Clinical Psych Exam 2

Front 1

what is psychotherapy?

Back 1

*an intention: to restore a level of functioning, change thoughts, help individual.. social positive effect as well

*a relationship: alliance..establish support and motivation.. unconditional positive regard.. allows us to approximate

*an experiment: can't really predict the outcome since clients are so different

*a lie?: no a quick fix as patients often assume.. may over-promise results

Front 2

the players

Back 2

i. psychologists:
1. clinical
2. counseling
3. school

ii. psychiatrists
1. medical model
2. prescription priviledges

iii. social work, MFT

iv. paraprofessionals: e.g. psych assistant/ student interns.. cannot bill for psychotherapy

Front 3

issues of expertise (mainly masters vs doctoral)

Back 3

there is no evidence that more training = more success

Front 4

patient vs. client

Back 4

some (e.g. Rogerian) don't like the term patient because it implies illness

Front 5

who seeks therapy?

Back 5

*women are more likely to seek

*the YAVIS-- Young Attractive Verbal Intelligent Successful

*the trainwreck patient.. seen more in community mental health clinics

Front 6

why do patients come in for treatment? -- presenting problem

Back 6

*psychopathology.. often depression

*adjustment/situational difficulties

*self-improvement.. infrequen

*recreational.. just like having that therapy hour where someone really listens to them

Front 7

ethical guidelines

Back 7

1. confidentiality

2. informed consent

3. humane and empathetic treatment

4. objectivity

Front 8

confidentiality

Back 8

helps client feel safe in revealing personal things about themselves

Front 9

when can confidentiality be breeched?

Back 9

in court

if the patient is homicidal or suicidal

if there is abuse of a child or elderly person

Front 10

informed consent

Back 10

lets the patient know what can/can't happen

what will happen

the limits of confidentiality

the providers credentials

if the session is going to be recorded etc

Front 11

pros and cons of disclosure

Back 11

PROS:
* can humanize therapist
* allows patient to normalize their pathology
* enhances the relationship with commonalities

CONS:
* could expose something and have bad consequences (e.g. Sarah in "If Rape Were Legal..."
* could threaten credibility
* don't want to hijack therapy session for yourself (e.g. Sarah again)

basically, disclosure is potentially very powerful, but should be used judicially

Front 12

humanistic alliance

Back 12

unconditional positve regard

"teamwork makes the dream work"

client centered

Front 13

psychodynamic alliance

Back 13

a tale of transference

allows patient to transfer their problems to the therapist because they don't feel safe/are not able to do so with the real object

Front 14

cognitive-behavioral alliance

Back 14

necessary but not sufficient

in this case relationship AND expertise are essential

Front 15

behavioral alliance

Back 15

important that the trust the bahvioral advisor

Front 16

research on alliance

Back 16

MOST IMPORTANT VARIABLE IN POSITIVE OUTCOME

Front 17

influence of Bruer on psychoanalysis

Back 17

had hysteric patient, Anna O., and used hypnosis on her

she was not able to drink..discovered during hypnosis that she had seen a dog drinking water out of a cup and had repressed it

she was able to use her paralyzed arm while under hypnosis

Front 18

the common medical perception of hysteria

Back 18

let it go and it will go away

viewed hysterical people as weak.. Freud argued these problems were legitimate and organic ailments

Front 19

the role of hypnosis

Back 19

more normal during hypnotic state

it was a temporary respite but allowed the unconscious thoughts to surface i.e. showed the root of the problem

Front 20

the talking cure

Back 20

revolutionary at the time that one's pathology could be cured through talking

met with skepticism

Front 21

Freud rethinks the usefulness of hypnosis

Back 21

found that it didn't work for most people.

he had some disdain for hypnosis because of it's closeness to Mesmer & animal magnetism

Front 22

most likely to respond to hypnosis

Back 22

creative intelligent people

Front 23

resistance

Back 23

i. repressed material
ii. sublimation

unconcious, inherent refusal to reveal the id...self-protective

Front 24

free association

Back 24

say whatever and unconcious will eventually surface

classic image of psychotherapy..couch, clipboard etc.

Front 25

dream interpretation

Back 25

"royal road to the unconscious"

they don't make sense because that is another manifestation of resistance

Front 26

manifest content

Back 26

the actual plot of the dream

Front 27

latent content

Back 27

what the symbolism actually means

if we can interpret, we can solve pathology

Front 28

transference

Back 28

unconscious redirection of feelings from one person to another

Front 29

psychosexual stages

Back 29

oral
anal
phallic
latency
genital

Front 30

necessary conditions for client centered therapy

Back 30

i. individual/client responsibility: client has to want to get better..motivation within themselves (therapist does nothing)

ii. inherent drive for self-actualization: everyone is naturally motivated to grow

iii. therapist's job is to create a nurturent environment where the client does not feel judged

iv. don't set limits on attitudes: client is allowed to think and believe what they want

v. therapeutic techniques emphasize understanding

Front 31

what will normally happen in client centered therapy

Back 31

i. client expresses deep motivating attitudes

ii. the client will explore the attitudes more genuinely

iii. the client will accept themselves/their attitudes more fully

iv. client will develop new goals to fix what they don't like

v. client will develop new behavior in support of their new goals

Front 32

final thoughts of Rogerian techniques

Back 32

active listening techniques e.g. minimal encouragers and use of restate

therapist cannot give advice/tell them what to do

good for establishing the alliance but not beneficial after that

Front 33

Beck's CBT for depression

Back 33

*environmental/situational etiology of depression..drugs are only a bandaid

*nutshell: taking illogical thinking and replacing it with new, more adaptive knowledge

*therapist is directive...borderline confrontational

Front 34

CBT/RET: The ABC model

Back 34

Activating events

Belief

Consequences

**A DOES NOT LEAD TO C

**use REFRAMING to elicit a more controlled reaction.. not a slave to consequences, but is a conscious process that must be learned

Front 35

types of behavioral techniques

Back 35

systematic desensitization

token economies

behavioral contract

Front 36

why do group therapy?

Back 36

i. peer support

ii. more pragmatic/time efficient/cheaper for the individual

iii. the power of synergism: two or more things working together

Front 37

therapeutic factors in group

Back 37

i. sharing new information: hearing someone share their story first may grease the wheels

ii. instilling hope: increases sense of hope..seeing someone with the same problem cope

iii. universality: normalization..others struggle with it too

iv. altruism: helping others makes you feel better about yourself

v. interpersonal learning: hone in on interpersonal skills..allows them to interact in a safe environment under supervision

vi. recapitulation of the primary family: seeing group as your family..allows for transference

vii. group cohesiveness: the actual relationships of the group members

Front 38

process group vs. psychoeducational

Back 38

process: no set agenda

psychoeducational: set agenda

Front 39

potential problems in marital therapy

Back 39

the therapeutic triangle

gender of the therapist may effect the ability to establish alliance with a particular partner

tendency to have a greater alliance with one specific partner..need to fight against this

gender stereotypes in the marriage: emphasis on shared responsibility

Front 40

family therapy

Back 40

therapist as ringleader-- difficult

systematic approach
i. circular causality.. the family as a whole is what is maladaptive not just one individuall

identifying fundamental relationship issues

therapist as a communication/behavioral consultant

Front 41

tertiary prevention

Back 41

seeks to lessen the severity of disorders and to reduce short-term and long-term consequences of mental health problems

Front 42

secondary prevention

Back 42

involves interventions for people who are at risk for developing a disorder

Front 43

primary prevention

Back 43

involves avoiding the development of disorders by either modifying environment or strengthening individuals so that they are not susceptible to those disorders in the first place

Front 44

the community as client

Back 44

promoting group/community cohesion

using research as a form of intervention

Front 45

who cares about psychotherapy outcome?

Back 45

i. insurance companies

ii. consumers/patients

ii. therapists

iii. others: significant other, bosses, family

Front 46

within subject methodology

Back 46

one subject

pre-design and post-design

Front 47

between subject design

Back 47

multiple subjects

each given a different treatment and then compared

Front 48

Eysenck’s bombshell

Back 48

i. called into question the effectiveness of psychotherapy

ii. suggested that placebo was more effective

iii. motivated psychotherapy research in decades to follow

Front 49

Luborsky

Back 49

outcome research

i. compared types of therapeutic treatments .. found no difference.. "all have won and all must have prizes"

Front 50

dose response research

Back 50

how much therapy is needed?

with 6-8 sessions 50% see improvement

with 26 sessions 75% see improvement

Front 51

meta-analysis

Back 51

the studies become the subjects

converts the results into a common statistic

Front 52

criticisms of meta-analysis

Back 52

assumes that all studies being looked at were good studies..not always the case

only as good as the research results of the original studies

bias..being selective in the studies included

are they really comparing apples to apples?

Front 53

problems with consumer report surveys

Back 53

bimodal: either really good or really bad

tend to rate satisfaction on inoccuous issues..i.e. service..may be a good therapist with a shitty receptionist/couldn't get a parking space

Front 54

Seligman consumer report surveys

Back 54

used to determine consumer satisfaction of psychotherapy

involved thousands of participants

results came back incredibly positive..yay psychotherapy!!!

but wait! the response rate was awful

fail.

Front 55

empirically validating psychotherapy

Back 55

establishment of the APA task force: brought order to the chaos of psychotherapy ..tested which treatments were legit, and imposed guidelines

1995: published 25 empitically validated treatments that met their criteria

1998: 2nd published list: 71 validated treatments

2001: 3rd list: 145

Front 56

criticism of emirically validating psychotherapy and the one good thing that came out of it

Back 56

critics insisted the whole process was not scientific..not objective, overly restrictive

good thing: the birth of treatment manuals..yesss

Front 57

common factors research

Back 57

following Luborsky's results, researchers said, "hey, let's identify the common factors that predict success in psychotherapy!!!!!!!" ..maybe not so enthusiastically, but still.

included:
i. therapist common factors, e.g. warth, expertise etc
ii. client common factors
iii. relationship/alliance common factors

Front 58

Perls

Back 58

gestalt therapy

manipulate/frustrate the patient

inquire about what they are doing..their bevahiors and idiocincracies

very much in the moment..don't let people escape to the past or the future

be aware of the real you right now

Front 59

Ellis

Back 59

rational-emotive therapy/CBT

somewhat confrontational..direct but not agreeing with everything client says

rationalizes clients thoughts

speaking A LOT..

tone = more conversational..focus towards solving a problem

Front 60

Dawes

Back 60

psychotherapy is built on a myth

outcome should be meaningful to an outside observer..must insist that psychotherapy be assessed in a way that allows the outside observer to reach a conclusion about its effectiveness

Front 61

Strupp's analogy

Back 61

outcome judgements are contingent on values placed on human behavior...

global outcome as a "still photograph of an object in motion"

Front 62

Dawe's coffee shop comment about "cured"

Back 62

symptom remission as the primary criteron of cure or improvement

Front 63

Dawes: therapist as the only individual with "credentials" to measure outcome?

Back 63

said this is very flawed..

therapists: committed to their profession and to a particular technique, are the last to know when their efforts are ineffective

also, evaluating outcomes without the patients input ignores lessons from history

Front 64

regression effect

Back 64

people are often unhappy..it follows that they are less likely to be unhappy later, regardless of what happens in the meantime

since people enter therapy when they are unhappy, they are less likely to be unhappy later regardless of the therapy.

creates an illusion that therapy has helped alleviate their unhappiness

Front 65

role of self-selection bias in outcome?

Back 65

difficult to determine causation

Front 66

Apples to oranges criticism of Glass & Smith

Back 66

meta-analysis compares apples to oranges: problems of clients vary greatly across different studies.. some clients are anxious/depressed/schizophrenic

Front 67

Dawe's conclusions based on Glass & Smith

Back 67

i. psychotherapy works
ii. credentials/training is irrelevant
iii. type of therapy is irrelevant
iv. length of therapy is irrelevant

Front 68

Argument of Strupp and Lambert

Back 68

the studies about credentials/expertise were flawed

combine an attack on the studies themselves with an appeal to hypothetical studies that have not been conducted

the outcomes for the professionals might be different from those of the paraprofessionals depending on the types of clients they treated, or the types of techniques they used

Front 69

historical roots of child clinical psychology

Back 69

Lightner Witmer at U-Penn..applied clinical psych and gave advice about student with reading problem..lead to first clinic..focus on adult psychopathology came later

Front 70

unique characteristics of working with children

Back 70

the referral process: children rarely seek help themselves..parent or gaurdian does

developmental characteristics-- determining what is age appropriate vs. what is age inappropriate.. e.g. diagnosing bipolar in a 5 year old..their moods always vascilate between mania and depression, but not reflective of psychopathology

they are harder to diagnos becase what is acceptable in children is broader than with adults

Front 71

resileincy in children

Back 71

kids have incredibly plasticity

Front 72

childhood stressors

Back 72

educational..special ed

parental conflict/divorce (divorce is better handled by older children)

abuse

Front 73

advantages/disadvantages of assessment with kids

Back 73

disadvantages
i. reading limitations
ii. verbal limitations
iii. physical/coordination limitations

advantages
i. spontaneity
ii. less likely to malinger or manipulate testing

Front 74

ways of assessing children

Back 74

behavioral rating scales -- rated by teachers/parents

clinical interviews -- both parents and children

intelligence testing

achievement/aptitude testing

personality testing

behavioral observations

measures of family interactions/dynamics

Front 75

childhood disorders (and treatments)

Back 75

retardation.. maximize their capacity to full potential

learning disorders.. special ed etc

motor skills disorders

communication disorders.. speech therapy

pervasive developmental disorders..aspergers/autism

ADD/ADHD

oppositional defiant disorder and conduct disorder

feeding/eating disorders.. pica

elimination disorders.. bed wetting/soiling, fecal smearing