B)
Interventions can represent and come from the full range of approaches, principles, and techniques social workers use: group therapy; task-centered treatment; cognitive plans and tracking; advice giving; social support; new case management service; et al.
Methods of assessment include
Interviewing (questioning), observation, and report/records reviews
Interpersonal Conflicts
Intimacy and sexuality, communication, hostility, and control of others
Erikson: Young adulthood (age 18-35 years)
Intimacy versus isolation. Development taks at this time is to form intimate relationships. Failure to achieve intimacy can lead to alienation and isolation.
Stage 3 of Group Development
Intimacy. Refers to the development of group cohesion and solidarity
Therapeutic Content at Different Levels of Personality
Intrapersonal conflicts, interpersonal conflicts, individuo-social conflicts, beyond conflict to fulfillment
Aggression Instinct (Psychodynamic Therapies)
Introduced by Adler.
Community Mental Health Act of 1963
Involuntary hospital commitment (i.e., in an asylum) become increasingly common up to the 1950's, as had institutionalization of those otherwise disabled. The Community Mental health Act of 1963 began to reverse this trend, as did the 1999 US Supreme Court ruling in Olmstead vs. LC Laws mandating the last restrictive environment (LRE)
Recruiting Diverse Populations
Involve key community members/ organizations Advisory board Study staff Show how the study benefits the community Cultural competence (barriers) Train interviewers Recruit where population members are
Factitious disorder
Involves a feigning of symptoms primarily in order to receive the attention offered when one assumes a sick role.
Hypochondriasis
Involves a misapprehension or misinterpretation of bodily symptoms.
Problem-oriented recording
Involves a statement of the problem and when it was resolved. This type of approach is commonly used in the medical setting, with SOAP (subjective-objective-assessment-plan) as the guideline for charing the client's treatment. "S" is information relative to the client's request. "O" refers to the observable and measure criteria. "A" is the counselor's assessment, and "P" notes how treatment will be carried out.
Performance audit
Involves a third-party evaluator to reviews and rates program performance standards.
Social-cognitive theory
Involves a triadic reciprocal interaction among the environment, personal factors (beliefs, preferences, expectations, self-percepetions, and interpretations), and individual behavior.
Operant Conditioning
Involves a type of learning in which behaviors are influenced mainly by the consequences that follow them.
Decision-oriented approach
Involves an evaluation of existing agency data, along with observation, interviews, and surveys
Mindfulness
Involves being aware of our experiencing in a receptive way and engaging in activity based on this nonjudgmental awareness.
Confluence
Involves blurring the differentiation between the self and the environment
In Vivo Exposure
Involves client exposure to the actual anxiety-evoking events rather than simply imagining these situations.
Social phobia
Involves fears about being in social situations involving performance and scrutiny
Malingering
Involves feigning symptoms primarily to derive an external reward (lawsuit settlement, disability benefits, etc.)
Restructuring
Involves helping clients learn to monitor their self-talk, identify maladaptive self-talk, and substitute adaptive self-talk for their negative self-talk.
Interpersonal Effectiveness
Involves learning to ask for what one needs and learning to cope with interpersonal conflict
Incorporation
Involves making images of others part of one's own image.
Phenomenological inquiry
Involves paying attention to what is occurring now.
Projection
Involves perceiving in the environment those aspects of oneself that are bad or threatening.
Displacement
Involves placing the energies from highly charged emotional ideas onto more neutral ideas.
Discrimination
Involves putting negative thoughts and feelings into action (actually impeding choices, options, benefits, etc., in response to feelings of prejudice)
Reorientation
Involves shifting rules of interaction, process, and motivation. Facilitated through changes in awareness, which often occur during the therapy sessions and which are transformed into action outside of the therapy office.
Partialization
Involves taking complex ideas, thoughts, or concerns voiced by a client, and reducing them to smaller parts that the client can process and response to more easily.
Positive reinforcement
Involves the application of a reward (praise, any object, approval, etc.) for engaging in specific positive behavior.
Economic in theory of personality
Involves the distribution, transformation, and expenditure of psychological energy
Negative reinforcement
Involves the escape from or the avoidance of aversive (unpleasant) stimuli. The individual is motivated to exhibit a desired behavior to avoid the unpleasant condition.
Adaptive
Involves the inborn preparedness of the individual to interact with an evolving series of environments
Choosing
Involves the individual becoming aware of new alternatives, including the deliberate creation of new alternatives for living.
Negative Reinforcement
Involves the removal of a negative stimulus in response to positive behavior (i.e., nagging stops when a desired behavior occurs).
Informed Consent
Involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it.
Albert Ellis, who espoused rational emotive behavior therapy (REBT), believed that abnormal behavior is a result of
Irrational thinking. Ellis felt that abnormal behavior resulted from irrational thinking and that the interpretation of life events-rather than the events themselves-causes an individual's choice of behavior.
Quantitative Research
Is admittedly subjective Seeks to understand Produces hypotheses Data often processed as received Research is the instrument Uses inductive logic Descriptive knowledge
Qualitative Research
Is admittedly subjective Seeks to understand Produces hypotheses Data often processed as received Research is the instrument Uses inductive logic Descriptive knowledge Uses flexible design Uses observational interviewing techniques Not concerned with generalizability Concerned with transferability to client's specific situation
Ventilation
Is allowing a client unfettered expression to relieve into pressures, fears, and concerns.
A-B-C Framework
Is central to REBT theory and practice. The model provides a useful tool for understanding the client's feelings, thoughts, events, and behavior. A is the existence of a fact, or an activating event, or an inference about an event, of an individual. C is the emotional and behavioral consequence or reaction of the individual: the reaction can be i.e. there healthy or unhealthy. A (the activating event) does not cause C (the emotional consequences). Instead B, which is the person's beliefs about A, largely creates C, the emotional reaction.
Primal anxiety
Is due to the assumed birth trauma of being overwhelmed with stimulation. Primal anxiety is the bodily basis for panic
Key principles and concepts of the psychoanalytic approach include:
Is generally a long-term therapeutic orientation as time is require to identify, expose, and resolve repressed and unconscious information, experiences, drives and motivations that produce distortions and dysfunctions
Self-Esteem (Existential)
Is not a function of how much other people value us. That is social esteem.
Clarification
Is sharper and more-detailed feedback regarding the particular phenomenon that the patient is experiencing.
Diagnosis
Is sometimes part of the assessment process. Consists of identifying a specific mental disorder based on a pattern of symptoms. Both assessment and diagnosis can be understood as providing direction for the treatment process.
Intentionality (Existential)
Is the creation of meaning, the basis of our identity.
Measurement Reliability
Is the extent to which an instrument measures the variables consistently.
Oral personality
It is not considered pathological but rather an immature person
Frustration (Experiential)
It is only through frustration that we are motivated to rely on our own resources to overcome what is frustrating us.
Gestalt therapists regard a client's past
It is significant and the present is more important. While gestalt therapists recognize the significance of a client's past to behavior and attitudes, the greater emphasis is placed on the client's current thoughts, feelings, and behavior
Why are we using the "single-system" design?
It's inclusive of the many types of clients served by social workers (one or more persons or groups) It emphasizes the person in environment focus of practice It's practical - easily tailored to practice settings...
Therapeutic Relationship in BT
Its importance varies according to behavioral method. Accurate observation is critical for effective treatment. Therapists establish secure relationship as a precondition for psychotherapy. Therapist modeling is crucial.
A Major Alternative to Existential Therapy: Existential-Humanistic
James F. T. Bugental (1915 - 2008) Third force in psychology European vs. American -Existential analysts report more classic psychoanalytic techniques. -Existential-humanistic report more physical contact, more activity, more warmth.
Egocentrism in children
Jean Piaget felt that egocentrism (being unable to see something from another's point of view) was a part of child development. He didn't view it as selfishness but rather as indicative of a child not yet being able to think about another's view at the same time as his own--because young children see themselves as the center of the universe
Lawrence Kohlberg's theory of moral development was an extension of
Jean Piaget's theory of cognitive development. Kohlberg believed that moral development involved a more protracted and complicated developmental process than Piaget had postulated. Kohlberg felt that morals (ethics, honesty, altruism, etc.) were absent in the newborn, and that age was less a predictor of moral development than was intelligence and social interaction. Thus, innate cognitive ability and social experiences (especially via the family) were the primary source of moral development
Theorist who researched children's cognitive development and referred to the "preoperational stage"
Jean Piaget. Between the ages of 3 and 6, children are in Piaget's second stage of cognitive development (proportional). In this state children can think in symbols even though they cannot yet use logic.
Collective Unconscious
Jung. The deepest level of the psyche containing the accumulation of inherited experiences of human and prehuman species.
Transference-Focused Psychotherapy (Psychodynamic)
Kernberg's object relations treatment.
Cognitive Behavioral Approaches: Cognitive Behavioral Therapy
Key Figure: A. T. Beck founded cognitive therapy, which gives a primary role to thinking as it influences behaviors; Judith Beck continues to develop CBT. Donald Meichenbaum is a prominent contributor to the development of CBT.
Cognitive Behavioral Approaches: Rational Emotive Behavior Therapy
Key Figure: Albert Ellis founded rational emotive behavior therapy, a highly didactic, cognitive, and action-oriented model of therapy that stresses the role of thinking and belief systems as the root of personal problems.
Cognitive Behavioral Approaches: Behavior Therapy
Key Figures: B.F. Skinner, Arnold Lazarus, and Albert Bandura This approach applies the principles of learning to the resolution of specific behavioral problems. Results are subject to continual experimentation. The methods of this approach are always in the process of refinement
Experiential and Relationship-Oriented Therapies: Existential Therapy
Key Figures: Viktor Frankl, Rollo May, and Irvin Yalom. Reacting gigabits the tendency to view therapy as a system of well-defined techniques, this model stresses building therapy on the basic condition of human existence, such as choice, their freedom and responsibility to shape one's life, and self-determination. It focuses on the quality of the person-to-person therapeutic relationship.
Elizabeth Kubler-Ross
Known for her work in death and dying, and she developed a five-stage theory regarding people's experiences as they adjust to their encroaching death. Denial, anger, bargaining, depression and acceptance. People may experience the stages in differing orders, and some people may skip one or more stages altogether.
Abraham Maslow
Known for his humanistic theory and "hierarchy of needs." His theory states that individuals exhibit behavior that seeks to meet their needs, beginning with the most basic needs and building to higher-level needs.
Narcissistic Personalities
Kohut. Result from insufficient mirroring or idealizing.
Practicalities of Behavior Therapy
Large variation in practice. Typically conducted in individual format; group format used for cost efficiency. Relentlessly time-efficient; clients typically seen less frequently and for shorter durations than other therapies. Therapy success to be frequently evaluated. Interventions performed in the natural environment have benefits. Much of behavior treatment conducted by caseworkers, teachers and technicians. Technology used as part of treatment. Mandate is to demonstrate competency in empirically supported methods (evidence- based practices).
Conflict Model
Largely at unconscious level, Motivating forces are Eros and Thanatos, Conflicts lead to defense mechanisms, Type of defense mechanisms are dependent on psychosexual stage.
Typical time period of onset for a substance abuse disorder
Late adolescence to early adulthood
Subpoena
Law enforcement officials are not automatically entitled to the confidential client information, even a court subpoena does no necessarily grant a social worker the right to freely disclose confidential information
Failure to develop a sense of industry
Leads to a sense of inferiority or inadequacy. Erikson believed that some individuals fail to develop a sense of industry not become of unconscious conflicts but because their culture discriminates against people of particular races or religions and fails to educate them adequately in the tools of that culture's trade.
Self-Regard (Person-centered)
Leads to individuals viewing themselves and their behavior in the same way that significant others have viewed them.
Interviewing requires a combination of which two types of skills
Learned and innate
Common point in defining culture
Learned through socialization. Every profession defines culture in its own way. For our purposes, culture includes beliefs and behaviors that are learned through socialization as well as being a group orientation.
General rules for SSD
Length of phase (suggestions) Keep all the same length Controls for maturation To reduce carry over effects use shorter phases (treatment) Extend phases to include cyclic subject variables i.e. menstrual cycle, daily issues
A Major Alternative in Multicultural Therapy: Psychotherapy with LGBT Clients
Lesbian, gay, bisexual, and transgender (LGBT) clients are oppressed minority group. Homophobic attitudes toward LGBT clients persist. Gay affirmative therapy celebrates and advocates for LGBT. Reparative/sexual conversion therapy attempts to "convert" clients to heterosexual orientation, but is largely discredited.
Emotion-Focused Therapy in Experiential
Leslie Greenberg (1945-present) Originally known as process-experiential therapy. Respond to client markers: Two-chair work for splits. Empty-chair dialogue for unfinished business. Combines client-centered and Gestalt.
Emotion-Focused Therapy (Experiential)
Leslie Greenberg and colleagues.
Key ecological concepts in ecological systems theory
Level of fit between the person and the environment and the interaction between environments.
Corrective Emotional Experiences
Level of individual experience in which the cathartic reactions come directly from within the person.
Integrative Therapies
Look beyond the confines of single-school approaches to see what can be learned and how patients can benefit. Goal: Enhance the effectiveness and efficiency of psychotherapy. Characterized by spirit of open inquiry and transtheoretical dialogue. Avoid the "dogma eat dogma" history of psychotherapy.
Genital Personality
Loves sex without the urgent dependency of the oral character, is fully potent in work without the compulsivity of the anal character, and is satisfied with self without the vanity of the phallic character.
Theory of Psychopathology in Existential Therapy
Lying (inauthenticity) leads to neurotic anxiety. Existential anxiety differs from neurotic anxiety. Freud: Instinctual drives produce anxiety, which produces defense mechanisms. Existential: Awareness of ultimate concerns produces anxiety, which produces defense mechanisms.
Mindfulness-Based Cognitive Therapy (Third Wave)
MBCT began with Beck's cognitive therapy for depression and added mindfulness- based stress reduction. MBCT developed to prevent relapse of major affective disorders. Centers on "modes of mind." Employs consciousness raising, choosing, and counterconditioning like ACT and DBT.
Sigmund Freud
MD from University of Vienna. Founder of psychoanalysis. Origins of many behavioral disorders are rooted in childhood. Humans are in internal conflict and tend to produce compromise solutions. Mental representations of ourselves, others, and relationships profoundly impact our daily functioning.
Alfred Adler
MD from Vienna University. Colleague and early disciple of Freud.
Contact
Made by seeing, hearing, smelling, touching, and moving. In Gestalt therapy, contact is necessary if change and growth are to occur. Effective contact means interacting with nature and with other people without losing one's sense of individuality.
Medard Boss
Made reference to dasein or being in the world, which pertains to our ability to reflect on life events and attribute meaning to these events.
Differentiation Period (Psychodynamic)
Mahler. During which the child practices separating individuating from significant others. Ex: crawling away from parent and then running back, peekaboo.
Integration Stage (Psychodynamic)
Mahler. Under normal conditions, the stages of differentiation shift at about 2 years of age into an integration stage. Through the integrating process, the self and object representations, which have become independently perceived, are now fit into relationships with each other. During this stage, the child also begins to integrate the good and the bad self images into a single, ambivalently experienced self.
Issues Involved with Participant Observation
Maintaining Relationships: Develop an honest explanation for yourself and study Maintain support of key individuals Be unobtrusive and unassuming Don't be too aggressive in questioning others Ask sensitive questions only after strong rapport is established Don't fake a social similarity Be self-revealing only to a point Avoid giving or accepting money/gifts Be prepared for inter-group conflict
Being an effective communicator includes the ability to demonstrate compassion and?
Maintaining emotional distance. An effective counselor demonstrates compassion toward the client but does not get too close emotionally. Counselors need to maintain distance if they are to remain objective and rational in assisting the client.
Six Basic Techniques of Psychoanalytic Therapy
Maintaining the analytic framework Free association Interpretation Dream analysis Analysis of resistance Analysis of transference.
Sexual Trauma in Gender-Sensitive Therapies
Major contributor to psychopathology. About 1⁄4 of American women have experienced childhood sexual abuse. About 60% of rapes are acquaintance rapes; only 30% of rapes are reported. Rage related to sexual abuse can manifest itself in pathological symptoms.
Ensuring Accurate Observations
Make sure the behavior is the target of interest Make sure samples of times and places are representative Define the behavior(s) clearly Use appropriate recording procedure (construct a form)
Theory of Psychopathology in BT
Maladaptive behaviors reflect a deficit in cognitive activity. Problems are characterized by: Lack of coping response. Use of inappropriate cognitive responses (e.g., mislabeling). Ineffective strategies for problem-solving.
Vicarious liability
Malpractice liability generally runs from an agency's board of directors, to the director, supervisory staff, and then to the front-line social worker. Employer and supervisor liability accrues under the legal theory of vicarious liability. Although an agency may have liability insurance, it is usually recommended that individual social workers carry their own private coverage
Manic episodes duration
Manic episodes last days to months
Rationalization
Manufacturing "good" reasons to explain away a bruised ego Rationalization helps justify specific behavior, and it aids in softening the blow connected with disappointments. When people do not get positions they have applied for in their work, they think of logical reasons they did not succeed, and they sometimes attempt to convince themselves that they really did not want the position anyway.
I-it relationships (Existential)
Many people feel safe to relate only to objectified others and enter into I-it relationships.
Attachment (Psychodynamic)
Margaret Mahler and Bowlby. Through the process of attachment, the child enters the stage of normal symbiosis. In this stage, there is confusion in the child's mind as to what is self what is object, because neither is perceived as independent of the other. The stage normal lasts 2 to 7 months.
A-B Design Example
Marsha (Marsha, Marsha) has been your client for 10 weeks. As a wise social worker wanting to know if your work is effective or not, you have been providing your weekly case management for Marsha, and at week one, starting tracking Marsha's levels of depression and anxiety. You see that during the 3-week baseline assessment period, Marsha's scale score was above the clinical cutting score of 30 for the Beck Depression Scale. After you started your family therapy visits in week 4 (while continuing your case management services from week 1) you have recorded a decrease in depression scale scores from above 30 to closer to 20 by week 10. Marsha's level of anxiety (measured by the Index of Clinical Stress) decreased slightly over time.
Sensate Focusing
Masters and Johnson. A series of couples exercises used to alleviate anxiety related to intercourse in which partners take turns exploring and massaging each other's bodies.
Existential Givens
Matters of necessity-we must die, we must act- and hence are a negation of being, which his by definition open-ended and in the realm of possibility.
Threats to Internal Validity: Maturation
Maturation - changes occurring within the experimental subjects that are due to the passage of time (not specific to the particular events). Example: Anxiety increasing or decreasing naturally over the course of a day. Level of depression resolving naturally over time. This term covers all of the biological and psychological processes that vary with the passage of time. Between the first and second observation, respondents may have grown older, hungrier, more tired, more bored, etc. Researchers need to be careful of this when dealing with children because they are growing so much so quickly. If you're looking at a 6-week period, it's not that much of a problem, but 1 year is a long time.
Consultants
May have broad administrative authority and may be empowered to act very broadly or very narrowly, depending upon their assignment
Cautions in the Use of Standardized Scales
May not measure concept suggested by scale name Different measures of the same concept may not be equivalent Sometimes limited information about reliability and validity Concepts as measured may not be completely relevant to individual clients
Bias
May simply reflect a personal preference without negative overtones
Beyond Conflit to Fulfillment
Meaning in life, The ideal person
Beyond conflict to fulfillment
Meaning in life, the ideal person
Disqualifying Communication
Meaning that, by words or actions, it disqualifies what one has just said.
Nominal Measure Cont.
Means "in name only". This is the lowest level of measurement. You can only do descriptive statistics with nominal data.
Genuineness (Person-centered)
Means that therapists are freely and deeply themselves
Modeling therapy
Modeling in therapy can be done in several ways but quite simply involves the client's imitating a particular interaction or behavior in order to replicate it.
Listening with a third ear
Means to look for hidden meaning in what the client is communicating. Additional meaning may be gleaned from many factors beyond the actual spoken words, such as behavioral cues, tone of voice and more.
Measurement Error
Measurement error is the variance in responses that is not due to the variable being measured. No measure is error free! All measurements contain some error! It is important to identify these so that we can reduce errors.
Measuring Interventions
Measures of target problems (interventions) are often characterized in four ways: 1. Frequency: number of times a behavior or feeling occurs within a specified time period; 2. Duration: length of time an event or symptom lasts; 3. Interval: length of time between events; 4. Magnitude: intensity of a behavior or emotional state.
Measuring service delivery
Measuring service delivery is necessary in order to manage economic factors as well as to increase the efficiency and effectiveness of the services provided.
The federal health insurance program for the elderly is known as Medicare, and was designed for individuals over the age of 65, or the disabled, or individuals with end-stage renal disease (ESRD). Originally, this insurance had two specific components. Which are they?
Medical insurance and hospital insurance
The NASW defines the mission of social work as
Meeting the needs of individuals in a family and social context, promoting human well-being and aiding others to secure basic human needs, and addressing problems from a societal and environmental perspective
Elements
Members of the population
Gender-Role Expectations
Men must achieve or exceed masculine standards or accept "failure." Men hide feelings behind façade of toughness, resistance, and violence. Male problems (e.g., aggression) are often byproducts of typical socialization. Men find it difficult to seek help; seen as admission of weakness. Men often genuinely unaware of their emotions (normative male alexithymia).
Communication/Strategic Therapy in Systemic Therapy
Mental Research Institute (MRI) and Double Bind Communications Project Key figures: Jay Haley, John Weakland, Donald Jackson, Virginia Satir Communication key to understanding behavior. Assume that all behavior is communication. Classic example: double bind. Interventions change communication.
Object Relations in Psychodynamics
Mental representations of self and others (not interpersonal events). Partly energized by basic instincts, especially aggression. Prominent therapists include Fairbairn, Kernberg, and Kohut (the latter developing self psychology).
Object Relations
Mental representations of self and others (not interpersonal events). Partly energized by basic instincts, especially aggression. Prominent therapists include Fairbairn, Kernberg, and Kohut (the latter developing self psychology).
Effectiveness of Gestalt in Experiential
Meta analysis of 18 studies found average effect size, higher than placebo. Gestalt therapy showed slightly lower gains in direct comparisons. Gestalt not found superior to any other therapy but more effective than no treatment. Some studies that found Gestalt inferior to other therapies might be due to allegiance effect.
Effectiveness of Constructivist
Meta-analyses on SFT, but many studies neither controlled nor randomized. SFT conclusions: Superior to no treatment; frequently briefer than alternatives; insufficiently investigated in RCTs; findings from existing RCTs are equivocal. Few RCTs on effectiveness of narrative therapy. Reaction against typical "scientific" objectification and standardization.
Progressive muscle relaxation
Method of teaching people to cope with the stresses produced by daily living. It is aimed at achieving muscle and mental relaxation and is easily learned.
Acceptance and Commitment Therapy (ACT)
Mindfulness-based approach. Involves fully accepting present experience and mindfully letting go of obstacles.
Effectiveness of Behavior Therapy
More empirical research than any system of psychotherapy. Superior to no treatment and placebo. Behavior treatment more effective than non-behavioral for childhood disorders. Behavior marital therapy (BMT) produces significant changes maintained over time.
In psychoanalytic theory, four forces motivate behavior
Pleasure principle, anxiety, defense mechanisms and psychosexual development.
The basic functions of administrators includes
Monitoring, reviewing, advising, and evaluating employees; planning and delegation; conflict resolution and mediation; advocacy (both horizontally and departmental staff, and vertically between other departments and staff
Theory of Psychopathology:
More conditional the parents' love, the more likely pathology. Incongruence between what is experienced and what is person's self-concept. Psychopathology reflects a divided personality due to lack of wholeness. Defensive reactions prevent threatening experiences from coming into awareness. Defenses cause inaccurate perceptions due to distortions and selective omission of information.
Preparation
More confident and less tempted. Assess the pros as higher than the cons. Most likely to participate in change programs and most likely to benefit. About 20% of people are in preparation or in early action.
Effectiveness of EFT Couples Therapy in Experiential
More effective than no treatment and control groups. 70-73% recovery for marital distress. Now recognized as evidence-based treatment for couples distress.
Distressing and anxiety-provoking thoughts may be rejected by the conscious mind and focused into the unconscious mind by a process called
Repression
Compensation (Psychodynamic Therapies)
More frequent and powerful defense mechanism. Serves not as a defense against anxiety per se but rather as a defense against the aversive feelings of inferiority.
Conditioning in BT
More similar a stimuli is to original fear provoker, the more fear it produces. Constantly anxious clients have been conditioned to an omnipresent fear stimuli. Anxiety impairs other behaviors, leading to secondary symptoms. As disorder progresses, client's complaint goes from anxiety to avoidant behaviors.
Effectiveness of MI in PCT
More than 200 RCTs. Project MATCH Strongest support in treatment of substance abuse. Particularly effective with ethnic minority and resistant clients. May need to be combined with another evidence-based treatment.
Threats to External Validity: Multiple-treatment interference
More than one IV or a combination or ordering of treatments likely to occur in the "real world". Likely to occur whenever multiple treatments are applied to the same respondents because the effects of prior treatments are not usually erasable, so how do you discern which one had the effect? In substance abusers, how do we determine if it is current treatment or past treatment that resolved the substance abuse?
Logotherapy (Existential)
Most concerned with meaninglessness
Quantitative Methods
Most often used for explanatory or evaluative (experimental) research (sometimes descriptive). Goal is to develop an understanding that correctly reflects reality.
Qualitative Methods
Most often used for exploratory (and descriptive) research. Goal is to develop an "authentic" understanding of a social process, individual experience or setting.
Inferiority Feelings
Motivate us to strive for mastery, success (superiority) and completion. We are driven to overcome our sense of inferiority and to strive for increasingly higher levels of development.
Therapeutic Relationship: Experiential
Must be a genuine encounter with accurate empathy. Client's immaturity receives negative feedback (not unconditional regard). Therapist must block own urges to take control of client's life. Client's responsibility to take hot seat. Therapist will prompt client to produce, not just talk about, a new self.
Ideal supervisory situation
Mutual understanding and agreement. Refers to when the supervisor and supervised achieve mutual understanding and agreement on the issue reviewed. If shared meaning is high, then the effectiveness of the supervision interaction also will be high.
Therapeutic Relationship: Existential
Necessary and sufficient conditions for personality change Genuineness/congruence Positive regard Accurate empathy
Simple random sampling
Need a complete sampling frame Elements are chosen at random from population Example: raffle winners
Systematic random sampling
Need a complete sampling frame (a list of population members) Randomly choose a place to start on the list Go down the list and choose every nth element
Stratified random sampling
Need a complete sampling frame that identifies all population members by characteristics (races, ages, genders, etc.) Randomly choose a sub-sample from each sub-population Proportionate vs. non-proportionate (disproportionate)
Therapeutic Processes in Integrative
Need for active intervention for neurotic patterns to change. Insight is one way of disrupting the destructive cycle of events. Employ behavioral methods such as assertion training. Insight and action are mutually facilitative.
Some of the most salient changes to the new DSM 5
No More Multiaxial Assessment System In prior versions of the DSM, a system that included 5 "axes" or dimensions was used for diagnostic and treatment purposes. The axes were: I) Clinical Syndromes / Disorders, II) Personality Disorders / Mental Retardation, III) Medical Conditions, IV) Psychosocial and Environmental Stressors, and V) Global Assessment of Functioning.
Effectiveness of Existential Therapy
No controlled research on its effectiveness. Opposition to controlled research due to mistrust of ordinary "scientific" research. Frankl's paradoxical intention is considered effective, but not more effective than straight directives. Paradoxical interventions show greater effectiveness with highly resistant patients.
Operationalization
Operationalization is going from a conceptual understanding of a term to an exact definition • The exact definition is linked to something we can observe (or collect data about)
Effectiveness of Gender-Sensitive Therapies
No randomized controlled studies on effectiveness of feminist therapy. Increased satisfaction commonly observed in same-gender therapy dyads. But no consistent benefit of patient-therapist gender matching on outcome. More difficult to test by traditional means because results are not limited to symptom remission.
Research Hypotheses: No Relationships
No relationship - specifies that there is no relationships between the IV and DV "Drug use does not impact depression" "There is no difference at which speed males and females learn"
4 Stereotypes of "True Masculinity"
No sissy stuff: Avoid anything "feminine." The big wheel: Must be successful, respected breadwinners. The sturdy oak: Exude confidence, strength, self-reliance. Give 'em hell: Behave aggressively and daringly.
Research Hypotheses: Non-Directional
Non-directional - does not specify direction of relationships between the IV and DV "Drug use impacts depression" "Males and females learn at different speeds"
Stages of Self-Development (Margaret Mahler)
Normal autism (first few months of life) Normal symbiosis, Lasts 2 - 7 months Attachment Symbiotic psychosis, Integration stage Splitting, Introjection
Effectiveness of Communication/Strategic in Systemic Therapy
Not a lot of controlled outcome studies. Effective in treating substance abuse. Uncertain effectiveness in other disorders.
Descriptive Research: Time Series Designs
Not as good as random assignment; but compares to a control group - sometimes called "non-equivalent control group design"
Autonomous work
Not expected to have a supervisor. Refers to social workers performing their duties independently, without the need for formal supervision of their work. Some believe that this self-directed approach to practice is better because it doesn't stifle creativity
Okay
Not helpful to use as a furthering response declaration. In some situations the word "okay" may be taken as a conversation conclusion-perceived as meaning "I understand, and no further explanation or discussion is necessary." Thus, other furthering responses would more likely cause a client to continue sharing. More helpful: "go on" insertion, "um-hmm" or "yes" interjections, or head nodding
Hypothesis Testing: Null
Null (no relationship - don't be confused) research hypothesis - states that the two variables are unrelated: "There is no relationship between social work students' feelings and research methods courses."
Null Hypothesis
Null hypothesis: A statement that the relationship between variables in a research sample is a fluke. It is the result of sampling error. Sampling Error is the natural tendency of a sample to differ from the population (especially a small sample). The sample must have been quite atypical. In other words, if the entire population had been studied, the same relationship between the variables would not have been found.
Content Analysis
Number of times "depression" or synonym used (interval/ratio level) 3 clinical social workers independently determine whether each appeared "severely depressed", "somewhat depressed" If two social worker are in agreement use as ordinal level
Frequency Recording
Number of times a behavior occurs during a given observation period Used when the number of times a behavior occurs needs to be increased or decreased Behavior must have a clear beginning and ending, and different occurrences must last about the same duration
Select the Number of Response Categories in IRS
Number selected can influence reliability and validity Number should be large enough to detect important differences, but not so large that it is difficult to distinguish among categories 5 to 11 about right, usually 7 to 9
Phases of SSD
Objective #2: Be able to list and describe the 2 phases of a SSD. 1. Baseline Period of no treatment (reflects natural state) Provide standard for evaluating the effect of IV and to determine if extraneous variables are operating (i.e. the control condition) 2. Treatment Introduction of the IV Phase length should be approximately as long as baseline (for comparison purposes) Repeated measurement of the DV continues 3. Know the general rules when using single subject designs Shouldn't change baseline until Little variability No trends Unless the trend is in the opposite direction of expected effect Only change one variable at a time
Reversal Design
Objective #4: Know the critical features for the reversal design. Critical features At least 2 conditions Baseline Treatment Same condition present for consecutive sessions Conditions don't alternate rapidly Types: AB ABA ABAB
Single subject design: defined
Objective 1: Be able to describe what a single subject (system) research design is. Single subject research designs: use one subject at a time to investigate the effects of a particular independent variable (treatment). Use multiple participants (replications) to increase external validity
Unit of Analysis
Objects or events under study (individuals, social roles, positions, relationships, social groupings, social artifacts)
Interval Recording
Observation time partitioned into specific time intervals Recording made of whether: the behavior occurred at all, or the behavior occurred throughout entire interval, or the behavior occurred at a particular time during the interval Estimate of frequency or duration
Client feedback about services
Obtaining client feedback after services can aid social workers in a number of ways. Client feedback not only can result in clients feeling more invested in treatment but also may reveal gaps in services and weak spots in the treatment process. Policy innovation and formation can benefit greatly from client feedback.
Mahler's Separation-individuation stage
Occurs between 5 and 24 months of age, and has four substages: 1) differentiation (5-9 months) and attention shifts outward and early caregiver separations occur (crawling away, etc.) 2) practicing (9-14 months) and autonomous ego functions emerge as mobility increases, 3) rapproachement (14-24 months) and desires for independence increase, but frequent checks ensure the caregiver remains present 4) object constancy (after 24 months) and the caregiver is internalized, and there is an understanding the caregiver exists despite any absence.
Erikson's psychosocial stage of development-stage of autonomy versus shame and doubt (Stage 2)
Occurs between ages 2 and 3. Children acquire the verbal and motor skills that facilitate autonomy
Projection
Occurs when a person acts towards others what he accuses them of acting to him
Reaction formation
Occurs when an opposing response to the one internally felt is substituted in order to relieve internal dissonance or distress. Ex: someone "bending over backwards" to favor a coworker to cover an intense dislike of the individual
Moral Anxiety
Occurs when one acts contrary to his or her moral beliefs.
Corrective Emotional Experience
Occurs when patients re-experience the old, unsettled conflict but with a new, healthier ending within the therapeutic relationship.
Deficit
Occurs when profits fall short of needed operating expenses.
Covert Behavior
Occurs within the individual and can not be observed directly by others e.g., positive, self-deprecating, or irrational thoughts
Adler Birth Order: Middle Child
Often feels squeezed out. This child may become convinced of the unfairness of life and feel cheated. This person might assume a "poor me" attitude and can become a problem child.
Abusive parents
Often have been abused as children themselves and feel rejected by their own parents. More likely to have children closer together in age, experience marital problems, and fight physically.
Videotaping as a case-based recording
Often used in medical situations and as a way to train students or staff. The approach is almost always used in conjunction with supplemental record-keeping
Practicalities (Systems)
Often work with spouses or with one patient. Central couple is most important. Strong proponent of family of origin therapy for psychotherapists. Active, short-term treatments that initiate the change process. Highly compatible with time-limited psychotherapy. MRI brief therapy averages 7 sessions.
Carl G. Jung (Psychodynamic Therapies)
Once hailed as the "Crown prince" of psychoanalysis and successor of Freud. Launch Analytical Psychology. Jung pursued a path different from Freud's when he found himself unable to accept the exclusively sexual nature of Freud's notion of libido. Jung relied extensively on the interpretation of dreams and symbols to access the patient's archetypes.
Bad faith (Existential)
Once we act on bad faith in ourselves, we are faced with impending guilt of knowing who we really are.
Compulsive Lifestyle (Psychodynamic Therapies)
One of the most common neurotic styles to emerge from parental domination. Developed by Adler. The constant nagging, scolding, deriding and fault finding of domination parents can lead to an inferiority complex in which the compulsive person feels powerless to solve life's problems.
Nomothetic explanation
One thing directly leads to (causes) another Predictive explanation Usually used with group designs
Empty Chair Technique
One way of getting the client to externalize the introject, a technique Perls used a great deal. Using two chairs, the therapist asks the lucent to sit in one chair and be fully the top dog and then shift to the other chair and become the under dog.
Practicalities of Gestalt Therapy: Experiential
One year of training at Gestalt training institute. Therapists are more informal about patient screening and outcome follow- ups. Therapy length can vary from one workshop to weekly sessions for 6 months. Briefer Gestalt therapy is the trend, with active and directive techniques.
Hypothesis Testing: One-Tailed Hypothesis
One-tailed hypothesis - states that the variables are related and predicts the direction: "Social work students will have higher feelings of love for research methods upon this course completion." What is the null hypothesis statement?
Four specific skills are used in MI to foster client safety (OARS) (Person-centered)
Open questions (evoke change talk), Affirmation (emphasize the client's strength, efforts, and steps in the right direction), Reflective listening (encapsulates the Rogerian skill of accurate empathy that allows the client to explore and experience the dilemma at hand), Summaries (draw together the client's change statements and then deliver them back to the client for ever larger impacts).
Four Skills of MI: OARS
Open questions, Affirmation, Reflective listening, Summaries
Extinction
Operant method of changing behavior. Refers to withholding reinforcement from a previously reinforced response.
Existential Humanistic Therapy
Operates at the interface of existentialism and humanistic theory and is closely allied with the "third force" in psychology.
Cluster evaluation
Optimum where multiple sites, programs, and interests are involved. The evaluative steps involve visiting each site, collecting records, orienting to each site, and identifying unique service plans, et cetera. Next a networking conference is held to identify commonalities and uniqueness among the programs. Cluster-lelve questions focus on information from early data collection and initial program analyses. Later conferences focus on findings and outcomes, with recommendations for change. Cluster evaluation involves many participants, and thus offer considerable certainty about the conclusions reached. Its primary limitations include the potential for bias and group-think to occur.
According to the psychoanalytic theory, attachment is the result of
Oral gratification. Children are born with a sucking reflex and derive pleasure, comfort, and security from sucking. A child who is gratified orally will more likely learn to bond and attach to her/his mother/caretaker
Freudian Psychosexual Stages
Oral, Anal, Phallic, Latency, and Genital
Self-Concept (Person-centered)
Our perceptions of what is characteristic of "I" or "me," our perceptions of our relationships to others and to the world, and the values attached to these perceptions.
Polarities (Experiential)
Our phony characters attempt to shield us from the fact that authentic existence involves, for each individual, facing personal polarities.
Why is research important in Social Work Practice?
Our powers of observation are not as good as desired. If you do not set out to systemically observe, then you error. 1. We overgeneralize. 2. We have selective observation (see what we want to see). 3. We use illogical reasoning. 4. We all have ego involvement (imaging ourselves). 5. We prematurely close inquiry.
Effectiveness of EMDR in Exposure Therapy
Outperforms no treatment. As effective as other exposure methods. Listed as "probably efficacious" for civilian PTSD. Eye movements have not been proven necessary component. Remains controversial despite large research base.
Several Depressogenic Assumptions
Overgeneralization: One experience applies to all situations. Selective abstraction: Only measuring oneself via failure. Excessive responsibility: Assuming oneself is responsible for all failures. Self-references: Assumption that everyone is paying attention to you. Dichotomous thinking: Everything is either one extreme or the other.
Which type of sexual disorder is most likely to come to the attention of a social worker
Paraphilias
Being a good listener
Part of being an effective listener consist of asking questions. Assumptions regarding what's being said can be problematic, because communication can differ from person to person
Maya (Hindu work for illusion) (Experiential)
Part of the phony level of existence that we construct between our real selves and the real world, but we live as if our maya is reality.
Research Protections
Participants Governmental regulation Review of proposed research Guidelines based on professional codes Careful project monitoring and responsibility of investigator in charge Written informed consent to participate Confidentiality
Effectiveness of Family Therapy as Tx Format in Systems
Particularly effective in motivating alcoholics to enter treatment. Significantly lower drug use after family treatment compared to non-family therapy. Family treatment of schizophrenia reduces relapse and improves outcome. Outperforms no treatment and TAU for youth with conduct problems
Title XVI
Passed by Congress in 1975, an amendment to the 1946 Hill-Burton Program. It established Federal grants, loan guarantees, and interest subsidies for health facilities and required them to provide certain levels of uncompensated service in perpetuity.
Theory of Psychopathology: Psychodynamic Therapies
Pathological personalities are those discouraged from attaining superiority in a socially constructive style. Emerge from atmospheres of: competition, mistrust, neglect, domination, abuse, pampering
Basic Mistakes (Psychodynamic Therapies)
Pathological personalities construct maladaptive goals by making such basic mistakes as generalizing about the nature of all human relationships on the basis of the very small sample they have experienced.
Therapeutic Relationship: IPT
Patient advocate, not neutral commentator. Not a manifestation of transference. IPT rarely analyzes the interpersonal relationship in psychotherapy. Therapist expresses empathy and warmth but not unconditional acceptance.
Therapeutic Processes (Integrative)
Patients are troubled by multitude of specific problems that are remedied with a similar multitude of specific techniques. Comprehensive assessment of patient's deficits and excesses (BASIC I.D.). Patient's problems (not therapist's theory) determine the technique or change processes. Employ any and all change processes as the case demands.
Therapeutic Processes 2 in Existential Therapy
Patients freely express themselves, with little intervention from therapist. Patients become conscious of repeating patterns of being. Existentialist's honest feedback facilitates breaking out of closed world. Burden of choosing is on client.
Emotionally Focused Empathy
Pay attention to and value their experiencing, process their experience both cognitively and bodily, view prior experiences in new ways, and increase their confidence in making choices and in pursuing a course of action.
The stages of change: Contemplation Stage (2)
People are aware of a problem and are considering overcoming it, but they have not yet made a commitment to take action to bring about the change
Ludwig Geismer
Scale of family functioning was developed in the 1950's to assess the social functioning of families that were dysfunctional. It can be useful in assessment, treatment and/or research.
Birth order or Ordinal Position (Psychodynamic Therapies)
People construct their lifestyles partly on the basis of early childhood experiences. Birth order is the child's position in the family constellation and is especially influential on his or her lifestyle.
Borderline Personality Disorder
People with BPD have moved into the separation process but have been thwarted by parental rejection of their individuation
The stages of change: Maintenance Stage (5)
People work to consolidate their gains and prevent relapse.
Automatic Thoughts
Perceived notions that are triggered by particular stimuli that lead to emotional responses.
Gestalt seeks to understand the phenomenological aspects of the client and refers to
Perceptions. Seek to understand perceptions regarding behavior and its motivation
External Validity
Perfect Internal Validity does not exist! External Validity is different (full description when we get to Sampling): The extent to which an intervention's effect (independent variable) can be generalized. In other words, to what extent can the findings be believed to apply beyond the sample actually studies? Factors to consider include: sample representativeness; sample setting; and, study procedures.
Practicalities of Third-Wave Therapies
Performed in individual, couple, and group formats with adolescents, adults, and older adults. Growing applications to many disorders and populations. Emphasis on teaching client and clinician the requisite mindfulness skills.
Top Dog and Under Dog (Experiential)
Perls called the most famous Gestalt polarities. We experience Top Dog as our conscience, the righteous part of us that insists on always being right. Top Dog attempts to be master by commanding, demanding, insisting, and scolding. Under Dog is the slavish part of us that appear to go along with the bullying demands of Top Dog's ideals but in fact control through passive resistance. Under Dog is the part of us that acts stupid, lazy, or inept as a means of trying to keep from successfully completing the orders of Top Dog.
Social Workers tend to primarily classify individuals using
Person in Environment relates the client's level of functioning to biological, social, and psychological life issues
Expressive Art Therapy
Person-centered expressive arts therapy. Extends the person-centered approach to spontaneous creative expression, which symbolizes deeps and sometimes inaccessible feelings and emotional states.
Assessment Should Cover
Personal history, family, social, community, religious and/or spiritual beliefs and practices, emotional (coping skills, support systems, prior psychiatric history, and treatment), intellectual, work, economic and legal
How do we decide on a problem?
Personal, social, and cultural values Practice experience/recognizing a gap, noticing something is missing Requests for Proposals (RFPs) for research funding Dissatisfaction or disagreement with existing ideas Personal history Professional and agency considerations Opportunity or luck
Personality Tests
Personality is a construct similar to intelligence in that a single prototype does not exist. Here is our definition: personality is the relatively permanent patterns that characterize and can be use to classify individuals. -Most personality tests are self-report measures. A self-report measure is a test-taking method in which the participants check or rate the degree to which various characteristics are descriptive of themselves. -Performance measures of personality are also used. A performance measure is a test-taking method in which the participants perform some real-life behavior that is observed by the researcher. -Personality has also been measured with projective tests. A projective test is a test-taking method in which the participants provide responses to ambiguous stimuli. The test administrator searches for patterns on participants' responses. Projective tests tend to be quite difficult to interpret and are not commonly used in quantitative research.
Theory of Personality: Existential Therapy
Personality is an emerging, a becoming, a process of being that is not fixed or characterized by traits. Being and world are inseparable. To understand a human being is to understand the world he/she constructs.
Exceptional eligibility programs
Serve groups with special common needs (e.g., The Veterans Administration)
A Major Alternative in IPT: Transactional Analysis (TA)
Personality is structured into 3 ego states: Parent: Both nurturing and controlling; copied from parents in childhood. Child: Impulsive and stimulus-bound state; present since childhood. Adult: Information gathering, data processing, and decision making.
Interpersonal Empathy
Pertains to understanding a client's internal frame of reference and conveying a sense of the private meanings to the person
Martin Heidegger
Phenomenological existentialism reminds us that we exist "in the world" and should not try to think of ourselves as beings apart from the world into which we are thrown.
Phobic Layer (Experiential)
Phobic about the pain that ensures from facing how dissatisfied we are with part of ourselves. The phobic responses frequently help us avoid what is really hurting.
5 Levels of Psychopathology: Experiential
Phony Level -Attempt to live up to self-imposed ideals of self. Phobic Level -Most critical level; avoidance of pain caused by not living up to self ideals. Impasse Level -Realization of change and death of old self. Implosive Level -Dealing with death of problematic parts of self. Explosive Level -Extreme release of energy that maintained neurosis.
Organ Inferiorities (Psychodynamic Therapies)
Physical weaknesses of the body that predispose us toward ailments such as heart, kidney, stomach, bladder and lung problems
Gestalt Theory
Places an emphasis on present behavior and awareness of what one is experiencing at any given moment. The client's view of what is being experienced, and the counselor's assistance in working through those feelings, can aid in altering behavior
Service delivery standards are often set by policy that is created through
Policy often is created through a series of repeated steps. It begins with the identification of a problem and then proceeds through goal-setting formulation, implementation, evaluation, change and, finally, termination
Guidelines for Constructing Goals in Constructivist
Positive (what behavior will replace the old behavior). Focus on how change will occur. Change what happens in the present. Must be practical. Must be specific. Must be client controlled. Set in the client's language.
Relationships Expressed by Hypothesis
Positive RelationshipDV increases as the IV increases Negative Relationshipvariables move in opposite directions—as one increases the other decreases
Erikson's terms syntonic and dystonic are best defined as
Positive versus negative. Successful personality development requires individual to cope with negative (dystonic) threats to self integrity, and to integrate positive (syntonic) personality skills.
Relational Psychoanalysis
Posits that therapist is unavoidably embedded in the relational field of the treatment; the pulls and feelings of the therapist are regarded as related to the patient's dynamics and as providing potentially useful information. Focuses upon desires, not sexual and aggressive drives.
Interval Measures
Possess the characteristics of nominal and ordinal levels; Mutually exclusive categories Inherent order Adds equal spacing between categories; Can add and subtract the numbers; Zero is arbitrary, so cannot make ratio statements (twice or three times as hot, cold, etc.); Temperature scales IQ scores
Revised Diagnoses: PTSD & Pedophilic Disorder
Posttraumatic Stress Disorder PTSD now includes 4 (instead of just 3) distinct diagnostic clusters. Behavioral symptoms will receive more focus, as will the unique developmental aspects with regards to children and teens with PTSD, having their own unique diagnostic criteria. Pedophilic Disorder This will be the new name for the disorder formerly known as Pedophilia. The diagnostic criteria will remain the same.
Feminist theory
Power accrues with those who have voice Respects indivudual's subjective experience and Shifts power to be evenly distributed Photovoice is an application of this theory
Stage 2 of Group Development
Power and control. Involves the development of roles and leadership within the group
Stage 1 of Group Development
Pre-affiliation. Involves getting acquainted and group apparel.
According to Piaget, a child begins to use symbols (i.e., language, images, etc.) during which developmental stage
Pre-operational stage. (2-7 years of age) is characterized by the use of symbols, language, conceptualization of a post and future and egocentricity (everything is seen as relative to him/herself)
The stages of change
Precontemplation Stage Contemplation Stage Preparation Stage Action Stage Maintenance Stage
Guidelines for Behavioral Observation
Preliminary assessment Decide on number of behaviors Specify behaviors Decide who should observe
If a social worker utilizes a confrontational approach with clients, social exchange theory would suggest the most likely result would be
Premature therapeutic termination by the client. Relationships are characterized as an exchange process
Steps in Constructing IRS's
Prepare the client Select rating dimensions Select the number of response categories Create equidistant response categories Construct overall summary score
Educational Assessment Tests
Preschool Assessment Tests. --These are typically screening tests because the predictive validity of many of these tests is weak. Achievement Tests. --These are designed to measure the degree of learning that has taken place after a person has been exposed to a specific learning experience. They can be teacher constructed or standardized tests. Aptitude Tests. --These focus on information acquired through the informal learning that goes on in life. --They are often used to predict future performance whereas achievement tests are used to measure current performance. Diagnostic Tests. --These tests are used to identify the locus of academic difficulties in students.
Primary Goal of Evaluation
Primary goal of evaluation is to improve practice, and what you do follows... e.g., design and duration are driven by practice considerations, targets of intervention and intervention itself driven by client needs
Primary Goal of Research
Primary goal of research is to develop knowledge, and what you do follows... e.g., design and duration fixed in advance and driven by research considerations, targets of intervention and intervention itself driven by research questions
Cases for Diagnoses DSM V
PrincipalandProvisionalDiagnoses: • When more than one diagnosis for an individual is given in an inpatient setting, the principal diagnosis is the condition established after study to be chiefly responsible for occasioning the admission of the individual. • When more than one diagnosis is given for an individual in an outpatient setting, the reason for visit is the condition that is chiefly responsible for the ambulatory care medical services received during the visit. • The specifier "provisional" can be used when there is a strong presumption that • the full criteria will ultimately be met for a disorder but not enough information is available to make a firm diagnosis. The clinician can indicate the diagnostic uncertainty by recording "(provisional)" following the diagnosis.
Private and social speech in child development
Private is with oneself and social with others. Private speech (speaking about to oneself) is common in early and middle childhood, and ranges from repetitive words to thinking aloud. Social speech seeks to be understood by another person.
The SOAP Method of progress notation is commonly used in which form of record-keeping?
Problem-oriented recording
Categories of risk for early-onset intellectual disability include:
Problems at birth and poverty. The causes of many cases of early-onset intellectual disability are difficult to determine. However, major categories of risk include genetic conditions, problems during pregnancy (as well as at and after birth), poverty and cultural deprivation.
V Codes
Problems or conditions not due to a mental disorder, but that require clinical attention
Acceptance
Process involving receiving one's present experience without judgment or preference, but with curiosity and kindness, and striving for full awareness of the present problem.
Working through
Process that consists of repetitive and elaborate explorations of unconscious material and defenses, most of which originated in early childhood. Is achieved by repeating interpretations and by exploring forms of resistance.
Feminist Therapeutic in Gender-Sensitive Therapies
Processes Consciousness raising: One's suffering due to gender restrictions and discrimination. Choosing: Can be achieved even within a patriarchic society. Counterconditioning: Healthy opposites applied to gender-linked, culture-induced distress. Social liberation: Increasing alternatives for equality; "the personal is political."
Stage-Matched Programs
Recognize behavior change occurs in stages. Are tailored to the needs of all participants, not just those in action. Can generate 80% participation. Can produce up to 8 times more impact than action-oriented programs.
Psychoanalytic Theory
Recognize the influence of past experiences and the environment in shaping current behavior. Intensely focuses on the past. Personality structure is seen as interrelated. See each individual as evaluating fragments of the self.
Integrative Motives
Proliferation of therapies. Inadequacy of single theory for all patients. External socioeconomic contingencies. Ascendancy of short-term, problem-focused treatments. Therapists observing and experimenting with various treatments. Commonalities contribute heavily to treatment outcome. Development of professional societies (e.g., SEPI) devoted to psychotherapy integration.
Effectiveness of Supportive Therapy
Proven effective for depression. Combined treatment more effective than either alone.
The NASW Standards fro Cultural Competence indicate that language diversity requires social workers to
Provide services and literature in a client's own language. Ideally, this will be accomplished via language-proficient staff or via professional interpreters, as confidentiality concerns and adequacy of interpretations may otherwise be an issue. The final five of ten NASW Standards for Cultural Competency: empowerment and advocacy, diverse workforce, professional education, language diversity, cross-cultural leadership.
Franz Alexander
Psychoanalytic Psychotherapy: Corrective emotional experience
Anna Freud
Psychoanalytic Psychotherapy: The Ego & the Mechanisms of Defense
Psychodynamic Approaches
Psychoanalytic Therapy Adlerian Therapy
Drive Theory (Psychodynamic Therapies)
Psychoanalytic emphasis on the id (so-called drive theory) is transformed by psychodynamicism into an emphasis on the ego and its functioning.
Bringing subconscious into consciousness
Psychoanalytic therapy can modify behavior by helping the client deal with past memories and thus improve behavior. This is done by bring the subconscious into conscious awareness, which aids in understanding the motivation for certain behaviors.
Theory of Psychopathology in Gender-Sensitive Therapies
Psychological distress is often environmentally induced and culturally determined. Many disorders (e.g., self-destructive behaviors) are coping efforts in oppressive, inescapable environments. Disorders caused in part by: Sex-role stereotyping Gender-role expectations Role strain and role conflict Sexual trauma Gender-related economics
ACT Theory of Psychopathology (Third Wave)
Psychological processes of the normal human mind are frequently destructive. We struggle to alter unwanted private events, even when decreasing them (experiential avoidance). Controlling linguistic contexts that perpetuate avoidance of undesirable thoughts and feelings leads to pathology (cognitive fusion).
Practicalities of Person- Centered Therapy (PCT)
Psychological testing is rare. Efforts to enhance trainee's empathy often result in sterile technique. Brief PCT is not common; possibly hundreds of sessions. Typically, sessions are once/week for multiple months.
Theory of Psychopathology in Systemic Therapy
Psychopathology is a function of unclear or hostile communication. Pathology is family's homeostatic mechanism to maintain system balance. Psychopathology occurs when rules of relating become ambiguous. Unclear communication patterns make rules ambiguous.
Theory of Psychopathology in Exposure Therapy II
Psychopathology occurs when information processing is blocked. Trauma is trapped or locked in the neurophysiology. Everyday stimuli trigger re-experience of traumatic event.
REBT's Theory of Psychopathology in CT
Psychopathology occurs when irrational beliefs cause emotional consequences. Psychopathology explained by ABCs: A→B→C Not A→ C
Sample Diagnostic: Section 2
Psychosocial Stressors and Developmental Functioning Psychosocial Stressors: Relational difficulties, 3‐ moderate, marital separation, 4‐severe, death of child past 3 months, 4‐severe Developmental Functioning: New 0‐4 coding scale: 3.5 1=none, 2=mild, 3=moderate, 4=Severe appears here
Multicultural Therapy
Psychotherapy developed by upper-class, White heterosexuals in western Europe. Therapy originally and erroneously envisioned as transcultural. Traditional therapies are increasingly inappropriate for addressing the problems of minority and oppressed groups. Changing demographics signal need for cultural awareness and competence.
Practicalities of Integrative & Eclectic Therapy
Psychotherapy integration and brief treatments are simpatico. Share a pragmatic and flexible outlook. Places significant demands on the therapist. A lifelong process of becoming competent in multiple techniques and/or theories.
Grounded Theory
Pure form includes entering data collection/analysis with no preconceived theories/ideas about the topic An inductive qualitative method that begins with observations & looks for patterns, themes, or common categories in order to build a theory of the phenomena Starts with "in vivo" or "open coding" staying very close to participants words phrases Coding then proceeds to higher level codes grouping the data under common themes (often called "axial" level codes) Ultimately, create a theory to explain the phenomena under study Theory NOT informed by previous research
Qualitative Data Analysis Example
Qn. "when did you first acknowledge that you had this problem?" Answers could be coded into time intervals (ordinal level) Descriptions of methods for coping with addiction - coded with category labels (nominal)
Qualitative Research Defined
Qualitative research is the study of people in their natural environments as they go about their daily lives. It tries to understand how people live, how they talk and behave, and what captivates and distresses them...More importantly, it strives to understand the meaning people's words and behaviors have for them (Emerson, 1983; Grinnell, 1997)
Family Constellation
Questionnaire that includes parents, siblings, and others living in the home, life tasks, and early recollections. When summarized and interpreted, this questionnaire gives a picture of the individual's early social world.
Assessment Measures Contd
Questions to be considered: • What are the purposes of using measures? • In assessment: • In practice: • What about compliance?
Defining Race & Ethnicity in Multicultural Therapy
Race: Category of persons related by common heredity or genetics and whose features are perceived in terms of external traits. Ethnicity: A shared culture with respect to lifestyles, norms, and values. Race and ethnicity not always the same. All people have multiple groups and not all members have same characteristics. Thus, crucial to avoid the myth of uniformity (all group members have the same characteristics).
Evaluation of Measures - Validity Types
Ranked from most to least subjective - an ongoing validation process: 1. Content -Face 2. Criterion -Predictive -Concurrent 3. Construct
Variable Measures
Ratio "Give number" Interval "1-10"; 11-20"; "21-30"; "31-40"; "41-50", etc Ordinal "1-10"; 11-25"; "26-32"; "33-40"; "41+" Nominal "Under 30" or "30 and older"
Threats to External Validity: Reactive Settings-Placebo Effect
Reactive settings (continued) The placebo effect is similar to this phenomenon. We now have double-blind medical experiments so that the researchers cannot affect the patients (through knowing what condition the patients are in) and the patients do not know what condition they are in.
Exercises
Ready-made techniques that are sometimes used to make something happen in a therapy session or to achieve a goal.
Action
Recently started to change overt problem. Consistent for less than 6 months. "Here I go!" Apply behavioral process. Loved by psychotherapists as the most successful in treatment.
Gestalt Theory
Recognize the influence of past experiences and the environment shaping current behavior. Primarily focuses on the present. Personality structure is seen as largely integrated but distinctly separate systems. Sees each individual from a holistic, total-person perspective (gestalt comes from the German word "wholeness"
Crisis Intervention
Recognizes the need for immediate, effective intervention, and a five-stage crisis sequence: 1) acknowledgement of the catastrophic/overwhelming event, 2) a sense of profound vulnerability that overmasters the client's usual coping skills, 3) a last straw precipitating event causing the individual to seek help, 4) emotional turmoil and imbalance, 5) the application of new and/or more effective coping skills leading to adequate adjustment and acceptance
Limits on release of records
Records may be withheld based upon issues of possible adverse reactions. In situations where a client is likely to have an adverse reaction (i.e., severe psychological compromise, issues of safety regarding the client and/or others) records may be withheld
Idealization and intellectualization, and displacement and substitution
Refer to defense mechanisms, as proposed by Anna Freud
Masculine Protest (Psychodynamic Therapies)
Refers chiefly to a woman protesting against her feminine role. Unlike Freud's proposal that a woman wishes to be a man and desires his anatomical structure, Adler recognized that a woman wishes to have a man's freedom and desires his privileged position in society.
Catchment Area
Refers to a certain geographical area served by an institution or agency
Gender typing
Refers to a child's learning his or her gender roles. It is strongly influenced by socialization factors and is often pronounced by the ages of 3 to 6.
Confluence
Refers to a tendency to reject, ignore, or deny any real differences between situations or experiences in favor of focusing on exaggerated or outright false perceptions of similarities.
Maintaining the Analytic Framework
Refers to a whole range of procedural and stylistic factors, such as the analyst's relative anonymity, painting neutrality and objectivity, the regularity and consistency of meetings, starting and ending the sessions on time, clarity on fees, and basic boundary issues such as the avoidance of advice giving or imposition of the therapist's values.
Oedipus Complex
Refers to a young male's competition with his father for the affection of his mother. It includes Freud's castration theory--that the child fears of castration by the father due to competition. As the superego develops, the competition wanes and the male child begins to internalize the values and beliefs of the father.
Sticking together (group cohesion)
Refers to all the variables that keep a group together. When positive attributes outweigh the negative, the group members feel the attraction to stick together. Cohesiveness is a healthy part of the group process
Anti-cathexis
Refers to checking force that enables individuals to resist that urges of the id.
Collaborative therapy
Refers to family therapy provided by two or more social workers pursuing the same cooperative goals
Autoplastic Behavior (in ego psychology)
Refers to individual changes in behavior that facilitate adaptation in a social environment
Community-based practice
Refers to locating services in the place where the population to be served actually lives. There are significant benefits to providing services in this way, including the likelihood that members of the community will support the organization in their own community. Clients who have easier access to services and feel more comfortable in familiar surroundings also are more likely to make use of the services offered.
Alloplastic Behavior (in ego psychology)
Refers to situations where the social environment itself is altered to facilitate adaptation.
Complementary therapy
Refers to supplemental intervention(s) that a social worker may use in addition to individual therapy
Interactional perspective
Refers to the processes of interaction between the supervised and the supervisor
Ecological Systems Theory
Refers to the relationship and adaptation of organisms among themselves and within their environment.
Cathexis
Refers to the urging force that individuals experience to pursue the unconscious wishes and desires of the id
Classical Conditioning (Respondent Conditioning)
Refers to what happens prior to learning that creates a response through pairing. Ivan Pavlov was a key figure in this area.
Transference
Represents the patient's neurotic, unrealistic, and antiquated feelings toward the analyst.
Behavioral Processes
Reinforcement management: Rewarding Counterconditioning: Substituting healthier alternatives for problem behavior Self liberation: Committing Stimulus control: Re-engineering environment
Theory of Psychopathology: IPT
Relationships affect mood, and mood affects relationships. Interpersonal disruption causes and results from depression. Disorders surface when situational stressors expose inability to cope.
Criteria for Research Problems
Relevancy of the Problem Researchability of the Problem Feasibility of the Study Ethical Acceptability
Reliability
Reliability refers to consistency or stability. In psychological and educational testing, it refers to the consistency or stability of the scores that we get from a test or assessment procedure. Reliability is usually determined using the positive values of a correlation coefficient, and this correlational index is called a reliability coefficient in this context. -When looking at reliability coefficients we are interested ONLY in the values ranging from 0 to 1; that is, we are only interested in positive correlations. The key point here is that zero means no reliability, and +1.00 means perfect reliability. -Reliability coefficients of .70 or higher are generally considered to be acceptable for research purposes. Reliability coefficients of .90 or higher are needed to make decisions that have impacts on people's lives (e.g., the clinical uses of tests). -Reliability is empirically determined; that is, we must check the reliability of test scores with specific sets of people. That is, we must obtain the reliability coefficients of interest to us.
Effectiveness of Structural Therapy in Systemic Therapy
Reliance on clinical case surveys. Few controlled studies. Found superior to no treatment and probably superior to individual treatment for substance abuse, psychosomatic disorder, and conduct disorder. Untested in treatment of other disorders.
Objective Empathy
Relies on knowledge sources outside of a client's frame of reference
Revised Diagnoses: Bereavement
Removal of Bereavement Exclusion This change acknowledges the fact that bereavement and Major Depression are not always entirely separate. Grief following a loss is a significant psychological stressor and may trigger a major depressive episode in some individuals.
The Baseline Phase and Internal Validity
Repeated measurements during the baseline phase control several threats to internal validity such as: Maturation Instrumentation Any patterns illustrative of these threats should appear during the baseline period.
Foundations of Single Subject Design
Repeated measurements of client target problem Baseline phase (A) Intervention phase (B)
Gains or Losses
Reported from non-business operating transactions (i.e., the sale of business equipment, furniture, etc.)
Animus and anima
Represent both biological and psychological aspects of masculinity and femininity, which are though to co-exist in both sexes.
Advocate
Represent, defends, or otherwise acts in behalf of one or more clients as related to needed policies, programs, and other actions
Paradoxical direction
Represents a cognitive approach to behavioral change. The cognitive approach sees behavior as emerging directly from thoughts and cognition, and thus it is best changed by identifying, confronting and altering specific misconceptions and false beliefs.
Cognitive Behavior Therapy (CBT)
Represents the mainstream of contemporary behavior therapy and is a popular theoretical orientation among psychologists. Operates on the assumption that what people believe influences how they act and feel.
EMTALA (Emergency Medical Treatment and Active Labor Act)
Requires all patients who present at an emergency room to be stabilized before discharge in life-threatening health situations.
Mental retardation
Requires both cognitive impairment (an IQ of 70 or lower) and an onset before the age of 18.
Stratified Random Sampling
Requires that participant selection based on a process where every client has equal chance of being selected.
Effectiveness of Person-Centered Therapies
Research on empathy, genuineness and positive regard show: -They are valuable contributors to outcome. -But are neither necessary nor sufficient. Meta-analyses -PCT superior to no treatment and placebo. -Allegiance effect in comparing PCT to others systems. -Similar treatment outcomes when controlling for investigator allegiance. -Smaller effects for children and adolescents.
Research Question Designs: Qualitative vs. Quantitative
Research questions will help you decide which design to pursue: Qualitative designs (data gathering before or after and focused questions generated) or, Quantitative designs (literature review used to produce focused questions and often hypothesis prior to data collection).
Effectiveness of Integrative Psychodynamic-Behavior Therapy
Research supports central tenets of cyclical psychodynamics. Controlled research and outcome studies have not been conducted. Other integrative therapies found more effective than no therapy and placebo, but not more effective than single-theory treatment.
Research Levels - Exploratory
Researcher begins inquiry without much insight into which variables may relate to the problem. External validity is not significantly important. Case Study Cross-Sectional Survey Design Longitudinal Case Study Design
Threats to External Validity: Researcher bias
Researchers tend to see what they want or expect to see. May unconsciously manipulate a study so that actual results agree with anticipated results.
Therapeutic Processes in Constructivist
Resolution of problems emerges from de- constructing old stories and constructing new, liberating ones. Consciousness raising: Become aware how stories were constructed by others (dominant discourse). Choosing: Plot alternative story to overcome the dominant discourse; use post-session letters. Counterconditioning: Externalize the old problem; use new, fuller words; become authors of our own stories.
Belmont Report principles
Respect for persons Beneficence Justice
Classical conditioning theory is also known as
Respondent conditioning theory. Classical conditioning theory was developed by John Watson and Ivan Pavlov. This theory suggests that all behaviors can be changed because all behaviors are learned.
Symbiotic Psychosis (Psychodynamic)
Results for a failure to differentiate reflecting a fixation at the symbiotic stage. The salient feature in childhood psychosis is that individuation, i.e., a sense of individual identity, is not achieved.
Surplus
Results when revenue and support exceeds operating expenses
Types of SSD
Reversal design Alternating treatments design Multiple baseline design Changing criterion design
Effectiveness of Multicultural Therapies
Reviews of multicultural treatment tend to reflect the race of the reviewer. Many racial and ethnic minorities are under- served in mental health. Most minority clients prefer same-race therapists, but no consistent differences in outcome when so matched. Meta-analyses conducted on culturally adapted therapies reveal a positive effect (d = .46).
Structural
Revolves around persistent functional units of the id, ego and superego
Sampling vs. Recruitment
Sampling is how you decide who to ask to be in your study Recruitment is how you locate & contact them and attempt to get them into your study Non-representative sample Poor sampling methods Recruitment failure, especially for diverse sub-groups
DSM III Contd
Robert Spitzer, was appointed Chair of the DSM Task Force and chose professionals who were committed to medically-oriented research. It must be noted here that these were mostly white male senior psychiatrists. Spitzer did not like the concept of "Neurosis" and intended to delete it because he felt "Neurosis" had no empirical basis which angered the psychoanalysts and due to opposition from these psychiatrists, the APA board of trustees threatened not to publish the DSM III unless "Neurosis" was included. The Task Force reinserted "Neurosis" before the final draft was published
Self Esteem (Rogers)
Rogers placed the need for self-esteem at the center of interpersonal problems, on he called it self-regard.
Non-directive (Person-centered)
Rogers. Given positive regard, clients are free to discuss whatever they wish in session. Clients, rather than therapists direct the flow of therapy.
Existential living (Person-centered)
Rogers. People let the self and the personality emerge from experience. Self is thus experienced as a process.
Necessary and Sufficient Conditions (Person-centered)
Rogers. Six conditions are necessary for a relationship to result in constructive personality change.These and only these conditions were hypothesized to produce therapeutic personality changes in all clients, in all therapies, and in all situations. Relationship, Vulnerability, Genuineness, Unconditional Positive Regard, Accurate Empathy, Perception of Genuineness.
Fully functioning person (Person-centered)
Rogers. The ideal type of individual would, of course, demonstrate organismic trusting.
It is the responsibility of a supervisor to ensure that all staff members are well-trained and effective at their jobs. This can be accomplished by way of direct instruction, in-house staff training programs, workshops, and continuing education courses. The most effective educational approach is to employ:
Role playing
Reality principle
Rules the ego. The ego does realistic and logical thinking and formulates plans of action for satisfying needs. Checks and controls the blind impulses of the id.
Sample Diagnostic: Section 1
Sample Diagnostic: Section 1 Diagnosis and clinical syndromes Principal Diagnosis Alcohol Use Disorder, in partial remission, severe Post‐traumatic Stress disorder, Moderate Borderline Personality disorder, narcissistic type, moderate Type I Diabetes, complicated
Representative sample
Sample is similar to population
Characteristics of Focus Groups
Samples are not representative: participants chosen because they have time to participate, knowledge of focus group topic, and share key characteristics with target population. Approximate size of group is 7 to 10 people. Focus group leaders create expectation that all will participate. Qualitative data collected through use of open-ended questions from an interview guide. Usually several focus groups are conducted to check for consistency of findings.
Anger
Second stage of grief. Typically focused on the unfairness and/or pain of the loss
Latency Stage (Erikson Psychosocial Stage)
Second stage. Critical in the development of a sense of industry, which involves learning to master many of the skills used in work. Freud, on the other hand, saw the latency stage as a quiet timeout during which no new personality traits developed.
Existential Tradition
Seeks a balance between recognizing the limits and tragic dimensions of human existence on one hand and the possible and opportunities of human life on the other hand.
Dream analysis
Seeks meaning in dreams, and is not likely to enhance personal confidence in and of itself.
Objective Interview
Seeks to discover information about: how problems in the client's life began, any precipitating events, a medical history, including current and past medications, a social history, the reasons the client chose therapy at this time, the person's coping with life tasks, and a lifetime assessment.
Technical Eclecticism in Integrative
Seeks to improve ability to select best treatment for client and problem. Guided by research and experience on others with similar problems. Actuarial rather than theoretical. Do not need to subscribe to underlying theory to use effective methods. Not to be confused with syncretism.
Social learning approach
Seeks to teach family members added skills (conflict resolution, negotiation, communication, etc.) to address and resolve family dysfunctiong
Therapeutic Relationship in CT
Seen primarily as precondition for effective treatment. Therapists demonstrate unconditional acceptance for client as person, but not necessarily liking. Therapists evaluate client's beliefs and behaviors (not as a person). Self-disclosure is common.
Threats to Internal Validity: Selection
Selection - biases resulting in differential selection of respondents for the comparison groups. In other words, the kinds of people selected for the experimental group differ from people selected for other conditions. The whole point of having a comparison group is to compare your treatment group to a comparable group of some sort. However, the two groups of persons might have differed anyway, without the intervention. For example, persons who enter parenting classes voluntarily usually begin the parenting classes with better parenting skills than those who choose not to enter parenting classes.
Selection of Interviewees
Selection of new interviewees should continue until a saturation point is reached, the point when new interviews yield little additional information.
Methods for Observing Behavior
Self-monitoring Self observation Overt or covert behavior Direct observation Outside observer Limited to overt behavior
How can we make client change readily visible?
Self-report, subjective, feeling states: I. Standardized Measures II. Individualized Measures Observable by self or others: Measuring Behaviors
Empathy (Person-centered)
Sense the client's private world as if it were our own, without our own anger, fear, or confusion getting bound up in the experience.
A Delphi Poll
Sensitive forecasting method named after the famous Greek oracle. Structures group communication so that expert panel reaches consensus on complex problems. Panel predicted the future of psychotherapy over next 10 years. 73 distinguished clinicians completed two polling phases.
Stage 5 of Group Development
Separation. Involves preparation for termination, including goal review, anticipated loss, and closure.
Client's spiritual connection when working with minority groups
Should always be explored. Whether or not the client identifies with a particular religion or spirituality, most minority groups have been influenced by religion in some way, even if only by the role it plays in traditions or history. Therefore, it always is wise to explore spirituality and religion, especially with a minority client.
It's significant to learn if a client takes responsibility for self or others because
Significant to one's responsibility to resolve issues. Generally, blaming others from one's problems doesn't aid in fixing the problems. Neither is is productive for clients to act as martyrs and take responsibility for others' choices.
CT's Theory of Psychopathology
Similar to REBT's theory of psychopathology. Maladaptive cognitions and dysfunctional attitudes cause psychopathology. Underlying cognitions vary specifically with behavioral disorder (cognitive specificity). Dysfunctional beliefs are not irrational per se, but too absolute or broad. Schemas: Cognitive organization.
Practicalities of Exposure Therapy
Similar to implosive therapy. 8-12 one- to two-hour sessions. Homework assigned. Training widely available from behavior and cognitive therapists.
Repeated Measurements
Single subject designs require repeated measurements of the dependent variable (the specific client target problem). Therefore, you must be able to measure the subjects' status on the target problem at regular intervals.
Pathways for Constructing Solutions in Constructivist
Small changes lead to larger changes. Each solution is unique. Solutions evolve out of conversations. Language is our reality. Same pathways and principles are used to build solutions with mandated or involuntary clients.
Research Designs in BT
Small-n designs yield valid data, but lack power and control of traditional research. Group designs more prevalent. RCT's (randomized clinical/controlled trials) considered the gold standard.
Income maintenance
Social insurance and public assistance. Consists of programs such as social security, unemployment, workers comp, supplemental security income, temporary assistance for needy families, and general assistance.
Role play
Social learning theory postulates that observation, imitation, and modeling are primary routes of learning.
Has powerful effect upon an individual's response to stress
Social support
Dignity in Code of Ethics
Social workers are expected to respect the dignity and worth of every person, which is a value specified by the NASW
Providing records to clients
Social workers have a responsibility to provide clients with their records upon request. In some cases, however, interpretation may be needed. Also, social workers should be careful that the confidentiality of other people's material in an individual's records is respected.
Social Causes of Psychopathology in Multicultural Therapy
Social, political, and economic inequality. Stress resulting from prejudice and discrimination. Internalized racism: Low self-esteem and self-hatred caused by discrimination. Problems with acculturation. Failure to be accepted by dominant culture.
Two Influential Constructivist Therapies
Solution-focused therapy (SFT) (Insoo Kim Berg) Narrative therapy (Michael White)
Dependent Variable
Something that is hypothesized to be caused by (or, to vary depending on) another variable
Independent Variable
Something that is hypothesized to cause (lead to) something else
Communication
Sometimes referred to as a circular reciprocally interacting process. In communication, each interaction is a consequence of the interaction that preceded it, and the receiver of a message becomes the sender of the next one. Around and around it goes in a continuing loop.
Process recording
Sometimes used in cases in educational settings or those involving the courts or legal issues. It is useful in the training of social work students but is often felt to be too involved, cumbersome and time-consuming in everyday practice
Dummy Variable
Special type of dichotomous variable Nominal level dichotomous variable can be made more quantitative (to perform higher level analysis)
Revised Diagnoses: Specific Learning Disorder
Specific Learning Disorder This replaces Learning Disorders and will include learning problems in: mathematics, oral language, written language, and reading. A specifier will be used to denote the specific area of learning difficulties.
Variables
Specific concepts or theoretical constructs we are investigating Must exist in at least two different states or capable of taking on more than one value Include: Independent->any characteristic, event or situation presumed to affect another variable (manipulated or controlled by the researcher) Dependent->variable presumably affected by an independent variable Extraneous->alternative explanations for relationships observed between independent and dependent variables Control->variables that we seek to control in our design that may explain away the relationship or lack thereof between the IV & DV
Culture Bound Syndromes
Specific patterns of behavior, beliefs, and experiences that appear to mimic a mental disorder, but which actually arise from specific cultural features, practices, and/or beliefs.
Conceptual Definition
Specifying abstract concepts or the process through which we specify precisely what we will mean when we use particular terms Intercultural sensitivity, "the ability to discriminate and experience relevant cultural differences"
Developmental Model II: Werner's organismic-developmental model
Stage 1: Experiences global whole with no distinctions among the component parts. Stage 2: Experiences differentiation of the whole into parts, but loses the big picture. Stage 3: Differentiated parts are organized and integrated into whole at a higher level; appreciation of unity and complexity.
6 Steps of Effective Contingency Management in BT
State problem in behavioral terms. Identify behavioral objectives. Take baseline measures. Conduct naturalistic observations. Modify existing contingencies. Monitor the results.
Theory
Statements used to explain the data in a given area; Or, in psychotherapy, it is a consistent perspective on human behavior, psychopathology, and the mechanisms of therapeutic change.
Threats to Internal Validity: Statistical Regression
Statistical Regression - subjects who receive extreme scores tend to score less extreme, (move toward the group average) during subsequent measurements. So, if you're testing a group of very, very anxious persons on an anxiety scale, they have nowhere else to go but becoming less anxious. If, however, you're testing a varied group of persons on an anxiety scale, if you have an extreme average score, it won't be as subject to change.
Statistical Significance
Statistical Significance (after running your data analysis and testing) as a finding is the goal! It means that you have found a statistically significant relationship between your hypothesized independent variable and dependent variable! It is the starting point for your research study findings, but not the "be all and end all". While the necessary goal is first this thing called "statistically significant" findings, it is still not the final or full analysis.
Cultural competence
Stems from the capacity to identify, accept, and affirm the intrinsic value of every person regardless of their differences, whether they are due to disabilities, age, gender, and orientation, race, religion, culture, ethnicity, language, etc.
DSM III Contd
Stepping back a bit, the 1970s produced an ongoing struggle for power within a professional field. The Psychiatrists wanted the profession to be more scientifically-oriented. There was a push by more research-oriented psychiatrists who felt that the psychodynamic-orientation was unscientific. The Psychoanalysts on the other hand wanted to retain the status quo.
Anal Traits
Stinginess/overgenerosity, constrictedness/expansiveness, stubbornness/acquiescence, orderliness/messiness, punctuality/tardiness, precision/vagueness
Unconscious
Stores all experiences, memories, and repressed materials. Needs and motivations that are inaccessible-that is, out of awareness-are also outside the sphere of conscious control.
Role Strain & Conflict in Gender-Sensitive Therapies
Strain: Multiple demands of different roles. Conflict: Clashing or conflicting roles. Women subscribing to traditional sex role have higher incidence of depression and anxiety as well as lower self-esteem. Stress created by society's antagonism toward changing roles.
Self-Management
Strategies include self-monitoring, self-reward, self-contracting, and stimulus control. The basic idea of self-management assessments and interventions is that change can be brought about by teaching people to use oping skills in problematic situations.
Relational Gestalt Therapy (Contemporary Gestalt Therapy)
Stresses dialogue and relationship between client and therapist.
Three Waves of Therapy
Strict behavior therapy (first wave). Behavior therapy manifested in cognitive therapy (second wave). Incorporate acceptance and mindfulness into standard cognitive-behavioral therapies (third wave).
Theory of Personality in Psychodynamic Therapies
Striving for superiority Core motivation Can be expressed in many ways Reaction to inferiority People create fictional goals for living and ideal self. Examples: -Peace and happiness throughout the land. -Honesty is the best policy. Feelings of inferiority are stimuli for dealing more effectively with world. Style of life -Influenced by feelings of inferiority. -Effected by ordinal position (birth order). -Prime mover is creative self.
Structural Theory of Psychopathology (Systemic Therapy)
Structural theory is more concerned with what maintains psychopathology than with its causes. Historical causes cannot be empirically determined and cannot be changed. Dysfunctional dynamics of the family system maintain psychopathology.
Impasse
Stuck point, or is the time when external support is not available or the customary way of being does not work.
Non-verbal communication
Studies on the percentage of non-verbal communication vary; however, it is reasonable to assume that as much as 80% of human communication is non-verbal in nature. For this reason, such factors as eye contact and body posture play a significant role in successful communication
Four major steps of the casework process
Study, assessment, intervention and termination. All of these steps work toward understanding what is dysfunctional and taking steps toward funding viable solutions.
SOAP Method
Subjective (what an individual reports or says), Objective (what is observed or revealed by testing) Assessment (an interpretation of both subjective and objective findings) and, Plan (formulation of a response to achieve a necessary outcome. Derived from a medical recoding technique, it generally encompasses the four key elements of a problem-oriented record: 1) a data (factual information such as found on a fact sheet), 2) a rank-order list of problems, 3) a plan (resolution of steps) and, 4) progress notes regarding follow-up actions taken
Revised Diagnoses: SUD
Substance Use Disorder This newly named disorder combines what was formerly two disorders: Substance Abuse and Substance Dependence.
Contemplators
Substitute thinking for acting. Often waiting for magic moment. Not confident about their abilities to change, feel unprepared or ambivalent. Typically less than 1% of those at risk participate in traditional programs. About 40% of people are contemplators.
The defense mechanism known as reaction formation is best described as
Substituting an opposite response to relieve distress.
Societal Systems
Such as a government agency
Formal Systems
Such things as community organizations
Informal Systems
Such things as family and the environment
Quantitative Questions
Suggest a specific relationship between variables independent variable(s) on dependent variable(s) e.g., Is A related to B? How are A & B related to C? How is A related to B under conditions C & D? May explore the causes of phenomenon to inform future points of intervention or promote understanding May explore how an intervention impacts specific outcome variables
Fixation
Suggests that pregenital personalities do not evolve in their schemas of people
Authority model of supervision
Suggests that supervisors are chosen based upon their position in the organization's hierarchical structure
Splitting
Suppressing the contradictory quality of a given entity or situation. The primary feature of splitting is the defining and separation of good and bad in order to maintain psychic well-being.
Levels of Change
Symptom/situational problems, Maladaptive cognitions, Current interpersonal conflicts, Family/systems conflicts, Intrapersonal conflicts
Objectifications (Existential)
Symptoms of psychopathology. In pathology, we experience ourselves as objects without choice or will.
Cognitive Distortions
Systematic errors in reasoning that lead to faulty assumptions and misconceptions. Arbitrary inferences, selective abstraction, overgeneralization.
Practice Evaluation
Systematic, explicit, and criterion-based determination of whether we are achieving the objectives and goals of practice that we set with our clients (that is, is what we're doing together working, or not?) Explicit rather than tacit way of approaching practice decisions
Existential-Integrative Therapy
Systemized by Kirk Schneider. Represents an expansion of existential therapy as well as an integration with other therapeutic models and modalities when in the needs of the patient and when in congruence with the tenets of humanism.
Theories that became increasingly popular within the social work profession in the 1980's
Systems Theory
Therapeutic Process in IPT
TA helps clients achieve increased consciousness. Increased consciousness allows clients to choose ego state and life position. Frequently combined with systems theory in couple/family treatment. Combined with Gestalt to form redecision therapy.
Tacit vs. Explicit Knowledge
Tacit practice knowledge - internalized "know-how" that is difficult to record and/or completely communicate Explicit practice knowledge - recordable information, optimized for external communication/sharing
Quick improvements in suicidal patients
Take a position of extreme caution. Suicidal clients who suddenly feel better are often not improving but rather are less conflicted because they have made the decision to take their lives. This is when extreme caution should be exercised by the counselor because the risk to the client is actually higher.
Supervisory-function supervision
Takes into account three specific areas of supervision, which are administrative, educational, and supportive.
What are the key elements of single-system designs?
Target (desired change) specified Target (desired change) measured Baseline (pre-test) and intervention phases Repeated measures, if possible Evaluation design Data analysis - practitioner-oriented Informs practice decision-making
Push-button Technique (Psychodynamic Therapies)
Technique that demonstrates that they can indeed choose to control their emotions. Used with clients who insist they would change if only they could control overpowering emotions.
Sustainment
Technique that involves reaching out, and supplying acceptance, encouragement, and reassurance to enhance the client's internal fortitude, sense self-worth, and ultimate confidence.
Rational Emotive Imagery (REI)
Technique where clients are asked to vividly imagine one of the worst things that might happen to them. As clients change their feelings about adversities, they stand a better change of changing their behavior in the situation.
Theories of process
Tell us how change occurs
Neglectful parents
Tend more toward irresponsibility and often are ignorant of child developmental issues.
Qualitative Questions
Tend to explore processes or experiences of participants in regard to a particular phenomenon Typically do not evaluate specific outcomes May look at differences of experiences among groups
Contemporary Psychoanalysis
Tends to be based on ego psychology, which does not deny the role of intrapsychic conflicts but emphasizes the striving of the ego for mastery and competence throughout the human life span.
Self-Authority (Person-centered)
Tends to mitigate against the use of psychometric tests and routine assessment in psychotherapy
Object
Term used by Freud for other people, because in id psychology others serve primarily as objects for intellectual gratification of pleasure rather than authentic individuals with needs and wants of their own.
Basic Design (A-B)
The A-B design is the basic single subject design and includes a baseline phase with repeated measures and an intervention phase continuing with the same measures.
Rational Emotive Therapy is also referred to as
The ABC theory of emotion.
Phony layer (Experiential)
The level of existence in which we play games and enact roles. At this layer, we behave as big shots
Baseline Phase (A)
The baseline phase (A) represents the period in which no intervention is provided—the subject is serving as his/her own control. Repeated measures are taken during the baseline phase until a pattern emerges.
Service in Code of Ethics
The NASW specifies six ethical principles based on the values that should guide all social workers. "The value of service" refers to the ethical principle of helping those in need and addressing social issues. Social workers are expected to use their skills to serve others and even donate some of their time in such service.
Informed consent
The ethical responsibility to disclose to a client all the associated costs, risks, and benefits of a proposed treatment, and then to obtain a client's explicit agreement before embarking on the proposed treatment
DSM III & Politics Contd
The Vietnam War offered some significant challenges to psychological and psychiatric services, as insurers would not reimburse for problems not associated with a DSM diagnosis. After a 10-YEAR political campaign by veterans and a few psychiatrists, war related-stress reactions were recognized in the DSM. Despite claims that the DSM III was data-driven, empirical literature was not the primary point of contention in deciding the fate of PTSD however, it was voted in.
Subception (Person-centered)
The ability of the organism to discriminate stimuli at a level below what is required for conscious recognition
BPD
The key features in borderline personality disorder involve instability in relationship and affect, poor self-image, and high impulsivity
Measurement
The act of measuring by assigning symbols or numbers to something according to a specific set of rules. When we measure, we attempt to identify the dimensions, quantity, capacity, or degree of something. Measurement can be categorized by the type of information that is communicated by the symbols or numbers assigned to the variables of interest.
Social interest
The action line of one's community feeling, and it involves being as concerned about others as one is about oneself. This concept involves the capacity to cooperate and contribute. Requires that we have enough contact with the present to make a move toward a meaningful future.
Countertransference
The analysts desires to make clients objects of gratification of their own infantile impulses. Include any of our projections that influence the way we perceive and react to a client. This phenomenon occurs when we are triggered into emotional reactivity, when we respond defensively, or when we lose our ability to be present in a relationship because our own issues become involved.
The DSM-5
The DSM 5 has three main sections Section 1 includes an introduction and instructions on how to use the new version; Section 2 covers the diagnostic categories; Section 3 includes conditions that need additional research, assessment measures, a glossary of terms, and other important information.
Federal protection for personal health records privacy was enacted in 1996. The legislation applies to all health care providers, health care clearinghouses, and health plan providers. It sets limits on the disclosure and uses of patient records, it also provides individual access to medical records, and it establishes the right to receive notices of privacy practices
The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
The precursor to the DSM was
The International Classification of Diseases (ICD). First published in 1948. Mental health and health conditions identified in ICD
Social justice in Code of Ethics
The NASW ethical principles specify that all social workers should work toward social change, especially for those in particular need. They also should seek to improve awareness and sensitivity about social issues.
Multiple Baseline Designs
The basic format of a multiple baseline design is to implement a series of A-B designs concurrently for at least three cases (clients; target problems; or settings). The lengths of the baseline phase is staggered to control for external events across the three cases. These designs are particularly helpful as a research tool as they allow for replication of results and control for history as a threat to internal validity.
Dramatic relief
The belief that cathartic reactions can be evoked by observing emotional scenes in the environment.
Thought insertion/withdrawal refers to?
The belief that thoughts are being put into or taken out of one's head. Is a type of delusion characterized by the belief that others are putting thoughts into or taking thoughts out of one's mind.
Time Order
The cause happens before (is measured before) the effect Experimental designs: researcher controls what happens and when things are measured. Strong. Longitudinal designs: measurements are done at multiple time points. Less strong but still good. Trend, panel, or cohort Cross-sectional designs: everything may be measured at the same time. Not very strong.
Mahler's Symbiotic Stage (2)
The child becomes aware of the need-satisfying object (mother) as a separate being.
Impasse (Experiential)
The child can no longer rely on the safe, secure environmental support, nor can the child rely on self-support.
Repression
The child must also defend against society's basic incest taboo. These conflicts lead to repression as the major defense against incestuous desires.
Certain communications between a social worker and a client are privileged communications and are generally protected from disclosure. The privilege can be exercised by:
The client
Resistance
The client throws up against becoming conscious of threatening forces from within. A concept of fundamental to the practice of psychoanalysis, is anything that works against the progress of therapy and prevents the client from producing previous unconscious material. Specifically, resistance to the client's reluctance to bring to the surface of awareness unconscious material that has been repressed.
The decision regarding which issues to address first is made by
The client, in exploration with the social worker. The client's right to self-determination must control the treatment process (except in situations of specific court-ordered treatment).
Family protection process
The concept of family projection refers to a parent transferring his or her energies from the conflicting spouse and onto a child within the family.
EBP
The conscientious and judicious use of current best evidence (research knowledge) in decision-making about interventions at all social work system levels. Social workers should be explicit about the outcomes planned, the rationale for intervention decisions, and their professional knowledge of these interventions. A social worker with healthy skepticism for newly proposed practice developments. A social worker who possesses the inclination and skills needed to successfully identify, locate, critique, implement, and evaluate practice relevant research/science information. A social worker who is able to point to specific evidence-based interventions and programs that are promising, effective, and those that have been discredited.
Gestalts (Experiential)
The continual process of forming wholes or Gestalts, that Perls posits as the one constant law of the world that maintains the intercity of organisms.
Counselor
The counselor and client may set goals and work toward problem-solving together, but the counselor shoulders far more responsibility. Just as a therapeutic relationship is different from a friendship, so therapy is not based on mutuality. For this reason, the counselor is in control of the direction of the counseling relationship and is responsible for enhancing any aspects of it.
Subjective Interview
The counselor helps the client to tell his or her life story as completely as possible. Facilitated by empathetic listening and responding. Active listening is not enough Subjective interview must follow from a sense of wonder, interest and fascination.
Dependent Variable Example
The dependent variable is impacted by the independent variable If you want to know how X impacts Y Y is the dependent variable "How does IV drug use impact Domestic Violence?"
Erikson's Psychosocial Perspective
The developmental stages postulated by Freud have been expanded by other theorists. Erikson's psychosocial perspective on personality development is especially significant.
Manifest Content of Dreams
The dream as it appears to the dreamer
The reality principle emerges from which personality system
The ego. Supplies rationality and serves to mediate between the demands of the id and the realities of the environment.
Threats to External Validity: Reactive Settings
The experimental setting may lead people to act differently than their everyday behavior. This would preclude generalization about the effect of the experimental variable upon persons being exposed to it in non-experimental settings. Also consider demand characteristics desire to be good subjects - experimenter's expectations. If people know that they're being studied, they often act differently--at least at first. Have you ever heard of the Hawthorne effect?
Measurement Validity
The extent to which an instrument measures what it is intended to measure.
Internal Validity Definition
The extent to which the observed changes in the dependent variable were caused (explained; correlated to) by the manipulation of the independent variable.
Oedipal Conflict
The father already has the rights and privileges of enjoying the mother.
Reality anxiety
The fear of danger from the external world, and the level of such anxiety is proportionate to the degree of real threat.
Moral anxiety
The fear of one's own conscience.
Neurotic Anxiety
The fear that the instincts will get out of hand and cause one to do something for which one will be punished. Anxiety about concrete things that is out of proportion to the situation. Is typically out of awareness, and it tends to immobilize the person.
Electra Complex
The female child experiences the electra complex between the ages of 3 and 7. The complex is characterized by unconscious sexual attraction for the father, awareness that she has no male sexual organs, and subsequent feelings of inferiority and blaming of the mother. Superego development also resolves this complex.
Organismic Self-Regulation
The figure-formation process is intertwined with this principle. A process by which equilibrium is "disturbed" by the emergence of a need, a sensation, or an interest.
Relevant validity evidence based on relations to other variables.
The first is called criterion-related evidence which is validity evidence based on the extent to which scores from a test can be used to predict or infer performance on some criterion such as a test or future performance. Here are the two types of criterion-related evidence: -Concurrent evidence—validity evidence based on the relationship between test scores and criterion scores obtained at the same time. -Predictive evidence—validity evidence based on the relationship between test scores collected at one point in time and criterion scores obtained at a later time.
Lying (Existential)
The foundation of psychopathology. Lying is the only way we can flee from nonbeing, to no allow existential anxiety into our experience.
Operating revenue
The funds derived through the provision of services and/or goods
Natural group
The group occurred naturally, and pre-existed the presence of the social worker.
Individuation
The harmonious integration of the conscious and unconscious aspects of personality-is an innate and primary goal.
Self-Psychology (Kohut)
The ideal identity is an autonomous self, characterized by self-esteem and self-confidence.
Archetypes
The images of universal experiences contained in the collective unconscious. Among the most important archetypes are the persona, the anima and animus, and the shadow.
Human relationships in Code of Ethics
The importance of human relationships is recognized by social workers, and the connection between these relationships is a focus of the social worker's professional practice
Self-Efficacy
The individual's belief or expectation that he or she can master a situation and bring about desired change.
Psychotherapy
The informed and intentional application of clinical methods and interpersonal stances, derived from established psychological principles, for the purpose of assisting people to modify their behaviors, cognitions, emotions, and/or other personal characteristics in directions that the participants deem desirable.
Actualizing Tendency (Person-centered)
The inherent tendency of the organism to develop all its capacities in ways which serve to maintain or enhance the organism.
It-It relationships (Existential)
The interactions of two objectified people. Are at best two human objects relating as roles with each other.
Superego
The internalized social component, largely rooted in what the person imagines to be the expectations of parental figures. The judicial branch of personality and includes a person's moral code, the main concerns being whether an action is good or bad, right or wrong. It represent the ideal rather than the real and strives not for pleasure but for perfection.
Intervention Phase (B)
The intervention (treatment) phase (B) represents the period in which the intervention is implemented. Repeated measurements of the same target problem are also taken during this phase. The pattern found in the intervention phase will later be compared to the pattern found in the baseline phase in order to determine if change has occurred with the targeted problem. "Set of actions, behaviors, or activities to achieve an objective". You take repeated measures, preferably in the same time periods as at baseline and of the same problem variables that you used during baseline. An intervention can be as simple as a direct verbal communication with your client system.
Delirium
The key feature is a rapid onset and fluctuating course throughout the day.
Compromise Formation
The mind is embroiled in constant conflict between conscious and unconscious forces, between what the individual immediately desires and what the society deems acceptable
Research Levels - Experimental (Evaluative)
The most convincing way to show cause-effect relationships; but also the most difficult to arrange in real social work settings. a. The independent variable(s) are introduced or manipulated, one at a time, by the researcher; b. There are one or more control groups that are not exposed to the independent variable; c. Research participants are randomly assigned to experimental and control groups.
Allegiance Effect
The most effective therapy tends to be favored by the researchers conducting the study.
Nominal Measures
The nominal level of measurement identifies variables whose values have no mathematical interpretation; they vary in kind or quality but not in amount. Religious affiliation ("Protestant", "Catholic", "Methodist") -In terms of the variable "Occupation", you can say that a lawyer is not equal to a nurse, but you cannot say that the "lawyer" is "more occupational" or "less occupational" than the nurse.
DSM III-R (Revisions) Contd
The number of diagnoses increased from 265 to 292. The reorganization and renaming of diagnostic categories was in response to critics, who were from the field of psychiatry as well as from the traditional medical field. Even though an increase of 27 diagnoses was significant in itself, this increase was much larger than could be explained by the research literature. Sleep disorders which were previously listed in the appendices were now promoted to "Mental Disorders"—a fact that was based on result of votes not research. Despite the Task Force's insistence on data-driven research, it was decided they would be placed in a new appendices titled "Proposed Diagnostic Categories In Need of Further Study."
Restructured Order of Chapters
The order of chapters (20 in all) in the DSM-5 are different from past editions, with related disorders chapters grouped together. For example, one of the new chapters is Trauma- and Stressor-Related Disorders, includes: Reactive Attachment Disorder Disinhibited Social Engagement Disorder Posttraumatic Stress Disorder Acute Stress Disorder Adjustment Disorders Other Trauma- and Stressor-Related Disorders Unspecified Trauma- and Stressor-Related Disorders
Analyzing Single Subject Designs
The overriding issue of concern is the practical (or clinical) significance of the findings. Has the intervention made a meaningful difference in the well-being of the subject? Several principles that can help indicate clinical significance include: Setting criteria: establish a set criteria with the client ahead of time; Cut-off scores: indicate whether the intervention has reduced the problem to a level below a clinical cut-off score; Costs and benefits: weigh the costs and benefits of producing the change.
Hypothesis Testing-Significance Level
The p-values are mathematical probabilities that the relationship found was due to sampling error. The accepted significance level (alpha level) value under most circumstances is p < .05. Thus, most significance tests are carried out using the .05, or 5%, level of significance (95% confidence interval). This means that 5 times out of 100 you can expect to obtain a relationship between variables just by chance.
Graphing
The phases of a single subject design are almost always summarized on a graph. The y-axis represents scores on the target problem while the x axis represents a unit of time. This example illustrates a subject's score on the Beck Depression Inventory over a week-long baseline period (measured daily).
Terminology
The phrase "general medical condition" is replaced in DSM-5 with "another medical condition" where relevant across all disorders. "Neurodevelopmental Disorders," replaces "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence" NOS or "Not Otherwise Specified" is replaced with Unspecified Other specified is added to include alternative criteria sets.
Creative Self (Psychodynamic Therapies)
The prime mover of the individual's lifestyle. The creative self keeps a person from becoming just a product of biological and social circumstances by acting on these circumstances to give them personal meaning.
Dream work
The process by which the latent content of a dream is transformed into the less threatening manifest content.
Operationalization Example
The process of connecting concepts to observations. The goal is to devise operations that measure the concepts we intend to measure—in other words to achieve measurement validity. Researchers develop an operational definition including: -what is measured -how the indicators are measured -the rules used to assign value to what is observed
Deflection
The process of distraction or veering off, so that it is difficult to maintain a sustained onctact
Lifestyle assessment
The process of gathering early memories and involves learning to understand the goals and motivations of the client.
Intellectualization
The process of neutralizing affect-laden experiences by talking in intellectual or logical terms.
Conceptualization
The process of specifying what we mean by a term.
Research Experiment and Practice Evaluation
The purpose of a research experiment using a single subject design is to test the efficacy of an intervention on a particular target problem. The design must control for threats to internal validity. On the other hand, the focus of practice evaluation using a single subject design is to describe the effectiveness of the program or intervention approach. Controlling for causality is less important.
Assumptions Underlying Testing and Measurement
The purpose of this section is to show you how measurement experts think, including their key operating assumptions. Before I list these assumptions (shown in Table 6.4), note the difference between testing and assessment. According to the definitions that we use: -Testing is the process of measuring variables by means of devices or procedures designed to obtain a sample of behavior and -Assessment is the gathering and integration of data for the purpose of making an educational evaluation, accomplished through the use of tools such as tests, interviews, case studies, behavioral observation, and specially designed apparatus and measurement procedures.
Hypothesis Testing Types
The relationship between the research (evaluative) hypothesis and null hypothesis is: Mutually exclusive; and, Exhaustive. Use a directional or non-directional hypothesis? Non-directional if direction of the variable relationship is unknown. Non-directional if the variable relationship in either direction is of importance or interest.
Broker
The role of broker involves linking clients to various resources and services for which they may qualify
Ethical Issues in Single Subject Design
The same ethical issues relevant to other designs also apply to single subject designs (such as informed consent and confidentiality). The unique ethical issue in single subject designs involves the need for repeated baseline measurements before treatment or an intervention is provided. Participants must understand that a needed intervention may be withheld until a baseline pattern is established.
A key difference between self-psychology and object relations theory is its focus on
The self/self-object relationship. In object relations theory, certain objects provide essential affirmation of the self at key developmental points (principally, the mother or other important caregiver, who provides necessary attention, nurturance and praise to engender a sense of value and self-worth. In self-psychology, the importance of key objects (called self-objects) persists. While the self-objects from which intrapsychic support is derived may change and evolve.
According to Sigmund Freud's psychoanalytic view, human behavior is influenced by
The subconscious mind
Allegiance effect
The tendency of the investigators to favor their own preferred treatment in conducting studies.
Halo Effect
The tendency to evaluate an individual too favorably or too negatively on the basis of one or a few notable traits is referred to as.
Ethnocentrism
The tendency to see one's own ethnicity and cultural patterns as superior and/or more acceptable is largely universal.
Catharsis
The therapeutic release of pent-up feelings and emotions.
Desein
The therapist's literally "being there" with the patient-means an unconditional meeting of experience and relational presence.
Reflection (Person-centered)
The therapist's work in increasing the client's consciousness was seen as almost entirely composed of reflection. As a mirror or a reflector of the client's feelings, the therapist would communicate to the client messages that said, in essence, "You feel..."
Behavioral Assessment Interview
The therapists's task is to identify the particular antecedent and consequent events that influence, or are functionally related to , an individuals behavior.
Meaninglessness (Existential)
The threat of meaninglessness is another contingency of human existence that produces anxiety.
Adler Birth Order: Second Child
The typical second child behaviors as if she were in a race and is generally under full steam at all times. The second born is often opposite of the firstborn.
Existential Anxiety
The unavoidable result of being confronted with the "gives of existence"-death, freedom, choice, isolation, and meaninglessness. Arises as we recognize the realities of our morality, our confrontation with pain and suffering, our needs to struggle for survival, and our basic fallibility.
The key benefits of bureaucratic organization are the efficient allocation of resources and the specialized skills developed by various bureaucratic employees. The key deficiency inherent in a bureaucratic structure is:
The universal application of rigid rules and procedures
Mandatory Ethics
The view of ethical practice that deals with the minimum level of professional practice.
DSM V
The work on the DSM V began in early 2009. There are significant changes in this edition and diagnoses have now increased for 365 to more than 400. The actual increase in new diagnoses is minimal and the over all increase is mostly due to the structure involving the use of spectrums and continuums. The most sweeping changes however, are in the area of "Substance Use Disorders." Also the DSM V is the first edition to elicit feedback from the entire mental health community.
Experimental Research Level: Posttest-only Control Group
Then if we want to again know about the amount of pretest-posttest change that is not available here (possible in Classic Experimental Designs), then chose the highly regarded but difficult to implement.
Existential anxiety (Existential)
Theologian Paul Tillich outlined certain conditions inherent in existence that tempt us to run from too much awareness. These conditions fill us with dread.
Continue Variable
Theoretically can take all numerical values Unlimited Eg. Height
Importance of Theories
Theories are frameworks, paradigms, or propositions used to explain what happens in the real world Formally stated General: relate to phenomena, not specific individuals Lead to predictions (hypotheses)
Carl Rogers
Theorized that the client is the center of his world, and his perceptions and behavior are related to that self. Each individual's concept of self is what determines choice of behavior.
Change in existentialism
Theorizes that humans are in a constant state of change. People have ultimate control over their lives and behavior, even though they cannot always control their thoughts
ACT Therapeutic Relationship (Third Wave)
Therapist acts as an experienced coach. Helps clients identify private events that interfere with effective action. Functions as a value clarification trainer. Teaches mindfulness and acceptance skills.
Presence
Therapist being completely attentive to and immerse in the lucent as well as in the client's expressed concerns.
Transtheoretical Relationship
Therapist is expert on process of change. Empathic, warm, and supportive. Relationship tailored to patient's stage: -With procontemplators, a nurturing parent -With contemplators, a Socratic teacher -With action, experienced coach -With maintenance, a consultant
Therapeutic Relationship (Systemic Therapy)
Therapist joins each member or sub- system of family. Initial relationship involves empathy, warmth, and caring. Once relationship established, therapist becomes authoritative leader. Therapist challenges, blocks, and disrupts homeostasis.
Therapeutic Relationship in Constructivist
Therapist shifts focus from problems to solutions. Ignites client initiative, improve use of their response-ability. Clients are experts on goals to construct. Clinicians are experts on the process and structure of therapy. Relationship is a multidisciplinary collaboration toward a shared solution.
APA Guidelines for Therapy with Women
Therapist should: Be free of gender-defined roles and stereotypes. Recognize reality and variety of sex discrimination and facilitate options for clients. Be knowledgeable about current research. Not use derogatory labels. Inform clients about therapy practices (informed consent). Realize that privilege belongs to client (not family or spouse). Not reinforce stereotypic dependency of women. Respect the client's assertive behavior. Recognize that abused clients are victims of crimes. Recognize the client's right to define sexual preference.
Therapeutic Relationship (Systems)
Therapists do not allow themselves to be triangulated. Maintain an objective "I" position. Therapist models autonomous, responsible, and differentiated behavior. Therapist relies on observation and reason (not empathy) to understand family.
DBT Therapeutic Relationship (Third Wave)
Therapists relate like healthy parents. Help set effective limits on emotional reactions that can disrupt therapy. Ensure patients have supportive groups and therapists have supervisory consultations. Therapists shift from parenting to teaching as tx progresses.
Acting "as if" (Psychodynamic Therapies)
Therapists use techniques that encourage clients to experiment slowly with the new alternatives for living
Counterresistance (Person-centered)
Therapists would respond to client resistance with confrontation or arguments are said to be exhibiting counterresistance.
Adlerian
Therapy in which the counselor helps the client clarify goals and move toward an "ideal self." Adlerian therapist seeks to assist clients in moving toward their ideal self. This is often accomplished through re-education, which helps clients understand their goals and their place in the social order
Hypothesis Testing: Alpha Levels
There are other alpha levels utilized: .10 (10%; 90% level of confidence); This means that 10 times out of 100 you can expect to obtain a relationship between variables just by chance. .01 (1%; 99% level of confidence). This means that 1 time out of 100 you can expect to obtain a relationship between variables just by chance. To not use p < .05 (95% level of confidence) you must show rationale that is compelling. P values (alpha) range from 0.00 to 1.00 0.00 = would never occur due to error 1.00 = error caused it
Alternate (research) hypothesis (HA):
There is a difference or association
Null hypothesis (HO):
There is no Difference -Between different groups of people -For the same people before and after an intervention Association -Between two variables
The stages of change: Precontemplation Stage (1)
There is no intention of changing a behavior pattern in the near future
Non-Supriousness
There is no other plausible reason why two variables are associated Example of spurious relationship: ice cream & murder rate Can attempt to rule out spurious relationships by Use of experimental designs (random assignment) Use of statistical controls
Systems and Postmodern Approaches: Feminist Theory
This approach grew out of the efforts of many women, a few of whom are Jean Baker Miller, Carolyn Zerbe Enns, Olivia Espin, and Laura Brown. A central concept is the concern for the psychological oppression of women. Focusing on the constraints imposed by the sociopolitical status which some have been relegated, this approach explores women's identity development, self-concept, goals and aspirations, and emotional well-being
Social learning approach
This approach postulates that communication problems lie at the root of most of all family problems.
Research Levels - Explanatory
This design tries to verify possible relationships between/among variables. Hope is to verify the presence of relationships between or among variables. Whenever possible, other variables that might somehow serve to misrepresent the true relationship between dependent and independent variables are controlled, either through manipulation or statistical methods. External validity is important.
Scales of Measurement: Nominal Scale
This is a nonquantitative measurement scale. -It is used to categorize, label, classify, name, or identify variables. It classifies groups or types. -Numbers can be used to label the categories of a nominal variable but the numbers serve only as markers, not as indicators of amount or quantity (e.g., if you wanted to, you could mark the categories of the variable called "gender" with 1=female and 2=male). -Some examples of nominal level variables are the country you were born in, college major, personality type, experimental group (e.g., experimental group or control group).
Scales of Measurement: Ratio Scale
This is a scale with a true zero point. -It also has all of the "lower level" characteristics (i.e., the key characteristic of each of the lower level scales) of equal intervals (interval scale), rank order (ordinal scale), and ability to mark a value with a name (nominal scale). -Some examples of ratio level scales are number correct, weight, height, response time, Kelvin temperature, and annual income. -Here is an example of the presence of a true zero point: If your annual income is exactly zero dollars then you earned no annual income at all. (You can buy absolutely nothing with zero dollars.) Zero means zero.
Interval Levels Example
This is the second highest level of measurement. Data is scaled and ranked with equal intervals. How long have you received counseling from this agency?: 1 to 30 days; 31to 60 days; 61 to 90 days; 91 days plus.
Descriptive Research ("Quasi-Experimental")
This level of design measures and describes relevant variables and distribution of their values. Does not introduce or manipulate an independent variable to see other variables affected - causation is not possible. Generally only see hypothesis testing to predict a relationship of association or correlation (positive and/or negative). Cases chosen must be representative and measured accurately to generalize findings. External validity is important and possible. One Group pre/post-test Design Static Group Comparison Design Time Series Design
Scales of Measurement: Ordinal Scale
This level of measurement enables one to make ordinal judgments (i.e., judgments about rank order). -Any variable where the levels can be ranked (but you don't know if the distance between the levels is the same) is an ordinal variable. -Some examples are order of finish position in a marathon, billboard top 40, rank in class.
ABC Model
This model of behavior suggests that behavior (B) is influenced by some particular events that precede it, called antecedents (A), and by certain events that follow it, called consequences (C).
Some of the most salient changes to the new DSM 5
This system is replaced with a more simplified, non- axial documentation approach in the DSM-5. Essentially, the former first three Axes (I, II, and III) are combined in Principal and/or provisional diagnosis. This includes clinical syndromes, medical conditions and other conditions that require clinical attention Where separate notations for the other two former Axes: psychosocial and environmental factors (IV), as well as disability (V) are placed in a category of psychosocial stressors and developmental functioning.
Systems Theory
This theoretical paradigm postulates that individuals, their environment, and their situations are closely interrelated. Change in any one area will therefore result in changes in other areas.
Implosive Therapy in Exposure Therapy
Thomas Stampfl (1923-2005) Basic tenets: Avoidance: Reduces anxiety in the short term. Generalization: Avoidance of similar situations. Extinction: Gradual disappearance of conditioned anxiety due to lack of reinforcement. While implosive therapy pioneered the confrontation of fear, it is less popular today than exposure therapies.
Ground (Gestalt)
Those aspects of the client's presentation that are often out of his or her awareness.
Figure (Gestalt)
Those aspects of the individual's experience that are most salient at any moment
Exploratory Research Levels
Three (3) conditions must be present to conclude one variable explains the change in the other: 1. x must actually precede y in time order; 2. x and y must be empirically correlated with one another. 3. All other explanations for changes in y must be ruled out. The observed correlation between two variables cannot be explained away as a result of the influence of some third variable that explains the two under consideration (third variable called spurious). For example, Grandpa may observe that your left knee generally aches just before it rains, but this does not mean that your joints affect the weather. A 3rd variable, relative humidity, is the cause of both your aching and the rain.
Lawrence Kohlberg proposed multiple levels and stages to moral development
Three levels with two stages in each level.
Duration Recording
Time a behavior occurs during a given observation period Used when the time a behavior occurs needs to be increased or decreased Behavior must have a clear beginning and ending
Brief Psychodynamic Therapy
Time limits (12 to 40 sessions). Targeting a focal interpersonal problem. Adopting a more active/less neutral stance. Establishing a rapid working alliance. Employing transference interpretations quickly. Emphasizing the process and inevitability of termination.
Practicalities of SFT in Constructivist
Time-effective treatment that usually lasts 3 to 5 sessions. Focus on solutions is tightly maintained. Designed to start, not finish, the solution. Applied to virtually all disorders and in all therapy formats. Frequently employed in coaching, education, and substance abuse.
Practicalities of Cognitive Therapy
Time-efficient treatment 1-20 weekly 50-minute sessions Treatment is structured by manuals. Bibliotherapy widely used. Homework is expected. Training is widely available.
IPT is
Time-limited Focused About current relationships Interpersonal Improving relationships Identifying assets Learning how to cope
The description of "open" or "closed" in regards to therapy refers to
Timing of admission. Closed groups allow participation only by members chosen at the time the group is formed. Open groups allow people to join at any time
In the initial interview, it often is best to ask as few direct questions as necessary for what reason?
To allay feelings of vulnerability in the client. Because of the power differential that exists between client and counselor, clients often feel vulnerable in the initial interaction with a counselor. For this reason, excessive personal questions can lead to a client's feeling paranoid and anxious.
The NASW Standards for Cultural Competence indicate that the most important need for self-awareness in matters of diversity is
To better appreciate the beliefs and cultural values of others. The first five of ten NASW Standards for Cultural Competence are: ethics and values, self-awareness, cross-cultural knowledge, cross-cultural skills, and service delivery
Introjection
To do as others want one to do
Inference
To draw conclusions about a population, you only utilize samples randomly drawn from a population. But by so doing, you always run the risk of this sampling error. Nevertheless, this is the only way to proceed and utilize inference. Inference requires an assessment of the degree of confidence we have when saying the relationship between two variables observed in the sample is a real one that exists within the population.
Socialization groups
To enhance interpersonal skills
Free association
To freely say whatever comes to mind, no matter how trivial or repulsive They try to say whatever comes to mind without censorship. This process of free association is known as the "fundamental rule"
Prejudice
To have negative thoughts or feelings about minority groups based solely on negative stereotypes, values, and judgments.
Interpretation
To make an unconscious phenomenon conscious. Consists of the analyst's pointing out, explaining, and even teaching the client the meanings of behavior that is manifested in dreams, free association, resistance, and the therapeutic relationship itself. Client's underlying motives for behaving the way they do in the here and now.
One way to modify a client's behavior (through the use of psychoanalytic therapy) is:
To strengthen the ego. In strengthening the ego, the counselor assists the client in the compromises between moral issues (superego) and basic desires (id). Behavior is modified by an increased awareness of these issues.
Martin Buber
Took a less individualistic stand than most of the other existentialists. He said that we humans live in a kind of betweenness; that is, there is never just an I, but always an other.
Figure-formation process
Tracks how some aspects of the environmental field emerges from the background and becomes the focal point of the individual's attention and interest. The dominant needs of an individual at a given moment influence this process.
Why use single-system designs to evaluate practice?
Traditional designs (randomized, control groups, etc. ) aren't easily integrated into everyday practice conditions A plan to identify and measure something the client wants or needs to change, measure it repeatedly over time--usually before, during, and sometimes after an intervention Generates info that can be used to collaboratively make ethical, effective practice decisions
A Major Alterative: Male-Sensitive Psychotherapy
Traditional therapy designed by men to treat primarily women. Psychotherapy for men based on an accurate understanding of male personality development. Men are negatively effected by gender role expectations and suffer from role strain (as do women).
Relational/Intersubjective Model
Transference is an interactive process between patient and therapist, Focus on desires, not drives, Locus of change is between people, not inside patient's mind, More concerned and active therapist stance.
Effectiveness of Object Relations Therapies
Transference-Focused Psychotherapy (TFP) vs. treatment as usual. Randomized clinical trials of TFP vs. CBT. Specific, structured psychotherapies are superior to unstructured treatments as usual. TFB and CBT of comparable effectiveness in treatment of borderline patients.
Operational Definition
Translation of conceptual variables into observable (i.e., measureable) terms; indicators that give meaning to a variable by spelling out what the researcher must do to measure it. Intercultural Sensitivity: as measured by the Intercultural Development Inventory (IDI). This theory-based instrument with established reliability and validity measures intercultural sensitivity along the continuum of ethnocentrism to ethnorelativism. The inventory is a paper and pencil test with fifty questions. It has five scales measuring degree of resolution for five steps on the continuum of ethnocentrism to ethnorelativism
Treatment Evaluation
Treatment Evaluation • Systematic data collected • Intervention specified • Clients selected on usual clinical criteria • Questions selected on the basis of client needs • Publication or presentation may result • Design tools used to answer clinical questions
Treatment Research
Treatment Research • Systematic data collected • Intervention specified • Participants selected on basis of scientific needs • Questions selected on scientific grounds • Publication or presentation may result • Design tools used to answer scientific questions
Practicalities of Men-Affirming Psychotherapy
Treatment formats more flexible than conventional, face-to-face therapy. Group therapy is powerful and common. Humor is frequent means to begin conversations about serious issues. Initially, therapist may avoid open-ended questions about feelings; focus on practical matters.
Supervisor/Supervisee relationship
Trust is critical to a successful supervisor/supervisee relationship because the supervised must feel secure in revealing what is happening with his clients, as well as in describing his own thoughts and feelings.
Erikson: Infancy Stage (first year of life)
Trust versus mistrust. If significant others provide for basic physical and emotional needs, infant develops a sense of trust. If basic needs are not met, an attitude of mistrust toward the world, especially toward the interpersonal relationships, is the result.
Association
Two events, constructs, situations, or variables are associated (correlated) with each other. Can use either experimental design (people randomly assigned to conditions) or observational design. Observational designs are less strong.
Probability
Two general methods for demonstrating an apparent relationship between variables was unlikely due to sampling error: 1. Replication - entails repeating a research study one or more times (very impractical); 2. Statistical analysis
Theoretical Integration
Two or more theories are integrated in hope that sum will be better than its parts. Blend both theory and technique. Hybrid examples: Psychoanalytic and behavioral; cognitive and interpersonal. Most integrated theory is cognitive therapy.
Hypothesis Testing: Two-Tailed Hypothesis
Two-tailed hypothesis - states that the variables are related but does not predict the direction: "Taking this course does cause social work students' feelings toward research course teachers to change." What is the null hypothesis statement?
Research Hypothesis Testing: Type 1 Error
Type I error - occurs when rejecting the null hypothesis (and correspondingly accepting the research hypothesis) and concluding that a relationship between variables in a sample exists in the population from which it is drawn, when in fact it really does not (alpha error).
Research Hypothesis Testing: Type 2 Error
Type II error - occurs when we fail to reject the null hypothesis and conclude no relationship, when it really exists (beta error).
Binary Variable
Type of dichotomous variable Numerical value categories 1 or 0 To denote presence or absence or variable
Dichotomous Variable
Type of discrete variable Only two categories Election (win/lose)
Schizophrenia
Typical symptoms include: grossly disorganized or catatonic behavior and/or speech, delusions and/or hallucinations, blunted affect (poor or inappropriate expressive responses to external stimuli), autism (intense self-preoccupation)
Practicalities of EMDR in Exposure Therapy
Typically 4 to 6, 90-minute sessions. Two weekend workshops and supervised practice to acquire competence. Providing pro bono treatment and training in disaster areas.
Multisystemic Family Therapy
Typically for youth with conduct disorders and substance abuse. Multiple targets of treatment: individual, family, and larger system. MST therapists often visit home of family. Intensive therapy approach.
Customer and peer review
Typically limited to interviews and surveys only
Judgmental
Typically refers primarily to an overall critical approach
Three Levels of Our World in Existential Therapy
Umwelt (in-nature): Ourselves in relation to biological and physical aspects Mitwelt (with-others): World of persons; the social world. Eigenwelt (for-ourselves): The way we reflect on, evaluate, and experience ourselves.
Behavioral cues
Understanding behavioral cues is necessary because of cultural diversity. Some studies suggest that body language can represent up to 75% of human communication. For this reason, and because of cultural differences in behavioral expression are significant, a professional should be aware of cultural differences in non-verbal communication.
Being empathetic to the client refers to
Understanding the client's feelings. Empathy is often understood as feeling what another is feeling. However, in a therapeutic relationship, the counselor ideally does not feel, condone or identify with the client's feelings. An empathetic counselor seeks to understand a client's feelings and uses that understanding to assist the client
Neuropsychoanalysis (Psychodynamic Therapies)
Unites the previously divided fields of neuroscience and psychoanalysis
Categories of Statistical Analysis Based on the Number of Variables
Univariate: Examine distribution of value categories (nominal and ordinal) and values (interval and ratio) for a single variable Bivariate: Relationship between two variables Multivariate: Examines relationship between three or more variables
Random Measurement Error
Unknown or uncontrolled factors with no trend or direction. Those that are neither consistent nor patterned: A. Test environment (reactive settings) B. Fatigue C. Misreading the question D. Error in data entry E. Researcher records the response wrong
Carl Jung
Unlike Freud (who believed personality is set in childhood), Jung believed that people continue to grow and "change throughout life." He believed that people suppress aspects of their personalities in order to meet responsibilities earlier in life, and later in life they bring those suppressed parts to the forefront.
Dysthymic disorder
Unlike major depressive disorder, which includes severe symptoms and lasts at least two weeks, dysthymic disorder has less intense symptoms and continues for two years or more.
Cluster random sampling
Use when a complete sampling frame doesn't exist Cluster: naturally-occurring group of population members (churches, zip codes, schools) Randomly choose clusters, then randomly choose members from each cluster Choosing more clusters = more representative Single-stage vs. multi-stage
Evaluation of Measures - Validity Types-Construct Validity
Use when you want to know if a test measures some underlying psychological construct. To what extent does the measure correlate in a theoretically predicted manner with other constructs. Most difficult to identify; but often times most useful in social work research (depression; anxiety, etc.).
Types of Reliability Measurements: Alternative forms (parallel forms)
Use when you want to know if several different forms of a test are reliable or equivalent. Consistency over two comparable multi-item measures of the same construct. Independently measure the sample people, with two different comparable multi-item measures, under the same circumstances.
Evaluation of Measures - Validity Types-Criterion Validity
Use when you want to know if test scores are systematically related to other criteria that indicate the test taker is competent in a certain area: Concurrent type Instrument is compared with an existing measure that has already been tested for validity. Predictive type Ability to predict an individual's performance. i.e. SAT's, GMAT's, LSAT's, GRE's (predictive)
Types of Reliability Measurements: Internal Consistency Reliability
Use when you want to know if the items on a test assess one, and only one, dimension. Independently measure the same people, with a single multiple-item measure, under the same circumstances. Internal Consistency Reliability types Split-half: Items divided in two separate halves. Score computed for each half-measure. Corrected correlation between halves (r > .80).
Types of Reliability Measurements: Test-retest Reliability
Use when you want to know whether a test is reliable over time (consistency). You independently measure the same people, with the same measure, under the same circumstances: correlate the scores from O1 and O2. Scores should be highly correlated (r > .80). Weaknesses: Multiple testing effects Requires 2 testing sessions May need a control group because of reactivity
Types of Reliability Measurements: Inter-rater (inter-observer) reliability
Use when you want to know whether there is consistency in the rating of some outcome. Consistency across observers. Multiple observers independently observe the same people, using the same measure, under the same circumstances.
Paraphrasing
Used to clarify what the client said. A modestly revised statement of a client's words. It is used to show respect and demonstrate that one was listening attentively.
Summarizing
Used to provide an overview of what the client said. Is providing an overview of the entire situation discussed to provide greater clarity and ensure mutual understanding.
Inferential Analysis
Used when we have access only to a sample and not entire population Group of procedures for determining how safe it is to make generalizations about parameters based on measurements taken of the variable within a sample drawn from population (statistics) Sample statistics - estimates of population parameters: can be more/less accurate
Non-Probability Sampling: Snowball sampling
Used when you don't know how to find members of the population but you have access to a couple of them Find a few members, choose them for your sample, and ask them to recommend others who would be appropriate for your sample
Characteristics of SSD (Single Subject Designs)
Uses repeated measures Need reliable measurement/instrumentation Requires a clear description of conditions and the DV Measurement, IV and DV operationally defined 2 general types of phases (could have probes, etc.) Baseline and treatment conditions
Validity
Validity refers to the accuracy of the inferences, interpretations, or actions made on the basis of test scores. -Technically speaking, it is incorrect to say that a test is valid or invalid. It is the interpretations and actions taken based on the test scores that are valid or invalid. -All of the ways of collecting validity evidence are really forms of what used to be called construct validity. All that means is that in testing and assessment, we are always measuring something (e.g., IQ, gender, age, depression, self-efficacy). -Validation refers to gathering evidence supporting some inference made on the basis of test scores.
Acute stage of the crisis state duration
Variable length depending on several factors. Believed that such state can last much longer than the originally thought 6-8 weeks, depending upon the nature of the event, what it means to the individual, and the coping mechanisms at hand.
Measures of Variability (Variation)
Variables must be interval or ratio level although some will also include ordinal level values. Does not measure skewness. next course topic. Captures how widely and densely spread a variable's distribution is. Rarely utilized with qualitative data sets.
Measures of Variability (Variation): Range
Variation is usually summarized with one of four statistics (all four require interval or ratio level data): The range is calculated as the highest value in a distribution minus the lowest value. It can be drastically altered by one extreme value (an outlier): "Maximum value minus the minimum value + 1" 2, 3, 3, 4, 5, 5, 7, 8, 9, 10, 11, 11, 14, 14, 15, 16, 18, 20 Range is 20 - 2 + 1 = 19
Characteristics of Intensive Interviewing
Varying degrees of structure in the interview Use of open-ended questions Consistency and thoroughness Use of lengthy interviews Establishing a partnership with the interviewee Recording/transcribing answers
A Major Alternative to Existential Therapy: Logotherapy
Viktor Frankl (1905-1997) Logo = meaning Meaninglessness leads to pathology. Similar in content to existential analysis but closer to psychodynamic therapies. Techniques include interpretation, confrontation, and paradoxicals.
Will-to-meaning (Existential)
Viktor Frankl. Basic sustenance of existence. Neitzsche's- "he who has a why to live for can bear with almost any how."
Visual Analysis of Measurements
Visual analysis is the process of looking at a graph of data points to determine whether the intervention has altered the subject's baseline pattern of scores. Three concepts that help guide visual inspection are: 1. Level: examine the amount or magnitude of the target variable; has the amount changed from baseline to intervention period? 2. Trend: examine the trends in baseline and intervention phases; has the intervention altered the direction of the trend or the slope of the line? 3. Variability: examine how different or divergent the scores are in the baseline and intervention period; has the intervention changed the amount of score variability?
Therapeutic Relationship (Integrative)
Warm caring relationship is a precondition of change, but not the central process. Empathy and positive regard useful, but not necessary or sufficient. Each client is unique and so should be the relationship; therapist as authentic chameleon. Flexibility in and outside session.
Rollo May
Was one of the main proponents of humanistic approaches to psychotherapy, and he was the principal American spokesperson of European existential thinking as it is applied to psychotherapy.
Soren Kierkegaard
Was particularly concerned with angst-a Danish and German word whose meaning lied between English words dread and anxiety-and he addressed the role of anxiety and uncertainty in life.
Punishment
Way behavior is controlled. Sometimes referred to as aversive control, in which the consequences of a certain behavior result in a decrease of that behavior. The goal of reinforcement is to increase target behavior, but the goal of punishment is to decrease target behavior.
The Context of Systemic Therapies
We can only be understood within social context; contextless is meaninglessness. Patient is the entire system, not the identified patient (IP). General Systems Theory and cybernetics are the intellectual inspirations for systems tx Systems = Parts of an organization + Relationships among those parts.
Systematic Measurement Error
We can predict the direction of the error the measure (consistently measures something other than intended). a. Social desirability (cultural bias; Reactive settings); b. Acquiescence bias (Interaction effect); c. Leading questions (Researcher bias); e. Non-random sampling (Selection biases); f. Demand Characteristics - answers to please researcher.
Most commonly used Intelligence Quotient (IQ) Test
Wechsler Adult Intelligence Scale (WAIS)
At what minimum frequency should supervisors provide staff meetings and/or individual staff supervision
Weekly. These encounters should be structured, consistent, oriented to case and/or situational reviews, and should result in evaluative feedback to the staff person(s) involved
Cases for Diagnosis Sheet
What are the primary symptoms? What is the approximate duration of the disorder? Howsevereordebilitatingisthedisorder? Was there an identified precipitant for the symptoms? Using the Outline provided, what primary and/or provisional diagnoses would you suggest? • Make sure your clinical formulation supports the diagnoses.
4 Key Questions in Research
What exactly do you want to study? Why is it worth studying? In what ways does the proposed study have significance for practice and policy Does it contribute to our general understanding of things?
Exploratory Research
What is it like being homeless? Scary, shameful, insecure
Nominal Example
What is level of measurement for the variable "political party affiliation", with values "Democrat", "Independent", "Republican" or "Green"?
Ratio Example
What is the level of measurement for the the variable, "Number of Presidential Elections In Which Respondent Voted in Entire Life", measured by the number the respondent reports?
Interval Example
What is the level of measurement for the variable "Political Ideology Scale", measured on a scale of 6-24, where 6=Very Conservative and 24=Very Liberal?
Social Liberation
When changes in the environment make more alternative available to individuals, such as more jobs being available to LGBT individuals, this is moves towards social liberation.
Counseling can be interminable
When factors exist that limit its ability to be effective. One of those factors is when therapy goals are unrealistic.
Unfinished Business (Gestalt)
When figures emerge from the background but are not completed and resolved
Condition of Worth (Person-centered)
When individuals being to act in accordance with the introjected or internalized values of others.
Education
When the information given a client concerns environmental events
Feedback
When the information given a client concerns the individual's own actions and experiences.
Stereotypes
When working with clients, professionals should keep in mind the words "known facts" as a means to help combat stereotypes. Can occur both consciously and subconsciously by professionals as well as non-professionals. By focusing on "known facts," a professional can maintain a clearer focus on a non-stereotypic mind-set.
Prediction
When you apply elements of prior cases to anticipate or predict the outcome of a current or future case.
Tarasoff vs. Regents of the University of California
Where a therapist heard a credible threat and only called law enforcement authorities (failing to notify the intended victim)
Conflict-Free Spheres of the ego (Psychodynamic Therapies)
Wheres id psychology assumes that the ego serves only a defensive function in balancing the ongoing conflicts between instincts and the rules of society, ego psychology assumes that there are conflict free spheres of the ego. Therefore, there is an autonomous ego.
Counselor self-examination
While it may be prudent for a counselor to speak with a supervisor or colleague about what he or she is experiencing, the best first step would be self-examination. Self-awareness is an important quality in a competent counselor, which is why counselors often are urged to enter counseling themselves. It's important for a counselor to be self-aware in order to competently treat clients.
DSM IV-TR
While the APA stated that any new diagnoses were to meet rigorous scientific tests for inclusion in the DSM IV, most were simply carried over from earlier editions. The APA admitted that most of the diagnoses would not meet the new standards and therefore were thus kept. A few years following publication, the announcement was made that the DSM IV was to be revised. This revision would only include adding and deleting text; thus the DSM IV-TR was published in 2000 and is now translated in 22 languages
Descriptive Research
Who are the homeless? How many are women? How many are children? How many are from various cultural groups? When did they become homeless? How long have they been homeless? How many are former felons?
Explanatory Research
Why do people become homeless? Personal choice? Work aversion? Alcoholism? Mental illness? Financial or similar crises? Job loss? Changes in society? Trying to specify causality- X→Y
The Outlier Affect
Why more than one measure of the center? Each has advantages. Median is not sensitive to outliers; Mean is sensitive to outliers. In 1984, the University of Virginia announced that its Department of Communications graduates' mean starting salary was $55,000. The outlier, the salary of NBA center Ralph Sampson, did not represent the earning power of the B.A. in Speech from UVA. interestingly, the median salary was not published.
A Major Alternative to Existential Therapy: Reality Therapy
William Glasser (1925-present) Lack of responsibility causes pathology. Mentally ill have formed strategies to deny reality and responsibility. Attempting to control others is source of misery. Primarily present-centered and choice- focused.
Motivational Interviewing (Person-centered)
William R Miller. person-centered, directive approach that enhances intrinsic motivation to change by helping clients explore and resolve ambivalence.
A Major Alternative & Extension in PCT: Motivational Interviewing (MI)
William R. Miller (1947-present) Combines elements of person-centered style and technique. Found therapist empathy (not treatment method) predicted success of therapy for problem drinkers. Research supports MI's effectiveness.
Withdrawal Designs (A-B-A and A-B-A-B)
Withdrawal designs indicate that the intervention is concluded (A-B-A) or is stopped for some period of time before the intervention is begun again (A-B-A-B).
Gender-Related Economics
Women clustered in lower paying, sex role occupations. Divorced women and their children constitute an increasing proportion of the poor. Average woman worker with same education receives 81¢ to a dollar for a man. 40-90% of working women have been sexually harassed. Professional women assigned to "mommy track" or hit the "glass ceiling."
Consciousness raising
Work to increase the consciousness of clients and began with Freud's work to make the "unconscious conscious." Confrontation and clarification, Interpretation, Working through
Insight (awareness) therapies
Work with consciousness (raising)
Inductive Reasoning
Works the other way, moving from specific observations to broader generalizations and theories. Informally, we sometimes call this a "bottom up" approach (please note that it's "bottom up" and not "bottoms up" which is the kind of thing the bartender says to customers when he's trying to close for the night!). In inductive reasoning, we begin with specific observations and measures, begin to detect patterns and regularities, formulate some tentative hypotheses that we can explore, and finally end up developing some general conclusions or theories.
Therapeutic Relationship in Systems
Youth, family, and entire system are recipients of services. Devoted to systemic change. More accurate to speak of multiple collaborations, rather than the therapeutic alliance.
Drisko states that the five key factors necessary for a quality of therapeutic relationship between client and clinician are:
affective attunement, mutual affirmation, joint efforts to resolve missteps, goal congruence, and using varying types of empathy.
"Blank-screen" Approach
in classical psychoanalysis, analysts typically assume an anonymous stance.
Positive Reinforcement
involves the addition of something of value to the individual (such as praise, attention, money, or food) as a consequence of certain behavior.
Existential guilt
is a consequence of having sinned against ourselves.
Jansen & Harris - FIVE PHASES to beginning treatment: Phase One: Alleviate or minimize apprehension
o Make folks comfortable, use small talk, get comfortable introductions, who they are where they go to school, where they work, their ages, etc. o Talk about the "ground rules" of the work - the book says here that you will inform folks of what to do and what they shouldn't do... this is a good idea, but I think we need to be gentle initially with the "don'ts". Try to let folks get their whole thoughts out, try to listen to others, try to be respectful, etc.. This is good, but we might want to couch it in terms of what you as a therapist are going to try to help folks with. I'll try to help folks get their opinions out, help folks listen to each other, stuff like that. o Also, if you try enforce rules too early, you're really saying "don't be yourselves", and thus decrease the likelihood that you will see the real them. o *** Not described here - Initially, we talk about the agency, talk about what we do, how long we've been doing it, etc. We also might ask them about their previous experiences in therapy or with social workers.... Have them describe their experiences, whether it was successful, etc. o Give each person an opportunity to speak a little
Jansen & Harris - FIVE PHASES to beginning treatment: Phase Five: Establish a commitment to a plan of action
o So we have to get commitment that they are interested in continuing the process
Jansen & Harris - FIVE PHASES to beginning treatment: Phase Two: Ask family members to explain what is wrong
o Sometimes this is called circular questioning. Asking each member the same question. Try to resist the temptation to start solving problems... you are collecting data here. One piece of data you're collecting is how members do at interacting with and listening to each other. Family issues might emerge here... people interrupting each other, others reluctant to speak, others seeking approval as they speak. Resist the temptation to start trying to fix these patterns... o ***** The authors say here that this might be an appropriate time to start to institute some rules... such a folks don't interrupt each other. I'd be careful of this... you don't want to drive them away half way through the first session.... There are ways to address such issues more slowly. Such measures MAY be appropriate, but we have to be careful, especially initially. o If someone doesn't want to speak, respect that but ask if it's ok if you come back to them and ask their opinions. I'd really like to hear your opinion about what's going on....
Jansen & Harris - FIVE PHASES to beginning treatment: Phase Four: Concentrate on how family members relate to each other
o You can do this by asking the family to provide info on the problem. How long have they been having the problem? What is its intensity? What have they tried thus far to address the problem? What has kept them from completely solving the problem themselves? We watch communication patterns as they provide this info
Jansen & Harris - FIVE PHASES to beginning treatment: Phase Three: Establish agreement about what is wrong
o You're trying to establish some agreement so that family can begin to work forward. Folks will see problems differently, so we have to figure out how to either frame the problem that covers both people's needs or to get them to be ok with working on several problems at once, one from one person and others from others o Watch for patterns of blame and conflict to emerge, and try to reframe problems so that goals for therapy won't include the blame - "to get Bobby to quit being such a jerk" o Try to limit the initial problem list to just a few... three or four.... let them help you prioritize them o Try to turn little superficial problems into larger ones: change a list like he won't pick up his socks, doesn't listen to us, hits his sister... to a common theme.... He won't respct our requests, or he doesn't mind us.
Object relations (Psychodynamic Therapies)
objects meaning people (or their mental representations). Freud's original emphasis on biological forces and defense mechanisms shifts to social forces and coping or mastery experiences.
Social role theory
posits that one's behaviors, predispositions, and desires arise through a set of specific socially determined roles internalized during the socialization process of the formative years.
Behavior Therapy
practitioners focus on directly observable behavior, current determinants of behavior, learning experiences that promote change, tailoring treatment strategies to individual clients, and rigorous assessment and evaluation.
The reciprocal model emphasizes
the individual and society. Works to assist both the individual and society (and the relationship between the two). Another common model is the social goals model, which is formed to meet social interests only.
According to Freud, there are three levels of consciousness
the unconscious mind, the preconscious mind, and the conscious mind
Hypothesis Testing: Evaluation
● Evaluation (research) hypothesis (H1) - statement of a proposed relationship between (or among) the variables: "Eating Hostess Cupcakes causes increases in waist size measurements." ● Null hypothesis (Ho) - states that two variables are unrelated (no relationship exists): "Eating Hostess Cupcakes does not cause increases in waist size measurements."