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134 Cards in this Set

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Behaviorism/Interventions
Behavior is generated and maintained by factors external to the person, by various environmental and situational stimuli. Behaviorists believe psychopathology results from problematic learned patterns.
Treatments Based on Classical Conditioning
Involve unlearning previous problematic connections (anxiety, phobias, addictions), change is accomplished by techniques that rely on counterconditioning or classical extinction.
COUNTERCONDITIONING
Based on principle of "reciprocal inhibition" (two incompatible responess cannot be experience at the same time- stronger responses will inhibit the weaker). Focus is on weakening the maladaptive CR by strengthening an incompatible response. Specific interventions: aversive conditioning, systematic desensitization, sensate focus, and assertiveness training.
AVERSIVE CONDITIONING
Only used to eliminate "bad" or "deviant" behaviors, by pairing the CS with a new & stronger stimulus.Can be done In Vivo or in Imagination (covert sensitization). Example: trying to quit smoking or drinking.
While there are short term benefits, not effective in long term, with high rates of recidivism.
Systematic Desensitization
(Wolpe) Commonly used to treat specific phobias. Training pt to relax deeply, construct "anxiety hierarchy", and expose the ppt to lowest situation on hierarchy (in vivo or imagination). Recent research suggests prolonged & intense exposure (flooding) is most effective for specific phobias.
SENSATE FOCUS
(Masters & Johnson)Uses pleasure to inhibit performance anxiety. Pleasure is elicited at first sign of anxiety, with goal to have intercourse without anxiety. Designed to influence the 1st stage of sexual response, the excitement stage.
Assertiveness Training
Utilizes the assertive response, which is antogonistic to social anxiety. Patients practice in role playing and in real-life.
Classical Extinction
Presenting the CS (conditioned stimulus) without the US (unconditioned stimulus), to the point that the CS no longer elicits the CR.
1. Flooding
2. Implosive Therapy
FLOODING
Can be done in vivo or in imagination. Presenting the CS without the US (usually unknown), while being prevented from fleeing. Prolonged exposure (45 min) is more effective than multiple briefer periods of exposure which can actually exacerbate the fear. Flooding with response prevention appears to be more effective than systematic desensitazation for agoraphobia, OCD, and specific phobias.
IMPLOSIVE THERAPY
(Stampfl) conducted in imagination ONLY. After the patient is exposed to feared object, psychosexual themes are discussed & interpreted.
Treatment Approaches Based on Operant Conditioning
Involve either reinforcement or punishment. A functional assessment of behavior is conducted, defining the target behavior and determining its antecedents and consequences. Includes identifying the contingencies that serve to maintain the behavior and can be manipulated as part of the behavior modification program.
Types of Reinforcement
1. Primary: those that reinforce EVERYONE at all ages and in all cultures (e.g. food)
2. Secondary: acquire their reinforcing value through training or experiences (e.g. praise)
3. Generalized: Are not inherently reinforcing, but take on reinforcing value because it allows access to other reinforcers (e.g. money, tokens)
Shaping
Shaping by successive approximations, a person is reinforced for every step taken toward achieving target behavior.
Token Economies
Using tokens in a consistent and systematic manner as reinforcement for appropriate behaviors. These could be used to purchase goods or privileges. Originally used on schizophrenic psychiatric ward.
Contingency Contracting
Application of operant conditioning techniques to the naturalistic environment, utilized when there are problematic interactions between two or more people. Therapist helps identify behaviors they most want from each other and negotiates for their exchange.
The Premack Principle
(Principle of Reinforcer relativity) Using high frequency behaviors to reinforce low frequency behavior.
Differential Reinforcement of Other Behaviors
DRO or DRI/A (Differential Reinforcement of Incompatible Responses/ Alternative Responses) combines EXTINCTION & POSITIVE REINFORCEMENT. e.g. Child ignored for tantrum (extinction)but reinforced when engaged in on-task behavior.
Self Reinforcement
Administering reinforcement to oneself. One element of BEHAVIORAL SELF CONTROL or SELF REGULATION PROCEDURES
Self Control Procedures
Self monitoring: keeping detailed record of what one does
STIMULUS CONTROL: narrowing the range of stimuli that elicit a particular behavior & developing incompatible responses.
AVERSIVE CONTROL OF BEHAVIORS
1. Positive Punishment
2. Escape Learning
3. Avoidance Learning
4. Overcorrection
Positive Punishment
Applying an aversive stimulus (e.g. yelling) after an undesirable behavior has been emmitted. Rarely used in clinical setting.
Research shows PP merely suppresses the behavior but does not eliminate it. To optimize effectiveniss, it should be delivered at maximum intensity the 1st time, it should be certain, and there should be little delay between the occurrence of the undesirable behavior and the punishment.
Escape Learning
The aversive stimulus cannot be avoided altogether, however, once started can be STOPPED by emitting desired behavior. ex. animal is shocked, but can stop it but pushing the lever
Avoidance Learning
One can entirely AVOID the aversive stimulus by emitting the desired behavior in time.
Overcorrection
Type of punishment that involves restitution or reparation, as well as physical guidance. For example, the kids have to clean up their mess, plus clean up another room
Treatment Approaches based on Social Learning Theory
1. Symbolic Modelng
2. Live or In Vivo Modeling
3. Participant modeling
SYMBOLIC MODELING
Filmed modeling involves observing a film in which a model enjoys progressively more intimate interaction with a feared object or anxiety producing setting
LIVE OR IN VIVO MODELING
Entails having the person observe a live model engage in graduated interactions with a feared object or anxiety-producing situation
PARTICIPANT MODELING
consiste of live modeling plus contact with the model.The model gradually guides the person in activities with the feared object or situation. Appropriate for children with phobias.
LINEHAN'S DIALECTICAL BEHAVIOR THERAPY
DBT is a structured outpatient therapy program for borderline personality disorder. Dialectical point of view, "acceptance" and "change" underlies therapy.
The patient must agree to 4 conditions: to work in therapy for specified period (1 yr) & within reason to attend all sessions; to work on reducing suicidal behavior if present; to work on therapy-interfering behaviors; and to attend skills training.
Primary modes of treatment: individual therapy, telephone contact, skills training, and therapist consultation.
Interventions Based on Cognitive Behaviorism
Organisms do not simply learn associations or develop responses by trial and error. Rather, learning is characterized by internal processes that must be understood. Earliest critic of pure behaviorism was Kohler.
Rational Emotive Therapy
REBT- ELLIS: born out of dissatisfaction with psychoanalysis. REBT approaches problems in a direct & straightforward way, by convincing patients of their irrationality (that causes emotional disturbance).
ABC model (Activiting event; Belief: Consequence)
DEF component is therapy (Disputing intervention, E= adoption of more Effective philosophy, and new Feelings)
Techniques of REBT
Direct instruction, persuasion and logical disputation are major procedural components. Techniques are active and confrontative, includes modeling, rehearsal, homework, & relaxation. Multimodal and integrates cognitive, affective and behavioral techniques.
Has been applied to an array of problems.
Cognitive Therapy
BECK overlaps with REBT in cognitive focuses, but differs in that it emphasizes EMPIRICAL HYPOTHESIS TESTING as mean of changing belief systems. Assignments and homework are use to allow pts. to test validity of their beliefs. Uses SOCRATIC QUESTIONING, continually seeking pt's views of the problem. A more COLLABORATIVE approach.
Psychological symptoms come from MALADAPTIVE THOUGHTS. negative thinking occur automatically & outside conscious awareness. Coined "logical errors", "faulty conceptions" and "self-signals"
BECK'S MALADAPTIVE COGNITIVE TRIAD
1. Negative view of SELF, defective & inadequate
2. Negative view of the WORLD, expectation of failure & punishment
3. Negative view of the FUTURE, expectation of continued hardship or negative appraisal of future. Techniques include daily logs, activity scheduling, attempting tasks gradually to improve mastery with goal to identify & test negative cognitions, develop alternative and more flexible schemas, and rehearse new cog and behavioral responses.
COGNITIVE BEHAVIOR MODIFICATION (CBM)
MEICHENBAUM:2 programs are Self-Instructional Training and Stress Innoculation Training. Approach focuses on "self-statements" or the verbalizations that pt's make to themselves.
Self Instruction Therapy
Set of procedures that combines modeling & graduated practice with elements of RET, to help with problems of task completion (good for ADHD).
1. Therapist Modeling: verbalizes steps
2. Therapist Verbalization: pt performs task while therapist verbalizes
3. Patient Verbalization: Pt performs tasks while verbalizing
4. Patient SILENTLY talks through the task
5. Independent Task performance
PROTOCOL ANALYSIS
Procedure used when person is learning task and is asked to describe aloud the steps being taken to solve the task. Used to gain access to problem solving strategies.
Stress Innoculation Training
(MEICHENBAUM) Provides a set of guidelines for treating stress & PTSD.
Central idea is "innoculation", idea of bolstering a patient's repertoire of coping responses.
1. Education & Cognitive Preparation: taught not to react directly to event, but reactions depend on their interpretation
2. Coping skills acquisition: Focuses on developing new skills or to utilize already available coping skills
3. Application of Skill in Imagination & In Vivo: central component is relapse prevention
Self Control Model of Depression
(REHM) Attempts to integrate cognitive & behavioral models of depression. Views depression and its concomitant low rate of behavior (i.e. apathy, low interest) as a result of negative self-evaluation, lack of self-reinforcement, and high rate of self punishment.
RELAPSE PREVENTION
(MARLATT) Cognitive Behavioral model that views addiction as OVERLEARNED HABIT and attempts to minimize the effects of relapse by teaching addicts that relapse is inevitable.
Patients identify triggers, with most common as pt's negative emotional state. Triggers may include external factors or internal situation.
Classical Psychoanalysis
Freud's view of human nature is DETERMINISTIC. Behavior is determined by irrational forces, unconscious motivation, biological & instinctual drives, and psychosexual events of the 1st six years of life.
Divided personality into 3 parts: ID, EGO, SUPEREGO
ID
The most primitive part of the psyche, ruled by INSTINCTS, which includes the LIBIDO (eros or life instincts) and AGGRESSION (thanatos or death instinct).
Operates on the PLEASURE PRINCIPLE, seeks immediate gratification without concern about consequences. Largely unconscious, lacks organization, & disregards reality. Evidence can be found in dreams, jokes, free association, and slips of the tongue.
EGO
The part of the psyche that is modified by interaction with the external world. Operates on the REALITY PRINCIPLE, awareness of the real world & consequences, and is able to delay gratification for long-term gain. The EXECUTIVE, contols consciousness and its task is to suspend or satisfy ID impulses using means that are rational, socially acceptable, and reasonably safe.
SUPEREGO
Includes the conscience, moral code, and internalized parental & social standards. Superego forces the Ego to satisfy the Id in a moral & ethical manner. Weapon is GUILT. Is considered the ideal, standard of perfection , and evolves through the Oedipal stage.
Freudian Mental Functioning
PRIMARY PROCESS: Chief characteristic is an urgent attempt at tension reduction, even at the expense of reality (dreams & hallucinations)
SECONDARY PROCESS: Characterized by focusing on meeting the demands of reality and by the ability to delay gratification (thinking & speaking).
Neurotic Anxiety & Defense Mechanisms
Results when the unacceptable urges of the Id become too strong to be controlled by the Ego, and these impulses edge their way into consciousness. Ego is unable to control by rational methods and resorts to Defense Mechanisms (to prevent forbidden impulses from entering consciousness). Works through self-deception and distortion of reality so the Id's urges will not have to be acknowledged. Includes: repression; regression; projection; displacement; reaction formation; intellectualization; rationalization; sublimation.
REPRESSION
Most basic & commonly used, believed to underlie ALL other defenses. Involves forcing disturbing impulses out of consciousness, "motivated forgetting"
REGRESSION
Guarding against anxiety by retreating to behavior of an earlier, less demanding, and safer stage of development.
PROJECTION
Seeing one's unconscious urgings in another person's behavior (suspicion & paranoia)
DISPLACEMENT
Transference of emotions from the original object to some substitute or symbolic representation. Can be a factor in phobias.
REACTION FORMATION
Engaging in behaviors that are the exact opposite of the Id's real urges. Ex. mother with agressive feelings toward child will be overprotective
INTELLECTUALIZATION
Distancing self from one's feelings.
RATIONALIZATION
Coming up with self-satisfying, but incorrect reasons for one's behavior.
SUBLIMATION
Finding socially acceptable ways to discharge energy from unconscious forbidden desires (normal). Example: desire to smear feces = painter
Schizoid Personality's defense
(Millon) intellectualization
Narcissistic Personality's defense
(Millon) rationalization
Paranoid Personality's defense
(Millon) projection
Borderline personality's defense
(Millon) regression
Histrionic personality's defense
(millon) dissociation
Dependent personality's defense
(Millon) introjection
Antisocial personality's defense
(Millon) acting out
ALLOPLASTIC
Reactions to stress involve trying to change or blaming the external environment (ex. borderline or narcissistic)
AUTOPLASTIC
Reactions to stress involve trying to change oneself or blaming oneself (example: depression)
Focus of Psychoanalysis
to making the unconscious conscious. The cornerstone is FREE ASSOCIATION. Treatment includes: clarification, confrontation, interpretation, working through. Analysis of dreams is important. Transference & countertransference is important
Ego Psychology
Focus on the Ego's capacity fro integration and adaptation. HARTMANN, ANNA FREUD, ERIK ERIKSON
HARTMANN
The Father of EgoPsychology- believe ego did not arise out of the Id, but in parallel with it. People not only driven by passions, but also their thinking. "Conflict Free Sphere" for ego functions occuring and developing outisde of conflict, incluidng perception, learning, memory, and locomotion.
ANNA FREUD
Saw the Ego as medium through which we can get a fuller picture of the Id and Superego, noted the Ego's inherent ability to reconcile drive conflicts with the demands of reality.
ERIK ERIKSON
Combine ego psychology with lifespan theory. Described human behavior as an interaction between the internal world of the psyche and the external social world. Erikson's 8 stages correspond with Freud's up to stage 5.
OBJECT RELATION THERAPY
The capacity to have mutually satisfying interpersonal relationships- "OBJECT" refers to the relationship of the infant to another person. Early relations thought to have a profound impact on personality development. Therapsists play active role and void the "blank screen" of classical analysis. Focus of therapy to experience object relations that are different than those experienced as a child.
MELANIE KLEIN
"splitting" is major defense mechanism used when the infant has hostile feelings toward a loved object, and "splits" the object into two (ex. the "good breast" and the "bad breast"). Splitting prevents OBJECT CONSTANCY (integrating the good and bad into a whole representation)
WINNICOTT
Discussed being a "good enough mother" rather than a perfect one. Described pathology resulting from abandoning true self for a "false self". Highlighted importance of transitional object, which serves a link between the child and their mother (e.g. a "lovey")
MAHLER
Deveoped 6-stage theory that describes the porcess of separation and individuation: normal infantile autism; symbiosis; differentiation; practicing; rapprochement; object constancy. Separation is becoming a discrete physical entity by physically distancing.
KOHUT'S SELF PSYCHOLOGY
Posited a "healthy" narcissism, where infant naturally focuses on getting its own needs met. In turn develops healthy sense of self. Includes mirroring, idealzing, twinship.
Focus on "empathic attunement" and prefer interpretations that are "experience near".
NEO-FREUDIANS
(SULLIVAN, HORNEY, FROMM)
Neo-Freudians
Focused on the impact of social and cultural factors in determining personality. Psychological disturbances results from faulty learning and maladaptive style of interacting with the environment. Therapy seen as an interpersonal experience in which the therapist can help the pt examine difficulties in relating to people. Relationship used to facilitate process of identifying tendencies to misperceive or misinterpret behavior of others.
SULLIVAN
Known for Interpersonal Theory, believed personality only exists in the emotional exhchange between people, person reflects "personality" in response to others. Drew from Piaget's theory of cognitive development. Developed 3 modes of existence: PROTOTAXIC; PARATAXIC; SYNTAXIC.
3 MODES OF EXISTENCE (SULLIVAN)
PROTOTAXIC: BIRTH-7 MOS, involves serial sensation & stream of sensory experience that are isolated a& uncoordinated with one another.
PARATAXIC: 8-11 mos, involves sequential sensations, & the dominance of temporal sequence serves as the only conception of causality (transference is an example of parataxic distortion)
SYNTAXIC: 12 mos-2 yrs, involves causal sensation, logical & analytical thinking, ability to predict cause from knowledge of effects.
INTERPERSONAL THERAPY (IPT)
Based on Sullivan's work, IPT is a 16-session, time limited therapy that connects the patients' presenting problems to interpersonal difficulties. Focuses on the here and now. Commonly targets: grief, role dispute, role transition or interpersonal deficits. Attempts to foster a positive therapeutic alliance. No other traditional psychodynamic techniques used.
HORNEY
Neurosis is a culturally defined construct, indicating deviation from the common pattern of behavior in a given society. Neurosis develops from the feelings of alienation, basic anxiety & hostility that result from the child's discovery of helplessness in the face of all-powerful adults. 3 neurotic trends:
1. moving compliantly TOWARDS others
2. moving AGGRESSIVELY AGAINST others
3. Moving DETACHEDLY AWAY from others
FROMM
Incorporated concepts from existentialist philosophers (Marx) and biewed behaviors as resulting from sociocultural & economic conditions. Thought the experience of freedom frightened most people. TWO modes of existence: HAVING & BEING.
ADLERIAN (INDIVIDUAL) PSYCHOLOGY
Each person strives for superiority or personal competences, not just to survive but TO MASTER LIFE. Thought people are primarily motivated by SOCIAL (AGGRESSIVE) urges, rather than sexual. Believed happiness and success is related to social connectedness and ability to transcend self. The more one's lifestyle is struggle for power at other's expense, the more maladaptive behavior present. Childhood feelings of inferiority can motivate mastery or contribute to neurosis. Birth order has significant effect.
ADLERIAN APPROACHES TO THERAPY
Interpretation is important technique, looking for mistaken goals & faulty assumptions. Stress current concerns and future goals, rather than past (teleological view). Involves pragmatic, problem-solving approach, and tries to influence patient to form more positive attitudes toward self & others.
STEP PROGRAM
(SYSTEMATIC TRAINING IN EFFECTIVE PARENTING) Advocates democratic approach in parenting that values & respects child's contribution. Uses natural & logical consequences as basis of discipline. Misbehavior usually reflect 1 of 4 mistaken goals: attention, power, revenge, giving up.
JUNGIAN psychology
Structure of the psyche includes the CONSCIOUS EGO, PERSONAL UNCONSCIOUS, & COLLECTIVE UNCONSCIOUS. Collective unconscious is transpersonal, with ARCHETYPES (primordial images & ideas and common to all members of a race). Neurosis represents the struggle to free self from the interference of the archetypes with their progress toward personality integration. Neurosis is more about striving toward psychological maturity or individuation.
JUNGIAN TECHNIQUES
To utilize interpretation to help gain awareness of the unconscious, with a particular focus on the symbolic meaning of dreams, myths, & folklore. Therapist's role is active effort to guide the patient into a productive relationship. Methods are direct focusing of the session, rather than free association, and exchange of ideas and the level of real relationship rather than utilizing the transference. Jungians see transference as a projection of the personal and/or collective unconscious.
Therapies based on Humanism/ Existentialism
Emphasize the patient's subjective experiences and requires the therapist to enter the pt's subjective world. Emphasis is on freedom, choice, autonomy, purpose, and meaning. Focus is on present. HUMANISTS believe believe move in the direction of actualization. EXISTENTIALISTS believe we have no internal nature, the world lacks intrinsic meaning, and people are faced with what to make of this meaninglessness. Includes: Client Centered Therapy, Gestalt, & Reality Therapy.
CLIENT CENTERED THERAPY
(ROGERS) People have inborn capacities for purposive, goal-directed behavior, and if free of adverse condition, will develop into self-accepting, kind, socialized persons. Faulty learning causes hate, ineffectiveness, & antagonism. Pathology is thought to be due to incongruence between self (true feelings) and experience (awareness of feelings & express them to others).
Key Characteristics of Client Centered Therapy
EMPATHY: Empathic understanding
WARMTH: unconditional positive regard & acceptance
GENUINESS: congruence, being truthful & authentic
Gestalt Therapy
(Perls) People structure experiences as whole, integrate organisms, not in cognitive or affective fragments. Perceptions are combinations of figure (what is attended to) and ground (what is ignored). Healthy functioning is maintaining flexible & adaptive contact with environment. Without this, personality can fragment, limited awareness, and deficiencies in responsibility, authenticity & self-regulation.
Techniques of Gestalt
Focus is on becoming aware of the whole personality by discovering aspects of self that are blocked from awareness. Therapy is active, with challenges to transference, discourage questions, & keep to here & now. To enhance the capacity to communicate or make contact with the self & others. "Empty chair" technique plays out dreams.
Gestalt Boundary Disturbances
1. Intojection: people take information whole, being gullible & overly compliant.
2. Projection: People project their feelings onto other, paranoia.
3. Retroflection: People turn back on self what they would like to do to others (self-destructive)
4. Deflection: people distance themselves from feelings through distraction, humor, asking questions.
5. Confluence: Lack of awareness of differentiation between self & others, attempt to avoid conflict.
Reality Therapy
(GLASSER) Key feature is RESPONSIBILITY. Clarify pt's values & help them evaluate current behavior & consequences of possible courses of action & decide on realistic solutions. Goal is to get patient to accept responsibility. Key element is CHOICE THEORY, all behaviors generated from within & people have choices in what they do. Contract may be signed. Widely implemented in clinical populations. Schools Without Failure is based on this.
Transactional Analysis
(BERNE) Roots in anti-deterministic philosophy. Goal is for patients to be aware of the intent behind their communications & to eliminate deceit so pts can interpret own behavior accurately. Looks at early decisions made & capacity tom make new decisions. Key concepts include ego states, transactions, games, strokes, & life scripts.
Concepts in Transactional Analysis
EGO STATES: components of the personality are the parent, adult & child.
TRANSACTIONS: interactions between the ego states of 2 persons, and occur at overt or covert level. Can be complementary, crossed, or ulterior.
GAMES: an orederly series of ulterior transactions, commonly ends in bad feelings.
STROKES: Recognition given to a person, can be positive or negative.
LIFE SCRIPTS: Pattern that have developed that dictate one's life. Parents give child messages (injunctions) about how they must behave to get strokes- this results in decisions that guide adult development & behavior.
HYPNOTHERAPY
a/k/a altered state of consciousness or dissociated state. Depth of trance can range from decreased motor activity to deep anesthesia & visual/auditory experience. In deep trance, capacity post-hypnotic suggestion. Used to treat chronic pain, asthma, conversion, & substance abuse.
In memory retrieval, may report more false memories than true. Also may resconstruct false memories to "fill in the gaps".
BIO-FEEDBACK
Involves operant conditioning of normally involuntary ANS functions, with goal of alleviating symptoms. By visual or auditory display, pt given feedback and taught to regulate 1 or more bio causes (involves decreased sympathetic arousal). Commonly used in conjunction with relaxation training.
Techniques: thermal biofeedback; EMG; EEG; GSR (Galvanized skins response)
FEMINIST THERAPY
Promote independence & autonomy. They do not attempt to bond, to avoid dependence. View sexism as cause of problems. Therapists strive for egalitarian relationship and make self-disclosing statements (serve as role model).
PROCHASKA'S TRANSTHEORETICAL MODLE OF BEHAVIOR CHANGES
Series of stages in making changes in behavior. Used in treatment of addictive behaviors, as well as promoting healthy behaviors. 5 stages: PRE-CONTEMPLATION; CONTEMPLATION; PREPARATION; ACTION; MAINTENCE
Five-Factor theory of Personality
"The Big 5" Costa & MacRae utilized factor analysis on list of traits and arrived at 5 basic traits: (OCEAN) OPENNES, CONSCIENTIOUSNESS, EXTROVERSION, AGREEABLENESS, NEUROTICISM
FAMILY THERAPIES
General Systems theory: system is an interaction of component parts which seeks homeostasis.
CYBERNETICS: focuses on circular nature of feedback loops (negative or positive).
Psychodynamic Family Therapy
Emphasis on facilitating individual maturation & freeing members from unconscious patterns of anxiety & projection rooted in the past. Family clarify communications & honestly admit feelings.
Object-Relations Family Therapy
(FRAMO)Focuses on transferences & projections between members. help members become aware of what is being projected & address unwanted elements. Known for conducting FAMILY OF ORIGIN sessions (meeting with entire family of one spouse)
Structural Family Therapy
(MINUCHIN)Family viewed as a single interrelated system, assesed by: hierarchy of power, clarity & firmness of boundaries, and significant alliances & splits (subsystems). In healthy families, there is strong parental coalition at top level, with clear firm boundaries, & flexibility for autonomy & independence. In contrast, rigid boundaried = disengaged or emotionally distant, diffuse boundaries = enmeshed relationships.
3 boundary problems: triangulation, detouring, stable coalition.
TRIANGULATION
Child is caught in middle of parents conflicts, with each parent demanding child side with them. When they do, other parents views them as attacking. Child becomes paralyzed.
DETOURING
Parents express distress THROUGH the child, who becomes the identified patient. Creates false harmony between parents, blaming the child as source of problems or uniting to protect weak sick child.
STABLE COALITION
One parent unites with child againt the other parent, in a rigid cross-generational coalition.
GOALS of STRUCTUAL FAMILY THERAPY
to unbalance or reorganize family structure. Therapist "joins" the family, is expert who diagnoses dysfunctional elements & assigns intervention. Focuses on shifting positions to disrupt malfunctioning patterns, include taking sides, blaming, & forming coalitions. Effective for child/ adolescent problems.
COMMUNICATIONS FAMILY THERAPY
the MRI group (Satir, Watzlawick, Haley, etc.) focused on communication and impact on family functioning.
DOUBLE BIND
Maladaptive communication:
1. injunction telling the person that if they do or don't do something, they will be punished
2. injunction (usually nonverbal) conflicting with the 1st at a more abstract level
3. tertiary injunction that prohibits escaping (i.e. pointing out inconsistency)
Interventions of Communications Family Therapy
Techniques include teaching, pointing out problematic patterns, and PARADOXICAL INTERVENTION (prescribing the symptom)
Formulated double bind theory of schizophrenia (not supported)
HALEY STRATEGIC FAMILY THERAPY
Combo of structural & communications therapy. Treatment focuses on resolving presenting problems only, underlying pathology is not addressed. Focus on interrupting rigid feedback cycle & defining clearer hierarchy.
MILAN GROUP: SYSTEMIC FAMILY THERAPY
(PALAZZOLI, BOSCOLI, CECCHIN & PRATA) Key aspects:
CIRCULAR QUESTIONING: aimed at gathering info at the same time introducing info into family system. Families do not function reciprocally, but 1 subsystem is trying to establish control.
PRESCRIPTION OF RITUALS: To alter family's direction from current course (secrecy, isolation, recording, outings)
BOWEN: FAMILY SYSTEMS THERAPY
Families have clearly differentiated members, with overall balance of intellectual & emotional force. Dysfunctional families function as single organism through which overt symptoms are expressed.
UNDIFFERENTIATED EGO MASS
The family emotional system, the emotional oneness that exists & shifts within the family in definite patterns of emotional reactivity. Believes there is multigenerational transmission process of pathology, where pathology is repeated through generations.
GOALS OF FAMILY SYSTEMS THERAPY
Personal differentation from family-of-origin. Assesed by 1) degree of fusion vs ability to differentiate 2) analysis of emotional triangles in presenting problems. Therapist works to shift the triangle and work with most psychologically available member (indiv if needed). Utilized genograms.
SOLUTION FOCUSED THERAPY
Encourages identification of solutions & focus on strength. Assumption that expectations are powerful. Techniques: The MIRACLE QUESTION, EXCEPTION QUESTIONS, SCALING QUESTIONS.
NARRATIVE THERAPY
symptoms thought to stem from "problem saturated descriptions", sense of powerlessness. Therapist takes directive approach, by having patient "restory".
SOCIAL EXCHANGE THEORY
(Stuart) Behavior in relationships is maintained by ratio of costs & benefits. Aim is to enhance behavioral change. Utilized "caring days" to increase positive reciprocity & commitment.
Group therapy
(YALOM) 12 distinct factors: insight; instillation of hope; universality; imparting information; altruism; corrective recapitulation of primary family group; deveopment of socializing techniques; imitative behavior, interpersonal learning; group cohesivess; catharsis; existential factors. COHESIVENSS is most critical. 3 STAGES: INITIAL; 2ND; 3RD.
COHESIVENESS
Most critical component in group therapy; analagous to rapport; groups show greater acceptance, intimacy & understanding; permit greater expression of hostility & conflict.
YALOM'S 3 STAGES OF GROUP THERAPY
1. attempts to get oriented, hesitant participation; communication is restricted & stereotyped; members give & seek advice; members typically talk to therapist, rather than each other.
2. conflict among members, rebellion towards leader; attempts at dominance.
3. If 2nd stage is negotiated, development of closeness & cohesiveness.
CRISIS INTERVENTION
Crucial aspect in rapid treatment, with goal of resolving crisis and avoiding development of chronic symptoms. Intervention terminated as soon as resolved & patient understands the steps that led to its development & resolution.
CLIENT CENTERED CONSULTATION
Helps consultee with INDIVIDUAL CASE. May make an expert assessment and suggest specific ways to handle the case.
CONSULTEE CENTERED CONSULTATION
Helps the CONSULTEE with problems they are having with working with patients.
CONSULTEE CENTERED ADMINISTRATIVE CONSULTATION
Focuses on consultee's difficulties that limit effectiveness in instituting programmatic change.
PROGRAM CENTERED ADMINISTRATIVE CONSULTATION
Focuses on developing, expanding, or modifying a program.
PREVENTION
PRIMARY: to prevent onset or occurrence of disease or disorder -> reduce incidence
SECONDARY: focuses on early identification & treatment of illness/disorder that ALREADY EXISTS
TERTIARY: focuses on reducing the residual effects of a chronic disability or minimizing further negative consequences.
Physical Abuse
32% under 5 yo
27% 5-9 yo
27% 10-14 yo
14% 15-18
more than half of abused kids were born prematurely or low birthweight. Most come from poor, socially isolated homes. Most commonly perp is female, 80% live in the home. 80% live in 2-parent home, 20% in 1-parent home. 90% of perps were abused as children.
Sexual Abuse
50% of cases are family perps. Father-daughter incest usually involves passive, weak or incapacitated M, daughter who takes on maternal role, Father ETOH abuse, and overcrowding.
25% children under 8, with peaks of abuse 9-12 yo.
DOMESTIC VIOLENCE
predictor of abuse is presence of verbal abuse. Change in perp takes place only when woman refuses to tolerate situation, usually following arrest.
DIVORCE
At time of divorce, children tend to have more academic, social & behavioral problems than those from intact homes. Children of divorced parents tend to have higher levels of depression, marital problems, lower SES, & lower health.
METANALYSIS
Applies methods & principles of research to literature to quantify, using EFFECT SIZE (SD units of difference between treated & untreated subjects)
EYSENCK found 2/3 of neurotics improved over 2 years whether treated or not (widely criticized)
SMITH, GLASS, MILLER
Found effect size .85 in comparing treated & untreated individuals (80% do better at end of treatment than non treated)
Client Variables
23% dropped out after 1st session, 70% after 10th session. Lower SES and lower educated dropped out sooner & more frequently. African Americans terminate earlier.
SEX & AGE UNRELATED to length of treatment or outcome. Anixety & depression improve most.