Lcsw Board Prep

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3 major pathways associated with relapse in substance abuse

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- exposure to drug
-exposure to conditioning, such as certain people, places, and things.
-exposure to non-specific stress

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Signs of alcohol withdrawal

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nausea, vomiting, tremor, sweating, and hallucinations

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CIWA-AR

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Clinical Institute Withdrawal Assessment for Alcohol Scale Revised. Provides a score for the severity of alcohol withdrawal, ranging from mild to moderate to severe.

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PL 94-142- Education for all Handicapped Children Act

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enacted in 1975. Provides funds for public school programs to ensure equal educational opportunities and free special services for all children with learning and other disabilities. The act was amended in 1986 to provide early intervention for children from birth to 3 who are at risk of developmental delay. The act was replaced in 1990 with the Individuals with Disabilities Education Act (IDEA)

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Individuals with Disabilities Education Act- PL 101-476

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Enacted in 1990 and expanded in 1997. Ensures appropriate services and public education to children with disabilities form age 3 to 21. Special education services are to be provided for all children considered to have disabilities based on a school assessment procedure. If this assessment is deemed inadequate or inappropriate, parents may request that an independent evaluation be conducted at the school's expense. The child's apparent strengths and limitations are evaluated by school professionals known as the IEP team, including classroom teachers, special education teachers, psychologists and social workers, and school administrators, along with parents, to design an IEP. IDEA also established an ombudsperson program to help resolve problems that create barriers for students.

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No Child Left Behind Act (NCLB) of 2001

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Established numerous benchmarks for student performance and created accountability mechanisms for schools that were not meeting average yearly progress targets.

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Malpractice

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To be sued for malpractice, there must first be demonstrated proof that the legal duty existed between you and the client, that you violated that duty by failing to conform to professional standards of care, that evidence exists showing you to be negligent in not conforming to an accepted stards of care, and it can be demonstrated that the client has been harmed or injured in some way and that you were the proximate cause of the injury for which damages are sought.

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Risks factors that place children at higher risk of developing emotional and behavioral disorders (Shonkoff and Phillips, 2000)

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-Genetic or biologic vulnerability or difficult temperament (ADHD, etc. . .)
-environmental, such as extreme poverty or disrupted psychological attachments in early life.
-Having a parent with a mental illness or substance abuse disorder and witnessing or being a victim of family violence and abuse

The more risk factors present, the greater the likelihood that the child will experience serious mental health challenges.

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Paternalism

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Limiting clients' right to self-determination by withholding information, misleading or lying, or coercing them. This is done to protect them from self-harm.

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Homeostasis

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The tendency of a system or organization to maintain stability and, when disrupted, to adapt and strive to restore the stability previously achieved. From General Systems Theory

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General Systems Theory

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A conceptual orientation that attempts to explain holistically the behavior of people and societies by identifying the interacting components of the system and the controls that keep these components (subsystems) stable and in a state of equilibrium. It is concerned with boundaries, roles, relationships, and flow of information between people. It is a subset of systems theories that focuses on living entities, from microorganisms to societies.

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ID

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First structure of personality under Freud's theory. Present at birth. Consists of the individual's unconscious instinctual drives/needs (the source of all psychic energy). It's demands are centered on the body and governed by the pleasure principle. It attempts to force the ego to meet its demands without regard to the long term consequence.

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Ego

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Second structure of Freud's personality theory. Develops approximately 6 mo of age. It responds to the id's inability to gratify all of its needs. It is focused on the reality principle and defers gratification until an appropriate object is available. It mediates between the demands of the body and the realities of the environment.

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Superego

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Third structure of Freud's personality theory. Develops approximately at age 4 or 5. Serves as the conscience, sense of right and wrong.

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Fixation- per Freud

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the partial or complete arrest of personality development at one of the psychosexual stages- defense mechanism

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Undoing- Freud

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the individual engages in a repetitious ritual to abolish the results of a previous action. - defense mechanism

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Substitution- per Freud

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replacing an unobtainable or unacceptable goal with one that is obtainable or acceptable- defense mechanism

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Isolation - per Freud

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memories are separated from the emotions that once accompanied them- defense mechanism

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Compensation- per Freud

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a mental mechanism in which one tries to make up for real or imagined characteristics that are considered to be undesirable. defense mechanism

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identification- per Freud

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a mental process in which a person forms an image of another person who is important and then thinks, acts, and feels in a way that resembles the other person's behavior. defense mechanism

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conversion- per Freud

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anxiety or emotional conflict is transformed into overt physical manifestations or symptoms such as pain, loss of feeling, or paralysis. defense mechanism

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dissociation- per Freud

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the individual has thoughts of feelings that are inappropriate to the current situation-

-defense mechanism

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denial- per Freud

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protects the personality from anxiety and guilt by disavowing or ignoring unacceptable thoughts, emotions, or wishes.

-defense mechanism

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introjection - per Freud

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AKA incorporation. a mental mechanism in which the individual derives feelings from another person or object and directs them internally to an imagined form of the person or object.

-defense mechanism

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projection- per Freud

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unacceptable aspects of one's own personality are rejected or attributed to another person or entity

-defense mechanism

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reaction-formation- per Freud

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Reaction Formation occurs when a person feels an urge to do or say something and then actually does or says something that is effectively the opposite of what they really want. It also appears as a defense against a feared social punishment. If I fear that I will be criticized for something, I very visibly act in a way that shows I am personally a long way from the feared position. A cause of Reaction Formation is when a person seeks to cover up something unacceptable by adopting an opposite stance. Reaction Formation goes further than projection such that unwanted impulses and thoughts are not acknowledged.

-defense mechanism

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regression- per Freud

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behavior and thought patterns that indicate a return to earlier or more primitive levels of development

-defense mechanism

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repression- per Freud

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the individual unconsciously pushes certain unacceptable memories, ideas, and desires from the consciousness.

-defense mechanism

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displacement- per Freud

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transfers certain thoughts, feelings, and wishes onto other thoughts feelings, or wishes that are more desirable or tolerable. Displacement occurs when the Id wants to do something of which the Super ego does not permit. The Ego thus finds some other way of releasing the psychic energy of the Id. Thus there is a transfer of energy from a repressed object-cathexis to a more acceptable object. Example being the boss gets angry and shouts at me. I go home and shout at my wife. She then shouts at our son. With nobody left to displace anger onto, he goes and kicks the dog.

- defense mechanism

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Sublimation- per Freud

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Sublimation is the transformation of unwanted impulses into something less harmful. This can simply be a distracting release or may be a constructive and valuable piece of work.

When we are faced with the dissonance of uncomfortable thoughts, we create psychic energy. This has to go somewhere. Sublimation channels this energy away from destructive acts and into something that is socially acceptable and/or creatively effective. Example being I am angry. I go out and chop wood. I end up with a useful pile of firewood. I am also fitter and nobody is harmed.

-Defense mechanism

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Rationalization- per Freud

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an individual explains or justifies an action or thought to make it acceptable when it is unacceptable at a deeper psychological level.

-defense mechanism

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Intellectualization- per Freud

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Intellectualization is a 'flight into reason', where the person avoids uncomfortable emotions by focusing on facts and logic. The situation is treated as an interesting problem that engages the person on a rational basis, whilst the emotional aspects are completely ignored as being irrelevant.

Jargon is often used as a device of intellectualization. By using complex terminology, the focus becomes on the words and finer definitions rather than the human effects. Example being a person told they have cancer asks for details on the probability of survival and the success rates of various drugs. The doctor may join in, using 'carcinoma' instead of 'cancer' and 'terminal' instead of 'fatal'.

-Defense mechanism

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Freud's stages of psychosexual development

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-Oral- (0 to 12 mo)
-Anal (1 to 3 Years)
-Phallic- (3 to 6 yrs)
-Latency- (6 to 12 yrs)
-Genital (12 yrs and older)

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Freud's Oral stage

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(0 to 12 mo) - source of satisfaction is by mouth- Primary conflict is weaning- fixation in this stage produces dependence, passivity, gullibility, sarcasm, or other oral fixation (like over eating)

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Freud's Anal stage

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(1 to 3 Years)- Source of satisfaction is anal region- primary conflict is toilet training. Fixation produces anal retentiveness, stinginess, selfishness, obsessive-compulsive behavior, and anal expulsiveness (cruelty and messiness). Learn to control the environment by giving/holding feces.

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Freud's Phallic stage

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(3 to 6 yrs)- source of satisfaction is genital region (masturbation) Primary conflicts are the Oedipus/Electra complexes- fixation produces a phallic character (sexual exploitation of others). Successful conflict resolution produces identification with the same sex parent and develops the super ego and self esteem

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Freud's Latency stage

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(6 to 12 yrs)- During this phase the emphasis is on developing social skills rather than sexuality. No new conflicts are raised. The child consolidates previous progress.

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Freud's Genital stage

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(12 yrs and older)- Source of satisfaction are genitals (sexual intercourse). Sexuality becomes focused in mature, genital love and adult sexual satisfaction

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Erikson's developmental stages

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-Trust v Mistrust (0-12mo)- virtue = hope
-Autonomy v Shame/Doubt (12-36mo) - virtue = will power
-Initiative v Guilt (3-6yr) - virtue = independence/purpose
Industry v Inferiority (6-11yr) - virtue = competence
-Identity v Role Confusion (Adolescence) - virtue = fidelity
-Intimacy v Isolation (Early Adulthood) - virtue = love
-Generativity v Stagnation (Middle Adulthood)- virtue = caring
-Integrity v Despair (Late Adulthood)- virtue = wisdom

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Kohlberg's stages of Moral development

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Developed using the "Heinz story".
Level 1- Punishment proves disobedience is wrong.
Stage 1- punishment-obedience oriented- moral judgment is based on a desire to avoid punishment.
Stage 2- instrumental-relativist orientation- (What's in it for me?) - motivated by the desire to satisfy own needs.
Level 2- Punishment is a risk one wants to avoid- Conventional morality (ages 10-13 yrs)
Stage 3- good interpersonal relationships-"good boy/good girl", motivated by the desire to to avoid disapproval of others. -see rules imposed by society
Stage 4- order and law orientation- moral judgments are based on desire to avoid censure by authority-
Level 3- Postconventional morality (adolescence to adulthood- not reached by most adults)
Stage 5- legalistic orientation-social contract and individual rights- concerned with maintaining the respect of equals and the community, maintaining social order, and obeying democratically determined laws. The greatest good for the greatest number of people.
State 6- Universal ethical principles orientation- individual's own conscience is the only criterion for moral conduct- may have to break a law in order to reach the higher social good- he has since deemed this a "theoretical level" because he does not know that anybody can reach this level.

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PIGOLU

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Piaget's theory of intellectual development

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-Sensory-Motor (0 to 2 yrs)- Differentiates self from objects, recognizes self as an agent of change and begins to act intentionally, achieves object permanence. Learns by assimilation or accommodation. develops object permanence
Pre-operational stage (2-4 yrs)- Meanings of objects and events begin to be manipulated (stick becomes gun), can think in symbols (therefore language begins), language is very egocentric, Can think about something without the object being present. Cannot conserve.
Intuitive phase (4 to 7 yrs)- still a tendency to focus attention on one aspect of an object while ignoring others.
Concrete operational (7 to 11 yrs)- child can think logically about objects and events, achieves conservation of number (age 6), mass (age 7), and weight (age 9), can classify objects according to several features and can order them in a series along a single dimension such as size, can use symbols and use them logically. Can take into another person's point of view and consider more than one perspective. Hard time apply to non-concrete events
Formal operations (11 yrs +)- can think abstractly and in relative terms. Can think hypothetically and can engage in deductive reasoning. Shows renewed egocentrism (self consciousness, self criticism, and self admiration)

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Assimilation-Piaget

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the process of adding new information to an existing schema

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Accommodation- Piaget

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Altering or revising an existing schema in light of new information

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Classification- Piaget

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The ability to group objects together on the basis of common features

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Class inclusion- Piaget

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the understanding, more advanced than simple classification, that some classes or sets of objects are also sub-sets of a larger class. (ex. there is a class of objects called dogs. There is also a class called animals. But all dogs are also animals, so the class of animals includes that of dogs)

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Conservation- Piaget

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The realization that objects or sets of objects stay the same even when they are changed about or made to look different ( 1 cup of water is the same in a tall glass or a short fat one)

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Decentration-Piaget

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The ability to move away from one system of classification to another one as appropriate

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Egocentrism- Piaget

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Normal for kids younger than 6, the inability to see the world as someone else sees it and adapt to it. The belief that you are the center of the universe and everything revolves around you. Not moral selfishness.

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Operation- Piaget

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The process of woking something out in your head. Children under 7 have to act, try things out in the real world, to work things out (like count on their fingers); older children and adults can do more in their heads.

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Schema (or scheme) - Piaget

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The representation in the mind of a set of perceptions, ideas, and/or actions, which go together.- guides the encoding and retrieval of new information

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incongruous hierarchies

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Strategic family therapy- child uses symptoms to change the behavior of the parent

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outpositioning- Strategic family therapy

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having someone take the role other family members place on them to the extreme

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Symptom prescription

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or exposure based paradox- to expose the families hidden relationships- symptoms are paradoxically encouraged to lessen the behavior or bring it under conscious control

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restraining techniques- strategic family therapy

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telling the family they can't move very fast because they aren't ready- paradoxical directive- will have own impetus to work out problem

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Rituals (Milan group)

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directive to engage the whole family in some behavior that exaggerated or broke rules or family myths, family members may thank each other for their respective symptoms, mother and father may alternate days for parental responsibility. . .

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Positioning strategy

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Used by a strategic therapist by looking at the family's perception of their problem and exaggerating it to make them feel it is worse than it is so that they'll want to work on it more. Used to help family work on problem in more direct way

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Difference vs organic and psychological psychosis

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Not discrete diseases, these disorders are clinical syndromes. Although most psychotic disorders do not have clear etiology, disorders related to medical conditions and substance withdrawal are more easily traced to precipitating factor(s) and are therefore likely to be easily diagnosed.

Evaluation of persons suspected of having a psychotic disorder requires a good history and a physical examination by a physician. Generally non-organic disorders present with disturbances in thought and emotion, while organic disorders tend to present with mental clouding, confusion, and disorientation because of some degree of delirium. although there are many exceptions. Characteristics that suggest the presence of an organic disorder include the following:

1. No personal or family history of mental illness. Initial psychotic breaks usually occur in early adulthood (early twenties for men, late twenties for woman). The lack of history makes it more likely that there is some organic factor operating. On the contrary, someone who presents with schizophrenia-like psychotic symptoms will undoubtedly have some family or personal history of psychiatric treatment, particularly when the subject is well into adulthood.

2. A history of serious medical illness with periodic relapses suggests organic etiology, especially when the subject is an elderly person.

3. Rapid onset, within a few hours or several days, is a strong indicator of organic etiology. When symptoms are not organically based, family members usually report that the client has been acting "strange" for some longer period of time.

4. The client presents with significant memory loss, confusion, disorientation, and clouding of consciousness. These symptoms may fluctuate quickly, even within hours.

Both Major Depression and Bipolar Disorder may have psychotic symptoms that are secondary to affective ones. Affective disturbance always precedes psychosis in these cases. Additionally, Pervasive Developmental Disorder NOS and Autistic Disorder may have psychotic symptoms which appear to be secondary to developmental impairment. Especially at times of intense stress, individuals with severe personality disorders may have brief periods of psychosis. When environmental stressors are stabilized, either through direct psychosocial intervention or by removing the individual from the environment and placing him/her into a stable and safe environment (such as a hospital), psychotic symptoms usually resolve.