Intro to Clinical Psychology Study Guide Chapters 11 & 14
Intro to Clinical Psychology Study Guide Chapters 11 & 14 Psych 373
Edinboro University of Pennsylvania
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This 9 page Study Guide was uploaded by Lisa Montanez on Wednesday April 27, 2016. The Study Guide belongs to Psych 373 at Edinboro University of Pennsylvania taught by Dr. LaBine in Spring 2016. Since its upload, it has received 57 views. For similar materials see Introduction to Clinical Psychology in Psychlogy at Edinboro University of Pennsylvania.
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Date Created: 04/27/16
INTRO TO CLINICAL PSYCHOLOGY STUDY GUIDE CHAPTERS 11 & 14 CHAPTER 11: CONSTRUCTIVE THEORY AND THERAPY Constructivist theory and therapy: short term therapy spend more time looking at solution instead of the problem/ Believe that knowledge and reality are constructed within the individual/ focus on the mind and brains of the individuals Constructivist therapy helps clients restore and reconstruct their lives in a more adaptive and satisfying way Constructivist therapy focus mainly on the present and the future Post-modern philosophy: objectivity and reality are individually or socially constructed o Social constructionist: focus on what’s happening between people as they join together to create realities o Milton Erickson: The innovative inspiration for strategic therapy approach with individuals and family/ focus on how to reconstruct and deconstruct the skill his clients brought to therapy/ also known for brief hypnotherapeutic techniques and innovative approaches Utilization: Erickson therapy intervention style, it refers to utilizing the strength clients brought in to therapy ex: humor, work experience, language style and personal resources as well as non-verbal behavior The confusion technique: Erickson refer to this because at times he would speak to clients in non-linear and confusing words. Erickson personal attributes Optimistic Clever and intelligent Indirect and collaborative o De Shazer (develop solution focus therapy) o O’ Hanlon (solution-oriented therapy now called possibility therapy) o Epstein and White (narrative therapy) Major theoretical assumptions o Emphasis is on the subjective meaning attached to experience, rather than the objective experience Post modernism: does not have scientific deterministic reality/antirealism subjectivism Modernism- scientific objective deterministic reality o The importance of language according to the constructivist: language builds and maintains our worldview (language determines our reality Language Presupposition questions: ex: the solutionist would ask a depressed patient what good things happen this week instead of how was your week The main goal of presupposition question is to construct a question that will help client hear, feel, and picture themselves functioning in the future without problems Victim/survivors: Debate on what people who are receiving mental health care should be called (patient, client and psychiatric survivors) o According to the solution-focus and narrative therapy: Change is both constant and inevitable/ change happens every day both internal and external (socially) o According to the constructivist: since change is inevitable therapist can help guide clients change in a positive direction/ also believe that only a small change is required to change big problems Small changes are generative meaning small changes build over time o Therapy is collaborative cooperative, co-constructive conversation Collaborative process led constructive therapist to denounce the concept of resistance/ according to constructive therapist resistance is natural and is caused by the therapist not client The client is the expert on themselves and their situation Credulous approach to assessment: basically if you want to know what’s going on with the clients asked and they will tell you and you must believe what the client tells you /The therapist is like the consultant/cab-driver Help define the problem in a way that is solvable/ resistance does not exist Assessment: o Solution focus therapist Scaling questions: asking client’s to rate problem, progress or therapy related issue on 1-10 scale to monitor client progress, obtain rating of the client problem from the client perspective, identify immediate therapy goals and make specific plans for the improvement Percentage questions: measures what client change would look like o Constructive Therapy focuses on the following o lead constructive theory and therapy with Erickson’s value of utilization concept Strength Solutions Exceptions to problems (center view point) Optimism and self-efficacy New versions of personal stories that promote greater psychological health o Theory of psychopathology: client’s problems arise because they use either ineffective solutions Ways to deal with ineffective solution is by changing the viewing and the doing Client Belief in an unhealthy pathology individual or family based narrative Client shows up to therapy because the dominant theme of personal problems is making the non-dominant theme of personal strength and resourcefulness unclear In therapy: most of what we are talking about is not the truth o Solutionist theorist did not want to know the truth they just care about what make sense to the clients and if it helps move the clients forward Constructivist: knowledge and reality are constructed within the individual (could be influence by cognitive and biological process within the individual)/ basically we create our own reality or problem and can reassemble our problem, believe that clients can change their past from the present Structure of therapy o Solutionist open broadly and moves quickly to identifying goals and solution/focus on helping clients generate solutions to their problems Solution focus brief therapy: emphasize that clients don’t need to know anything about why or how their problem originated/ therapist don’t need to know how clients problem develop nor do they need to know a lot about the problem itself Solution focus brief therapy general rule: at the beginning of a session follow the client lead The primary tool in solution focus and narrative therapy is questioning Ex of questioning: What brings you here? If this session goes well what will we accomplish together/ these questions help client’s identify specific goals they want from treatment Narrative questions focus more original construction of client problem such as how the problem first started and how it affected the client view of herself ex: how will your life go forward if the problem continues in the future o Deconstructing and reconstructing of client’s personal narrative is the road to improvement o de Shazer: do not spend time on problems o O’Hanlon: empathy with clients/develop solution oriented therapy through Milton Erickson’s work/strategic intervention and problem solving techniques developed at MRI and solution focus brief therapy O’Hanlon/believe that therapist should take responsibility for issues that clients do not bring up that led to painful life outcomes/approach focus on o Acknowledging and validating client’s emotions and experience o Less directive and less formulaic o More collaborative o Open to considering political, gender and historical factors as important in problem solving Narrative therapist: may want to know how the narrative was constructed focus on the past/story that defines and organize each individual life and relationship with the world o Solution focus therapy categorize client’s in three motivational level Motivation: customers for change: eager to work in therapy Complaints: interested in therapy because of the insistence of another/ also what gets the client in the door may not be what keeps them in therapy Visitors to treatment: mandated clients who are not interested in therapy o Therapeutic techniques: Pretreatment change ex: what improvement have you notice between when you call for the appointment and now? Assume that clients tend to improve after calling and making an appointment through hope Unique account and re-description questions: constitute the mainstay of many narrative and solution based approaches “unique outcome” “sparkling moment” therapist can attack either of the two/ used when client say things related to progress Ex of outcome or sparkling moment questions: how did you beat the fear and go out shopping Externalization of the problem: occurs when you try getting people to think about change/ externalization conversations take away clients sense of accountability and reduce defensiveness, thereby allowing client and therapist to work collaboratively against the problems. Objectify and identify the problem as a separate entity Doing the problem: from O’Hanlon perspective if what you do is the depression than the belief client could do something else Carl Rogers with a twist: Empathy but adding and changing the words a bit help/ is an example of a subtle, indirect linguistically based strategy for shifting client perspective Ex: client says I feel like cutting myself Therapist replied so you have felt like cutting yourself. Relabeling and Reframing: basically finding other ways to discussed client experience by adding strength/ client are customer for change not clients and therapy is a conversation not counseling o The language used is a foundation of reframing or positive relabeling Ex: Stubborn relabel as determined and lazy relabel as gentle on myself Reframing refers to taking skills from one context and applying them to a new one Exceptions questions: is designed to build hope and identify small behavior patterns when client’s problem occur or stop occurring. implied that only small changes are needed to make larger changes/ seek minor evidence to show that client problems is not always huge and overbearing Constructivist use exception sequences to build a case for pre-existing client strength and resources. Hypothetical solutions “Miracle question”: is the most well-known solution therapy techniques/ The miracle question helps client’s focus on a positive future Formula task First session formula: do something different/ deigned to shift client focus from on the past and negative expectation to the present/future and positive expectation o Believe that there are many positive quality existing in people who come for treatment Social Constructivism: two or more people join together to create a reality (ex: object relations two persons) ex: when a client comes in for therapy the therapist and the client work together to create a meaning for the client o Social constructivist believe problems are co-creation there the client can take a part his/her problem and reassemble it/holds that clients can change their past from the present o Revisionist History: in therapy you are taking people history and creating a more revisionist history to help the clients cope CHAPTER 14: INTEGRATIVE & EVIDENCE-BASED NEW GENERATION THERAPIES Multi-modal therapy o Arnold multi-model therapist focus on assessment, technical applications and therapist interpersonal style. o Arnold Lazarus-technical eclectic First thing he does is assessment o Arnold Assessment is done on seven dimension he called it BASIC I.D assessment and diagnosis involve a thorough evaluation of all seven/ treatment focus on alleviating problems within these seven domains Behavioral (observational measurable behavior) Affect (emotions and mood) ex: anxiety Sensations (physical sensations) asked clients to speak about body experience Imagery (mental pictures) Cognition (client thoughts and beliefs) Interpersonal relationships Drugs and biology (biological factors of client condition) o Arnold authentic chameleon: refer to shift in interpersonal style by therapist to match client’s preference/ every client is different so therapist must change their style to fit clients Interpersonal variable multi-model therapist considers the following when deciding how to approach client in therapy Level of formality or informality Amount of personal disclosure How often a new topic of conversation is initiated Levels of defectiveness’ Level of supportiveness Level of reflectiveness Recommend using assessments especially multi-model life history inventory which includes questions regarding therapy expectations ex: a client states that she hopes therapy is like a mirror” is a cue for therapist to use person centered approach o Multi-model therapist will use any therapy technique that seems appropriate based on empirical research or a logical or practical rationale/ therapist use their intuition when deciding what therapy approach to use Multi-model therapy requires skill in a wide variety of therapeutic interventions EMDR: Eye movement desensitization reprocessing: an evidence based trauma treatment in adults and children. Includes the following theoretical perspective o Psychodynamic: focuses on past traumatic events o Behavioral: consistent with exposure therapy, focus on present fear/anxiety and specific stimuli o Cognitive: Clients are asked to identify negative and positive beliefs about the self; there is also utilization or activation of an information processing model o Person centered: follows the client lead rather than dictating the course or direction of therapy o Physiological or body-centered: focus on physical-affective links associated with trauma experiences EMDR Protocol include 8 basic phases: o History: assessment of client readiness and initial treatment planning o Preparation: making sure clients have skill for coping with stress that might be generated from the treatment process o Assessment: a target memory and any negative belief relating to the belief is identify and rated along with hope for positive belief/ emotional and physical characteristics is articulated o Desensitization: Bilateral stimulation eye movement taping or audio stimulation ensues/ therapist explains and initiate the EMDR process and follows the client experience o Installation: Bilateral stimulation is repeated and link positive belief to memory o Body scan: a review of client’s physical body sensation/ negative body sensations are process through bilateral stimulation o Closure: clients are required to keep a journal and are reminded of the self-calming strategies o Reevaluation: occur when clients return for the next session/ include reevaluation of client status and progress Dialectical Behavior therapy (DBT) Marsh Linehan o Originally developed for women with Para suicidal behaviors and borderline personality disorder ex: behavior that will inflict self-injury o Integrate cognitive-behavioral and eastern meditation practices, psychodynamic, person-centered, gestalt, strategic and paradoxical approaches. o United shade of America DBT three stages to change is called the dialectic o First: An initial proposition, life has meaning and positive possibilities is experienced o Second: The initial proposition is negated through a contradictory experience: Life has no relevance meaning or positive possibilities o Third: The contradictory is resolved through the negation of the negation: “Life can be both inherently meaningful and completely irrelevant DBT Radical acceptance: “I accept you as you are and willing to help you change” 5 Functions of DBT: o Enhancing skills and capabilities o Improving client’s motivation o Generalizing skills and capabilities from therapy to outside therapy o Improving the therapist’s capabilities and motivation to treat BPD patients o Structuring the client’s environment to support and validate the clients and therapist’s capabilities Acceptance and Commitment Therapy (ACT) behavioral component of new generation therapy o Steven Hayes o Russ Harris ACT is based on rational frames theory ACT: believes all thoughts are normal and natural not deviant Major components of ACT o Mindfulness/Buddhist/person centered concept of acceptance Mindfulness is used by clients to help them accept their negative thoughts o Behaviorism Goal of ACT o To change people relationship to their symptoms/ basically move from fighting symptoms to accepting symptoms Goal of ACT according to Russ Harris: Increase psychological flexibility o The ability to be present o The ability to control behavior to some valued ends ACT is based on relational frame theory o Emphasize the importance of language/ language help us understand relations between things ACT Model: my problems = words/words = entangled fusion = control or avoid – relief/struggle = life restriction all leads back to problems o ACT model My problems: mindfulness diffusion helps Accept the problem and bring the individual in the present and helps you evaluate your values and leads to flexibility and commitment which then leads to growth Emotion-Focus Therapy (EFT) o Leslie Greenberg develop (EFT) o Components of EFT Person Centered Gestalt Key areas of (EFT) Emotion focus therapy o Emotional awareness (therapist should increase clients emotional awareness) o Increase emotional expression (getting clients to think and express their emotions) o Emotional regulation (help clients learn to tolerate their emotions) o Reflection (help clients make meaning of their emotions) o Transformation: replacing one emotion with another o Corrective emotional experience Emotion-focus therapy: o Primary adaptive (our emotion have meaning and if we adapt to it is a good thing) o Primary maladaptive (emotions that are unhealthy and interferes with daily functions) o Secondary emotions (is it the emotions we are feeling or is the emotion a cover up for what’s really going on) Affective problem markers: signs that indicate there is a difficult emotional area that needs to be explore Techniques of EFT: Focusing o Two chair technique o Empty chair technique Interpersonal psychotherapy: short term and focal approach to treating depression/ design specifically for treating depression o Klerman-depression: Believe that depression occurs in an interpersonal context, if you resolve the interpersonal issues, the depression will lift o Uses cognitive and behavioral intervention/focus primarily on real interpersonal relationships instead of internalized object relations Four interpersonal areas: o Grief: bereavement following the death of a love one o Interpersonal role (dispute role conflict): conflict in an important interpersonal relationship o Role transition (basically refers to people who have difficulty adjusting to life changes) Ex: birth of a child, graduating from college o Interpersonal deficit (sometime people have difficulty forming relationship) ex: somebody who lacks social skills IPT protocols: o Time limited o Focus on one or two interpersonal problem areas o Focus on current rather than past relationships o Interpersonal rather than intrapsychic emphasis o Address cognitive-behavioral issues in terms of how they affect important social relationships o Recognizes but don’t focus on personality variables o Based on medical model clients are looked at as having clinical depression
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