What do

clinicians do? Private practice (therapy, most common) Insurance companies Hospitals (mental health or regular) Schools/universities Industry corporations Legal systems (not many) Prisons

Counseling centers (non-profit) Military (large employer) CIA, FBI (law enforcement) Can perform assessments (only them) APA/APS Becoming a clinician Kinds of therapists o Psychoanalyst (MD or PhD)

o Psychiatrist (MD, serious mental disorders) o Psychologist (PhD, PsyD, or EdD; scientist-practitioner model) o LCSW (MSW and 2 year internship) o MFT/MA o Nurse practitioner Path for clinical psychology PhD (4-6 years) 3,000 hour internship (not paid)

History of Clinical Psychology

Samantha Waxman

History of Clinical Psychology Mental Health Parity and Addiction Equity Act (2008) o Federal laws (came into law January 2010) o Requires group health plans and insurance that people with mental health problems get same equities as someone with physical problems o Only applies to plans that cover mental health, could just drop it o Always cover schizophrenia, bi-polar, and depression Patient Protection and Affordable Care Act o o o o May 2010 (Obama) For employers who have over 50 employees Same coverage for mental and physical problems Same as parity, but a bit stronger, still could drop mental health coverage

Current Issues Models of training (Boulder, Vail) o First model for clinical psychology was Boulder (scientist practitioner model) Conference in Boulder, Colorado (1960s) Equal knowledge of science and psychology Best trained at universities Almost everywhere today, now heavy emphasis on science PhD o 1973, conference in Vail, Colorado Led to PsyD degree People should just be trained as psych, less emphasis on science and research 30% PsyD through universities Manage Health Care Revolution o Mental health in particular o Manage and negotiate services and rates with provides (kind of like Costco) o Corporate model, profit driven

o Give of what you charge and guarantee a steady flow of patients o Intermittent therapy, shorter therapy, save money, likely they wont get better so they end up coming back later o Not driven by what is best for the patient, only driven by money o Encourages groups and psychoeducation for people (good thing) o HMO: fewer providers, pay less to manage costs, costs are fixed o PPO: More providers, of typical rate o Utilization (who gets to use it) and case management o Dont typically pay for couples therapy or psychological assessment o Impact on clinical psych: Cost effective, profit driven, reduce number of times to see patients, ask patient to take cheaper drug than prescribed Restriction in services, dont pay for assessment, only short, group, or intermittent Training different, more master therapists given same duties but paid a lot less, private practice training diminished, health psychology increased, short therapy training increased Positive~ more community services than there have ever been o Cyclical, at low level right now Prescription privileges o The ability to prescribe psycho-active drugs o Pro: Access to high quality psychotropic drugs (only 17% are prescribed by clinical psychologists) o Increased by 60% between 1985-2005 o Doctors go to conferences or people come in to give them samples and take their word, dont know about research o Advertising o No competence or follow-up with doctors

o Cons: Safety issue, not enough training with whats going on in the body, will change training for clinical psychologists, high malpractice insurance rates for practitioners, further devalues therapy Multicultural Therapy o Yes, treating people from a different culture than you are o Egalitarian attitude and understanding persons culture Review of Research Methods Case study o Intensive study on 1 person, descriptive o Setting stage for other types of research o Cant generalize (weakness) o Can formulate hypotheses (strength) o Freud o Promotes empathy Epidemiological research: Incidence, prevalence o Huge sample sizes o Correlational design o Incidence: Number of occurrences within a year o Prevalence: Percent of people that have a disorder at any given rate of time o Find out risk factors o Survey method (weakness) Correlational method o -1.0 to +1.0, relationship only o Magnitude, direction, effect size Experimental research: Pharmaceuticals o Uncommon in clinical psychology

o IV and DV and control o Can determine cause and effect Ethics in Clinical Psychology Really important for clinical psychology Welfare and protection of people you work with Aspirationle principles (idealistic ways of being) and standards (laws) Standards:

o Multicultural, no dual-relationships o Evaluation and assessment, only in context of professional role o Advertising, cant deceive people o Psychotherapy~ no sexual relationship, cant abandon client, have to terminate when not needed, sets the therapeutic frame~ set of conditions under which clinical psychologists willing to provide therapy set my psychologist, informed consent o Confidentiality~ exceptions: if they are under 18, parents hold privileges unless they are under 16 and crime victim, child abuse report immediately, duty to warn~ must warn victim if client is homicidal o Teaching training o Phorensics o Resolving ethical issues~ 5 years to report except for sex

Diagnosis and Clinical Interviews

Samantha Waxman

Intro to Clinical Diagnosis Abnormality and normality (A-N): Definitions? o No real set definition, vary widely by culture (even throughout US) o US has very unique system for diagnosis o Abnormality: In general, not conforming to the norms, behavior isnt frequent, distressed and not able to function well o Normality: If biology is okay, an ideal, strive for it, reflects socially acceptable behaviors, developmental process o Have a lot of moral values attached to them o 6 characteristics of a healthy person (Jahoda): 1. Attitude towards self~ realistic attitude toward self, know who they are in relation to others 2. Ability to grow and develop~ not stuck in spot where they arent able to progress 3. Intergration~ parts of self are intergrated with one another 4. Autonomy~ independent thought in action, not dependent on others to define them 5. Perception of reality~ basic sense of what reality is, absence of psychosis, empathy only in reality 6. Environmental mastery~ love, work, and play o In general, people who are abnormal lack voluntary control, lack flexibility, experience themselves as weak among powerful forces, self concept is distorted, can be driven by deficiency, experience very powerful negative feelings (chronically), sense that there is a threat present, inability to be empathetic o Can cross over, no one is immune to abnormality (acute psychosis) o In general, people who are normal, when tired or stressed may be angry or depressed or have bad thoughts o Most disorders from stress o Whether person has control over themselves A-N on a continuum

o There is a breaking point for everyone (stress and coping resources) o Best possible adaptation they can make o Symptoms are functioning their equilibrium (they dont come from nothing) o Relying on things that have worked in the past o Diathesis-Stress Model~ have vulnerability inside themselves, triggered by stress o Levels of dysfunction: 1. Most mild, anxiety, conscious efforts of self control 2. Detachment from reality, discomfort, personality disorder level (frozen emotion reactions) 3. Escape of naked aggression, acts of violence 4. Psychotic, serious disturbance of persons sense of reality (hallucinations) Abnormalities and the DSM o DSM defines abnormality based on subjective distress in social occupational/interpersonal function, average behavior and stress and/or disturbance in occupation/interpersonal

social functioning, symptomatic (usually) DMS: Diagnostic and Statistical Manual Why categorize? Category vs. dimension o Law (court cases), treatment plans o Table 5.2 in textbook (pg. 129) o Either has symptoms or not (5 or more) o Dimensional system~ how much of it do they have o Current DSM only categorical, new DSM has both (good to do both) Brief intro to DSM o Many versions, changed dramatically o DSM-V comes out in 2013, major revision Definitions o Symptoms~ Emotions, behaviors, and cognitions that are signs or indicators of an underlying disorder

o Disorder~ Collection of symptoms that co-occur with one another, a syndrome that causes distress, dysfunction, and/or risk of suffering death Biggest content change to DSM-V o Personality disorder section, used to be 10 now fewer A lot of overlap, systems overlap Trying to find a way that is more reliable 5 now: 1. Antisocial 2. Avoidant 3. Borderline 4. OCD 5. Schizotypal o Rate disorders 1-5 o 6 traits: rate 0-3 1. Negative emotionality 2. Introversion 3. Antagonism 4. Disinhibition 5. Compulsivity 6. Schizotypy Multiaxial assessment: 5 axes o Axis I: Clinical Disorder Main access, everything in DSM except personality disorders or mental retardation o Axis II: Personality Disorders, Mental Retardation o Axis III: General Medical Conditions That are relevant to Axis I disorder

o Axis IV: Psychosocial and Environmental Problems That can affect them now o Axis V: Global Assessment of Functioning (GAF) Number between 1-100 How well person is functioning in general Clinical Assessment: Clinical Interview Structured Diagnostic Interview o First thing you do (all kinds of interview)

o Working in hospital and need quick diagnosis o Very strict and structured, people feel unpersonal Clinical Interviews o Most common o Why questions are bad to use o Open-ended, unstructured (but opposite with children or if no time) o Provide ability to diagnose o Assess nature and origins of symptoms o Assess personality functioning o Suggest treatment and prognosis o Testing hypotheses while asking questions Mental Status Exam o Testing someone who is seriously impaired o Always given in hospitals o Medical problems caused by psychological disorder o Psychosis o Comments on persons appearance, basic behavior, mood during interview, perception, level of consciousness, oriented

to person/place/time, concentration, memory, intelligence, insight, judgment, content of their thinking o More formal Effect Interviewing Better you are at this, more people will explore themselves to you Skills: o 1. Sense of empathy, genuine interest in person, warm, emotionally present, open, display concern, involved in interview o 2. Timing, progress from less threatening to threatening and end with less threatening, specific in middle, general beginning and end, wait for opening from client o 3. Verbal communication skills~ perception checking, paraphrasing (focus on feelings not words), active listening, avoiding why questions, avoid judgmental or evaluative words (good/bad, right/wrong, stupid/smart), no false reassurance, no hostile responses

o 4. Non-verbal communication skills~ culturally specific, open body posture, distance, eye-contact, facial expression, activity level

Psychological Testing

Samantha Waxman

Intro: Psychological Testing 3 strategies of development o 1. Rational/theoretical test development Most common (e.g. Beck test) Person developing test has idea about what questions will measure a certain disorder o 2. Empirical/criterion keyed test development Opposite of rational Dont know why things relate to disorders, they just do Also pretty popular Can lead you to develop theories about the disorder o 3. Internal consistency/ factor analysis Form of reliability Quite common, do after rational (usually) How are questions all related in a pattern Get rid of questions that dont relate to others Statistical Most common tests: o 1. Clinical Interview

o 2. WAIS-R o 3. MMPI o 4. Sentence Completion Tests o 5. TAT and Rorschach Intelligence Tests What are they? Why used? o Used to look at general factor of intelligence, academic achievement, learning disabilities, early decline o Take long time to administer, expensive o Incremental validity has to be high o Definition: 1. Intelligence is an overall capacity or potential enabling a person to understand the world and deal effectively with its challenges 2. Personality traits dont interfere with it Theories o Spierman: General factor theory of intelligence Specific factors to each ability

o Sternberg: 120 abilities, no test measures them all o Cattell: 2 types of general intelligence 1. Fluid~ genetically based capacity 2. Crystallized~ info memorized o Gilford: no general factor of intelligence, about divergent thinking (creativity) Structure of the intellect model, 6 aspects of the intellect Judgment (common sense), give correct answer, alternative answers, memory, general cognitive factors o Gardner: 6 separate intelligence 1. Linguistic (verbal intelligence, W>M) 2. Musical (usually math too) 3. Math (logical) 4. Spatial (M>W) 5. Bodily 6. Personal (empathy, site/incite) Measures of IQ (MA/CA) * 100 o IQ: Intelligence Quotient (mental age/ chronological age X 100) o Try to measure mental age o Stanford Bine test (original), originally used to access children o Wechsler~ Compared every persons scores with people of same age, most common (Wechsler Adult Intelligence ScaleRevised) WAIS-R o Age affects in IQ, peak at young adulthood and then decline o o o o o o o (working memory) 1970s Concern about validity, IQ scores misinterpreted Cultural bias Good clinician can interpret intelligence really well Highest reliability of all tests, .97 Test re-test, .95 (very high) in 7 weeks Validity: Latino and black scores lower

o Used all 3 strategies of development for test o IQ and grades correlation = .5 o Measures verbal comprehension, perceptual organization, and memory o Best predictor is verbal test o Scales and scoring Scale that test info (basic cultural) Digit span~ read numbers and have person repeat them, then have them do it backwards Vocab test Basic arithmetic Comprehension Similarities 5 performance scales: 1. Picture completion 2. Picture arrangement 3. Block design (timed) 4. Object assembly (puzzles) 5. Digit symbol (timed)

Extra point for speed o Average IQ is 100 130+ = very superior (98 percentile) 120 129 = superior 110 119 = high average 90 109 = average 80 89 = low average 70 79 = borderline <69 = mentally retarded (1 percentile) o Standard deviations: 85 115 = 65% 70 130 = 95% 55 145 = 98% o How well are they able to perceive information o Unusual if verbal is 15 points or more than performance, problem with brain, ADD o Clinicians look at:

Scores Content~ what do they say, how is their reasoning Style while taking test~ transaction between clinician and client, how do they react to own success or failure, motivation level How are cognitive functions organized~ what do they rely on most, more concerned with understanding or performance Objective Tests: MMPI (Minnesota Multiphasic Personality Inventory) History and development Developed in 1947 Over 100 questions True/false Lots of scales measuring different things (clinical and validity scales) o Assess psychopathology, not for normal people Reliability and validity o Over 10,000 studies (mostly criterion) o Not due to construct validity o o o o o o o o o o o Original was bad Generated massive amount of research Lots of overlap between scales Only developed with criterion key (90/10) Very hard scale to fake Used in prisons, courts, and hospitals 2 main factors (measurements) 1. Maladjustment (psychopathology) 2. Resiliency

Validity highest when used with interview data Cross-cultural, not good with Asian Americans, black higher Need to know cultural norms Adolescent version because they tend to score higher on adult version o Standardization for MMPI~ problem because only college students tested Interpretation o o o o

o Validity scales: L~ Lie F~ Fake bad K~ Fake good HS~ Hypochrondriasis (physical complaints with no origin) D~ Depression Hy~ Hysteria (dramatic, very flirty, superficial affect) Pd~ Psychopathic deviation (anti-social) Mf~ Masculine/feminine (not important, bad scale) o Look Pa~ Paranoia (most likely invalid if low) Pt~ Psychothenia )general unhappiness, best scale for it) Sc~ Schizophrenia (culturally sensitive) Ma~ Hypomanic (energy level, look at Ma and Pd) Si~ Social introversion (social style in relation to symptoms) at validity scales Can tell if they are lying, making self look good/bad, or

random If F > 90 = invalid F K > +/- 10 = invalid Over 65 = suspicious Saw-tooth~ most likely invalid o If valid, go to second step and look at 1. Elevation (high score, high pathology) 2. Slope~ / = ascending (more serious, psychosis), \ descending (neurosis, not too serious), flat doesnt really mean anything 3. Scatter~ variability (how land have they had it), flatter = had problem for a long time, more they differ = more transparent, crisis Hs, D, Hy = neurotic, not as serious Look for V, if D is 10 or more points lower than Hs and Hy = neurotic triad, convergent historic,

physical complaints, and no distress (only if above line) Pa, Pt, Sc, Ma = more serious Look for V, if Pt is 10 or more points lower than Pa and Sc = paranoid schizo triad o Next step, start looking at individual scales o Scales are not linear o Bipolar = high in D and high in Ma Projective Tests: Thematic Apperception Test (TAT) Designed to discover persons characteristic modes of behavior by how they interpret ambiguous stimuli (picture) Can never be completely ambiguous, but can be perceived in a number of ways Interpretation: 27 needs and press (Murray) o How client expects people to behave, how they view themselves, how they behave o Determine what needs are expressed or not, and what environmental forces are being used o Person always represents self as hero o What to look at: Who is the hero? How does the patient regard his/her environment? Help or hinder person? How does the hero behave? What does the hero like/dislike? What are the heros inner states? How do they feel? How is the heros behavior expressed? Outcome? Evaluation o Most studies done on TAT are academic o Most reliability and validity in needs scoring part o Validity varies by who gave it and the situation o Correlates highly with intelligences and length of stories o Useful, but wouldnt want to diagnose with it o Used for treatment planning

Rorschach Psychodiagnostic (ink blot) Administration, interpretation o Now used for personalities o 10 cards~ black, red, and brightly colored o What do you see in the ink blot card o More psychopathology = more trouble o Go through cards a 2nd time (inquiry)~ get information on each of the responses o Observe behavior and write about it o At the end, you would have about 25 responses and times for o o o o o o each response (length of responses) Reaction time important Reliability and validity have been questioned for years because it is being used for things it was not designed for Only 22% score it, no validity unless scored Exner system is more valid, best predictor of suicide, one of best tests for organic brain problems Used in admissions to hospitals Good at testing intelligence

o Movement responses highly correlated with intelligence and creativity o Indicator of psychosis, only talking about small white spaces Drawing Tests Not too valid or reliable Exception for draw person in rain rest o Person = you o Are they protected from the rain o Rain = environmental stress o Is rain touching them Draw tree hit by lighting is good test o Tests trauma in your life

Psychodynamic Perspective Methods and Cases

Samantha Waxman

Does psychotherapy work? No o Haans Isink~ first study to test against psychotherapy (1950s) Control group~ people being discharged from mental hospitals Looked at people with insurance issues but no therapy as control too Found that a smaller percentage of people in therapy improved than the control Different measures used Not a replicated study

Yes o Enough empirical evidence that shows it works, lots of replications o Smill, Vlas, and Miller Found that those who get therapy do 70-80% better and 5% deteriorate o Most diamatic improvement in 6 months, and 2 years for long

lasting improvement o Frank Barron~ ego-strength scale to find out if you will get better o Better put together, the better they will do (mood disorder or adjustment is easiest) o Chronic disorders very hard to treat, can help with relief but no cure o Longer the therapy, longer the effect What can affect outcomes of studies? Methodological issues o Cant prove cause without experiment (which is usually unethical) o Waiting list control studies short term Unethical to not treat patient o Control can see therapist, but therapist does not do therapy o Pay attention to in research:

1. Who is the sample? How recruited, voluntary, coerced, paid, genuine real sample, is mood induced 2. Who were the therapists? Interns or licensed, what is their orientation 3. What patient variables were controlled and not controlled? What did they match 4. What assessment measures did they use? Before and after

o Research very hard because all people and therapists are different 6 stages of change (Prochaska) o 1. Precontemplation No intention of change happening 50-60% in this stage o 2. Contemplation Know you have a problem, but still not committed to change 30-40% in this stage o 3. Preparation Intending to take action soon, almost ready, very brief o 4. Action Clients actively engaged in changing maladaptive behavior and thoughts 20% in this stage o 5. Maintenance Change has happened, preventing relapse

o 6. Termination Relapse no longer a threat, person is ready to go What are psychodynamic and psychoanalytic therapy and how are they different from other forms? Psychoanalysis introduction o Form of therapy where the psychoanalyst adheres to standard techniques which are focused on the interpretation of

o o o o

unconscious defenses starting in childhood, lead to insight in transference relationships with analyst 3-5 times a week, 50 minute sessions Dont want to give too much time for them to rebuild defense Only get into it if not psychotic or it will make you worse, not for people in crisis Used mostly with: Personality disorders Depression Anxiety

Eating disorders Couples therapy o Has empirical evidence o Best to cure personality disorders Psychodynamic introduction o Psychoanalysis is a psychodynamic therapy o Not the same o Not all psychodynamics are psychoanalysis by any means o A form of therapy that holds to the basic tenants of psychoanalysis, particularly the idea that the psychi is dynamic which influence behavior and thoughts and feelings Goal is to make what is unconscious conscious, so therapist could understand the patient and they can understand themselves Look at interplay at unconscious forces (conflict) Many types of psychodynamic therapy How is it different than other therapy, 4 factors: 1. Trying to evoke emotions, getting at feelings

o o o

2. Bringing troublesome feelings to awareness of client 3. Trying to integrate difficulties now with past life experience 4. Using therapist-patient relationship to help change patient Psychodynamic Techniques Clarification, confrontation, interpretation

o Clarification~ clarify what the client means, understand what they mean, never want to impose own meanings o Confrontation~ pointing out discrepancies between persons behavior and feeling (e.g. say sad but smiling), noting what they want to do and what they are really doing in the world, not hostile, operation of the persons defenses o Interpretation~ interpreting persons behavior as its relating to the past, explores relationships inside and outside therapy and with caregivers and how they are related, present as hypothesis to client, but dont always present or have to Analysis of resistance (some use and some dont)~ natural normal indicator of healthy psychi, happens when interpreting something that happened to client, resisting interpretation, indicator that you are on the right track Technical neutrality o Therapist avoids communicating judgment (positive or negative) to patient, remains neutral o Avoids providing praise, advise, and restrains own need to be liked or approved of or idealized by the client to help client feel safe o Helps therapist avoid enactments of clients early life and getting at unconscious o Cant calood with their unconscious o Dont take sides in persons conflicts Transference and countertransference o Transference~ everybody is either parent or self, no other people, only one way to be (not psychotic), project them on to others, everybody is the same All of us have one main transference pattern Transference to the therapist, need to recognize it Biggest way to make unconscious conscious Attach to therapist, see parents positive qualities Resolution of transference big thing Showed most often under stress o Countertransference~ therapists transference onto the client

Therapist transference to the client (always suspect first) and reality Realistic response to patients dramatic behavior Realistic response or transference Basic Psychoanalytic Concepts Most important~ Anxiety-Repression-Defense model o Client leads and determines where you go o Example:

Psychodynamic Perspective Methods and Cases, Jung

Samantha Waxman

Basic Jungian Psychotherapy Concepts CS, PUCS, CUCS o Consciousness~ same as Freud o Personal unconscious~ personal experiences repressed (fears, wishes, desires) o Collective unconscious~ collective experiences (archetypes), common to all people Strata of the unconscious

Most interested in the collective unconscious Jung only one that works with people who are actively psychotic Ego filters out what psychi cant handle, psychotic person has no ego and lives in their unconscious Main archetypes o An archetype is a form empty of experience which serves to guide behavior, structured in the mind that is inherited, template (e.g. business card), films good at seeing and explaining archetypes o Archetype is form with no content that helps structure a persons behavior, has to be the same across all cultures and time o 4 main archetypes: 1. Persona~ conscious of it in our 20s, social role, mask we put on in society = actor (collective archetype), external social role in dreams (e.g. work) 2. Shadow~ all you think you arent, positive and negative qualities, represents qualities you think you dont have but you do, closest to consciousness, can become conscious, project shadows on other people, get to know who we are, natural thing we do, project

when we need the quality, most common psychotic issue is with the shadow (both +/-), anxiety and depression can be shadow problem, g-d/demon, same gender in dreams (mostly threatening), can appear as animals or creatures 3. Anima/animus~ usually gets projected onto therapist, contrasexual side of self. Anima~ nurturing, harmony, receptive, evaluative. Animus~ action oriented, protective, discriminative, hierarchical. Need therapy for anima to emerge, compelling opposite

gender character or guides 4. Self~ everything (all archetypes) that you are, totality of you (all CS, PUCS, CUCS) Archetypes show themselves most in dreams o Vivid, memorable, symbolic o Show archetypal journey o Water = symbol of unconscious deep emotions/feelings The Heros Journey o Most common and well known archetype in the West o Hero~ everywhere and always (part of archetype) has courage, brave, self sacrificing, overcome hardships, strong (emotionally or physically), high moral/integrity, humble, likeable, innocent (at the beginning) o Hero story~ struggle, on good side, reward (praise, treasure), threshold, love interest, leave home (resists) o Go through hero stage in early adulthood, leaving parents, shows journey everyone takes (e.g. college) o Want to find self o Bring gift of consciousness and less projection onto others o Demeter and Persephone myth

Behavioral and Cognitive Therapy

Samantha Waxman

Behavioral Therapy How behavior develops o Behavior arises from a condition (Skinner) o Brief, structured, directive form of therapy o Therapist is an educator about systems they have and how they were conditioned and teach new way to solve it o Very system focused o Relationship not emphasized o Inner experience and history of client not relevant o Classical Conditioning S R Try to replace response with new one (unconditioned response conditioned response) Ex. Phobic responses

Therapies o Counter conditioning 1. Reciprocal inhibition Focus on feeling Try to eliminate feeling by forcing opposite feeling on them when they respond to the thing Inducing relaxation 2. Aversion conditioning Trying to give person bad response to change a bad one they have (e.g. alcohol abuse) Antabuse~ for alcohol abuse, makes you throw up when you take a drink Ex. Cigarette smoking, wash mouth out with soap Takes time, have to keep it up until response is truly changed 3. Systematic desensitization Used for fears and phobias Have them write down everything that causes them anxiety in their phobic situation (all the steps that cause them anxiety) Leading person through each step that they wrote down very slowly and observe their anxiety and

stop when you see it and get person into relaxed state Bensons Relaxation Response Takes very long time, maybe weeks o Extinction: Flooding (with response prevention) Flood them with emotion so they no longer feel it as response Common with OCD Force them to be exposed to stimulus (phobias) Response prevention~ dont let them escape the flood o Reward and Punishment (contingency management) Punishment and reinforcement Shaping by successive approximations Give reward when doing something you want them to do, harder and harder to get reward, widely used with children Time out Force them to avoid reinforcers, no longer get reinforced Reinforcement by tokens Give something (tokens) that can be exchanged for bigger reward later on Self-reinforcement Taught with all others Learn to reinforce self for appropriate behavior Punishment ineffective, reinforces behavior o Behavioral Rehearsal Role playing Translates it to real life Cognitive-Behavioral Therapy 3 main therapies: o 1. Linehans Dialectical Behavior Therapy (DBT) Popular, for borderline personality disorder (impulsecontrol), problem regulating feelings, very effective Therapist is teacher, teaches 4 skill modules twice, take about 1 year (individually and group)

Very

1. Mindfulness~ awareness of the present moment 2. Emotion regulation~ regulate emotions and appreciate effect on other people, increase positive emotions 3. Distress tolerance~ how to sooth yourself 4. Interpersonal effectiveness~ how you deal with conflict, how you make and keep friends, how you get your needs met, how you say no effective at controlling symptoms of borderline

o 2. Ellis Rational-Emotive Behavior Therapy (REBT) Only therapy where warm relationship between therapist and clients is bad (controversial) Good with people who are hard narcissistic who wont be hurt by hostile therapy, good with anger problems and religion Often group therapy settings

Teaches person how to have different response through D and E (disputed belief and effective behavior) Goal is always to change the demandingness of the client

o 3. Michenbaums Cognitive-Behavioral Therapy Very big in the field More cognitive than behavioral Basically combined both and uses them both (strict cognitive therapy) Cognitive Therapy (Beck) Distorted thinking is cause of psychological problems, help a person change their thoughts

Focus is solving problems by modifying dysfunctional thoughts Brief, 12-16 sessions, 16 max Very structured, directive Therapist educates client and teaches them how to change Focus on thoughts, cognition Each disorder has a specific core relief, no matter who has it and thats what they target Helps client conduct hypothesis testing of their thoughts Often used in group and couples therapy Used with people who have 1 main symptom (symptom focused) Good for depression, anxiety, phobia, eating disorders, and borderline, but not for psychotic Basic Model o World Schemas Perception Behavior

o Schema~ system of beliefs around a given topic that influences our perception of reality Techniques o Disputing thoughts, cognitive distortions (homework~ designed to test distortions) o Distortions can cause mood disorders o Just manages symptoms, doesnt cure

Psychoanalytic (Freud)

Samantha Waxman

Psychoanalysis is a form of therapy where the psychoanalyst adheres to standard techniques which are focused on interpretation of unconscious defenses starting in childhood, lead to insight in transference relationships with analyst 3-5 times a week, 50 minute sessions Dont want to give too much time for them to rebuild defense Only get into it if they are not psychotic or it will make it worse, not for people in crisis Used mostly with personality disorders (best to cure them), depression, anxiety, eating disorders, and couples therapy Basic Psychoanalytic Concepts Most important: Anxiety-Repression-Defense model o Client leads and determines where you go o Example:

IN TEXT BOOK (Pg. 326) and Freud reading Personality Structure Id, ego, superego Psychosexual Stages Oral stage Anal stage Phallic stage Latency stage Genital stage Oedipus Conflict/ Complex

Jungian

Samantha Waxman

CS, PUCS, CUCS Consciousness~ same as Freud Personal unconscious~ personal experiences repressed (fears, wishes, desires) Collective unconscious~ collective experiences (archetypes), common to all people Strata of the unconscious

Most interested in the collective unconscious Jung only one that works with people who are actively psychotic Ego filters out what psyche cant handle, psychotic person has no ego and lives in their unconscious Archetypes An archetype is a form empty of experience which serves to guide behavior, structured in the mind that is inherited, template (e.g. business card), films good at seeing and explaining archetypes Archetype is form with no content that helps structure a persons behavior, has to be the same across all cultures and time archetypes: 1. Persona~ conscious of it in our 20s, social role, mask we put on in society = actor (collective archetype), external social role in dreams (e.g. work) 2. Shadow~ all you think you arent, positive and negative qualities, represents qualities you think you dont have but you do, closest to consciousness, can become conscious, project shadows on other people, get to know who we are, natural thing we do, project when we need the quality, most common psychotic issue is with the shadow (both +/-), anxiety and depression can be shadow problem, g-d/demon, same gender in dreams (mostly threatening), can appear as animals or creatures

4 main

3. Anima/animus~ usually gets projected onto therapist, contrasexual side of self. Anima (female)~ nurturing, harmony, receptive, evaluative. Animus (male)~ action oriented, protective, discriminative, hierarchical. Need therapy for anima to emerge, compelling opposite gender character or guides 4. Self~ everything (all archetypes) that you are, totality of you (all CS, PUCS, CUCS) Archetypes show themselves most in dreams Vivid, memorable, symbolic Show archetypal journey Water = symbol of unconscious deep emotions/feelings Dream Work reading

Humanistic

Samantha Waxman

Humanistic Psychotherapy~ client centered, clients ability to choose, the way they behave is a choice, dont diagnose or give advice, idea is to help client grow in awareness of themselves and understand themselves better Focus on present (not past), conscious awareness, growth Relationship between patient and therapist seen as equal (peers) Therapist is non-directive Used for 1 year 3 main systems (more in book, ch.13) 1. Existential 2. Gestalt 3. Client-centered Rogers Client-Centered Therapy Therapist focuses on feelings connected to what the client is saying vs. content (non-verbal, overt emotions) Accept feelings Can only clarify what the person has said, do not suggest, no evaluation Therapist expected to provide client with naturally supportive environment where client feels comfortable to express emotions with no judgment Unconditional positive regard~ not evaluating, always warm and caring attitude (pg. 352) Help = acceptance

Cognitive (Beck)

Samantha Waxman

Distorted thinking is the cause of psychological problems, help a person change their thoughts Focus is solving problems by modifying dysfunctional thoughts Brief, 12-16 sessions, 16 max Very structured, directive Therapist educates client and teaches them how to change Focus on thoughts, cognition Each disorder has a specific core relief, no matter who has it Helps client conduct hypothesis testing of their thoughts Often used in group and couples therapy Used with people who have 1 main symptom (symptom focused) Good for depression, anxiety, phobia, eating disorders, and borderline, but not psychotic Techniques: o Disputing thoughts, cognitive distortions (homework designed to test distortions) o Distortions can cause mood disorders o Just manages symptoms, doesnt cure More in textbook pg. 393

Basic Model Schema~ system of beliefs around a given topic that influence out perception of reality World Schemas Perception Behavior

Behavioral

Samantha Waxman

Behavior arises from a condition (more in textbook, Ch. 14) Brief, structured, directive form of therapy Therapist is an educator about systems they have and how they were conditioned and teach new way to solve it Very system focused Relationship between client and therapist not emphasized Inner experience and history of client not relevant Classical Conditioning S R Try to replace response with new one (unconditioned response conditioned response) Ex. Phobic responses Therapies: Counter conditioning o 1. Reciprocal inhibition Focus on feeling Try to eliminate feeling by forcing opposite feeling on them when they respond to the thing Inducing relaxation o 2. Aversion conditioning Trying to give person bad response to change a bad one they have (e.g. alcohol abuse) Antabuse~ for alcohol abuse, makes you throw up when you take a drink Ex. Cigarette smoking, wash mouth out with soap Takes time, have to keep it up until response is truly changed o 3. Systematic desensitization Used for fears and phobias Have them write down everything that causes them anxiety in their phobic situation (all the steps that cause them anxiety) Leading person through each step that they wrote down very slowly and observe their anxiety and stop when you see it and get person into relaxed state Bensons Relaxation Response Takes very long time, maybe weeks

Extinction: Flooding (with response prevention) o Flood them with emotion so they no longer feel it as response o Common with OCD o Force them to be exposed to stimulus (phobias) o Response prevention~ dont let them escape the flood Reward and Punishment (contingency management) o Punishment and reinforcement o Shaping by successive approximations Give reward when doing something you want them to do, harder and harder to get reward, widely used with children o Time out Force them to avoid reinforcers, no longer get reinforced o Reinforcement by tokens Give something (tokens) that can be exchanged for bigger reward later on o Self-reinforcement Taught with all others Learn to reinforce self for appropriate behavior o Punishment ineffective, reinforces behavior Behavioral Rehearsal o Role playing o Translates it to real life