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Clinical Psychology (EPPP).pdf, Exams of Nursing

Aston UniversityNursing

Clinical Psychology (EPPP).pdf

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Clinical Psychology (EPPP)
Clinical Psychology -
- the study, diagnosis, and treatment of psychological and behavioral disorders
Assumptions of Psychodynamic Therapies -
- human behavior is motivated by unconscious processes
- early development has a profound effect on adult functioning
- universal principles explain personality development and behavior
- insight into unconscious processes is a key component of therapy
Freudian Psychoanalysis -
- human beings are determined by irrational forces, unconscious motivations, biological and
instinctual needs and drives, and psychosexual events that occur during the first five years of life
Freud's Personality Theory -
- composed of two theories: structural (drive) theory and developmental theory
Structural Theory
(Freud) -
- the personality is composed of three structures: the id, ego, and superego
Id -
- present at birth and consists of the person's life and death instincts
- operates on pleasure principle and seeks immediate gratification of its instinctual drives in order to
avoid tension
Ego -
- develops at six months of age
- operates ont eh reality principle that defers gratifcation until an appropriate object is available in
reality and employs thinking
- mediates conflicting demands of pleasure and reality
Superego -
- develops between four and five years
- represents an internalization of society's values and standards
- attempts to permanently block socially unacceptable drives
Developmental Theory
(Freud) -
- emphasizes the sexual drives of the id and proposes that an individual's personality is formed
during childhood as a result of certain experiences during psychosexual stages of development
- over or undergratification of a person's sexual needs during a stage is associated with different
personality outcomes
Oral Stage -
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Clinical Psychology (EPPP)

Clinical Psychology -

  • the study, diagnosis, and treatment of psychological and behavioral disorders Assumptions of Psychodynamic Therapies -
  • human behavior is motivated by unconscious processes
  • early development has a profound effect on adult functioning
  • universal principles explain personality development and behavior
  • insight into unconscious processes is a key component of therapy Freudian Psychoanalysis -
  • human beings are determined by irrational forces, unconscious motivations, biological and instinctual needs and drives, and psychosexual events that occur during the first five years of life Freud's Personality Theory -
  • composed of two theories: structural (drive) theory and developmental theory Structural Theory (Freud) -
  • the personality is composed of three structures: the id, ego, and superego Id -
  • present at birth and consists of the person's life and death instincts
  • operates on pleasure principle and seeks immediate gratification of its instinctual drives in order to avoid tension Ego -
  • develops at six months of age
  • operates ont eh reality principle that defers gratifcation until an appropriate object is available in reality and employs thinking
  • mediates conflicting demands of pleasure and reality Superego -
  • develops between four and five years
  • represents an internalization of society's values and standards
  • attempts to permanently block socially unacceptable drives Developmental Theory (Freud) -
  • emphasizes the sexual drives of the id and proposes that an individual's personality is formed during childhood as a result of certain experiences during psychosexual stages of development
  • over or undergratification of a person's sexual needs during a stage is associated with different personality outcomes Oral Stage -
  • Freud's first stage of personality development, from birth to about age 2, during which the instincts of infants are focused on the mouth as the primary pleasure center. Anal Stage -
  • Freud's second stage of psychosexual development where the primary sexual focus is on the elimination or holding onto feces. The stage is often thought of as representing a child's ability to control his or her own world. Phallic Stage -
  • Freud's third stage of personality development, from about age 4 through age 7, during which children obtain gratification primarily from the genitals. Latency Stage -
  • Freud's fourth stage of psychosexual development where sexuality is repressed in the unconscious and children focus on identifying with their same sex parent and interact with same sex peers. Genital Stage -
  • Freud's last stage of personality development, from the onset of puberty through adulthood, during which the sexual conflicts of childhood resurface (at puberty) and are often resolved during adolescence). Defense Mechanisms -
  • occur when the ego is unable to ward off danger through rational, realistic means
  • these operate on an unconscious level and deny or distort reality (danger or anxiety helps alert the ego to impending threats, such as conflict between the id and the superego) Repression -
  • defense mechanism in which id's drives are excluded from conscious awareness by maintaining them in the unconscious Reaction Formation -
  • defense mechanism in which one avoids an anxiety evoking instict by doing the opposite View of Psychopathology (Freudian) -
  • maladaptive behavior results from an unconscious, unresolved conflict that occurred during childhood Psychoanalytic Therapy -
  • goal is to reduce symptoms by bringing the unconscious into conscious awareness and integrating previously repressed material into the personality
  • use free associations, dreams, resistances, and transferences to confront, clarify, interpret, and work through Free Associations -
  • a method in psychotherapy where a patient is encouraged to sit back, relax, free his/her mind, refrain from trying to be logical, and report every image or idea that enters his/her awareness, usually in response to some word or picture that the therapist provides as an initial stimulus
  • the ways a person chooses to compensate for inferiority and achieve superiority determine this and impact a person's personality
  • impacted by early experiences, such as family context Healthy Style of Life (Alder) -
  • life is marked by goals that reflect optimism and confidence and contributing to welfare of others Unhealthy (Mistaken) Style of Life (Alder) -
  • life is characterized by self-centeredness, competativeness, and striving for personal power View of Pychopathology (Alder) -
  • metal disorders are characterized by maladaptive attempts to compensate for feelings of inferiority, a preoccupation with achieving personal power, and a lack of social interest Alderian Therapy -
  • therapy tries to understand patient's style of life and reorient patient to a more adaptive life style
  • uses lifestyle investigation to learn information about patient's family constellation, hidden goals, and basic mistakes (distorted beliefs and attitudes) Libido -
  • general psychic energy Assumptions of Jung's Analytical Psychotherapy -
  • behavior is determined not only by past events but also by future goals and aspirations
  • personality is the consequence of both conscious and unconscious factors
  • personality consists of two attitudes (extraversion and introversion) and four psychological functions (thinking, feeling, sensing, and intuiting)
  • personality develops throughout life Personality Theory: Conscious (Jung) -
  • oriented toward the external world, governed by the ego, and represents individual's thoughts, ideas, feelings, perceptions, and memories Personality Theory: Personal Unconscious (Jung) -
  • contains experiences that were once conscious but are now repressed or forgotten Personality Theory: Collective Unconscious (Jung) -
  • latent memory traces that have been passed down from one generation to the next Personality Theory: Archetypes (Jung) -
  • primordial images that cause people to experience and understand phenomenon in a universal way
  • exs include the self (unified personality), the persona (public mask), the shadow (dark side of personality), the anima and animus (feminine and masculine) Individuation (Jung) -
    • integration of conscious and unconscious aspects of one's psyche that leads to the development of a unique identity
  • this process leads to the development of wisdom View of Psychopathology (Jung) -
    • symptoms are unconscious messages that something is awry and he needs to fulfill a task Jung's Analytical Psychotherapy -
    • goal is to rebridge the gap between the conscious and the personal and collective unconscious
  • therapy relies mostly on interpretations designed to help the client become aware of her inner world
  • utilizes dreams, transference, and countertransference
  • focuses ont eh here-and-now, only addressing past when it will help client understand the present Assumptions of Object Relations Theory -
    • object-seeking (relationships with others) is a basic inborn drive
  • focus is on child's early relationship with objects Objects Relations Personality Theory (Mahler) -
    • focuses on the processes which help an infant assume his own identity Object Relations Theory: 1 month old (Mahler) -
    • infant is in a state of normal autism and is oblivious to the external environment Object Relations Theory: 2-3 months old (Mahler) -
    • infant is fused with mother and does not differentiate between I and not-I Object Relations Theory: 4 months old (Mahler) -
    • separation-individuation phase
  • child separates through sensory exploration and physical exploration (when learn to walk) Object Relations Theory: 3 yrs old (Mahler) -
    • child has developed a permanent sense of self and object (object constancy) and is able to perceive others as both separate and related View of Psychopathology (Object Relations) -
    • maladaptive behavior is the result of abnormalities in early object relations (e.g., during separation-individuation)
  • use behaviors such as nodding, eye contact, reflecting feelings Assumptions of Gestalt Therapy (Fritz Perls) -
    • based on premise that each person is capable of assuming personal responsibility for his own thoughts, feelings, and actions and living as an integrated whole
  • people temd to seek closure
  • a person's perceptions of parts as wholes reflect his current needs
  • a person's behavior represents a world that is greater than the sum of its parts
  • behavior can be fully understood only in its context
  • a person experiences the world in accord with the principle of figure/ground Gestalt Personality Theory (Perls) -
    • personality consists of the self and the self-image
  • the self is the creative aspect of personality that promotes the inherent tendency for self-actualization
  • the self image is the darker side of the personality that hinders growth and self actualization by imposing external standards View of Psychopathology (Gestalt) -
    • maladaptive (neurotic) behaviors involves an abandonment of the self for the self-image and a resulting lack of integration
  • it often stems from disturbance in the boundary between the self and external environment Boundary Disturbance: Introjection -
    • occurs when a person accepts concepts, facts, and standards from the environment without actually understanding or fully assimilating them
  • very compliant in therapy Boundary Disturbance: Projection -
    • disowning aspects of the self by assigning them to other people
  • in extreme cases can result in paranoia Boundary Disturbance: Retroflection -
    • doing to oneself what one wants to do to others
  • ex turn anger toward another person inward Boundary Disturbance: Confluence -
    • absence of boundaries between the self and the environment
  • client is often intolerant of any differences between onself and others and has feelings of guild and resentment Gestalt Psychotherapy -
    • goal is to help a client achieve integration of the various aspects fo the self in order to become a unified whole
  • therapists avoid diagnostic labels and view historical events as important only when they directly affect client's functioning
  • transference is counterproductive
  • primary curative factor in therapy is awareness which is defined as fully understanding one's thoughts, feelings, and actions in the here-and-now Gestalt Empty Chair Technique -
    • role play is used to help clients become aware of and integrate aspects fo the personality that have been disowned or denied Assumptions of Existential Therapies (e.g., Logotherapy) -
    • emphasize the human conditions of depersonalization, loneliness, and isolation
  • people are not static, but are in a constant state of becoming View of Psychopathology (Existential) -
    • maladaptive behavior is a natural part of the human condition Existential Psychotherapy -
    • goal is to help clients overcome their troublesome feelings (e.g., of meaningless) so they can live in a more committed, self-aware, authentic, and meaningful way
  • therapist-client relationship is most important tool Paradoxical Intention -
    • used to reduce client's fear by having her focus in an exaggerated and humorous way on the feared situation Assumptions of Reality Therapy (William Glasser) -
    • influenced by control theory which states human behavior originates from within the invidual rather than from external forces
  • therapy is based on premise that people can take control of their own lives
  • rejects medical model and concept of mental illness View of Psychopathology (Reality Therapy) -
    • maladaptive behavior occurs when a person develops a failure identity by fulfilling her needs for belonging, power, freedom, and fun in an irresponsible way Reality Psychotherapy -
    • goal of therapy is to identify responsible and effective ways for satisfying needs and developing a success identity
  • focuses on current behaviors and beliefs
  • views transference as detrimental
  • stresses conscious processes
  • emphasizes value judgments, especially ability to judge right and wrong Brief Therapies -
    • time limited (6-30 sessions)
  • focuses on clients presenting concerns

View of Psychopathology (Transtheoretical Model) -

  • does not address etiology or characteristics of maladaptive behavior
  • focuses on factors that facilitate behavior change Transtheoretical Model: Precontemplation Stage -
  • individual has little insight into the need for change and does not intend to change Transtheoretical Model: Contemplation Stage -
  • individual is aware of the need for change, considering changing in the next six months, but not committed to change
  • ambivalence Transtheoretical Model: Preparation Stage -
  • individual plans to take action, usually within the next month, and has a realistic plan for modifying her behavior Transtheoretical Model: Action Stage -
  • individual takes concrete steps to change her behavior and often makes a public commitment to change Transtheoretical Model: Maintenance Stage -
  • individual has maintained behavior change for at least six months and is taking steps to prevent lapses and relapses Transtheoretical Model: Termination Stage -
  • individual feels confident that there are no risks for relapse
  • this stage was not included in the original version of the model Motivational Interviewing (Miller & Rollnick) -
  • method developed specifically for clients who are ambivalent about changing their behavior
  • also utilizes five stages of change
  • uses aspects of client-centered therapy including therapist empathy, reflective listening, and responding to resistance in nonconfrontational ways
  • also address client's beliefs about his ability to change (self-efficacy) General Systems Theory (biologist Ludwig von Bertalanffy) -
  • defines a system as an entitiy that is mantained by the mutual interactions of its components
  • interacting components are best understood by studying them in their context Open System -
  • a system that continuously receives input from and puts output to the environment and is more adaptable to change
  • ex. family Homeostasis -
  • the tendency for a family to act in a way that maintains the family's status quo
  • thus if one family member improves, the problems is likely to reappear elsewhere in the family Cybernetics -
  • key feature is the concept fo feedback loops through which a system receives information
  • applied to family communication processes by Gregory Bateson Cybernetics: Negative Feedback Loop -
  • reduces deviation and helps a system maintain its status quo Cybernetics: Positive Feedback Loop -
  • amplifies deviation or change and thereby disrupts the system
  • promotes appropriate change in a dysfunctional family system Assumptions of Communication/Interaction Family Therapy -
  • all behaviors are communication and people are always communicating
  • communication has a report function (informational) and a command function (makes a statement about the relationship between communicators) - problems arise when these are contradictory
  • communications patterns are either symmetrical or complementary CI Family Therapy: Symmetrical Communications -
  • reflect equality between communicators, but may escalate into competition CI Family Therapy: Complementary Communications -
  • reflect inequality and maximize differences between communicators (e.g., dominant and submissive roles) CI Family Therapy: Double-Bind Communication -
  • associated with Schizophrenia
  • involves conflicting negative injunctions such as: do that and you'll be punished being said, but don't do that and you'll be punished being expressed nonverbally
  • recipient of communication is also not allowed to comment or seek help from someone else View of Psychopathology (Communication/Interaction Family Therapy) -
  • accepts a circular model of causality such that a symptom can be both a cause and effect of dysfunctional communication
  • dysfunctional communication patterns include blaming and criticizing, mindreading, and overgeneralizing
  • have overly rigid boundaries and are isolated from one another Minuchin: Enmeshed Families -
  • have boundaries that are too permeable and are overly dependent and close to one another Minuchin: Detouring -
  • a chronic boundary problem
  • parents focus on their child by overprotecting them or blaming (scapegoating) the child for the family's problems Minuchin: Stable Coalition -
  • a chronic boundary problem
  • when a parent and child form a cross-generational coalition and consistently gang up on the other parent Minuchin: Triangulation (Unstable Coalition) -
  • a chronic boundary problem
  • occurs when each parents demands the child side with him/her agains the other parent View of Psychopathology (Structural Family Therapy) -
  • family dysfunction is viewed as the result of an inflexible family structure that prohibits the family from adapting to maturational and situational stressors in a healthy way Structural Family Therapy -
  • the goal of therapy is to restructure the family
  • may also use other techniques such as behavioral therapy to address more short term goals
  • interventions focus on the here and now, are directive, and use concrete approaches
  • techniques are designed to unbalance the family's homeostasis in order to facilitate transformation in the family structure Structural Family Therapy: Joining -
  • therapist becomes a part of the family system in a leadership position by blending with the family
  • tracking: identifying and using the family's values, life themes, and significant life events in conversation
  • mimesis: adoptions the family's affective and communication style Structural Family Therapy: Evaluating the Family Structure -
  • assess the family's structure, including transactional patterns, power hierarchies, and boundaries
  • develop a family map to help make a structural diagnosis and determine therapy goals Structural Family Therapy: Enactment -
  • family members are asked to role-play their relationship patterns so that they can be identified and altered Structural Family Therapy:

Reframing -

  • relabeling behaviors so that they can be viewed in a more positive way Strategic Family Therapy (Jay Haley) -
  • influenced by communication/interaction and structural schools of family therapy as well as the use of hypnotic techniques and paradoxical directives
  • goals is to alter a family's transactions and organization, especially its hierarchies and generational boundaries
  • insight is considered counterproductive because it increases resistance View of Psychopathology (Strategic Family Therapy) -
  • maladaptive symptoms are an interpersonal phenomenon that represents a strategy for controlling a relationship when all other strategies have failed
  • struggle for control becomes pathological when intent to gain control is denied and symptoms occur Strategic Family Therapy: Stages of First Session -
  • social stage: observe family interactions and encourage the involvement of all family members
  • problem stage: gather information about why the family came to therapy
  • interaction stage: family members discuss the identified problems while therapists observes
  • goal setting: family members agree to contract of goals Strategic Family Therapy: Directives -
  • assignments to be performed outside of therapy Strategic Family Therapy: Paradoxical Intervention -
  • uses the client's resistance in functional ways (e.g., by resisting the directive the client abandons his dysfunctional behavior)
  • ordeals: unpleasant tasks the client must perform whenever a symptom occurs
  • restraining: encouraging the family not to change
  • positioning: exaggerating the severity of symptoms
  • reframing: placing the symptoms in another frame of reference
  • prescribing the symptom: instructing family members to deliberately engage in the symptom View of Psychopathology (Milan Systemic Family Therapy) -
  • assumes there are circular patterns of action and reaction in a family system
  • maladaptive behaviors result from a family's patterns becoming so fixed that family members are no longer able to act creatively or make new choices about their lives Systemic Family Therapy (Mara Selvini-Palazzoli) -
  • goal of therapy is to help family members see their choices and assit them in utilizing their ability to choose
  • emphasizes understanding their relationships and problems in alternative ways

Orientation, Hesitant Participation, Search for Meaning, Dependency -

  • characterized by attempts to determine the group's structure and meaning, a restricted and rational communication style, search for similarities among group members, and advice seeking and giving
  • members look primarily to the leader Second Stage of Group Therapy: Conflict, Dominance, Rebellion -
  • each member attempts to establish his preferred amount of initiative and power until a social hierarchy emerges
  • advice giving is replaced by criticism and negative comments Third Stage of Group Therapy: Development of Cohesiveness -
  • group bond develops and trust increases
  • attendance improves and members shown concern when another member is absent
  • Yalom describes this as a critical aspect of therapy and says it is analogous to therapist-client relationship in individual therapy Benefits of Group Therapy -
  • provides opportunities for mutliple transferences
  • is a social microcosm that promotes hope, universality, altruism, interpersonal learning, etc
  • group members usually rate interpersonal input, catharsis, self-understanding, and cohesiveness as most important factors Group Therapists Role (Yalom) -
  • creation and maintenance of the group through minimization of forces that threaten cohesiveness (e.g., absences, subgrouping)
  • culture building - foster appropriate behavioral norms, use expertise to change patterns, and use self- disclosure as a model
  • activation and illumination of the here and now Concurrent Group and Individual Therapy (Yalom) -
  • believes primary problem wtih concurrent therapies is that clients tend to rely on individual therapy to drain off affect from the group rather than work on issues with the group members Premature Termination from Group Therapy -
  • 10 - 35% dropout during the first 12-20 sessions
  • prescreening can reduce this rate and enhance therapy outcomes Clients for Group Therapy -
  • good candidates have a presenting problem that is related to interprsonal issues (shyness, argumentative)
  • motivated to change
  • psychologically and verbally sophisticated
  • finds peer support and feedback beneficial
  • does not have problems with following group norms for acceptable behavior Feminist Therapy -
  • therapies emphasize the power differences between men and women and how that differential impacts both men and women's behaviors
  • built on view that a woman's circumstances always reflect the position of women in society View of Psychopathology (Feminist Therapy) -
  • symptoms are related to: the nature of traditional feminine roles, survival tactics as a means of exercising personal power, and/or arbitrary labels that society has assigned to certain behaviors to exert social control Feminist Therapy Goals -
  • primary goal is empowerment, or helping women become more self-defining and self-determining
  • do not attempt to fit client's to the mainstream Feminist Therapy: Striving for an Egalitarian Relationship -
  • techniques to minimize power differential between therapist and client that focus on power with rather than power over
  • use self-disclosures, demystify the therapy process, encourage clients to set their own goals and evaluate therapy progress Feminist Therapy: Avoiding Labels -
  • therapists do not use traditional labels to describe feelings and behavior and de-emphasize traditional assessment and diagnosis Feminist Therapy: Avoiding Revictimization -
  • avoid blaming women for their current problems
  • place the responsibility for the abuse on the abuser and emphasize the woman's strengths Feminist Therapy: Involvement in Social Action -
  • therapists believe that to be effective they must be social and political activists Nonsexist Therapy -
  • recognizes the impact of sexism and avoids the use of gener-biased techniques
  • focuses more on individual factors and modifying personal behavior than sociopolitical factors Feminist Object Relation Theorists -
  • focus on two contributors to gendered behaviors: the sexual orientation of labor and the mother- child relationship Hypnosis -
  • adjunct therapy
  • experiencing alterations of memory, perception, and mood in response to suggestions
  • not linked to any particular neurobehavioral or psychophysiological process Repressed Memories -
  • links attitudes about health to subsequent behaviors
  • health behaviors are influenced by: the person's readiness to take action, perceived susceptibility to the illness, perceived severity of its consequences, evaluation of costs and benefits of acting, and internal and external cues that trigger action
  • believes behavior can be modified by targeting people's knowledge and/or motivation to act Health Locus of Control Model -
  • health related behaviors reflect locus of control beliefs
  • beliefs related to whether they can control their behavior or it is based on luck or other unconrtollable factors Consultation -
  • a process in which a human services professional assists another with a work-related problem with a client system
  • goal is to help the client and client system in some specified way
  • differs from supervision in that supervisor is usually of the same proession and has administrative responsibility and power Stages of Consultation: Entry -
  • identify the client's needs, create a contract, and physically and psychologically enter the system
  • resistance is most common at this stage
  • decrease resistance by clarifying the nature of the relationship and establishing a collaborative relationship Stages of Consultation: Diagnosis -
  • entails gathering information, defining the problems, setting goals, and generating possible interventions Stages of Consultation: Implementation -
  • choosing an intervention, formulating a plan, and starting it Stages of Consultation: Disengagement -
  • evaluating the results, planning for future issues, reducing involvement and follow-up, and termination Consultation: Formative Evaluations -
  • periodically conducted to assess the consultation process Consultation: Summative Evaluations -
  • conducted to assess the consultation product Mental Health Consultation: Client-Centered Case Consultation (Gerald Caplan) -
  • involves working with the consultee to develop a plan that will enable to consultee to work more effectively with a particular patient
  • consultant acts as an expert and provides as much relevant information as possible Mental Health Consultation:

Consultee-Centered Case Consultation -

  • goal is to enhance the consultee's performance in delivering services to a particular population or group of clients
  • focus on consultee's skills, knowledge, abilities, and/or objectivity Mental Health Consultation: Program-Centered Administrative Consultation -
  • working with one or more administrators to resolve problems related to an existing program Mental Health Consultation: Consultee-Centered Administrative Consultation -
  • help administrative level personnel improve their professional functioning so they can be more effective in the future with regard to program development, implementation, and evaluation Parallel Process -
  • supervision issue that is based on issues related to transference, countertransference, and projection
  • when a therapist (supervisee) replicates problems and symptoms with the supervisor that the client is having Eysenck's Outcome Study (1952) -
  • summary of articles indicated that effects of psychotherapy are small or nonexistent
  • any positive effects that do occur are nothing more than spontaneous remission
  • critisized for methodological issues (e.g., no therapy group may not have been good matched controls and received some treatments) Smith et al's Outcome Study (1980) -
  • used meta-analysis
  • obtained a mean effect size of .85, indicating that the average client at the end of therapy is better off than 80 percent of those who need therapy but remain untreated Lipsey & Wilson's Outcome Study (1993) -
  • concluded that psychological treatments equal or exceed those for medical and educational interventions and stated that psychological treatments are generally efficacious Lambert & Bergin's Outcome Study (1994) -
  • based on meta-analyses that have not found any one type of therapy consistently supervior across different types of disorders (except CBT for certain disorders), authors said that positive change is not due to any specific technique
  • positive change is related to shared factors: catharsis, positive relationship with therapist, advice, behavioral regulation, cognitive learning, and mastery Psychotherapy with Older Adults -
  • most common health problems include anxiety, severe cognitive impairment, and depression
  • respond well to a variety of forms of psychotherapy to a degree comparable to younger adults, but respond more slowly Gatz et al.'s Outcome Study -