PSYC 3083 Counseling Psych Exam 1
A psychologist refrains from multiple relationships if the relationships could reasonably be expected to impair the psychologist's objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.
3.05 Multiple Relationships
When psychologists agree to provide services to a person or entity at the request of a third party, psychologists attempt to clarify at the outset of the service the nature of the relationship with all individuals or organizations involved. This clarification includes the role of the psychologist (e.g., therapist, consultant, diagnostician, or expert witness), an identification of who is the client, the probable uses of the services provided or the information obtained, and the fact that there may be limits to confidentiality.
3.07 Third-Party Requests for Services
Barter is the acceptance of goods, services, or other nonmonetary remuneration from clients/patients in return for psychological services. Psychologists may barter only if (1) it is not clinically contraindicated, and (2) the resulting arrangement is not exploitative.
6.05 Barter With Clients/Patients
-Psychologists base the opinions contained in their reports (including forensic testimony), on information and techniques sufficient to substantiate their findings. -Psychologists provide opinions of individuals only after they have conducted an examination of the individuals. -When psychologists conduct a record review and an individual examination is not necessary for the opinion, psychologists explain this and the sources of information on which they based their conclusions and recommendations.
9. Assessment
Membership in APA commits members and student affiliates to comply with the standards of the ____________ and to the rules and procedures used to enforce them. Lack of awareness or misunderstanding of an Ethical Standard is not itself a defense to a charge of unethical conduct.
APA Ethics Code
___________ & _____________ are aspirational goals to guide psychologists toward the highest ideals of psychology. They are not themselves enforceable rules, they should be considered by psychologists in arriving at an ethical course of action. The Ethical Standards set forth enforceable rules for conduct as psychologists.
The Preamble and General Principles
denoting aspects of a person's thoughts, impulses, attitudes, and behavior that are felt to be acceptable and consistent with the self-conception
ego-syntonic
Reviews indicate that most major therapies are about ____________ -because they have common factors. Such as therapist warmth, empathy, genuineness, therapeutic alliance, neutrality, ability to listen, acceptance, willingness to listen, provision of objective, non-threatening feedback
equally effective (DoDo Bird Effect)
Lambert (1992) & Hubble et al. (1999) argue that 40% of therapy outcome is related to ___________ (getting a better job; faith; supportive social network).
factors in the client's life that cause or facilitate change
The therapeutic technique, Psychoanalysis uses:
free association and analysis of defenses and transferences
Before 1973, __________ was listed in the DSM as a diagnosable mental illness. Now considered a disorder only if ego dystonic and if it causes disruption of functioning. If individual is comfortable (ego-syntonic) with his or her sexual orientation, then not a disorder
homosexuality
Clinical psychologists often specialize in specific areas such as:
mood and/or anxiety disorders, eating disorders, psychosis, learning problems, neuropsychological disorders, or SUDS
The DSM uses a ________ system to classify a patient
multi-axial (five axes)
________ is a milder mental disorder characterized by distortions of reality, but not a complete break with reality
neurosis
Individuals from Middle Eastern cultures may complain of _____________.
problems of the heart.
This Ethics Code applies only to ____________ that are part of their scientific, educational, or professional roles as psychologists.
psychologists' activities
A ___________ is a severe mental disorder characterized by a disconnection from reality
psychosis
The early editions of the DSM was rooted in a distinction between two poles of mental disorder:
psychosis and neurosis
Many have argued (see Hubble et al, 1999) that the _____________ of the client to use what is offered is most important. Attitudes and interventions such as warmth, support, self-disclosure, deeper exploration, and so on appear to be highly beneficial to some clients, less so for others, and in fact harmful to others. Client hope and belief that healing is possible is also critical
readiness, willingness, and ability
Among far eastern cultures, depression may be experienced ___________ (weakness, tiredness) rather than ____________ (e.g., sadness, guilt).
somatically; emotionally
American psychologist Lightner Witmer (1867-1956), defined "Clinical Psychology" as:
the study of individuals, by observation or experimentation, with the intention of promoting change
15% due to expectancy, 15% due to specific _________________.
theoretic technique used
30% of therapy outcome is related to ____________, such as empathy, warmth, acceptance. "Therapeutic alliance"
therapist characteristics
APA's Diagnostic & Statistical Manual of Mental Disorders was initially developed ____________. Before the DSM, communication between psychiatrists, especially in different countries, was not uniform. The establishment of specific criteria was also an attempt to facilitate mental health research. The multiaxial system attempts to yield a more complete picture of the patient, rather than just a simple diagnosis.
to give more objective terms for psychiatric research
The primary issue with diversity is the ___________________ , to understand and treat the patient. Ex: Therapist believes that women should be assertive and equal to men. Ex: Therapist believes that husbands and wives should share power equally. Ex: Therapist believes in monogamy. Ex: Therapist believes that youth should show respect and deference to adults. Ex: Therapist believes that patients should dress well when they come to therapy. Ex: Therapist believes that individuals without education or position in society and somehow not quite "equal."
unknowing (and perhaps knowing) attempts to use one's values, experiences, beliefs
In the APA (2005) standards of accreditation, "_____________," is one of the eight domains that any graduate program and internship program must address to be accredited.
"Cultural and Individual Differences and Diversity"
A current trend in therapeutic intervention is the use of an "________" ________, which combines two or more techniques or models.
"eclectic" approach
The most recent version of the DSM is the _______________, published in 2000. The vast majority of the criteria for the diagnosis were not changed from DSM-IV
'Text Revision' of the DSM-IV, also known as the DSM-IV-TR
Culture bound/specific syndromes:
-A "disease-like" condition (not voluntary) -Widely recognized in that culture -Other cultures are unfamiliar with the condition -No organic basis -Usually recognized and treated by the folk medicine in that culture -Individual not legally responsible for his behavior when afflicted by the syndrome
The following can greatly affect how the patient responds to medication:
-Age (children and older people need smaller doses) -Height & weight (volume of distribution; fat stores) -Diet (protein intake; grapefruit juice = inhibitor) -Exercise -Smoking and alcohol use (inducers)
Criticisms of diagnosis and assessment include:
-Bias -Overlap in diagnoses -Use of diagnoses as social control -Stigmatizing -Self-fulfilling prophecies -Categorizes or pigeon-holes people
Four states now have white minorities:
-California, -Hawaii, -New Mexico -Texas
Journals addressing cultural issues:
-Cultural Diversity and Ethnic Minority -Hispanic Journal of Behavioral Sciences -Journal of Black Psychology -Journal of Cross-Cultural Psychology -Journal of Cultural Diversity -Journal of Gender, Culture, and Health -Journal of Multicultural Counseling and -Development -Psychoanalysis, Culture, and Society - Psychology of Men and Masculinity
APA Divisions: Division 35— Division 36— Division 44— Division 45— Division 51—
-Division 35—Society for the Psychology of Women -Division 36—Psychology of Religion -Division 44—Society for the Psychological Study of Lesbian, Gay, and Bisexual Issues -Division 45—Society for the Study of Ethnic Minority Issues -Division 51—Society for the Psychological Study of Men and Masculinity
We know that there are many psychological problems that do not fit well into the DSM:
-Extreme anger (without being destructive) -Very low frustration tolerance - give up easily -Lying without gain -Engaging in self-destructive behaviors -Extremely poor self-esteem leading to self-doubt and inability to socialize -Boredom leading to frequent changes in jobs, friends, homes resulting in no gain -Pseudostupidity
It is arguable that Humanistic psychology is more of an outlook than a set of techniques. Even so, there are several therapeutic approaches that could be called Humanistic, including:
-Gestalt Therapy, -Existential therapy, -Experiential psychotherapy, -Psychodrama, -Transpersonal therapy
Clinical psychologists in _________, ___________, and ___________ now have the prescription privilege
-Guam, -New Mexico, -Louisiana
Relevant APA Ethical Standards: -Principle E: -Standard 2.01: -Standard 3.01: -Standard 9.06:
-Principle E: Respect for People's Rights and Dignity -Standard 2.01 Boundaries of Competence -Standard 3.01 Unfair Discrimination -Standard 9.06 Interpreting Assessment Results
Clinical psychologists use a variety of therapeutic techniques that reflect (most of the time):
-Psychodynamic, -Cognitive Behavioral, -Humanistic, -Systems (e.g. family or couples therapy), -Gestalt, -Existential, -Transpersonal models
Related Areas of Psychology:
-School Psychology -Developmental Psychology -Neuropsychology -Educational Psychology (Ph.D. or Ed.D.) -Forensic Psychology -Industrial/Organization Psychology -Health Psychology
Psychoses typically involve:
-hallucinations -delusions -illogical thinking
Rogers believed that a client needed 3 things from a therapist:
1. Congruence -- genuineness, honesty with the client. 2. Empathy -- the ability to feel what the client feels. 3. Respect -- acceptance, unconditional positive regard
Prochaska et al. (2003) have developed a stage of change model for addiction but could be used to assess therapy readiness:
1. Precontemplative: Person does not think she has a problem; not considering change. 2. Contemplation: Person recognize a problem; not ready to do anything about it. 3. Preparation: Getting ready to do something 4. Action: Doing something 5. Maintenance stage: Avoiding relapse
Psychiatrists versus Clinical Psychologists: 1. 2.
1. Psychiatrists have a medical degree (MD), and Psychologists earn Ph.D. or Psy.D. 2. Psychiatrists train more in the "Disease-Medical Model", and Psychologists train more in the Bio-Psycho-Social Model, research, psychometric assessment
Psychodynamic Diagnostic Manual lists 6 criteria of healthy functioning:
1. See both self and others accurately in complex and stable ways 2. Maintain intimate and satisfying relationships 3. Express full range of emotions 4. Regulate emotions and impulses adaptively 5. Function in a morally healthy manner 6. Appreciate conventional notions of what is realistic; Respond to stress resourcefully
When psychologists believe that there may have been an ethical violation by another psychologist, they attempt to resolve the issue by bringing it to the attention of that individual, if an informal resolution appears appropriate and the intervention does not violate any confidentiality rights that may be involved.
1.04 Informal Resolution of Ethical Violations
Psychologists do not discriminate (based on age, gender, gender, race, etc). Psychologists do not engage in sexual harassment. Harassment is sexual solicitation, physical advances, or verbal/nonverbal conduct that is sexual in nature, that occurs in connection with the psychologists' activities, and is unwelcome or offensive.
3. Human Relations
A multiple relationship occurs when a psychologist is in a professional role with a person and at the same time is in another role with the same person. -Examples: 1) student and employee 2) student and patient 3) boss and patient 4) pastor and patient
3.05 Multiple Relationships
If an ethical violation is not appropriate for informal resolution, psychologists take further action, such as conferring with state licensing boards. This standard does not apply when an Intervention would violate confidentiality rights.
1.05 Reporting Ethical Violations
When obtaining informed consent to therapy, psychologists inform patients as early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for the patient to ask questions and receive answers.
10.01 Informed Consent to Therapy
-Psychologists do not engage in sexual intimacies with current therapy patients. Psychologists do not engage in sexual intimacies with individuals they know to be close relatives, guardians, or significant others of current patients. Psychologists do not terminate therapy to circumvent this standard. -Psychologists do not accept as patients persons with whom they have engaged in sexual intimacies. -Psychologists do not engage in sexual intimacies with former patients for at least two years after cessation of therapy.
10.05 Sexual Intimacies
Psychologists terminate therapy when it becomes reasonably clear that the patient no longer needs the service, is not likely to benefit, or is being harmed by continued service. Question: When does therapy actually end?
10.10 Terminating Therapy
The first edition (DSM-I) was published in 1952, and had about ______ different disorders. DSM-II was published in 1968 with a growth to _______ disorders. Both editions were strongly influenced by the __________ approach
106 disorders; 140 disorders; psychodynamic approach
Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience. Psychologists planning to provide services, teach, or conduct research involving populations, areas, techniques, or technologies new to them undertake relevant education, training, supervised experience, consultation, or study.
2.01 Boundaries of Competence
When psychologists conduct research or provide assessment or therapy, they obtain informed consent except when conducting such activities without consent is mandated by law or governmental regulation. When psychological services are court ordered, psychologists inform the individual of the nature of the anticipated services, including whether the services are court ordered or mandated and any limits of confidentiality, before proceeding.
3.10 Informed Consent
-Psychologists have an obligation to protect confidential information obtained through or stored in any medium, recognizing that the extent and limits of confidentiality may be regulated by law or established by institutional rules or professional or scientific relationship. -HIPAA -The Health Insurance Portability and Accountability Act (HIPAA; 1996, 2000). Initially concerned with transferability of insurance, but came to be concerned with confidentiality and security of health data. -HIPAA regulations require that access to patient information be limited to only those authorized and that only the information necessary for a task be available to them.
4.01 Maintaining Confidentiality
The field of _____________ integrates science, theory, and practice to understand, predict, and alleviate maladjustment, disability, and discomfort as well as to promote human adaptation, adjustment, and personal development. ____________ focuses on the intellectual, emotional, biological, psychological, social, and behavioral aspects of human functioning across the life span, in varying cultures, and at all socioeconomic levels.
American Psychological Association's Definition; Clinical Psychology
_____________(recognized in DSM) , is derived from the Malay/Indonesian/Tagalog word, meaning "mad with uncontrollable rage." -Example: a man who has shown no previous inclination to violence, will in a sudden frenzy, attempt to kill or injure anyone he encounters. Amok episodes of often result in the death of the attacker (killed by bystanders or commits suicide).
Amok (also spelled amuck or amuk)
Many theorists built upon Freud's fundamental ideas, including:
Anna Freud, Alfred Adler, Carl Jung, Heinz Hartmann, Karen Horney, Erik Erikson, Ronald Fairbairn, Otto Kernberg, Melanie Klein, Heinz Kohut, Margaret Mahler, David Rapaport, Donald Winnicott, and Harry Stack Sullivan
Antidepressants: _________ & _______ need smaller doses of TCA's b/c they metabolize TCA's more slowly than Caucasians
Asians & Hispanics
Antipsychotics (AP's): -______ metabolize AP's more slowly and thus need smaller doses. _________ & _________ have greater risk for developing Metabolic Syndrome for unknown reasons. BZD's _______ & _____ > sensitivity than Caucasians and thus need smaller doses
Asians; African Americans & Hispanics; Asians & African Americans
__________ (Latinos)-similar to but different from panic attack.
Ataque de nervios
-Axis I: -Axis II: -Axis III: -Axis IV: -Axis V:
Axis I: major mental disorders, such as depression, schizophrenia, anxiety, developmental disorders (e.g., autism) and learning disabilities Axis II: Personality disorders and mental retardation Axis III: Non-psychiatric medical conditions Axis IV: Stress and social functioning Axis V: Global Assessment of Functioning (on a scale from 1 to 100)
A. Five (or more) of the following symptoms have been present during the same two-week period and which represent a change from previous functioning. One or both of the following symptoms must be present: 1) Depressed mood 2) Loss of interest or pleasure (anhedonia)
Diagnostic example of Major Depressive Disorder from DSM
GAF categories: Scores 61 to 100 = Scores 50 to 60 = Scores 40 to 49 = Scores < 40 =
Scores 61 to 100 = generally doing well. Includes the more neurotic disorders. Scores 50 to 60 = moderate social, education, work, and family problems. Scores 40 to 49 = serious impairment Scores < 40 = very serious, inability to function or care for oneself, psychotic, MR.
_____________ was developed in the 50's and 60's by Albert Ellis and Aaron Beck (both of whom had analytic training!).
Cognitive Behavioral Therapy (CBT)
_____________facilitates personal and interpersonal functioning across the life span with a focus on emotional, social, vocational, educational, health-related, developmental, and organizational concerns. Through theory and research, and with a sensitivity to multicultural issues, it aims to alleviate distress and maladjustment and increase ability to function.
Counseling psychology
___________ of why one becomes ill will determine what the diagnosis is, what treatments are acceptable, and how well a patient complies with treatment recommendations
Cultural explanations
Many clinical psychologists diagnose their patients (or clients) based on criteria described in the _______ or ______, although some clinical psychologists do not use a medical or categorical approach
DSM or ICD(International Classification of Disorders)
________ is tentatively scheduled for publication in 2012, with initial planning having begun in 1999. The APA Division of Research expects to begin forming DSM development workgroups in 2007
DSM-V
Need at least 5 of the following 9 symptoms for Depression:
Depressed mood most of the day, nearly every day . . . in children and adolescents, can be irritable mood. (2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day - anhedonia (3) Significant weight loss when not dieting or weight gain (4) Insomnia or hypersomnia nearly every day (5) Psychomotor agitation or retardation (6) Fatigue or loss of energy nearly every day (anergia) (7) Feelings of worthlessness or guilt (8) Problems with attention, memory, and concentration (9) Recurrent thoughts of death
___________ has many symptoms, and these symptoms are expressed in different degrees among different culture.
Depression
issues that you have that are inconsistent to problems about who you are
Ego Dystonic
issues that you have that are consistent to problems with who you are
Ego Syntonic
Example of Ego-Syntonic
Ex. A person who drinks all the time but its who they are and its not a problem but occasionally it gets out of hand
Example of Ego-Dystonic
Ex. My family are Christians they don't believe in drinking. I drink and sometimes binge drinking and I know its against my family values
____________ developed in the '50s as a reaction to behaviorism &psychoanalysis
Humanistic Psychology
___________ (Korean)- an anger syndrome with agitation but no depression
Hwa-byung
__________ emphasizes uniqueness and differences (sometimes called emics)
Idiographic
The term "Clinical Psychology" was introduced in a 1907 paper by the American psychologist:
Lightner Witmer (1867-1956)
-Motivated by a need to reduce costs. -(HMO, Medicaid, Medi-care, Private Insurance, PPO, etc) permit limited number of sessions, which can dramatically affect the focus, goals, and choice of techniques! -Often puts non-professionals in charge of determining how many sessions or what services a patient will receive. -Research suggests that HMO's should focus more on outcomes than specific EBP's.
Managed Care
-These issues can involve any group of persons who do not share the majority point of view, values, customs, beliefs. -Gays, racial minorities, different religious groups, non-English speaking ethnic groups, opposite gender ?. -The problem is that almost any individual can claim to have unique experiences that the therapist has not had. Ex: Unmarried therapist treating parents!
Multicultural and diversity issues
__________ emphasizes commonalities (sometimes called etics)
Nomethetics
Humanistic Psychology originated with:
Rogers and his Person-Centered Therapy (often referred to as Rogerian Therapy). Goal: integration of the whole person
_________ (Eskimos) Includes hysteria (screaming, uncontrolled wild behavior), depression, coprophagia, insensitivity to extreme cold (such as running around in the snow naked), echolalia. May be due to vitamin A toxicity and/or sensory deprivation?
Pibloktoq (Eskimos) "Arctic hysteria"
_______________ are the same except there is more emphasis on clinical practice and less emphasis on research. And they follow the "Practitioner-Scholar Model"
Psy.D.
The Psychodynamic perspective developed out of the:
Psychoanalysis of Sigmund Freud
Forms of Cognitive Behavioral Therapy include:
Rational Emotive Behavior Therapy and Dialectic Behavior Therapy(only therapy that seems to work with borderline personality disorder)
When is a patient ready for therapy?
Therapy not usually successful when a patient is forced to come to therapy. Prochaska et al. (2003) have developed a stage of change model for addiction but could be used to assess therapy readiness.
What is the training for a counseling psychologists?
Typical training requirements for the Ph.D. include four years of college, 4 to 5 years of graduate school, one year of internship, and one year of post-doc supervision. And they follow the "Scientist- Practitioner Model"
__________ complain of sadness and lack of enjoyment of life.
Westerners
Clinical psychology is the application of psychological knowledge and techniques to:
alleviate distress and promote health
Neuroses typically involve:
anxiety and depression
Numerous specific standards and principles in the most recent edition of the American Psychological Association (2003) ethical code compel psychologists to _________________. Their inclusion as standards makes it clear that awareness of _______________ is a requirement rather than merely an ethical aspiration psychologists.
be culturally competent and sensitive; diversity issues
In 1980, with DSM-III, the psychodynamic view was abandoned and the _________became the primary approach
biomedical model
Counseling psychology is unique in its attention
both to normal and abnormal development.
Clinical psychology is the application of psychological knowledge and techniques to alleviate distress and promote health. This includes:
conducting and using scientific research, assessment (interviews and testing), consultation, and application of various psychotherapeutic techniques.
Today,psychoanalysis/ psychodynamic approach focuses on:
conflicts and whether the individual's resolution of the conflict is adaptive, and often attempts to uncover unconscious thoughts and childhood experiences that contribute to the conflict.
Cognitive Behavioral Therapy is helpful with the following two mental disorders:
depression and anxiety disorders
The object of Cognitive Behavioral Therapy is to:
discover the irrational thinking that leads to emotions that motivate problem behaviors