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FAU / OTHER / CLP 4343 / What are the core components of existential psychotherapy?

What are the core components of existential psychotherapy?

What are the core components of existential psychotherapy?

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School: Florida Atlantic University
Department: OTHER
Course: clinical psychology
Professor: Larry miller
Term: Spring 2018
Tags: clinical psychology and Psychology
Cost: 50
Name: Study Guide: Clinical Psych
Description: Study Guide: Clinical Psych
Uploaded: 04/20/2018
74 Pages 23 Views 24 Unlocks
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PSY 4943: CLINICAL PSYCHOLOGY


What are the core components of existential psychotherapy?



SPRING SEMþTER 2018

INSTRUCTOR: DR. LAURENCE MILLER

FLORIDA ATLANTIC UNIVERSITY

FINAL EXAM STUDY GUIDE

FINAL EXAM STUDY GUIDE 

*NOTE: This is a general study guide. Study comprehensively.*

1. What are the corrective, transformative, and adaptational models of psychotherapy?

a. Transformative: Effective fundamental changes in personality that will lead to positive behavior change.


What type of psychotherapy is utilized by most practicing therapists today?



i. Examples: Psychodynamic therapy; existence therapy.

ii. A kind of depth therapy in the sense that true change can only come in accepting a person's role in the world. At the completion of the Don't forget about the age old question of bus 2110 class notes

therapy the person should have a new way on conceptualizing their

role in the world. One would be able to notice a change in their overall view of their personality and they must understand how they can

change it to create a positive situation for themselves. You are We also discuss several other topics like nku psychology

essentially transforming the individual, with their help and

cooperation.

b. Corrective: Directly change specific dysfunctional behaviors or reaction patterns, without necessarily affecting the whole personality. However, may have generalized effects.


What is the difference between eclectic and integrative therapies?



i. Examples: Behavior therapy, cognitive therapy, cognitive-behavior therapy. We also discuss several other topics like uci physics

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ii. Not focusing on changing their overall life, just specific problems they have that can have in effect on their life. Things like, if the person can’t deal with criticism and they get a bad performance review that leads

to them storming out of their job, if this happens often one could say it is difficult for them to stay employed. Their reaction to criticism is

what will be changed in this case, not their overall personality, just this specific characteristic that hinders their chances of staying employed. You are correcting a flaw that harms the individuals life in one way or another. We also discuss several other topics like syp consum

c. Adaptional: Help the person use the abilities and resources he/she has to optimally adjust to their individual circumstances. If you want to learn more check out robert mearns concordia

i. Examples: Supportive-expressive psychotherapy, counseling, life coaching.

ii. Help them cope the best they can to deal with the situation they are in. If you can help a person just a little bit, teaching them the

strategies to help their daily lives, it can have a profound change in

someone's life even if you are not changing their personalities or

specific characteristics. You are helping a person adapt to what is

going on in their lives at the moment.

2. What is the difference between eclectic and integrative therapies? a. Eclectic psychotherapy= select the best treatment for a particular patient or problem.

i. Using different therapies depending on what client is dealing with, using them individually.

b. Integrative psychotherapy= blending and adaptive therapeutic strategies for a particular patient or problem.

3. What type of psychotherapy is utilized by most practicing therapists today? a. Most practicing psychotherapies use an integrative approach, but one that may be driven by a particular system or model, often the one they learned in graduate school.

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4. What are the common factors that have been shown to contribute to success in virtually all forms of psychotherapy?

a. Working Alliance = Client needs to feel like there is a connection and the psychotherapists understands them and they can communicate freely. The fiduciary relationship needs to be a good match.

b. Agreement on therapeutic goals = agreement between psychotherapists and clients on what needs to be done to help the client. Sometimes goals may change, there needs to be flexibility.

c. Realistic and attainable goals = it needs to be something that can change and during a reasonable time frame. Breaking things down into small goals is often advised.

d. Positive expectations of patient = client need to have some confidence that psychotherapists can help them. Generally it takes a couple sessions, usually by the third session.

e. Rationale for the change process

f. Patients ability & willingness to change

g. Opportunity for catharsis & expression = Clients want an opportunity to let their emotions out.

h. Insight, understanding & meaningful narrative

i. Opportunity to learn & practice new attitudes & behaviors.

5. Which therapists qualities and characteristics have been found to contribute to successful psychotherapy?

a. Knowledge = The more knowledge you have the better you will be at anything you do. The ideal practitioner never stops learning, always

educating yourself because you want to excel in your craft.

b. Flexibility = You have the ability to be flexible in how you use this knowledge. c. Maturity = Modeling a certain grown up in the room behavior, provide a model of mature behavior within the therapy patient.

d. Diagnostic skill = Doesn't just mean knowing dsm codes, basically means trying to size up the person. Trying the figure out what is going on with this person.

e. Interpersonal skill

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f. Communication skill = Ability to communicate effectively with other types of people.

g. Psychotherapeutic techniques = Want to have as many of these techniques and use them in integrative ways.

h. Cultural competence = Adapt communication style to the person you are dealing with so that you two can understand each other. Importantly, on their level so that it does not come across as if you are talking down to them, or treating them like first graders.

6. What effects have psychopharmacology and the rise of third-party (insurance) payment had on the modern practice of psychotherapy? a. Medication

i. At first, medication was applied to more severely disordered patients (schizophrenia, bipolar disorder, major depressive disorder).

ii. By the 1070’s & 80’s, medications were frequently being prescribed for the “walking wounded”, i.e. outpatients with mild-moderate anxiety & mood disorders.

iii. While psychiatrists predicted supremacy of the medical model, real mental health patients didn't want to think of themselves as nothing

more than a collection of symptoms: they wanted to make some

meaning of their lives.

People mostly do not want to just ease the symptoms many want to actually solve their problems.

b. Psychotherapy Reimbursement

Main reimbursement types:

i. Out of pocket.

ii. POS/FFS Insurance. (point of service/fee for service)

iii. Managed care. = insurance company decides, why provided

unecessary care. Streamlining and making more efficient.

iv. Salary. = If you work for a hospital or the government you can get paid by salary. It's good because you know what you are getting but bad

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because if you are on salary there is a limit on how much you can

earn.

v. Contract fee. = A flat fee for a patient. The idea is that you get a flat fee per year for any amount of sessions they need.

c. Insurance:

i. At first, insurance covered almost every form of psychotherapy, with almost unlimited session, greatly expanding the patient pool & types of therapists.

ii. Excesses & abuses (mainly from medical practices, including

psychiatry & substance abuse treatment) led to the backlash &

crackdown in the late 1970’s-1980’s with the advent of managed care: insurance companies telling doctors what they could & could not do.

iii. Insurance also “democratized” mental health care, so practitioners were seeing fewer YAVIS’s and more low-income, low-education, less cooperative, less motivated, more externalizing,

personality-disordered & difficult to treat patients; also more

mandated referrals, e.g. drug abusers, criminal offenders, etc - the

anti-YAVIS.

iv. Today’s psychotherapy practice for clinical psychologists will typically include a diverse patient population geared to the demographics for

the practitioner's community & the specialization of the

psychotherapists.

7. What effects patients demographics and cultural diversity had on the the modern practice?

a. Varied ages.

b. Varies SES (socioeconomic status) and income

c. Limited verbal skills

d. Limited abstract cognitive abilities and “psychological - mindedness.” e. Frequently unstable employment, legal, and personal status.

f. Cultural diversity.

g. Externalizing disorders.

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8. What are the main components of Freudian psychoanalytic theory and how do these relate to the major strategies and techniques of psychoanalytic psychotherapy?

a. Sigmund Freud (1856-1939)

b. Symptoms, dreams, and Freudians slips.

c. Id, ego and superego

i. Id- Largely unconscious. Impulsive, aggressive.

ii. Ego- Compromises between the two.

iii. Superego- Conscience, pure, always trying to do things correctly. d. Psychosexual stages of development.

i. Oral Stage (0-1 year)

ii. Anal Stage (1-3 years)

iii. Phallic Stage (3 to 5 or 6 years)

iv. Latency Stage (5 or 6 to puberty)

v. Genital Stage (puberty to adult)

e. Oedipus & Electra Complexes

f. Conflict and defense mechanisms.

i. Repression: Not being consciously aware of something. This person is not even aware that they are repressing something.

ii. Denial: Refusing a statement.

iii. Projection: Projecting one's emotions onto someone else, disguising these feelings as if it is someone else's instead of are own. “You don't like me!” when in reality it is you that doesn’t like that person.

iv. Displacement: Taking out your emotions on someone who may not be even responsible. Displacement does not have to be emotions one

has in that day it can go way back.

v. Rationalization: Coming up with a rational explanation for something that is not rational. This person is not just lying they honestly believe this rational explanation.

vi. Reaction formation: Behaving in the exact opposite way of what they impulsively want to be.

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vii. Sublimation: In which socially unacceptable impulses or idealizations are unconsciously transformed into socially acceptable actions or 

behavior, possibly resulting in a long-term conversion of the initial 

impulse. 

g. Psychoanalytic Psychotherapy 

i. Free association: an individual lays there and says whatever comes to your mind without censoring anything in anyway. The idea was that by doing this, unconscious material would sneak around the defense 

mechanisms and make their way out! 

ii. Dream interpretation: even in the manifest context of the dreams our unconscious disguises itself. 

iii. Transference & countertransference 

1. Transference: We react to any kind of authority figure in terms 

of ways we react to our parents. The patient projects unto the 

therapists the fear, and feelings they have towards other 

authority figures. 

2. Countertransference: The emotional reaction of the analyst to 

the subject's contribution. 

iv. Interpretation & resistance 

1. Interpretation 

2. Resistance 

v. Working-through 

9. What are the main features of theory and practice in the psychotherapeutic modalities of Alfred Adler, Carl Jung, the ego psychologists, and object relations theory?

Psychoanalysis: Neofreudians 

a. Carl Jung (1875-1961) 

i. Analytical psychology 

ii. Collective unconscious: In all of us exists not only our unconscious but the conscience of all of those that live before us. 

iii. Animus and anima 

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1. Animus: In the unconscious of a woman it is expressed as a 

masculine inner personality 

2. Anima: In the unconscious of a man, this archetype finds 

expression as a feminine inner personality. 

iv. Introversion-extraversion 

1. Introversion: People who are introverted tend to be inward 

turning, or focused more on internal thoughts, feelings and 

moods rather than seeking out external stimulation. 

2. Extraversion: Extroversion is characterized by sociability, 

talkativeness, assertiveness and excitability. 

b. Alfred Adler (1870-1937) 

i. Individual Psychology 

ii. Striving for superiority : What drives people is the drive for status. iii. Inferiority complex: The feeling that one is not worthy or entitled. 

Psychoanalysis: Ego-Psychologists 

iv. Heinz Hartmann.Riley Gardner 

v. David Rapaport 

vi. Merton M. Gill 

vii. Roy Schaefer 

c. Emphasis on conscious cognitive functions of the ego.

d. Attention, concentration, perception, memory, reasoning, action.

e. More emphasis on individual choice and self-determination.

f. Concept of cognitive style.

g. Introduced experimentation into psychodynamic research and theory. h. Pioneered the use of brief psychodynamic therapies.

Object Relations Theory & Therapy

i. Melanie Klein, Otto Kernberg

j. Emphasizes interpersonal aspects of conflicts in personality development and in psychotherapy.

k. Less emphasis on unconscious dynamics and more emphasis on conscious processes and interpersonal relationships.

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10. What are the similarities and differences between brief psychodynamic psychotherapy and time-limited psychotherapy?

a. Brief Psychodynamic Therapies

i. Rely on basic psychodynamic concepts, but streamline the therapeutic process; approximately 6 months vs. many years.

ii. Usually deal with less severe psychopathology.

iii. More specific, here-and-now focus.

iv. Greater therapists activity.

v. Less reliance on transference.

vi. Less reliance on dream and paraprax interpretation.

b. Time-Limited Dynamic Psychotherapy (TLDP)

i. Most associated with Hannah Levenson.

ii. Similar to traditional psychoanalysis, but more active and accelerated. iii. Short-term, but relies on a version of the transference phenomenon: 1. Patients bring to therapy their unconscious, maladaptive

interpersonal scripts.

2. Psychotherapist acts as a mature,stable transference object to

provide a corrective emotional experience.

3. Patient practices new interpersonal skills in the real world and

reports back to therapists: reciprocal relationship.

11. What are the main features of theory and practice of the neoFreudian and feminist approaches to psychodynamic psychotherapy?

Psychoanalysis: Neofreudians 

a. Carl Jung (1875-1961) 

i. Analytical psychology 

ii. Collective unconscious: In all of us exists not only our unconscious but the conscience of all of those that live before us. 

iii. Animus and anima 

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1. Animus: In the unconscious of a woman it is expressed as a 

masculine inner personality 

2. Anima: In the unconscious of a man, this archetype finds 

expression as a feminine inner personality. 

iv. Introversion-extraversion 

1. Introversion: People who are introverted tend to be inward 

turning, or focused more on internal thoughts, feelings and 

moods rather than seeking out external stimulation. 

2. Extraversion: Extroversion is characterized by sociability, 

talkativeness, assertiveness and excitability. 

b. Alfred Adler (1870-1937) 

i. Individual Psychology 

ii. Striving for superiority : What drives people is the drive for status. iii. Inferiority complex: The feeling that one is not worthy or entitled. 

Feminists Psychodynamic Theory & Therapy

c. Reaction to perceived sexism of other traditional psychodynamic systems. d. Karen Horney: “feminine inferiority” is a culture-based phenomenon (influenced by anthropologist Margaret Mead).

e. Womb envy = Mens compulsive drive for dominance and achievement is compensation for their not being able to bear children.

● Real self vs ideal self = therapy addresses the human capacity for change and growth. Harbinger of the humanistic psychotherapies.

● People cope with conflicts of autonomy vs. authority by three main strategies: ○ Moving toward people: connection. If this is taken too far it could lead to dependence.

○ Moving against people: confrontation, challenge, competition. If taken to far a person can become isolated, impulsive.

○ Moving away from people: self-sufficiency or avoidance.

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12. What are the similarities and differences between classical and operant conditioning, and what are the main theoretical concepts of each.

a. Classical Conditioning:

i. Unconditioned stimulus. = A stimulus that evokes an unconditioned response without any prior conditioning. (No learning needed for the response to occur)

ii. Unconditioned response. = An unlearned reaction/ response to an unconditioned stimulus that occurs without prior conditioning.

iii. Conditioned stimulus. = A previously neutral stimulus that has, though conditioning, acquired the capacity to evoke a conditioned response. iv. Conditioned response. = A learned reaction to a conditioned stimulus that occurs because of prior conditioning.

v. Extinction. = when a conditioned stimulus is no longer paired with an unconditioned stimulus. 

vi. Generalization. = the tendency to respond in the same way to 

different but similar stimuli. 

vii. Human examples.

b. Operant Conditioning:

i. Positive reinforcement. = involves the addition of a reinforcing 

stimulus following a behavior that makes it more likely that the 

behavior will occur again in the future. When a favorable outcome, 

event, or reward occurs after an action, that particular response or 

behavior will be strengthened. 

ii. Negative reinforcement. = a response or behavior is strengthened by stopping, removing, or avoiding a negative outcome or aversive 

stimulus. 

iii. Punishment. = any change in a human or animal's surroundings that occurs after a given behavior or response which reduces the 

likelihood of that behavior occurring again in the future. 

iv. Shaping by successive approximations. = Instead of rewarding only the target, or desired, behavior, the process of shaping involves the

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reinforcement of successive approximations of the target behavior, or for acting in a way that gets closer and closer to the desired behavior. v. Schedules of reinforcement.

vi. Clinical and social applications.

13. Describe the common clinical applications of behavior therapy used in modern practice.

a. Counterconditioning. =is a type of therapy based on the principles of classical conditioning that attempts to replace bad or unpleasant emotional 

responses to a stimulus with more pleasant, adaptive responses. 

b. Systematic desensitization. = Combination of classical and operant conditioning. Set of a hierarchy of aversive situation and teach that person a relaxation response, anything that calms that person physiologically. Learn to associate the relaxation with the anxiety.

c. Biofeedback & behavioral medicine.

d. Aversive conditioning. = the use of something unpleasant, or a punishment, to stop an unwanted behavior. 

e. Time-out from reinforcement. = a procedure in which a child is placed in a different, less-rewarding situation or setting whenever he or she engages in undesirable or inappropriate behaviors. 

f. Differential reinforcement of other behavior (DRO). = you will reinforce any behavior except the undesired behavior. ... when the target behavior has not occurred during a specific period of time. DRO procedures provide 

reinforcement for the absence or omission of a target behavior.” 

g. Token economies. = A token economy is a form of behavior modification designed to increase desirable behavior and decrease undesirable behavior with the use of tokens. Individuals receive tokens immediately after 

displaying desirable behavior. The tokens are collected and later exchanged for a meaningful object or privilege. 

h. Modeling, role-playing, rehearsal.

14. Describe the common dysfunctional cognitions targeted in cognitive therapy. a. Dichotomous thinking (all or nothing). = you may see only the extremes of things, never the middle 

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b. Overgeneralizing =It is a course of thinking where you apply one experience and generalize to all experiences, including those in the future 

c. Exceptionalizing ( discounting positives).

d. Catastrophizing.

e. Magnification (of bad).

f. Minimization ( of good).

g. Personalization.

h. Mind reading: over assumption.

15. Describe the common clinical applications of cognitive therapy used in modern practice.

a. Direct disputation = Trying your best to rationalize your doubts. Your psychotherapist helps you dispute your thoughts.

b. Thought stopping = literally stopping when you're thinking something negative or that is harming you. Temporarily stopping spirally thoughts. Usually accompanied by other techniques.

c. Hypothesis testing = Thinking about problems as problems that need to be overcome.

d. Cognitive restructuring =Process of learning to identify and dispute irrational or maladaptive thoughts. 

e. Imagery = imagining yourself doing the thing you want to do.

f. Affirmations = Simply telling yourself something can have the same or better effect than someone else telling you.

g. Self-Talk

h. Task-relevant self-instructional training = often taught to military personal. This is for getting through stressful situations. Giving yourself instructions on how to solve the problem in an acute situations.

i. Combining and integrating techniques.

j. Ultimate transition to self-management.

16. What are the main concepts and applications of Rational Emotive Behavior Therapy (REBT)?

a. ABC

i. A= Adversity or activating event

ii. B= Belief(s) about the event

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iii. C= Consequences (dysfunctional emotional and behavioral)

b. Focus on evaluating B

i. Look for assumptions and thoughts that are illogical,rigid, unrealistic &/or self-destructive.

c. Therapeutic techniques rely on active disputation of irrational beliefs: discourage musturbation.

d. Therapeutic dialog is often in the form of questions:

i. “So, what?”

ii. “How do you know?”

iii. “What's the worst that could happen?”

e. Critiques: may trivialize (make something seem less serious) serious problems.

17. Where does the mindfulness concept come from and how is it applied to modern psychotherapy?

a. Adapted from Zen Buddhist meditation,mainly by Jon Kabat Zinn. b. “Mindfulness means paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.”

c. When a problem appears insoluble,engage and accept the thoughts and feelings, without resistance or confrontation.

d. Relieves the distress of ineffective striving.

e. Allows possible solutions to “emerge”.

f. Critiques:

i. Is this really a cognitive therapy?

ii. Some problems need practical solutions.

18. What are the key principles and applications of Dialectical Behavior Therapy (DBT)? a. Originally developed by Marsha Linehan for treatment of borderline personality disorder. Other applications.

b. Dialectic= back and forth exchange, comparing opposites, to clarify a concept or position.

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c. Dialectical therapy= exchanges between patient and therapists are intended to resolve simultaneous, contradictory feelings, in order to get at the true, core feelings.

d. DBT encourages patients to develop & utilize four core problem solving strategies and skills.

i. Emotion regulation: identify,describe, and accept unpleasant emotions, rather than avoid them or fight them.

ii. Distress-tolerance: develop capacities for self-soothing and

impulsive-control to deal with impulsive, potentially dangerous

behaviors, e.g. aggression, suicide, other self-harm, or drug relapse.

iii. Interpersonal effectiveness: Develop and utilize practical interpersonal coping skills to build social self-confidence.

iv. Mindfulness: When action is not possible, learn to acknowledge and accept painful thoughts & feelings.

19. What are the core theoretical foundations of existential and humanistic psychotherapies?

a. Meaning: Existential-Humanistic Psychotherapy

i. Reaction against pathology-oriented model that characterizes

traditional psychodynamic therapies, and the mechanic model that

characterizes cognitive- behavioral therapies.

ii. For example,

1. Feud: “transformative neurotic misery into ordinary

unhappiness.”

2. Maslow: :bringing out inner goodness, creativity, and growth.”

iii. Finding meaning while living in the real world.

20. Describe the main concepts and applications of the humanistic psychotherapies. a. Existential-Humanistic Psychotherapies

i. Emphasis on conscious choice, not unconscious determinants.

ii. Less interested in diagnosis and etiology.

1. These are just labels we give to people. Yes we know people

have different personalities but that's not the focus, we are

here to treat your struggles in life that come from how you

react to things.

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iii. Less deterministic, more proactive.

iv. Therapists as teacher or guide, not transference object or behavioral contingency manager.

21. Describe the key concepts and applications of Rogerian humanistic psychotherapy. a. Client-Centered Psychotherapy

i. Carl Rogers: clients, not patients.

ii. In humanistic psychotherapy, psychopathology consist of

incongruence between the real self and the ideal self (cf. Horney).

iii. Goal of humanistic psychotherapy is to foster congruence between the 2 selves.

iv. Two main defence mechanisms: distortion and denial.

v. According to Rogers, a fully functioning person has seven

characteristics:

1. Openness to experience.

2. Existential lifestyles: living each moment.

3. Organismic trust: make one’s own confident decisions.

4. Freedom of choice ( cf. ego autonomy).

5. Creativity.

6. Reliability & constructiveness.

7. Rich, full life.

b. Client- Centered Psychotherapy: Components.

i. Empathy = Therapists tried to understand client’s perceptions,

thoughts and feelings from the client’s perspective. Therapists then

relates this back to the client in the form of reflective statements that allow the client to clarify his/her own thinking.

ii. “What i hear you saying is…”

iii. Unconditional positive regard = Full acceptance of the clients by the therapists, without judgment. Allows the client to feel safe in

expressing his/her innermost thoughts and feelings.

iv. Q: Should all clients be accepted equally? Are judgements never to be made? Is giving advice a form of judgement?

v. Genuineness = Therapists serves as a model of honest, non defensive, authentic human interaction and communication.

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vi. Like psychoanalysis, the therapist's presence is an important factor in humanistic psychotherapy , bt unlike psychoanalysis, this presence

relies on transparency and authenticity, not deliberate opacity as a

transference object.

22. What are the components of Maslow’s hierarchy of needs theory and how is it applied to psychotherapy?

a. Five basic needs: each one needs to be satisfied in order for the next one to be addressed ( but there may be exceptions - cf. Victor Frankl).

b. Most people are lucky to live life with 3 or 4 of the needs fulfilled.

c. A few people make it to need 5: self-actualization.

i. Physiological= Oxygen, food, water, sleep, sex, basic health &

nutrition.

ii. Safety= physical & material security, family & social stability, access to healthcare.

iii. Love/Belonging= Mate, friends, family, community.

iv. Esteem= Achievement ,respect,confident,pride,self-acceptance. v. Self-Actualization= Optimal fulfillment of one’s

potential,morality,creative in any field of endeavor.

d. People who self-actualize report peak experiences: near-transcendent states of consciousness associated with optimal functioning.

e. Self- Actualization is not an absolute yardstick, but is based on each person’s individual type & level of potential: there are multiple ways to be

psychologically healthy, productive & creative.

f. Q: What about differences in personality & psychopathology?

g. Q: Not really a therapeutic system per se.

h. Q: May be more useful for high-functioning YAVIS’s who are frustrated in their personal goals.

i. Q: Finds modern application in may performance coaching systems. 23. What are the core components of existential psychotherapy?

a. Less cheerily optimistic than humanistic psychotherapy, although often grouped together because both take a less pathological, more practical, here-and-now approach to problem in living.

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b. Origin in existential philosophy: we are alone in the universe with no absolute principles to guide us, so each person must create their own meaning to deal with the challenges of life, and so avoid impaired by existential anxiety.

c. Rollo May: Love and Will

d. Viktor Frankl: Man’s Search for Meaning.

e. Irvin Yalom: Existential Psychotherapy.

24. What are the four existential challenges of existential psychotherapy and how do they play out in the four dimensions of treatment?

a. Yalom: The 4 Challenges of Existential Psychotherapy

i. Isolation = No matter how close one becomes to another (a child, a parent, a lover), there is an ultimate unbridgeable gap 

ii. Meaninglessness = what is the purpose of a human beings life.

iii. Freedom = To what extent does on have to self actualize and express what they want to do.

iv. Death = “Aristotle = All philosophy is learning how to die.” What happened after you die?

b. Yalom: The 4 Task of Existential Psychotherapy

i. Create authentic meaning in these four dimensions:

1. Physical dimension: limits

2. Psychological dimension: identity

3. Social dimension: authentic interaction.

4. Spiritual dimension: personal narrative and immortality

project.

25. What have been some of the critiques of existential psychotherapy? a. Existential- Humanistic Psychotherapy: Questions

i. Useful for most clinical problems?

ii. Suitable for YAVIS’s only?

iii. How do we know when anxiety or depression are “clinical” vs.

“existential.”?

iv. Is philosophy orientation itself tied to personality dimensions?

v. Rise and fall of philosophical counseling (Marinoff).

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vi. Existential & humanistic elements incorporated into many integrative psychotherapies: cf. personal narrative.

26. What are the goals of supportive psychotherapy and how do they differ from those of other psychotherapies?

a. Supportive Psychotherapy

i. There are supportive aspects in all forms of psychotherapy, but for certain patients and for certain problems, supportive psychotherapy is the treatment of choice.

ii. May be incorporated into other forms of therapy, as needed.

iii. Sometimes patients will say: “Just f**king telling me what to do!” Sometimes, this is the correct approach, sometimes not.

iv. Supportive psychotherapy may be applicable to the following

treatment contexts:

1. Intellectually limited patients.

2. Cognitively disabled patients.

3. Physically disabled patients.

4. Severed psychopathology.

5. Elderly patients.

6. Low-insight or psychological-mindedness.

7. Cultural diversity.

8. Tough guys: traditional masculine orientation.

9. Military, law enforcement, first responders.

10. Correctional facilities.

11. Mandated treatment referrals.

12. Crime victims.

13. Crisis intervention & psychological first aid.

b. Supportive Psychotherapy

i. Many of these patients have felt out of control for most of their lives, so providing a way for them to achieve some kind of control and

confidence over any aspects of their lives is an important step toward productive behavior change.

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ii. Some patients may bound in and out of therapy as needed, other may require regular, long-term, and even lifelong care (cf. medical/rehab

model).

iii. For some patients supportive psychotherapy may be the vehicle of trust and confidence that enables more intensive types of therapy.

27. Describe the commonly used supportive psychotherapy techniques. a. Supportive Psychotherapy Techniques

i. Empathic presence

ii. Non Judgemental attitude ( to a point).

iii. Assist clarification & expression of thoughts and feelings.

iv. Assist clarification & expression of problems & goals.

v. Practical advice.

vi. Scripts & behavioral rehearsal.

1. The goal is to give them a template, a different idea on how to

approach things. Not necessarily an actual script.

vii. Impulse control.

viii. Assist in developing capacity for self-directed action, depending on patient.

ix. Psychotherapists as auxiliary ego or hired frontal lobes.

x. In supportive therapy, the clinician is typically more active and

directive than in other forms of psychotherapy.

28. What are some of the common problems that impel couples to seek therapy? a. Couples Therapy: Some Typical Problem

i. Problems can be multiple, complex, and interrelated, but often

revolve around common themes.

ii. Financial stresses.

1. The idea is who deserves what that makes the financial strain.

Usually the most common reason to fight, because money is

resource.

iii. Overcommitment to work or other non-relationship activities:

hobbies, socialization.

1. Overcommitment to anything other than relationship can

sometimes be thought of as infidelity.

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iv. Legal problems.

v. Illness or disability.

vi. Substance abuse.

1. A lot of substance abuse you will be seeing will be below the tip

of the iceberg.

vii. Infidelity or other sexual issues.

viii. Childcare issues, e.g dysfunctional child.

ix. Change in personality and/or behavior in one or both members. x. Change in goals and expectations of the relationship.

xi. Relatives and other people problems.

xii. Different problems at different life stages.

xiii. Always a combination of person and situation.

29. What are the important issues to be addressed at the outset of couples therapy? a. Couples Therapy: Basic Issues

i. Does the couple want to stay together or split? Do they know? Do they agree?

1. Trying to clarify what the agenda is. Do they each have a clear

idea of what they want? If they do not, make a note of that.

ii. Is the problem new or has it been present for most or all of the

relationship?

iii. What are the diagnostic issues ( personality & psychotherapy) that characterizes one or both parties.

iv. How much is a couple problem and how much an individual problem? What is the ratio: 50-50, 80-20?

v. What are the roles of other people in the couple’s problems: parents, children, relatives, friends, job?

vi. What has the couple tried so far, e.g. self-help, previous therapies? 30. Describe the commonly used couples therapy techniques.

a. Couples Therapy: Strategies & Applications

i. Not one “perfect” way, but flexible approach.

ii. Couples therapy may start as individual therapy, and vice-versa. iii. Initial interview of couple.

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iv. Separate interview of each member.

1. Anything disclosed in an individual session is to be kept in that

session, privacy is a big deal. You do not want to seem like a

double agent of some sort.

v. Reconvene and strategize.

1. Eventually you would want to get them both in a room once

again to try and talk thing out.

vi. Clarification of communication

vii. Clarification of goals: compatible? Realistic?

viii. Practical advice and behavioral homework.

ix. Dealing with relationship dissolution.

31. What types of problems impel people to seek treatment for their families? a. Couples problems ( see couples therapy).

b. Parent-child issues.

i. Parents disagree on child’s problems.

ii. Parent disagree on basic child-rearing issues.

c. Extended family issues.

d. Work/family issues.

i. Work overcommitment

ii. Family stresses.

e. Triangulation.

i. The parent tries to get the child on their side. Most likely by telling the child their problems, sometimes even by bad mouthing the other

parent.

f. Divorced families.

g. Blended families.

i. When parents remarried and now you have step siblings and step children and how you interact and are getting along with them.

h. Adult child problems (growing area).

i. Post high-school, college age, who sometimes has problems, mental illness, or they don't do anything at all.

i. Clarification of the problem(s).

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j. Clarification of family roles.

k. Agreement on goals.

l. Development of a coherent family narrative.

m. Interview and treatment of different family members, in varying

combinations.

n. Family practice model of family therapy.

32. What are the main strategies and techniques used in family therapy? a. Family Therapy

i. Another large province of LCSWs, LMHCs, and LMFTs.

ii. Treats family as the unit of therapeutic intervention.

iii. Like couples therapy, often burdened by a variety of “structural models.”

iv. Family therapy may begin as individual therapy, child therapy, or couples therapist, then evolve to include more family members.

v. Or, over time, family therapy may become more focused on individual family members.

vi. Frequently, there is a complex mix-and-match dynamic with families that have been in treatment over a length of time.

vii. IP= identified patient: who is the ”problem” that is being brought in for therapy - or who does the family think it is or project it on to? More

than one IP? Is everyone an IP.

33. Describe the main features of the therapy and practice of group psychotherapy, as well as practical issues involved in running such groups.

a. Group Therapy: Basic Concepts

i. Multiple models of group therapy: all emphasize important

therapeutic role of group interaction.

ii. Partially extends the transference relationship to many people.

iii. Serves as a laboratory for “true” feelings and interpersonal dynamics. iv. Role of therapist: moderator, guide, coach, or participants: multiple roles.

v. Role boundaries, ground rules (e.g. no dating, no business, etc.), and confidentiality issues: control? Liability?

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vi. Group therapy may be utilized as a stand-alone modality ( e.g. in institutions) or in combination with individual therapy.

b. Group Therapy: Practical Issues

i. Usually 5-10 members - enough for group dynamics to form, but not so many that some members will be left out.

1. Open groups = members come and go; usually no time limit.

2. Closed groups = Members start and finish together, usually

within a fixed number of sessions and a more structured

framework.

ii. Time frame usually longer than with individual therapy; average = 90 minutes.

iii. Sometimes utilize co-therapists, especially where the aim is to

specifically recapitulate the family group.

iv. Outside relationships. Usually constrained in some way. Don't want exclusionist, “special” pair-bonds or other relationships to interfere

with group dynamics.

1. No romance, no business, no socializing out the group.

2. Paradox of the group being a recapitulation of natural human

interaction, yet not actually a natural human interaction.

v. Confidentiality. Number of members make the commitment to

maintain consistent attendance and participation.

1. Session time usually longer than with individual therapy;

average = 90 minutes.

2. Session fee is usually smaller per patient than with individual

therapy, but therapists can still make extra income from group

therapy.

vi. Efficacy of group therapy: usually depends on the people and

problems being treated.

vii. Special problems in group therapy.

1. Dysfunctional members

2. Absenteeism

3. Expelling a dysfunctional member.

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34. What are common factors associated with successful group therapy and the strategies and techniques used to achieve success?

a. Group Therapy: Therapeutic Factors ( Yalom)

i. Cf. “Common factors.” Cf. group dynamics in nonclinical situations. ii. Instillation of hope = “ We’re all here for a common purpose to help one another.”

iii. Universality = “You mean, i'm not the only one with this problem?” 1. Homogeneous groups = Same based on patient population

and also on the issues being addressed.

2. heterogeneous groups = Different based on patient population

and also on the issues being addressed.

3. Specialized groups

4. Benefits and drawbacks.

iv. Group cohesiveness = “We’re all in this together, we share a common purpose, we’re special to one another.” Reinforces tribal loyalty.

v. Catharsis = May be easier to express inner thoughts and feelings once you’ve seen other do so in a nonjudgmental and supportive

environment (but beware of project hostility).

vi. Information/education = Therapeutic lessons tend to “stick” more when shared and discussed in a group setting.

vii. Interpersonal learning = Opportunity to try out new behaviors on others who are nonadversarial and supportive, and to get honest, but supportive, corrective feedback.

1. The group is a social microcosm that allows each member ,

over time to work out his/her own psychopathology or

dysfunctional relationship styles.

2. Less emphasis on historical developmental dynamics and

more on here-and-now relationships.

3. Therapy group relationships vs. “real” relationships?

viii. Imitative behavior = Explicit role-playing and implicit imitation of more functional relationships and communications.

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ix. Development of socialization techniques = Practice and rehearse specific scenarios for particular interpersonal problems, e.g. work, family,

other roles.

x. Altruism = For some members, learn that people aren’t all mean, selfish, hostile, abusive, untrustworthy, etc. Also learn how to give

unselfishly without fear of exploitation or abuse.

xi. Existential factors = Learn to deal with the meaning of life, death, evil, etc. May be especially important in some specialized group, e.g. PTSD, bereavement, disability, etc.

xii. Group therapy vs. support groups.

35. Describe the similarities and differences between child psychotherapy and adult psychotherapy, including some of the unique challenges and practical issues in treating children.

a. Clinical psychology actually began in large part with child psychology ( e.g. Witmer), but in the ensuing years, children have been alternately been neglected or overpathologize.

b. Many children are evaluated and treated in the context of family therapy, or child therapy may turn into family therapy, or vice versa (IP?).

c. When a child is the sole or primary focus of treatment, there is often a diagnosed or suspected clinical disorder. When the issue involves more genetic “behavioral problems,” it is more likely that the family will get involved.

d. Especially with younger children, much psychotherapy occurs through the proxy of the parents.

36. What are important factors to consider in the psychological assessment of a child? a. Child Psychological Assessment

i. Most childhood psychological disorders and behavioral problems can be categorized into:

1. Internalizing disorders = “Chili peppers,” i.e. anxiety,

depression, phobias, ADD.

2. Externalizing disorders = “Garlic,” e.g oppositionalism,

antisocial behavior, impulsivity, school problems, ADHD. May

also be comorbid with learning disorders.

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ii. May be combinations of these disorders, or other problems, e.g. autism, ADHD, substance use.

iii. Usually, the more specific the presenting problem, the more focused will be the assessment, e.g. educational issues, forensic evaluation,

etc.

iv. Type of child and problem will determine type of treatment.

b. Child Psychological Assessment: Key Factors

i. Presenting problem(s) = what are they, how bad, how long. Diagnostic issues.

ii. Developmental history = prenatal care, pregnancy or birth

complications, developmental milestones, illnesses, educational

history.

iii. Family History = genetic and psychosocial, immediate and extended family.

iv. Community/environment = family structure, socioeconomics,

neighborhood, school, extended family, peers.

c. Child Psychological Assessment: Key Components

i. A given case may not involve all of the following and some

components may depend on child’s age and clinical status.

1. Prior clinical records.

2. Interview with child.

3. Interview with parent(s).

4. Interview with child and parent(s): assess interaction.

5. Interview with collaterals.

6. Naturalistic observation.

7. Rating scales and checklists.

8. Specialized tests and measures: intelligence, scholastic,

personality, etc.

37. Describe the commonly used child therapy strategies and techniques, and the challenges and limitations of each.

a. Type of therapeutic strategy will depend on:

i. Child’s age and developmental stage,

ii. Nature of the problem or disorder

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b. Issues of confidentiality, informed consent, and mandated reporting. c. Having the “confidentiality discussion.”

i. Legally anything that the child says you must disclose to parents. You should emphasize to the parents that although they legally have the

right the know everything, it is wise if they respect their child's

confidentially and allow you to keep some things to yourself. Things

you must disclosure are of course just like anything else, something

that harms the child or those around them in any way.

d. Talk therapy. For older children and adolescents who have adequate communication skills and a willingness to talk.

i. Children may vary widely in their verbal skills, attention span, and maturity at any age.

ii. For younger children, talk is usually combined with other modalities. e. Play therapy. Involves the use of toys, games, artwork, etc.

i. Play as a nonthreatening, bonding exercise.

1. Because for many children playing is a way of making friends.

You can allow the children to bring in their own toys, and even

teach you how to play their games.

ii. Utilize play to encourage direct verbal communication.

iii. Utilize play to help children express metaphorically or symbolically what cannot be directly verbalized,either because of linguistic

immaturity or because material is too emotionally painful (e.g.,

trauma): incorporate projection and transference into play objects

and activities.

iv. Use caution when interpreting symbolic aspects of play therapy, e.g. legal implications.

f. Behavior therapy

i. May be effective for older children with internalizing disorders.

ii. For younger children or children or adolescents with externalizing disorder, much will occur via proxy of the parents.

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1. Train parents to create an environment in the household to

have parents reinforce the kind of behavior that they wish their

child to have. Parents must be on the same page regarding

goals.

g. Therapeutic modeling

i. Therapist provides a corrective emotional experience through

modeling of mature adult behavior.

ii. Can be subtle or overt.

iii. Combine with other therapeutic modalities.

iv. Combine with education and training of parents.

1. Basically you are trying to substitute more functional ways of

this family communicating and interacting with each other into

this families lives.

38. What are some of the effects of stress on human health, and how can mental health practitioners be of help in these matters?

a. Emotion-focused coping = focus on reducing effects of stressors, on feeling better, without necessarily addressing the causes.

b. Problem-focused coping = constructively deal with the cause of stress. c. Problem-focused coping traditionally thought to be more mature or healthy than emotion-focused coping, but both may have a role to play in the adaptive response to stressful circumstances.

d. Also consider role of social support & health

e. Psychophysiological Disorders: Treatment

i. Abreactive therapy

ii. Psychodynamic exploration

iii. Biofeedback

iv. Behavioral medicine

v. Lifestyle changes

vi. Cognitive-behavioral therapy

vii. Coping skills training: self-efficiency

viii. Family & psychosocial modalities.

ix. Treating the symptom or the patient?

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x. Role of MH professionals in medical treatment.

39. What are the stages of the General Adaptation Syndrome (GAS), and what do they tell us about the human stress response?

a. General Adaptation Syndrome: G.A.S. (Hans Selye)

i. Stage of Alarm:The alarm stage is also known as the fight or flight stage. When you're in the alarm stage, your heart beats faster,

sending more blood to your arms and legs in case you need to fight or flee.

ii. Stage of Resistance: occurs when moderate strain affects a person's life continuously for weeks.

iii. Stage of Exhaustion:Hopefully the issue is resolved in the alarm or

resistance stage, but the body cannot maintain the resistance stage for a long period of time.

40. What is the scientific basis for the practice of biofeedback therapy, and how is biofeedback therapy carried out in clinical practice?

a. Can you change physiological behavior ( e.g blood pressure) like you can change overt behavior (e.g throwing a ball into a basket)? Yes- if you can become aware of the behavior and your effects on it.

b. Biofeedback = Attempts to directly alter physiological functioning, using the behavior principles of classical and operant conditioning.

c. Typically involves training in some form of low-arousal technique, such as progressive relaxation or meditation, then uses counterconditioning or operant conditioning to change physiological response.

d. Apparatus-assisted biofeedback = use an electronic transducer to amplify an otherwise imperceptible physiological signal, which is then fed back to the subject to learn how to control.

e. Subject is training in a low-arousal or behavioral control technique to alter the amplified signal (visual or auditory) and, by extension, the physiological process underlying it. Lie detector in reverse.

f. Most commonly used biofeedback modalities.

i. Electromyogram (EMG): muscle tension. Higher activity = greater arousal.

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ii. Galvanic skin response (GSR): Sweat gland activity. Higher activity = greater arousal.

iii. Temperature: Lower peripheral temperature = greater arousal. iv. Does not necessarily tell you what type of arousal is being measured (anxiety vs. anger) or what physiological or psychological factors may underlie it.

g. Less commonly used biofeedback modalities.

i. Respiration: higher respiration rate = greater arousal

ii. Blood pressure: Higher blood pressure = greater arousal.

iii. Electroencephalogram: higher frequency, lower amplitude = greater arousal.

iv. More specialized applications to specific conditions or disorders. v. Direct and indirect applications; e.g. use EMG and temperature

regulation to treat hypertension or irritable bowel syndrome. Treating the stress response generally or the physiological response

specifically.

h. Biofeedback has been used to treat the following conditions and disorders. i. Tension & migraine headaches.

ii. Chronic pain

iii. Hypertension & cardiac rhythms disturbances.

iv. Irritable bowel syndrome & incontinence.

v. Depression ( vagus nerve stimulation).

vi. Epilepsy & ADHD (controversial)

vii. Performance enhancement (military, sports)

41. Describe the physiological modalities that are amplified and fed back to the patient in the most commonly practiced forms of biofeedback.

a. Answer above

42. What medical conditions or syndromes are the most common targets of biofeedback therapy in daily clinical practice?

a. Mood disorder

b. Psychotic disorder

c. Cluster B personality disorder

d. Suicidality.

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43. What are the most common applications of health psychology and behavioral medicine in daily clinical practice?

a. HPBM: Psych Assessment for Elective MED Procedures.

i. Based on past adverse outcomes, many physicians and medical

insurance companies require a basic psychological screening for

elective procedures that alter a patient's subjective state or

self-image, including:

1. Invasive pain-control surgeries, e.g. spinal cord stimulator or

morphine pump.

2. Gastric bypass or gastric banding surgery for weight control.

3. Cosmetic surgeries.

4. Other applications

ii. Evaluation usually involves screening for serious psychopathology or personality disturbances that might be associated with poor

compliance or adverse reaction to the procedure, such as:

1. Mood disorder

2. Psychotic disorder

3. Cluster B personality disorder

4. Suicidality.

iii. Evaluation typically includes the following components

1. Patients general medical history

2. History of the current disorder for which he/she is seeking the

procedure

3. Past efforts to deal with the disorder and successes and

failures.

4. Patients understanding of the proposed procedure

5. Patients understanding of the likely outcomes of the procedure

6. What will the patient do if the procedure is not successful?

44. What roles to psychologists play in the legal system?

a. Roles of a Forensic Psychologist

i. Expert witness

ii. Case consultant

iii. Trial consultant

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iv. Amicus curiae

v. Researcher/ investigation

vi. Clinical treatment provider

45. Describe the similarities and differences between an evaluation done for a patient in clinical practice and a forensic evaluation done for an attorney or the court. a. Background records.

b. Clinical interview

c. Collateral interviews

d. Psychological tests & measures

e. Case conceptualization

i. Comprehensiveness, consciousness, clarity, and transparency.

ii. Address relevant psycholegal issues, e.g disability, fitness for custody, insanity, etc.

f. Recommendations

46. What are the differences between the civil and criminal branches of the U.S. legal system?

a. Civil Forensic Psychology

i. Plaintiffs & defendants

ii. Lawsuit brought

iii. Preponderance of the evidence

iv. Civil competencies

v. Family law.

vi. Divorce & custody

vii. Torts & personal injury

viii. Contract law

ix. Injunctive lawsuits.

b. Criminal Forensic Psychology

i. Prosecuting & defense

ii. Charges filed

iii. Beyond a reasonable doubt

iv. Criminal competencies

v. Insanity defense (NGRI)

vi. Diminished capacity

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vii. Probation and parole

viii. Dangerousness prediction

ix. Adult & juvenile justice systems

47. What are the legal and psychological criteria for competency to proceed and mental state at the time of the crime(insanity)?

a. Civil Competencies

i. Presumption of competency may be set aside if there is compelling evidence to the contrary: burden of proof is on the challenge to

competency.

ii. Either the state of private parties may raise challenges to a person’s civil competency; the latter usually involve family members.

iii. If the court declares a person to be incompetent, that person will be appointed a guardian who is legally empowered to make decisions

regarding the ward’s person and property.

iv. If no family member is able or willing to serve as guardian, the person may become a ward of the court.

v. Adults or children.

b. Civil Competencies: Role of Psychologist

i. Psychological evaluation for civil competency typically includes:

1. Relevant Medical, Family, And Social History Records.

2. Clinical Examination Of Subject.

3. Administration of relevant psychological & neuropsychological

tests.

4. Interview of family members and other collaterals (e.g.

neighbors, institutional staff).

c. Criminal Competencies

i. In most U.S courts the competency criteria boil down to three main elements, consisting of the defendant's present ability to:

1. Understand and appreciate the nature of the charges against

him/her

2. Understand and appreciate the range of possible penalties.

3. Assist counsel in his/her own defense

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ii. Most states have their individual versions of these competency

criteria.

d. Criminal Competencies: Psych Evaluation Components

i. Identifying information

ii. Record review: past and present

iii. Description of defendant and charges.

iv. Basic facts about case ( arrest report, etc).

v. Defendants Response To, And Ratings Of, Competency Criteria.

vi. Diagnostic conclusions ( not required, but recommended).

vii. Forensic conclusion:

1. Competency to proceed.

2. Not competent to proceed, but restorable with

recommendations and time frames.

3. Permanently not competent to proceed.

viii. Criteria for involuntary hospitalization.

ix. Other recommendations.

48. What mental disorder diagnoses or psychological conditions would most likely be relevant to criminal competency or insanity determinations?

a. Characteristics of Noncompetent Defendants

i. Live on the margins of society: unmarried, socially isolated.

ii. Lower educational attainment, lower vocational status.

iii. Usually charged with less serious crimes; small proportion are

charged with violent crimes.

iv. History of mental health treatment

v. History of substance use and substance abuse treatment.

vi. Most common diagnoses relevant to CST: Psychotic disorder, severe mood disorder, mental retardation, dementia, substance abuse

effects, medical conditions.

Different defenses:

M’Naghten Standard (1843): “It must be clearly proven that, at the time of committing an act, the party accused was laboring under such a defect of reason, from disease of the

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mind, as to not know the nature and quality of the act he was doing, or if he did know it that he did not know he was doing wrong.”

American Law Institute (ALI) - Model Penal Code (MPC) Standard (1972): “A person is not responsible for criminal conduct is at the time of such conduct, as a result of mental disease or defect, he lacks the substantial capacity either to appreciate the criminality (wrongfulness) of his conduct or to conform his conduct to the requirements of the law.”

b. Insanity Defense

i. Actus reus = “guilty act”

ii. Men rea = “ guilty mind.”

iii. Insanity defense is a complete exculpatory defense

iv. Insanity defense may usually be raised at any point in the legal

proceedings.

v. In practice, the insanity defence is raised very rarely and is successful still more rarely.

c. Guilty But Mentally Ill

i. Currently, in 13 states, a defendant may be found GBMI, in which case he/she may be sentenced to as term consistent with the verdict, but

they are supposed to receive appropriate treatment.

ii. If the convictee cannot receive such treatment in prison, the are supposed to be transferred to a secure forensic mental health facility for treatment.

iii. In practice, the fate of GBMI defendant differs little from that of regular defendant who receive a guilty verdict.

d. Diminished Capacity

i. Aggravating and mitigating factors

ii. Although the accused was not legally insane, nevertheless, due to emotional distress, physical condition or other factors , he/she could

not fully comprehend the nature of the criminal act he/she is accused of committing.

iii. Diminished capacity is raised by the defense either (a) in attempts to remove the element of premeditation or criminal intent and thus

obtain a plea agreement or conviction for a lesser crime, such as

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manslaughter instead of murder; or (b) at sentencing as a mitigating

factor. Not exculpatory: still guilty.

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PSY 4943: CLINICAL PSYCHOLOGY

SPRING SEMþTER 2018

INSTRUCTOR: DR. LAURENCE MILLER

FLORIDA ATLANTIC UNIVERSITY

FINAL EXAM STUDY GUIDE

FINAL EXAM STUDY GUIDE 

*NOTE: This is a general study guide. Study comprehensively.*

1. What are the corrective, transformative, and adaptational models of psychotherapy?

a. Transformative: Effective fundamental changes in personality that will lead to positive behavior change.

i. Examples: Psychodynamic therapy; existence therapy.

ii. A kind of depth therapy in the sense that true change can only come in accepting a person's role in the world. At the completion of the

therapy the person should have a new way on conceptualizing their

role in the world. One would be able to notice a change in their overall view of their personality and they must understand how they can

change it to create a positive situation for themselves. You are

essentially transforming the individual, with their help and

cooperation.

b. Corrective: Directly change specific dysfunctional behaviors or reaction patterns, without necessarily affecting the whole personality. However, may have generalized effects.

i. Examples: Behavior therapy, cognitive therapy, cognitive-behavior therapy.

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ii. Not focusing on changing their overall life, just specific problems they have that can have in effect on their life. Things like, if the person can’t deal with criticism and they get a bad performance review that leads

to them storming out of their job, if this happens often one could say it is difficult for them to stay employed. Their reaction to criticism is

what will be changed in this case, not their overall personality, just this specific characteristic that hinders their chances of staying employed. You are correcting a flaw that harms the individuals life in one way or another.

c. Adaptional: Help the person use the abilities and resources he/she has to optimally adjust to their individual circumstances.

i. Examples: Supportive-expressive psychotherapy, counseling, life coaching.

ii. Help them cope the best they can to deal with the situation they are in. If you can help a person just a little bit, teaching them the

strategies to help their daily lives, it can have a profound change in

someone's life even if you are not changing their personalities or

specific characteristics. You are helping a person adapt to what is

going on in their lives at the moment.

2. What is the difference between eclectic and integrative therapies? a. Eclectic psychotherapy= select the best treatment for a particular patient or problem.

i. Using different therapies depending on what client is dealing with, using them individually.

b. Integrative psychotherapy= blending and adaptive therapeutic strategies for a particular patient or problem.

3. What type of psychotherapy is utilized by most practicing therapists today? a. Most practicing psychotherapies use an integrative approach, but one that may be driven by a particular system or model, often the one they learned in graduate school.

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4. What are the common factors that have been shown to contribute to success in virtually all forms of psychotherapy?

a. Working Alliance = Client needs to feel like there is a connection and the psychotherapists understands them and they can communicate freely. The fiduciary relationship needs to be a good match.

b. Agreement on therapeutic goals = agreement between psychotherapists and clients on what needs to be done to help the client. Sometimes goals may change, there needs to be flexibility.

c. Realistic and attainable goals = it needs to be something that can change and during a reasonable time frame. Breaking things down into small goals is often advised.

d. Positive expectations of patient = client need to have some confidence that psychotherapists can help them. Generally it takes a couple sessions, usually by the third session.

e. Rationale for the change process

f. Patients ability & willingness to change

g. Opportunity for catharsis & expression = Clients want an opportunity to let their emotions out.

h. Insight, understanding & meaningful narrative

i. Opportunity to learn & practice new attitudes & behaviors.

5. Which therapists qualities and characteristics have been found to contribute to successful psychotherapy?

a. Knowledge = The more knowledge you have the better you will be at anything you do. The ideal practitioner never stops learning, always

educating yourself because you want to excel in your craft.

b. Flexibility = You have the ability to be flexible in how you use this knowledge. c. Maturity = Modeling a certain grown up in the room behavior, provide a model of mature behavior within the therapy patient.

d. Diagnostic skill = Doesn't just mean knowing dsm codes, basically means trying to size up the person. Trying the figure out what is going on with this person.

e. Interpersonal skill

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f. Communication skill = Ability to communicate effectively with other types of people.

g. Psychotherapeutic techniques = Want to have as many of these techniques and use them in integrative ways.

h. Cultural competence = Adapt communication style to the person you are dealing with so that you two can understand each other. Importantly, on their level so that it does not come across as if you are talking down to them, or treating them like first graders.

6. What effects have psychopharmacology and the rise of third-party (insurance) payment had on the modern practice of psychotherapy? a. Medication

i. At first, medication was applied to more severely disordered patients (schizophrenia, bipolar disorder, major depressive disorder).

ii. By the 1070’s & 80’s, medications were frequently being prescribed for the “walking wounded”, i.e. outpatients with mild-moderate anxiety & mood disorders.

iii. While psychiatrists predicted supremacy of the medical model, real mental health patients didn't want to think of themselves as nothing

more than a collection of symptoms: they wanted to make some

meaning of their lives.

People mostly do not want to just ease the symptoms many want to actually solve their problems.

b. Psychotherapy Reimbursement

Main reimbursement types:

i. Out of pocket.

ii. POS/FFS Insurance. (point of service/fee for service)

iii. Managed care. = insurance company decides, why provided

unecessary care. Streamlining and making more efficient.

iv. Salary. = If you work for a hospital or the government you can get paid by salary. It's good because you know what you are getting but bad

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because if you are on salary there is a limit on how much you can

earn.

v. Contract fee. = A flat fee for a patient. The idea is that you get a flat fee per year for any amount of sessions they need.

c. Insurance:

i. At first, insurance covered almost every form of psychotherapy, with almost unlimited session, greatly expanding the patient pool & types of therapists.

ii. Excesses & abuses (mainly from medical practices, including

psychiatry & substance abuse treatment) led to the backlash &

crackdown in the late 1970’s-1980’s with the advent of managed care: insurance companies telling doctors what they could & could not do.

iii. Insurance also “democratized” mental health care, so practitioners were seeing fewer YAVIS’s and more low-income, low-education, less cooperative, less motivated, more externalizing,

personality-disordered & difficult to treat patients; also more

mandated referrals, e.g. drug abusers, criminal offenders, etc - the

anti-YAVIS.

iv. Today’s psychotherapy practice for clinical psychologists will typically include a diverse patient population geared to the demographics for

the practitioner's community & the specialization of the

psychotherapists.

7. What effects patients demographics and cultural diversity had on the the modern practice?

a. Varied ages.

b. Varies SES (socioeconomic status) and income

c. Limited verbal skills

d. Limited abstract cognitive abilities and “psychological - mindedness.” e. Frequently unstable employment, legal, and personal status.

f. Cultural diversity.

g. Externalizing disorders.

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8. What are the main components of Freudian psychoanalytic theory and how do these relate to the major strategies and techniques of psychoanalytic psychotherapy?

a. Sigmund Freud (1856-1939)

b. Symptoms, dreams, and Freudians slips.

c. Id, ego and superego

i. Id- Largely unconscious. Impulsive, aggressive.

ii. Ego- Compromises between the two.

iii. Superego- Conscience, pure, always trying to do things correctly. d. Psychosexual stages of development.

i. Oral Stage (0-1 year)

ii. Anal Stage (1-3 years)

iii. Phallic Stage (3 to 5 or 6 years)

iv. Latency Stage (5 or 6 to puberty)

v. Genital Stage (puberty to adult)

e. Oedipus & Electra Complexes

f. Conflict and defense mechanisms.

i. Repression: Not being consciously aware of something. This person is not even aware that they are repressing something.

ii. Denial: Refusing a statement.

iii. Projection: Projecting one's emotions onto someone else, disguising these feelings as if it is someone else's instead of are own. “You don't like me!” when in reality it is you that doesn’t like that person.

iv. Displacement: Taking out your emotions on someone who may not be even responsible. Displacement does not have to be emotions one

has in that day it can go way back.

v. Rationalization: Coming up with a rational explanation for something that is not rational. This person is not just lying they honestly believe this rational explanation.

vi. Reaction formation: Behaving in the exact opposite way of what they impulsively want to be.

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vii. Sublimation: In which socially unacceptable impulses or idealizations are unconsciously transformed into socially acceptable actions or 

behavior, possibly resulting in a long-term conversion of the initial 

impulse. 

g. Psychoanalytic Psychotherapy 

i. Free association: an individual lays there and says whatever comes to your mind without censoring anything in anyway. The idea was that by doing this, unconscious material would sneak around the defense 

mechanisms and make their way out! 

ii. Dream interpretation: even in the manifest context of the dreams our unconscious disguises itself. 

iii. Transference & countertransference 

1. Transference: We react to any kind of authority figure in terms 

of ways we react to our parents. The patient projects unto the 

therapists the fear, and feelings they have towards other 

authority figures. 

2. Countertransference: The emotional reaction of the analyst to 

the subject's contribution. 

iv. Interpretation & resistance 

1. Interpretation 

2. Resistance 

v. Working-through 

9. What are the main features of theory and practice in the psychotherapeutic modalities of Alfred Adler, Carl Jung, the ego psychologists, and object relations theory?

Psychoanalysis: Neofreudians 

a. Carl Jung (1875-1961) 

i. Analytical psychology 

ii. Collective unconscious: In all of us exists not only our unconscious but the conscience of all of those that live before us. 

iii. Animus and anima 

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1. Animus: In the unconscious of a woman it is expressed as a 

masculine inner personality 

2. Anima: In the unconscious of a man, this archetype finds 

expression as a feminine inner personality. 

iv. Introversion-extraversion 

1. Introversion: People who are introverted tend to be inward 

turning, or focused more on internal thoughts, feelings and 

moods rather than seeking out external stimulation. 

2. Extraversion: Extroversion is characterized by sociability, 

talkativeness, assertiveness and excitability. 

b. Alfred Adler (1870-1937) 

i. Individual Psychology 

ii. Striving for superiority : What drives people is the drive for status. iii. Inferiority complex: The feeling that one is not worthy or entitled. 

Psychoanalysis: Ego-Psychologists 

iv. Heinz Hartmann.Riley Gardner 

v. David Rapaport 

vi. Merton M. Gill 

vii. Roy Schaefer 

c. Emphasis on conscious cognitive functions of the ego.

d. Attention, concentration, perception, memory, reasoning, action.

e. More emphasis on individual choice and self-determination.

f. Concept of cognitive style.

g. Introduced experimentation into psychodynamic research and theory. h. Pioneered the use of brief psychodynamic therapies.

Object Relations Theory & Therapy

i. Melanie Klein, Otto Kernberg

j. Emphasizes interpersonal aspects of conflicts in personality development and in psychotherapy.

k. Less emphasis on unconscious dynamics and more emphasis on conscious processes and interpersonal relationships.

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10. What are the similarities and differences between brief psychodynamic psychotherapy and time-limited psychotherapy?

a. Brief Psychodynamic Therapies

i. Rely on basic psychodynamic concepts, but streamline the therapeutic process; approximately 6 months vs. many years.

ii. Usually deal with less severe psychopathology.

iii. More specific, here-and-now focus.

iv. Greater therapists activity.

v. Less reliance on transference.

vi. Less reliance on dream and paraprax interpretation.

b. Time-Limited Dynamic Psychotherapy (TLDP)

i. Most associated with Hannah Levenson.

ii. Similar to traditional psychoanalysis, but more active and accelerated. iii. Short-term, but relies on a version of the transference phenomenon: 1. Patients bring to therapy their unconscious, maladaptive

interpersonal scripts.

2. Psychotherapist acts as a mature,stable transference object to

provide a corrective emotional experience.

3. Patient practices new interpersonal skills in the real world and

reports back to therapists: reciprocal relationship.

11. What are the main features of theory and practice of the neoFreudian and feminist approaches to psychodynamic psychotherapy?

Psychoanalysis: Neofreudians 

a. Carl Jung (1875-1961) 

i. Analytical psychology 

ii. Collective unconscious: In all of us exists not only our unconscious but the conscience of all of those that live before us. 

iii. Animus and anima 

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1. Animus: In the unconscious of a woman it is expressed as a 

masculine inner personality 

2. Anima: In the unconscious of a man, this archetype finds 

expression as a feminine inner personality. 

iv. Introversion-extraversion 

1. Introversion: People who are introverted tend to be inward 

turning, or focused more on internal thoughts, feelings and 

moods rather than seeking out external stimulation. 

2. Extraversion: Extroversion is characterized by sociability, 

talkativeness, assertiveness and excitability. 

b. Alfred Adler (1870-1937) 

i. Individual Psychology 

ii. Striving for superiority : What drives people is the drive for status. iii. Inferiority complex: The feeling that one is not worthy or entitled. 

Feminists Psychodynamic Theory & Therapy

c. Reaction to perceived sexism of other traditional psychodynamic systems. d. Karen Horney: “feminine inferiority” is a culture-based phenomenon (influenced by anthropologist Margaret Mead).

e. Womb envy = Mens compulsive drive for dominance and achievement is compensation for their not being able to bear children.

● Real self vs ideal self = therapy addresses the human capacity for change and growth. Harbinger of the humanistic psychotherapies.

● People cope with conflicts of autonomy vs. authority by three main strategies: ○ Moving toward people: connection. If this is taken too far it could lead to dependence.

○ Moving against people: confrontation, challenge, competition. If taken to far a person can become isolated, impulsive.

○ Moving away from people: self-sufficiency or avoidance.

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12. What are the similarities and differences between classical and operant conditioning, and what are the main theoretical concepts of each.

a. Classical Conditioning:

i. Unconditioned stimulus. = A stimulus that evokes an unconditioned response without any prior conditioning. (No learning needed for the response to occur)

ii. Unconditioned response. = An unlearned reaction/ response to an unconditioned stimulus that occurs without prior conditioning.

iii. Conditioned stimulus. = A previously neutral stimulus that has, though conditioning, acquired the capacity to evoke a conditioned response. iv. Conditioned response. = A learned reaction to a conditioned stimulus that occurs because of prior conditioning.

v. Extinction. = when a conditioned stimulus is no longer paired with an unconditioned stimulus. 

vi. Generalization. = the tendency to respond in the same way to 

different but similar stimuli. 

vii. Human examples.

b. Operant Conditioning:

i. Positive reinforcement. = involves the addition of a reinforcing 

stimulus following a behavior that makes it more likely that the 

behavior will occur again in the future. When a favorable outcome, 

event, or reward occurs after an action, that particular response or 

behavior will be strengthened. 

ii. Negative reinforcement. = a response or behavior is strengthened by stopping, removing, or avoiding a negative outcome or aversive 

stimulus. 

iii. Punishment. = any change in a human or animal's surroundings that occurs after a given behavior or response which reduces the 

likelihood of that behavior occurring again in the future. 

iv. Shaping by successive approximations. = Instead of rewarding only the target, or desired, behavior, the process of shaping involves the

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reinforcement of successive approximations of the target behavior, or for acting in a way that gets closer and closer to the desired behavior. v. Schedules of reinforcement.

vi. Clinical and social applications.

13. Describe the common clinical applications of behavior therapy used in modern practice.

a. Counterconditioning. =is a type of therapy based on the principles of classical conditioning that attempts to replace bad or unpleasant emotional 

responses to a stimulus with more pleasant, adaptive responses. 

b. Systematic desensitization. = Combination of classical and operant conditioning. Set of a hierarchy of aversive situation and teach that person a relaxation response, anything that calms that person physiologically. Learn to associate the relaxation with the anxiety.

c. Biofeedback & behavioral medicine.

d. Aversive conditioning. = the use of something unpleasant, or a punishment, to stop an unwanted behavior. 

e. Time-out from reinforcement. = a procedure in which a child is placed in a different, less-rewarding situation or setting whenever he or she engages in undesirable or inappropriate behaviors. 

f. Differential reinforcement of other behavior (DRO). = you will reinforce any behavior except the undesired behavior. ... when the target behavior has not occurred during a specific period of time. DRO procedures provide 

reinforcement for the absence or omission of a target behavior.” 

g. Token economies. = A token economy is a form of behavior modification designed to increase desirable behavior and decrease undesirable behavior with the use of tokens. Individuals receive tokens immediately after 

displaying desirable behavior. The tokens are collected and later exchanged for a meaningful object or privilege. 

h. Modeling, role-playing, rehearsal.

14. Describe the common dysfunctional cognitions targeted in cognitive therapy. a. Dichotomous thinking (all or nothing). = you may see only the extremes of things, never the middle 

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b. Overgeneralizing =It is a course of thinking where you apply one experience and generalize to all experiences, including those in the future 

c. Exceptionalizing ( discounting positives).

d. Catastrophizing.

e. Magnification (of bad).

f. Minimization ( of good).

g. Personalization.

h. Mind reading: over assumption.

15. Describe the common clinical applications of cognitive therapy used in modern practice.

a. Direct disputation = Trying your best to rationalize your doubts. Your psychotherapist helps you dispute your thoughts.

b. Thought stopping = literally stopping when you're thinking something negative or that is harming you. Temporarily stopping spirally thoughts. Usually accompanied by other techniques.

c. Hypothesis testing = Thinking about problems as problems that need to be overcome.

d. Cognitive restructuring =Process of learning to identify and dispute irrational or maladaptive thoughts. 

e. Imagery = imagining yourself doing the thing you want to do.

f. Affirmations = Simply telling yourself something can have the same or better effect than someone else telling you.

g. Self-Talk

h. Task-relevant self-instructional training = often taught to military personal. This is for getting through stressful situations. Giving yourself instructions on how to solve the problem in an acute situations.

i. Combining and integrating techniques.

j. Ultimate transition to self-management.

16. What are the main concepts and applications of Rational Emotive Behavior Therapy (REBT)?

a. ABC

i. A= Adversity or activating event

ii. B= Belief(s) about the event

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iii. C= Consequences (dysfunctional emotional and behavioral)

b. Focus on evaluating B

i. Look for assumptions and thoughts that are illogical,rigid, unrealistic &/or self-destructive.

c. Therapeutic techniques rely on active disputation of irrational beliefs: discourage musturbation.

d. Therapeutic dialog is often in the form of questions:

i. “So, what?”

ii. “How do you know?”

iii. “What's the worst that could happen?”

e. Critiques: may trivialize (make something seem less serious) serious problems.

17. Where does the mindfulness concept come from and how is it applied to modern psychotherapy?

a. Adapted from Zen Buddhist meditation,mainly by Jon Kabat Zinn. b. “Mindfulness means paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.”

c. When a problem appears insoluble,engage and accept the thoughts and feelings, without resistance or confrontation.

d. Relieves the distress of ineffective striving.

e. Allows possible solutions to “emerge”.

f. Critiques:

i. Is this really a cognitive therapy?

ii. Some problems need practical solutions.

18. What are the key principles and applications of Dialectical Behavior Therapy (DBT)? a. Originally developed by Marsha Linehan for treatment of borderline personality disorder. Other applications.

b. Dialectic= back and forth exchange, comparing opposites, to clarify a concept or position.

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c. Dialectical therapy= exchanges between patient and therapists are intended to resolve simultaneous, contradictory feelings, in order to get at the true, core feelings.

d. DBT encourages patients to develop & utilize four core problem solving strategies and skills.

i. Emotion regulation: identify,describe, and accept unpleasant emotions, rather than avoid them or fight them.

ii. Distress-tolerance: develop capacities for self-soothing and

impulsive-control to deal with impulsive, potentially dangerous

behaviors, e.g. aggression, suicide, other self-harm, or drug relapse.

iii. Interpersonal effectiveness: Develop and utilize practical interpersonal coping skills to build social self-confidence.

iv. Mindfulness: When action is not possible, learn to acknowledge and accept painful thoughts & feelings.

19. What are the core theoretical foundations of existential and humanistic psychotherapies?

a. Meaning: Existential-Humanistic Psychotherapy

i. Reaction against pathology-oriented model that characterizes

traditional psychodynamic therapies, and the mechanic model that

characterizes cognitive- behavioral therapies.

ii. For example,

1. Feud: “transformative neurotic misery into ordinary

unhappiness.”

2. Maslow: :bringing out inner goodness, creativity, and growth.”

iii. Finding meaning while living in the real world.

20. Describe the main concepts and applications of the humanistic psychotherapies. a. Existential-Humanistic Psychotherapies

i. Emphasis on conscious choice, not unconscious determinants.

ii. Less interested in diagnosis and etiology.

1. These are just labels we give to people. Yes we know people

have different personalities but that's not the focus, we are

here to treat your struggles in life that come from how you

react to things.

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iii. Less deterministic, more proactive.

iv. Therapists as teacher or guide, not transference object or behavioral contingency manager.

21. Describe the key concepts and applications of Rogerian humanistic psychotherapy. a. Client-Centered Psychotherapy

i. Carl Rogers: clients, not patients.

ii. In humanistic psychotherapy, psychopathology consist of

incongruence between the real self and the ideal self (cf. Horney).

iii. Goal of humanistic psychotherapy is to foster congruence between the 2 selves.

iv. Two main defence mechanisms: distortion and denial.

v. According to Rogers, a fully functioning person has seven

characteristics:

1. Openness to experience.

2. Existential lifestyles: living each moment.

3. Organismic trust: make one’s own confident decisions.

4. Freedom of choice ( cf. ego autonomy).

5. Creativity.

6. Reliability & constructiveness.

7. Rich, full life.

b. Client- Centered Psychotherapy: Components.

i. Empathy = Therapists tried to understand client’s perceptions,

thoughts and feelings from the client’s perspective. Therapists then

relates this back to the client in the form of reflective statements that allow the client to clarify his/her own thinking.

ii. “What i hear you saying is…”

iii. Unconditional positive regard = Full acceptance of the clients by the therapists, without judgment. Allows the client to feel safe in

expressing his/her innermost thoughts and feelings.

iv. Q: Should all clients be accepted equally? Are judgements never to be made? Is giving advice a form of judgement?

v. Genuineness = Therapists serves as a model of honest, non defensive, authentic human interaction and communication.

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vi. Like psychoanalysis, the therapist's presence is an important factor in humanistic psychotherapy , bt unlike psychoanalysis, this presence

relies on transparency and authenticity, not deliberate opacity as a

transference object.

22. What are the components of Maslow’s hierarchy of needs theory and how is it applied to psychotherapy?

a. Five basic needs: each one needs to be satisfied in order for the next one to be addressed ( but there may be exceptions - cf. Victor Frankl).

b. Most people are lucky to live life with 3 or 4 of the needs fulfilled.

c. A few people make it to need 5: self-actualization.

i. Physiological= Oxygen, food, water, sleep, sex, basic health &

nutrition.

ii. Safety= physical & material security, family & social stability, access to healthcare.

iii. Love/Belonging= Mate, friends, family, community.

iv. Esteem= Achievement ,respect,confident,pride,self-acceptance. v. Self-Actualization= Optimal fulfillment of one’s

potential,morality,creative in any field of endeavor.

d. People who self-actualize report peak experiences: near-transcendent states of consciousness associated with optimal functioning.

e. Self- Actualization is not an absolute yardstick, but is based on each person’s individual type & level of potential: there are multiple ways to be

psychologically healthy, productive & creative.

f. Q: What about differences in personality & psychopathology?

g. Q: Not really a therapeutic system per se.

h. Q: May be more useful for high-functioning YAVIS’s who are frustrated in their personal goals.

i. Q: Finds modern application in may performance coaching systems. 23. What are the core components of existential psychotherapy?

a. Less cheerily optimistic than humanistic psychotherapy, although often grouped together because both take a less pathological, more practical, here-and-now approach to problem in living.

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b. Origin in existential philosophy: we are alone in the universe with no absolute principles to guide us, so each person must create their own meaning to deal with the challenges of life, and so avoid impaired by existential anxiety.

c. Rollo May: Love and Will

d. Viktor Frankl: Man’s Search for Meaning.

e. Irvin Yalom: Existential Psychotherapy.

24. What are the four existential challenges of existential psychotherapy and how do they play out in the four dimensions of treatment?

a. Yalom: The 4 Challenges of Existential Psychotherapy

i. Isolation = No matter how close one becomes to another (a child, a parent, a lover), there is an ultimate unbridgeable gap 

ii. Meaninglessness = what is the purpose of a human beings life.

iii. Freedom = To what extent does on have to self actualize and express what they want to do.

iv. Death = “Aristotle = All philosophy is learning how to die.” What happened after you die?

b. Yalom: The 4 Task of Existential Psychotherapy

i. Create authentic meaning in these four dimensions:

1. Physical dimension: limits

2. Psychological dimension: identity

3. Social dimension: authentic interaction.

4. Spiritual dimension: personal narrative and immortality

project.

25. What have been some of the critiques of existential psychotherapy? a. Existential- Humanistic Psychotherapy: Questions

i. Useful for most clinical problems?

ii. Suitable for YAVIS’s only?

iii. How do we know when anxiety or depression are “clinical” vs.

“existential.”?

iv. Is philosophy orientation itself tied to personality dimensions?

v. Rise and fall of philosophical counseling (Marinoff).

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vi. Existential & humanistic elements incorporated into many integrative psychotherapies: cf. personal narrative.

26. What are the goals of supportive psychotherapy and how do they differ from those of other psychotherapies?

a. Supportive Psychotherapy

i. There are supportive aspects in all forms of psychotherapy, but for certain patients and for certain problems, supportive psychotherapy is the treatment of choice.

ii. May be incorporated into other forms of therapy, as needed.

iii. Sometimes patients will say: “Just f**king telling me what to do!” Sometimes, this is the correct approach, sometimes not.

iv. Supportive psychotherapy may be applicable to the following

treatment contexts:

1. Intellectually limited patients.

2. Cognitively disabled patients.

3. Physically disabled patients.

4. Severed psychopathology.

5. Elderly patients.

6. Low-insight or psychological-mindedness.

7. Cultural diversity.

8. Tough guys: traditional masculine orientation.

9. Military, law enforcement, first responders.

10. Correctional facilities.

11. Mandated treatment referrals.

12. Crime victims.

13. Crisis intervention & psychological first aid.

b. Supportive Psychotherapy

i. Many of these patients have felt out of control for most of their lives, so providing a way for them to achieve some kind of control and

confidence over any aspects of their lives is an important step toward productive behavior change.

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ii. Some patients may bound in and out of therapy as needed, other may require regular, long-term, and even lifelong care (cf. medical/rehab

model).

iii. For some patients supportive psychotherapy may be the vehicle of trust and confidence that enables more intensive types of therapy.

27. Describe the commonly used supportive psychotherapy techniques. a. Supportive Psychotherapy Techniques

i. Empathic presence

ii. Non Judgemental attitude ( to a point).

iii. Assist clarification & expression of thoughts and feelings.

iv. Assist clarification & expression of problems & goals.

v. Practical advice.

vi. Scripts & behavioral rehearsal.

1. The goal is to give them a template, a different idea on how to

approach things. Not necessarily an actual script.

vii. Impulse control.

viii. Assist in developing capacity for self-directed action, depending on patient.

ix. Psychotherapists as auxiliary ego or hired frontal lobes.

x. In supportive therapy, the clinician is typically more active and

directive than in other forms of psychotherapy.

28. What are some of the common problems that impel couples to seek therapy? a. Couples Therapy: Some Typical Problem

i. Problems can be multiple, complex, and interrelated, but often

revolve around common themes.

ii. Financial stresses.

1. The idea is who deserves what that makes the financial strain.

Usually the most common reason to fight, because money is

resource.

iii. Overcommitment to work or other non-relationship activities:

hobbies, socialization.

1. Overcommitment to anything other than relationship can

sometimes be thought of as infidelity.

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iv. Legal problems.

v. Illness or disability.

vi. Substance abuse.

1. A lot of substance abuse you will be seeing will be below the tip

of the iceberg.

vii. Infidelity or other sexual issues.

viii. Childcare issues, e.g dysfunctional child.

ix. Change in personality and/or behavior in one or both members. x. Change in goals and expectations of the relationship.

xi. Relatives and other people problems.

xii. Different problems at different life stages.

xiii. Always a combination of person and situation.

29. What are the important issues to be addressed at the outset of couples therapy? a. Couples Therapy: Basic Issues

i. Does the couple want to stay together or split? Do they know? Do they agree?

1. Trying to clarify what the agenda is. Do they each have a clear

idea of what they want? If they do not, make a note of that.

ii. Is the problem new or has it been present for most or all of the

relationship?

iii. What are the diagnostic issues ( personality & psychotherapy) that characterizes one or both parties.

iv. How much is a couple problem and how much an individual problem? What is the ratio: 50-50, 80-20?

v. What are the roles of other people in the couple’s problems: parents, children, relatives, friends, job?

vi. What has the couple tried so far, e.g. self-help, previous therapies? 30. Describe the commonly used couples therapy techniques.

a. Couples Therapy: Strategies & Applications

i. Not one “perfect” way, but flexible approach.

ii. Couples therapy may start as individual therapy, and vice-versa. iii. Initial interview of couple.

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iv. Separate interview of each member.

1. Anything disclosed in an individual session is to be kept in that

session, privacy is a big deal. You do not want to seem like a

double agent of some sort.

v. Reconvene and strategize.

1. Eventually you would want to get them both in a room once

again to try and talk thing out.

vi. Clarification of communication

vii. Clarification of goals: compatible? Realistic?

viii. Practical advice and behavioral homework.

ix. Dealing with relationship dissolution.

31. What types of problems impel people to seek treatment for their families? a. Couples problems ( see couples therapy).

b. Parent-child issues.

i. Parents disagree on child’s problems.

ii. Parent disagree on basic child-rearing issues.

c. Extended family issues.

d. Work/family issues.

i. Work overcommitment

ii. Family stresses.

e. Triangulation.

i. The parent tries to get the child on their side. Most likely by telling the child their problems, sometimes even by bad mouthing the other

parent.

f. Divorced families.

g. Blended families.

i. When parents remarried and now you have step siblings and step children and how you interact and are getting along with them.

h. Adult child problems (growing area).

i. Post high-school, college age, who sometimes has problems, mental illness, or they don't do anything at all.

i. Clarification of the problem(s).

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j. Clarification of family roles.

k. Agreement on goals.

l. Development of a coherent family narrative.

m. Interview and treatment of different family members, in varying

combinations.

n. Family practice model of family therapy.

32. What are the main strategies and techniques used in family therapy? a. Family Therapy

i. Another large province of LCSWs, LMHCs, and LMFTs.

ii. Treats family as the unit of therapeutic intervention.

iii. Like couples therapy, often burdened by a variety of “structural models.”

iv. Family therapy may begin as individual therapy, child therapy, or couples therapist, then evolve to include more family members.

v. Or, over time, family therapy may become more focused on individual family members.

vi. Frequently, there is a complex mix-and-match dynamic with families that have been in treatment over a length of time.

vii. IP= identified patient: who is the ”problem” that is being brought in for therapy - or who does the family think it is or project it on to? More

than one IP? Is everyone an IP.

33. Describe the main features of the therapy and practice of group psychotherapy, as well as practical issues involved in running such groups.

a. Group Therapy: Basic Concepts

i. Multiple models of group therapy: all emphasize important

therapeutic role of group interaction.

ii. Partially extends the transference relationship to many people.

iii. Serves as a laboratory for “true” feelings and interpersonal dynamics. iv. Role of therapist: moderator, guide, coach, or participants: multiple roles.

v. Role boundaries, ground rules (e.g. no dating, no business, etc.), and confidentiality issues: control? Liability?

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vi. Group therapy may be utilized as a stand-alone modality ( e.g. in institutions) or in combination with individual therapy.

b. Group Therapy: Practical Issues

i. Usually 5-10 members - enough for group dynamics to form, but not so many that some members will be left out.

1. Open groups = members come and go; usually no time limit.

2. Closed groups = Members start and finish together, usually

within a fixed number of sessions and a more structured

framework.

ii. Time frame usually longer than with individual therapy; average = 90 minutes.

iii. Sometimes utilize co-therapists, especially where the aim is to

specifically recapitulate the family group.

iv. Outside relationships. Usually constrained in some way. Don't want exclusionist, “special” pair-bonds or other relationships to interfere

with group dynamics.

1. No romance, no business, no socializing out the group.

2. Paradox of the group being a recapitulation of natural human

interaction, yet not actually a natural human interaction.

v. Confidentiality. Number of members make the commitment to

maintain consistent attendance and participation.

1. Session time usually longer than with individual therapy;

average = 90 minutes.

2. Session fee is usually smaller per patient than with individual

therapy, but therapists can still make extra income from group

therapy.

vi. Efficacy of group therapy: usually depends on the people and

problems being treated.

vii. Special problems in group therapy.

1. Dysfunctional members

2. Absenteeism

3. Expelling a dysfunctional member.

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34. What are common factors associated with successful group therapy and the strategies and techniques used to achieve success?

a. Group Therapy: Therapeutic Factors ( Yalom)

i. Cf. “Common factors.” Cf. group dynamics in nonclinical situations. ii. Instillation of hope = “ We’re all here for a common purpose to help one another.”

iii. Universality = “You mean, i'm not the only one with this problem?” 1. Homogeneous groups = Same based on patient population

and also on the issues being addressed.

2. heterogeneous groups = Different based on patient population

and also on the issues being addressed.

3. Specialized groups

4. Benefits and drawbacks.

iv. Group cohesiveness = “We’re all in this together, we share a common purpose, we’re special to one another.” Reinforces tribal loyalty.

v. Catharsis = May be easier to express inner thoughts and feelings once you’ve seen other do so in a nonjudgmental and supportive

environment (but beware of project hostility).

vi. Information/education = Therapeutic lessons tend to “stick” more when shared and discussed in a group setting.

vii. Interpersonal learning = Opportunity to try out new behaviors on others who are nonadversarial and supportive, and to get honest, but supportive, corrective feedback.

1. The group is a social microcosm that allows each member ,

over time to work out his/her own psychopathology or

dysfunctional relationship styles.

2. Less emphasis on historical developmental dynamics and

more on here-and-now relationships.

3. Therapy group relationships vs. “real” relationships?

viii. Imitative behavior = Explicit role-playing and implicit imitation of more functional relationships and communications.

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ix. Development of socialization techniques = Practice and rehearse specific scenarios for particular interpersonal problems, e.g. work, family,

other roles.

x. Altruism = For some members, learn that people aren’t all mean, selfish, hostile, abusive, untrustworthy, etc. Also learn how to give

unselfishly without fear of exploitation or abuse.

xi. Existential factors = Learn to deal with the meaning of life, death, evil, etc. May be especially important in some specialized group, e.g. PTSD, bereavement, disability, etc.

xii. Group therapy vs. support groups.

35. Describe the similarities and differences between child psychotherapy and adult psychotherapy, including some of the unique challenges and practical issues in treating children.

a. Clinical psychology actually began in large part with child psychology ( e.g. Witmer), but in the ensuing years, children have been alternately been neglected or overpathologize.

b. Many children are evaluated and treated in the context of family therapy, or child therapy may turn into family therapy, or vice versa (IP?).

c. When a child is the sole or primary focus of treatment, there is often a diagnosed or suspected clinical disorder. When the issue involves more genetic “behavioral problems,” it is more likely that the family will get involved.

d. Especially with younger children, much psychotherapy occurs through the proxy of the parents.

36. What are important factors to consider in the psychological assessment of a child? a. Child Psychological Assessment

i. Most childhood psychological disorders and behavioral problems can be categorized into:

1. Internalizing disorders = “Chili peppers,” i.e. anxiety,

depression, phobias, ADD.

2. Externalizing disorders = “Garlic,” e.g oppositionalism,

antisocial behavior, impulsivity, school problems, ADHD. May

also be comorbid with learning disorders.

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ii. May be combinations of these disorders, or other problems, e.g. autism, ADHD, substance use.

iii. Usually, the more specific the presenting problem, the more focused will be the assessment, e.g. educational issues, forensic evaluation,

etc.

iv. Type of child and problem will determine type of treatment.

b. Child Psychological Assessment: Key Factors

i. Presenting problem(s) = what are they, how bad, how long. Diagnostic issues.

ii. Developmental history = prenatal care, pregnancy or birth

complications, developmental milestones, illnesses, educational

history.

iii. Family History = genetic and psychosocial, immediate and extended family.

iv. Community/environment = family structure, socioeconomics,

neighborhood, school, extended family, peers.

c. Child Psychological Assessment: Key Components

i. A given case may not involve all of the following and some

components may depend on child’s age and clinical status.

1. Prior clinical records.

2. Interview with child.

3. Interview with parent(s).

4. Interview with child and parent(s): assess interaction.

5. Interview with collaterals.

6. Naturalistic observation.

7. Rating scales and checklists.

8. Specialized tests and measures: intelligence, scholastic,

personality, etc.

37. Describe the commonly used child therapy strategies and techniques, and the challenges and limitations of each.

a. Type of therapeutic strategy will depend on:

i. Child’s age and developmental stage,

ii. Nature of the problem or disorder

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b. Issues of confidentiality, informed consent, and mandated reporting. c. Having the “confidentiality discussion.”

i. Legally anything that the child says you must disclose to parents. You should emphasize to the parents that although they legally have the

right the know everything, it is wise if they respect their child's

confidentially and allow you to keep some things to yourself. Things

you must disclosure are of course just like anything else, something

that harms the child or those around them in any way.

d. Talk therapy. For older children and adolescents who have adequate communication skills and a willingness to talk.

i. Children may vary widely in their verbal skills, attention span, and maturity at any age.

ii. For younger children, talk is usually combined with other modalities. e. Play therapy. Involves the use of toys, games, artwork, etc.

i. Play as a nonthreatening, bonding exercise.

1. Because for many children playing is a way of making friends.

You can allow the children to bring in their own toys, and even

teach you how to play their games.

ii. Utilize play to encourage direct verbal communication.

iii. Utilize play to help children express metaphorically or symbolically what cannot be directly verbalized,either because of linguistic

immaturity or because material is too emotionally painful (e.g.,

trauma): incorporate projection and transference into play objects

and activities.

iv. Use caution when interpreting symbolic aspects of play therapy, e.g. legal implications.

f. Behavior therapy

i. May be effective for older children with internalizing disorders.

ii. For younger children or children or adolescents with externalizing disorder, much will occur via proxy of the parents.

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1. Train parents to create an environment in the household to

have parents reinforce the kind of behavior that they wish their

child to have. Parents must be on the same page regarding

goals.

g. Therapeutic modeling

i. Therapist provides a corrective emotional experience through

modeling of mature adult behavior.

ii. Can be subtle or overt.

iii. Combine with other therapeutic modalities.

iv. Combine with education and training of parents.

1. Basically you are trying to substitute more functional ways of

this family communicating and interacting with each other into

this families lives.

38. What are some of the effects of stress on human health, and how can mental health practitioners be of help in these matters?

a. Emotion-focused coping = focus on reducing effects of stressors, on feeling better, without necessarily addressing the causes.

b. Problem-focused coping = constructively deal with the cause of stress. c. Problem-focused coping traditionally thought to be more mature or healthy than emotion-focused coping, but both may have a role to play in the adaptive response to stressful circumstances.

d. Also consider role of social support & health

e. Psychophysiological Disorders: Treatment

i. Abreactive therapy

ii. Psychodynamic exploration

iii. Biofeedback

iv. Behavioral medicine

v. Lifestyle changes

vi. Cognitive-behavioral therapy

vii. Coping skills training: self-efficiency

viii. Family & psychosocial modalities.

ix. Treating the symptom or the patient?

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x. Role of MH professionals in medical treatment.

39. What are the stages of the General Adaptation Syndrome (GAS), and what do they tell us about the human stress response?

a. General Adaptation Syndrome: G.A.S. (Hans Selye)

i. Stage of Alarm:The alarm stage is also known as the fight or flight stage. When you're in the alarm stage, your heart beats faster,

sending more blood to your arms and legs in case you need to fight or flee.

ii. Stage of Resistance: occurs when moderate strain affects a person's life continuously for weeks.

iii. Stage of Exhaustion:Hopefully the issue is resolved in the alarm or

resistance stage, but the body cannot maintain the resistance stage for a long period of time.

40. What is the scientific basis for the practice of biofeedback therapy, and how is biofeedback therapy carried out in clinical practice?

a. Can you change physiological behavior ( e.g blood pressure) like you can change overt behavior (e.g throwing a ball into a basket)? Yes- if you can become aware of the behavior and your effects on it.

b. Biofeedback = Attempts to directly alter physiological functioning, using the behavior principles of classical and operant conditioning.

c. Typically involves training in some form of low-arousal technique, such as progressive relaxation or meditation, then uses counterconditioning or operant conditioning to change physiological response.

d. Apparatus-assisted biofeedback = use an electronic transducer to amplify an otherwise imperceptible physiological signal, which is then fed back to the subject to learn how to control.

e. Subject is training in a low-arousal or behavioral control technique to alter the amplified signal (visual or auditory) and, by extension, the physiological process underlying it. Lie detector in reverse.

f. Most commonly used biofeedback modalities.

i. Electromyogram (EMG): muscle tension. Higher activity = greater arousal.

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ii. Galvanic skin response (GSR): Sweat gland activity. Higher activity = greater arousal.

iii. Temperature: Lower peripheral temperature = greater arousal. iv. Does not necessarily tell you what type of arousal is being measured (anxiety vs. anger) or what physiological or psychological factors may underlie it.

g. Less commonly used biofeedback modalities.

i. Respiration: higher respiration rate = greater arousal

ii. Blood pressure: Higher blood pressure = greater arousal.

iii. Electroencephalogram: higher frequency, lower amplitude = greater arousal.

iv. More specialized applications to specific conditions or disorders. v. Direct and indirect applications; e.g. use EMG and temperature

regulation to treat hypertension or irritable bowel syndrome. Treating the stress response generally or the physiological response

specifically.

h. Biofeedback has been used to treat the following conditions and disorders. i. Tension & migraine headaches.

ii. Chronic pain

iii. Hypertension & cardiac rhythms disturbances.

iv. Irritable bowel syndrome & incontinence.

v. Depression ( vagus nerve stimulation).

vi. Epilepsy & ADHD (controversial)

vii. Performance enhancement (military, sports)

41. Describe the physiological modalities that are amplified and fed back to the patient in the most commonly practiced forms of biofeedback.

a. Answer above

42. What medical conditions or syndromes are the most common targets of biofeedback therapy in daily clinical practice?

a. Mood disorder

b. Psychotic disorder

c. Cluster B personality disorder

d. Suicidality.

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43. What are the most common applications of health psychology and behavioral medicine in daily clinical practice?

a. HPBM: Psych Assessment for Elective MED Procedures.

i. Based on past adverse outcomes, many physicians and medical

insurance companies require a basic psychological screening for

elective procedures that alter a patient's subjective state or

self-image, including:

1. Invasive pain-control surgeries, e.g. spinal cord stimulator or

morphine pump.

2. Gastric bypass or gastric banding surgery for weight control.

3. Cosmetic surgeries.

4. Other applications

ii. Evaluation usually involves screening for serious psychopathology or personality disturbances that might be associated with poor

compliance or adverse reaction to the procedure, such as:

1. Mood disorder

2. Psychotic disorder

3. Cluster B personality disorder

4. Suicidality.

iii. Evaluation typically includes the following components

1. Patients general medical history

2. History of the current disorder for which he/she is seeking the

procedure

3. Past efforts to deal with the disorder and successes and

failures.

4. Patients understanding of the proposed procedure

5. Patients understanding of the likely outcomes of the procedure

6. What will the patient do if the procedure is not successful?

44. What roles to psychologists play in the legal system?

a. Roles of a Forensic Psychologist

i. Expert witness

ii. Case consultant

iii. Trial consultant

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iv. Amicus curiae

v. Researcher/ investigation

vi. Clinical treatment provider

45. Describe the similarities and differences between an evaluation done for a patient in clinical practice and a forensic evaluation done for an attorney or the court. a. Background records.

b. Clinical interview

c. Collateral interviews

d. Psychological tests & measures

e. Case conceptualization

i. Comprehensiveness, consciousness, clarity, and transparency.

ii. Address relevant psycholegal issues, e.g disability, fitness for custody, insanity, etc.

f. Recommendations

46. What are the differences between the civil and criminal branches of the U.S. legal system?

a. Civil Forensic Psychology

i. Plaintiffs & defendants

ii. Lawsuit brought

iii. Preponderance of the evidence

iv. Civil competencies

v. Family law.

vi. Divorce & custody

vii. Torts & personal injury

viii. Contract law

ix. Injunctive lawsuits.

b. Criminal Forensic Psychology

i. Prosecuting & defense

ii. Charges filed

iii. Beyond a reasonable doubt

iv. Criminal competencies

v. Insanity defense (NGRI)

vi. Diminished capacity

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vii. Probation and parole

viii. Dangerousness prediction

ix. Adult & juvenile justice systems

47. What are the legal and psychological criteria for competency to proceed and mental state at the time of the crime(insanity)?

a. Civil Competencies

i. Presumption of competency may be set aside if there is compelling evidence to the contrary: burden of proof is on the challenge to

competency.

ii. Either the state of private parties may raise challenges to a person’s civil competency; the latter usually involve family members.

iii. If the court declares a person to be incompetent, that person will be appointed a guardian who is legally empowered to make decisions

regarding the ward’s person and property.

iv. If no family member is able or willing to serve as guardian, the person may become a ward of the court.

v. Adults or children.

b. Civil Competencies: Role of Psychologist

i. Psychological evaluation for civil competency typically includes:

1. Relevant Medical, Family, And Social History Records.

2. Clinical Examination Of Subject.

3. Administration of relevant psychological & neuropsychological

tests.

4. Interview of family members and other collaterals (e.g.

neighbors, institutional staff).

c. Criminal Competencies

i. In most U.S courts the competency criteria boil down to three main elements, consisting of the defendant's present ability to:

1. Understand and appreciate the nature of the charges against

him/her

2. Understand and appreciate the range of possible penalties.

3. Assist counsel in his/her own defense

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ii. Most states have their individual versions of these competency

criteria.

d. Criminal Competencies: Psych Evaluation Components

i. Identifying information

ii. Record review: past and present

iii. Description of defendant and charges.

iv. Basic facts about case ( arrest report, etc).

v. Defendants Response To, And Ratings Of, Competency Criteria.

vi. Diagnostic conclusions ( not required, but recommended).

vii. Forensic conclusion:

1. Competency to proceed.

2. Not competent to proceed, but restorable with

recommendations and time frames.

3. Permanently not competent to proceed.

viii. Criteria for involuntary hospitalization.

ix. Other recommendations.

48. What mental disorder diagnoses or psychological conditions would most likely be relevant to criminal competency or insanity determinations?

a. Characteristics of Noncompetent Defendants

i. Live on the margins of society: unmarried, socially isolated.

ii. Lower educational attainment, lower vocational status.

iii. Usually charged with less serious crimes; small proportion are

charged with violent crimes.

iv. History of mental health treatment

v. History of substance use and substance abuse treatment.

vi. Most common diagnoses relevant to CST: Psychotic disorder, severe mood disorder, mental retardation, dementia, substance abuse

effects, medical conditions.

Different defenses:

M’Naghten Standard (1843): “It must be clearly proven that, at the time of committing an act, the party accused was laboring under such a defect of reason, from disease of the

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mind, as to not know the nature and quality of the act he was doing, or if he did know it that he did not know he was doing wrong.”

American Law Institute (ALI) - Model Penal Code (MPC) Standard (1972): “A person is not responsible for criminal conduct is at the time of such conduct, as a result of mental disease or defect, he lacks the substantial capacity either to appreciate the criminality (wrongfulness) of his conduct or to conform his conduct to the requirements of the law.”

b. Insanity Defense

i. Actus reus = “guilty act”

ii. Men rea = “ guilty mind.”

iii. Insanity defense is a complete exculpatory defense

iv. Insanity defense may usually be raised at any point in the legal

proceedings.

v. In practice, the insanity defence is raised very rarely and is successful still more rarely.

c. Guilty But Mentally Ill

i. Currently, in 13 states, a defendant may be found GBMI, in which case he/she may be sentenced to as term consistent with the verdict, but

they are supposed to receive appropriate treatment.

ii. If the convictee cannot receive such treatment in prison, the are supposed to be transferred to a secure forensic mental health facility for treatment.

iii. In practice, the fate of GBMI defendant differs little from that of regular defendant who receive a guilty verdict.

d. Diminished Capacity

i. Aggravating and mitigating factors

ii. Although the accused was not legally insane, nevertheless, due to emotional distress, physical condition or other factors , he/she could

not fully comprehend the nature of the criminal act he/she is accused of committing.

iii. Diminished capacity is raised by the defense either (a) in attempts to remove the element of premeditation or criminal intent and thus

obtain a plea agreement or conviction for a lesser crime, such as

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manslaughter instead of murder; or (b) at sentencing as a mitigating

factor. Not exculpatory: still guilty.

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