EPPP Clinical 2

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Freud's personality theory: ID (at birth)
pleasure principle

Ego (6 months)
reality principle

Superego (4 or 5 yrs)
moral values
Jung's personality theory: personal unconscious

collective unconscious (incl. archetypes)

transferences = projections of personal & collective unconscious
Neo-Freudians - who?: Karen Horney

Harry Stack Sullivan

Erich Fromm
According to Harry Stack Sullivan, maladaptive behaviour due to ...: parataxic distortions
Self Psychology - who?: Heinz Kohut

best known for work on narcissism
3 facilitative conditions for Person-Centered Therapy (Rogers): unconditional positive regard (respect)

genuineness (congruence)

empathy
Gestalt Therapy - who?: Fritz Perls
PSYCHOANALYSIS therapy goals: bringing unconscious into conscious awareness & integrating previously repressed material into personality
PSYCHOANALYSIS therapy techniques: free association

dream analysis

confrontation of resistance

transference by being neutral
PSYCHOANALYSIS - view of maladaptive behaviour: unconscious, unresolved conflict
ADLERIAN - personality theory: inferiority feelings

striving for superiotiry

style of life

social interest
ADLERIAN - view of maladaptive behaviour: mistaken style of life characterized by overcompensation, preoccupation for personal power, and lack of social interest
ADLERIAN - techniques: Systematic Training for Effective Parenting (STEP)

Systematic Training for Effective Teaching (STET)
JUNG'S - personality theory: personality is consequence of conscious & unconscious factors.

personality consists of extraversion and introversion
JUNG'S - view of maladaptive behaviour: symptoms are unconscious messages
JUNG'S - therapy goals: bridge gap between conscious and unconscious (both)

Note: countertransference useful
Object Relations - who?: Melanie Klein
Ronald Fairbairn
Margaret Mahler
Otto Kernberg
OBJECT RELATIONS - view of maladaptive behaviour: abnormalities in early object relations
OBJECT RELATIONS - therapy goals: restore client's ability to relate to others in meaningful ways
SELF PSYCHOLOGY - personality theory: parents' ability to provide their child with factors that lead to a cohesive send of self, or "healthy narcissism"
SELF PSYCHOLOGY - view of maladaptive behaviour: parents unempathic response to child leads to pathological narcissism
SELF PSYCHOLOGY - therapy goals: provide empathy to help client express unfulfilled narcissistic needs
INTERPERSONAL THERAPY - who?: Klerman & Weissman
IPT - view of maladaptive behaviour: depression related to problems in social roles & interpersonal relationships due to lack of strong early attachments
IPT - therapy goals: symptom reduction & improved interpersonal functioning
PERSON-CENTERED THERAPY - view of maladaptive behaviour: incongruence between self & experience
PERSON-CENTERED THERAPY - therapy goals: self-actualization
GESTALT THERAPY - personality theory: personality consists of self (creativity) and self-image ("darker side" due to external standards). One dominates.
GESTALT THERAPY - view of maladaptive behaviour: disturbance in boundary between self & self-image (i.e. external envirnoment)

4 boundary disturbances:
introjection (leading to neurosis)
projection
retroflection
confluence (no boundary bet self & environment)

Lack of integration

Problem with homeostasis
GESTALT THERAPY - goals: integration of self & self-image to become WHOLE
GESTALT - techniques: no questions

"I" language

empty-chair technique

dreamwork
REALITY THERAPY - who?: William Glasser
REALITY THERAPY - view of maladaptive behaviour: failure identity vs success identity
REALITY THERAPY - therapy goals: help clients identify responsible and effective ways to satisfy needs
Key feature of cybernetics re: family therapy: negative feedback loop (bad)
- reduces deviation
- maintains status quo

positive feedback loop (good)
- amplifies deviation/change
- disrupts system
Types of communication (2) re: communication/interaction family therapy: symmetrical communications
- equality between communicators
- competitive "one-upmanship"

complementary communications
- inequality bet communicators
e.g. dominant & submissive
COMMUNICATION/INTERACTION FAMILY THERAPY - view of maladaptive behaviour: circular model of causality

i.e. sysmptom is both cause and effect of dysfunctional communication patterns
COMMUNICATION/INTERACTION FAMILY THERAPY - therapy goals & techniques: alter interactional patterns maintaining symptoms

paradoxical strategies
EXTENDED FAMILY SYSTEMS THERAPY - who?: Murray Bowen
EXTENDED FAMILY SYSTEMS THERAPY - concepts (5): differentialtion of self

emotional triangle

nuclear family emotional system

family projection process

multigenerational transmission process
EXTENDED FAMILY SYSTEMS THERAPY - view of maladaptive behaviour: multigenerational transmission process

i.e. progressively lower levels of differentiation transmitted from one generation to the next
EXTENDED FAMILY SYSTEMS THERAPY - therapy goals & techniques: increase differentiation of all family members

therapeutic triangle
genogram
STRUCTURAL FAMILY THERAPY - who?: Salvador Minuchin
STRUCTURAL FAMILY THERAPY - concepts: rigid boundaries - "disengaged"

permeable boundaries - "enmeshed"

3 chronic boundary problems:

detouring
stable coalition
triangulation
STRUCTURAL FAMILY THERAPY - view of maladaptive behaviour: inflexible family structure
STRUCTURAL FAMILY THERAPY - therapy techniques: joining (by tracking)
enactment
reframing
STRATEGIC FAMILY THERAPY - who?: Jay Haley
STRATEGIC FAMILY THERAPY - view of maladaptive behaviour: communication misuse to increase control in relationship
STRATEGIC FAMILY THERAPY - therapy goals: alter hierarchies & generational coundaries in family

Note: insight = counterproductive due to resistance
STRATEGIC FAMILY THERAPY - therapy techniques: paradoxical intervention (to make use of resistance) by
- restraining
- positioning
- reframing
- prescribing the sx
ordeals
MILAN SYSTEMIC FAMILY THERAPY - who?: Mara Selvini-Palazzoli
MILAN SYSTEMIC FAMILY THERAPY - view of maladaptive behaviour: circular patterns of action and reaction in family system.

problems when family's patterns become fixed
MILAN SYSTEMIC FAMILY THERAPY - therapy goals: help family members see their choices
MILAN SYSTEMIC FAMILY THERAPY - therapy techniques: therapeutic team (observational mirror & conferences)

circular questioning (to clarify discrepancies in perspectives)
Steps of crisis intervention (4): relieving sx

restoring premorbid functioning

identifying triggers of crisis

identifying remedial measures
primary prevention: intervention available to all memers of a a group

e.g. public eduction on drugs
immunization program
prenatal nutrition for low SES
secondary prevention: emphasizes early detection and targets specific individuals

e.g. screening tests for 1st graders to identify learning probs
tertiary prevention: to reduce the duration and consequences of an illness that has already occurred

e.g. halfway houses
types of mental health consultation (4): client-centered case consultation

consultee-centered case consultation

program-centered administrative consultation

consultee-centered administrative consultation
client-centered case consultation: working with the consultee so that she can work more effectively with a particular client
consultee-centered case consultation: targets the consultee's skills & knolwedge so the consultee can be more successful in dealing with a particular group of clients
program-centered administrative consultation: working with administrators to resolve problems related to an existing program
consultee-centered administrative consultation: helps administrators improve their professional functioning with regard to program development and implementation
parallel process: occurs when therapist behaves toward supervisor in ways that mirror how client is behaving toward therapist
Eysenck outcome study: improvment

72% no-therapy
66% eclectic psychotherapy
44% psychoanalysis

... due to "spontaneous remission"
Smith, Glass & Miller outcome study: meta-analysis

mean effect size of .85

average client at end of therapy better off than 80% of those needing therapy
dose dependent effect of therapy: 75% pts show improvement at 26 sessions. But then levels off
stages of change (Prochaska & DiClemente): precontemplation
contemplation (within 6 months)
preparation (within 1 month)
action
maintenance (lasted for 6 months)
cultural encapsulation: BAD

tendency to interpret everyone's reality through own cultural assumptions & stereotypes
emic vs etic orientation re: MCT: emic (GOOD)
undertanding culture from perspective of members of that culture

etic (BAD)
assumes that universal principles can be applied to all cultures
high vs. low context communication re: MCT: high-context (culturally-diverse groups)
shared cultural understanding and nonverbal cues

low-context (Anglos)
relies primarily on verbal message
healthy cultural paranoia: appropriate mistrust of Afriacan-Americans toward whites resulting from racism and oppression
Ridley's model of paranoia re: MCT: intercultural nonparanoiac discloser (L Functional P; L Cultural P)

functional paranoiac (H Functional P; L Cultural P)

healthy cultural paranoiac (L Functional P; H Cultural P)

confluent paranoiac (H Functional P; H Cultural P)
acculturation (Berry): adopting his/her own culture and that of dominant group as intergration, assimilation, separation, or marginalization
categories of acculturation (4): integration

assimulation

separation

marginalization
integration re: acculturation: person maintains his own (minority) culture but also incorporates many aspects of the dominant culture
assimilation re: acculturation: person accepts majority culture which reliniquishing his own culture
separation re: acculturation: person withdraws from dominant culture and accepts his own culture
marginalization re: acculturation: person does not identity with either his own culture or dominant culure
5 stages of Racial/Cultural Identity Development Model Atkinson, Morten & Sue: conformity
dissonance
resistance & immersion
introspection
integrative awareness
4 stages of Black Racial (Nigrescence) Identity Development Model Cross: preencounter
encounter
immersion/emersion
internatlization/commitment
6 stages of White Racial Identity Development Model Helms: contact
disintegration
reintegration
pseude-independence
emmersion-emersion
autonomy
4 stages of Gay & Lesbian Identity Development Model Troiden: sensitization; feeling different
self-recognition: identity confusion
identity assumption
commitment; identity integration

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