reflects a deterministic and pessimistic view of human nature that views current psychological problems as being due to unconscious unresolved conflicts that arose during childhood
assumes that these conflicts cause anxiety and are the result of the divergent demands of the 3 aspects of personality:
a. id: present at birth and its life (sexual) and death (aggression) instincts are the primary source of psychic energy
--operates according to the pleasure principle and seeks immediate gratification of its instinctual needs using unconscious irrational means
b. ego: develops about 6mo and operates according to the reality principle
--it also seeks to at least partially gratify the id's instincts it attempts to do so in realistic rational ways
c. superego: last aspect of personality to develop
--represents the internalization of society's values and standards and acts as the conscience
--attempts to permanently block (rather than gratify) the id's instincts
proposes that when the ego is unable to resolve a conflict between the id and superego using rational means, it resorts to a defense mechanism
-defense mechanisms deny or distort reality and operate on an unconscious level
--includes repression, denial, reaction formation, projection, and sublimation
---repression is the basis of all other defense mechanisms, is involuntary, and involves keeping undesirable thoughts and urges out of conscious awareness
---denial is an immature defense mechanism that involves refusing to acknowledge distressing aspects of reality, includes: ignoring, distorting, and rejecting reality
---reaction formation involves defending against an unacceptable impulse by expressing its opposite
---projection involves attributing an unacceptable impulse to another person
---sublimation involves channeling an unacceptable impulse into a socially desirable (and often admirable) behavior
-occasional use of defense mechanisms is adaptive but repeated reliance on them keeps a person from resolving the conflicts that are causing anxiety
main psychoanalysis goals are to make the unconscious conscious and to strengthen the ego so that the behavior is based more on reality and less on instinctual cravings and irrational guilt
-primary technique is analysis of client's free associations, dreams, resistance, and transference, and the process of analysis consists of 4 steps
1. Confrontation: helping clients recognize behaviors they've been unaware of and their possible cause
2. Clarification: brings cause of behaviors into sharper focus by separating important details from extraneous material
3. Interpretation: involves explicitly linking conscious behaviors to unconscious processes
4. Repeated Interpretation: leads to catharsis (experience of repressed emotions) and insight into the connection between unconscious material and current behavior and then to working through (gradual process where client accepts and integrates new insights into their life) accepted some aspects of Freudian theory but rejected others
believed that behavior is driven by both positive and negative forces, personality continues to develop throughout the lifespan, and that behavior is affected by the past and the future
divided unconscious aspect of the psyche into the personal and collective unconscious
-personal unconscious: person's own forgotten/repressed memories
-collective unconscious: memories shared by all people and are passed down from one generation to the next
--contains archetypes: universal thoughts and images that predispose people to act in similar ways in certain circumstances
---expressed in myths, symbols, and dreams and include the persona, shadow, hero, and anima and animus
primary goal is to bring unconscious material into consciousness to facilitate the process of individuation
-happens primarily during the second half of life and is the process where a person becomes a psychological in-dividual, a separate, indivisible unity of whole
techniques used to achieve goal include dream interpretation and the analysis of transference, which Jung viewed as being due to the projection of elements of the personal and collective unconscious Derived from existential psychology and developed by several psychiatrists/ologists including Irvin Yalom, Rollo May, and Viktor Frankl
emphasize personal responsibility and choice and based on assumption that each person must ultimately define their existence
view psychological disturbances as result of an inability to resolve conflicts that arise when facing 4 ultimate concerns of existence:
-death
-freedom
-isolation
-meaninglessness
Distinguish between 2 types of anxiety:
-normal (existential anxiety): in proportion to an objective threat, doesn't involve repression, and can be used constructively to identify and confront the conditions that elicited it and motivate positive change
-neurotic anxiety: disproportionate to an objective threat, involves repression, and keeps people from reaching their full potential
primary goal of therapy is to help clients lead more authentic lives by assisting them in taking charge of their life, helping them choose for themselves the values and purposes that will define and guide their existence, and supporting them in actions that express these values and purposes
consider an authentic therapist-client relationship to be the most important therapeutic tool but may use other techniques such as questioning, interpretation, and reframing focuses on the interpersonal factors that contribute to a client's current symptoms
based on medical model and views depression and other mental disorders as treatable mental illnesses
Primary goals are symptom relief and improved interpersonal functioning
Developed as a treatment for acute depression but modified to treat BD, eating disorders, and several other disorders
Three stages of therapy:
a. initial stage: therapist determines the client's diagnosis and the interpersonal context of the client's symptoms
-information used to identify the primary problem that will be the focus for treamtment
--ex. for depression, problem areas are interpersonal role disputes, interpersonal role transitions, interpersonal deficits, and grief
-during this stage, clients are assigned the "sick role" in order to allow them to to be ill without blaming themselves for their symptoms and to view their illnesses as temporary and treatable
b. middle phase: therapist uses a variety of strategies to address the problem area identified in the initial stage
-common strategies include encouragement of affect, role-playing, communication analysis, and decision analysis
c. final stage: therapist addresses issues related to termination and relapse prevention incorporates concepts and principles of person-centered therapy, transtheoretical model, Bandura's concept of self-efficacy, and Festinger's notion of congitive dissonance
assumes that interventions are most effective when they match the client's stage of change, considered most useful for people in the precontemplation or contemplation stage
primary techniques are expressing empathy, supporting self-efficacy, developing a discrepancy (helping clients see the difference between their behaviors and goals), and rolling with resistance (decreasing client resistance by avoiding arguments and power struggles)
distinctive characteristic is the use of questions, reflections, affirmations, and other strategies to elicit and reinforce a client's "change talk" (statements that move the client toward making positive changes in behavior based on assumption that a family member's symptoms are related to problems in the family's structure and identifies subsystems and boundaries as important aspects of a family structure:
-subsystems: smaller units of the entire family system and are responsible for carrying out specific tasks (ex. parental subsystem is family members who care for the children)
-boundaries: implicit and explicit rules that determine the amount of contact that family members have with each other - differ in terms of degree permeability and exist on a continuum
--at one end, boundaries are overly diffuse and lead to enmeshed relationships, at the other end, boundaries are overly rigid and lead to disengaged relationships - midway between the.2 are clear boundaries that let family members have close relationships while allowing each member to maintain a sense of personal identify
Identified 4 rigid family triads - boundary problems that help parents obscure or deny their conflicts:
a. stable coalition: happens when one parent and a child form an inflexible alliance against the other parent
b. unstable coalition: known as triangulation and occurs when each parent demands that the child side with them
c. detouring-attack coalition: happens when parents avoid the conflict between them and blame the child for their problems
d. detouring-support coalition: happens when parents avoid their own conflict by overprotecting the child
maladaptive behaviors are due to a dysfunctional family structure that causes the family to repeatedly respond inappropriately to developmental and situational stress
primary goals of therapy are used to alleviate current symptoms and change the family structure by altering coalitions and creating clear boundaries
Therapy focuses on promoting behavior change rather than insight and consists of three overlapping phases:
a. joining: used by a therapist to establish a therapeutic alliance with the family and relies on 3 techniques:
-mimesis involved adopting the family's affective, behavioral, and communication style
-tracking involves adopting the content of the family's communications
-maintenance entails providing family members with support
b. therapist's next task is to evaluate the family's structure to make a structural diagnosis and identify appropriate interventions
-includes constructing a family map that depicts the family's subsystems, boundaries, and other aspects of the family's structure
c. therapist then uses reframing, unbalancing, boundary making, enactment, and other interventions to achieve therapy goals
-reframing: relabeling a problematic behavior so it can be viewed in a more constructive way
-unbalancing: used to alter hierarchical relationships and happens when a therapist aligns with a family member whose level of power needs to be increased
-boundary making: used to alter the degree of proximity between family members
-enactment: involves asking family members to role-play a problematic interaction so the therapist can get information about the interaction and then encourage family members to interact in an alternative way based on assumption that the family as a whole protects itself from change through homeostatic rules and patterns of communication
patterns of communication are referred to as family games, and family games associated with problematic behaviors are rigid, involve power struggles between family members, and are known as "dirty games:
primary goal is to alter the family rules and communication patterns that are maintaining problematic behavior
-involves providing the family with info that challenges family games and helps family members develop communication patterns that increase the family's ability to adapt to change
distinguished from other family therapies by its use of a therapeutic team and five-part therapy sessions (pre-session, session, intersession, intervention, and post-session) and gaps between therapy sessions of 4-6wks
strategies include hypothesizing, neutrality, circular questioning, positive connotation, and family rituals
-hypothesizing: continual interactive process of speculating and making assumptions about the family situation
--first hypotheses are based on info obtained in the initial telephone interview, and hypotheses are modified during therapy as new info about the family's functioning is acquired
-neutrality: therapist's interest in the family's situation and acceptance of each family member's perception of the problem
circular questioning: involves asking each family member the same question to identify differences in perceptions about events and relationships and uncover family communication patterns
--ex. might ask each member, when mom is depressed, what does dad do?
-positive connotation: type of reframing that helps family members view a symptom as beneficial because it maintains the family's cohesion and well-being
--purpose is to change the family's perception of a symptom from an individual family member's illness to, instead, a behavior that's voluntarily controlled and well-intentioned and involves the entire family system
-family rituals: activities that are carried out by family members between sessions and are designed to alter problematic family games
--ex. when parents are competitive in their control of children's behaviors or family events, the therapist might instruct the mother to make all family decisions on odd-numbered days and the father to make family decisions on even-numbered days influenced by humanistic psychology and communication and experiential approaches to family therapy
family systems seek a state of balance, with family problems arising when balance is maintained by unrealistic expectations, inappropriate rules and roles, and dysfunctional communication
Four dysfunctional communication styles:
-placating: involves agreeing with or capitulating to others due to fear, dependency, and a desire to be loved and accepted
-blaming: involves accusing, judging, and bullying others to avoid taking responsibility and to hide feelings of vulnerability and worthlessness
-computing: taking an overly intellectual and rational approach to avoid becoming emotionally engaged with others
-distracting: involves changing the subject and making inappropriate jokes to distract attention and avoid conflict
Congruent (or leveling) style: functional style that's characterized by congruence between verbal and nonverbal messages, directness and authenticity, and emotional engagement with others
Primary goal is to enhance the growth potential of family members by increasing their self-esteem, strengthening their problem-solving skills, and helping them communicate congruently
Satir viewed the therapist's "use of self" as the most important therapeutic tool and proposed that therapists have mx roles when working with clients including facilitator, mediator, advocate, educator, and role model
-also used several techniques to achieve therapy goals including family sculpting (involves having each family member to take a turn positioning other family members in ways that depict their view of family relationships) and family reconstruction (type of psychodrama that involves role-playing 3 generations of the family to explore unresolved family issues and events) evidence-based treatment for at-risk adolescents (ex. conduct disorder, substance use disorder) and their families
incorporates elements of structural, strategic, and behavioral family therapy, and is based on the assumption that problematic behaviors within a family serve important relationship functions (i.e. regulate interpersonal connections and relational hierarchies)
primary goal is to replace problematic behaviors with nonproblematic behaviors that fulfill the same relationship functions
-therapy normally involves 8-30 sessions over a 3-6mo period and consists of 3 stages:
-engagement and motivation stage: emphasis is on forming a therapeutic alliance with family members and helping family members reduce feelings of hopelessness and negativity, increase positive expectations for change, and develop a family-focused understanding of its presenting problems
--techniques used during this stage include joining and reframing
--once family members are engaged and motivated, next stage begins
-behavior change: immediate and long-term behavioral goals are identified and an individualized treatment plan for the family is implemented
--techniques used in this stage include training in parenting, communication, problem-solving, and coping skills
-generalization stage: the focus is on linking family members to community resources and helping them generalize their acquired skills to new problems and situations and identify ways to avoid relapse evidence-based treatment that was originally developed for adolescent offenders at risk for out-of-home placement and their families but has subsequently been adapted for adolescents with other serious clinical problems including psychiatric disturbances, substance abuse, and childhood maltreatment
based on Brofenbrenner's (04) ecological model which views individuals as being embedded in and influenced directly and indirectly by mx systems
focuses on the specific individual, family, peer, school, and social network variables that contribute to a youth's presenting problems, and on interactions between these factors linked with the presenting problems
includes nine treatment principles that are applied using an analytic process that structures the development, implementation, and evaluation of the treatment plan
-core principles are finding the fit between identified problems and their broader systemic context; focusing on positive and strengths; increasing responsibility; being present-focused, action-oriented, and well-defined; targeting behavior sequences; using developmentally appropriate interventions; encouraging continuous effort; stressing evaluation and accountability; and promoting generalization
therapy is provided in the family's home and in community settings where problems occur
interventions derived from strategic and structural family therapy, behavior therapy, and CBT and target factors that are driving problem behaviors
-ex. assessment might indicate that the drivers of an adolescent's daily marijuana use (and targets of treatment) are a high level of family conflict, low parental monitoring of the adolescent's behavior and ineffective discipline, the adolescent's poor social skills and friendships with peers who use drugs, opportunities for the adolescent to use drugs at school, and availability of drugs in the adolescent's neighborhood
therapy is delivered by multidisciplinary team that's tailored to the adolescent's and family's problem behaviors
-for someone with academic, conduct problems, frequent use of marijuana/cocaine, and a recent arrest for cocaine possession
---team may consist of a caseworker, family therapist, substance abuse counselor, and 2 other people who will work with the adolescent in their school and neighborhood each type consists of a triad that includes a consultant, a consultee (therapist or program administrator), and a client or program
1. Client-Centered Case Consultation: focuses on a particular client of the consultee who is having difficulty providing the client with effective services (ex. having trouble identifying an appropriate treatment)
-consultant's goal is to provide the consultee with a plan that will benefit the client
2. Consultee-Centered Case Consultation: focuses on the consultee with the goal of improving their ability to work effectively with current and future clients who are similar in some way (ex. with TBI, specific minority group, etc.)
-goal is to improve the consultee's knowledge, skills, confidence and/or objectivity
-several factors contribute to a consultee's lack of objectivity: ex. theme interference - happens when a consultee's biases and unfounded beliefs interfere with their ability to be objective when working with certain types of clients
Program-Centered Administrative Consultation: involves working with program administrators to help them clarify and resolve problems they're having with an existing mental health program
-goal is to provide administrators with recommendations for dealing with the problems they've encountered in developing, administering, and/or evaluating the program
Consultee-Centered Administrative Consultation: focuses on improving the professional functioning of program administrators so they're better able to develop, administer, and evaluate mental health programs in the future
Mental health consultations differs from collaboration in several ways
-ex. consultant has little or no direct contact with a consultee's client and is not responsible for the client's outcomes
--collaborator usually has direct contact with the client and shares responsibility for the client's outcomes research has found that utilization rates of mental health care services vary, depending on clients' gender, age, sexual orientation, and race/ethnicity
2018 National Survey of Drug Use and Health found that utilization rates were higher for female adults than for male adults
-found that, for all adult respondents, utilization rates were highest for respondents ages 26 to 49 followed by, in order, those 50 and older and those ages 18 to 25, which is consistent with the results of yearly surveys conducted since 2002
studies generally find that sexual minority men and women utilize mental health care services at higher rates than sexual majority (heterosexual) men and women do
-National Health Interview Surveys: sexual minority men and women were 2-4x more likely than heterosexual men and women to have talked with a mental health professional in the past year
-Hughes found that lesbians in their sample were more likely than heterosexual women to report being in recovery or having received treatment for alcohol-related problems
-Koh and Ross found that lesbians more likely than heterosexual women to seek therapy for depression
2018 National Survey of Drug Use and Health indicated that among all adult survey respondents, the use of outpatient mental health services in the past year was highest for respondents who identified themselves as belonging to 2 or more racial groups and lowest for respondents who identified themselves as Asian
-for inpatient mental health services, use was highest for those who identified themselves as American Indian or Alaska Native and lowest for those who identified themselves as Asian
National Survey of Drug Use and Health in 2015 collected data on use of mental health services by individuals ages 18+
-found that annual average use of outpatient mental services from 2008-12 were highest for respondents reporting two or more races, followed by, in order, those who identified themselves as being Black or African American, two or more races, Hispanic American, White, or Asian designed to address a range of diagnoses that not onlly share symptoms but also biological, psychological, and environmental mechanisms that increase the risk for and maintain those symptoms
premise underlying transdiagnostic treatments is that the commonalities across disorders outweigh the differences and that targeting the commonalities may have a number of important benefits compared to diagnosis-specific approaches
ex. treatments can reduce the cost and amount of time associated with training psychologists to deliver numerous diagnosis-specific interventions and they're better suited than single-diagnosis treatments for addressing comorbidities
some treatments (a) combine evidence-based strategies that are applicable to disorders within a single diagnostic category, while others (b) combine strategies that are applicable to disorders from different categories
-ex. of b is the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders - an emotion-focused, cognitive-behavioral intervention for anxiety, depression, and related disorders
--views neuroticism as the core characteristic shared by these disorders and focuses on mechanisms associated with neuroticism, including defecits in emotion regulation and avoidance of intense emotional experiences
---treatment consists of 8 modules: motivational enhancement, psychoeducation, emotional awareness, cognitive flexibility, emotion avoidance, interoceptive exposures, emotional exposures, and relapse prevention
--preliminary research found that UP produces substantial short-and long-term improvement in the symptoms of both principal and comorbid disorders as well as the underlying mechanisms associated with those disorders benefits: decreases patients' and providers' costs, increases access to psychotherapy, and reduces stigma and embarrassment that some people have when receiving psychotherapy at treatment facilities
-research found that in most cases, technology-delivered evidence-based practices provides roughly equivalent outcomes for members of diverse populations and a variety of disorders
a. Anxiety disorders: evidence that telehealth is effective for treating individual anxiety disorders but also for treating comorbid anxiety and mood disorders
--Berryhill did a review of effectiveness of psychotherapy, most often CBT - for treating panic disorder with agoraphobia, GAD, and SAD through telehealth - found sig improvement in anxiety symptoms, with controlled studies finding no sig differences between telehealth and in person
--another study compared telehealth CBT to in person CBT and found they to be similarly effective for reducing comorbid anxiety and depression and improving quality of life
b. PTSD: most studies evaluating use of telehealth for treating PTSD found it to be comparable to face-to-face in terms of effectiveness
-one study found that trauma-focused therapies in person and telehealth were similar in terms of reduction of PTSD, attendance and dropout rates, client satisfaction, and therapist fidelity to treatment protocols
--studies included in their review did not provide entirely consistent results with regard to the therapeutic alliance
---therapists providing telehealth said they didn't have trouble developing rapport with clients, but some reported barriers to developing a therapeutic alliance like the inability to detect nonverbal communications
c. MDD: Berryhill found that most studies reported stat sig decreases in depressive symptoms following telehealth with no stat differences between tele and in person groups receiving the same intervention
-also evidence that telehealth is useful for alleviating the insomnia and chronic pain that often accompany depression
-while a study evaluating the effectiveness of telephone-administered CBH found it to have a lower attrition rate than in-person CBT had, other studies have found that attrition rates for other modes of telehealth vary, depending on the population and type of intervention
d. Bulimia Nervosa: research found that it has beneficial effects but isn't necessarily as effective as in-person treatments
-ex. Mitchell compared telehealth to in-person delivered versions of manual-based CBT for BN - overall results showed that 2 versions had similar attrition rates and that both produced beneficial effects on outcome measures following treatment
--some differences: patients getting in-person CBT had non-sig higher rates of abstinence from binge eating and purging and sig greater reductions in eating disordered cognitions and depression
-Zerwas compared manualized version of CBT group therapy for BN via internet chat group and the same treatment delivered via traditional face-to-face group therapy
--found that patients in both groups experienced a decrease in bine eating and purging and comorbid symptoms of depression and anxiety by the end of treatment but some differences: immediately after treatment ended, patients with F2F therapy had a greater decrease in abstinence rates and anxiety symptoms but the gap between the 2 groups on these measures narrowed at the 12-mo follow-up, indicating that the pace of recovery was slower for patients who got therapy via the internet consists of unearned benefits that are conferred upon White individuals based solely on skin color and are inaccessible to racial/ethnic minorities
McIntosh proposes that most White people are unaware of their race-related privileges because they are maintained by denial
ex. going shopping without being followed/harassed by staff, see race widely represented on TV, can arrange to protect their children most of the time from people who might not like them, are never called upon to speak for members of their own racial group
macro level: systemic and consists of the benefits, rights, and immunities that Whites have within institutions
-ex. more favorable educational opportunities and housing conditions, better health care, and higher salaries
micro level: primarily intrapsychic and interpersonal and includes a sense of entitlement and social validation of Whiteness
proposed that it has substantial negative economic, political, and social costs for racial/ethnic minorities but also have some negative consequences for Whites
-ex. distorted beliefs about race and racism, limited exposure to people of different races and ethnicity, irrational fear of people of different races and ethnicity
--White privilege can interfere with a White therapist's ability to develop multicultural counseling competencies refers to the strength of a culture's social norma and tolerance for deviant behaviors
Tight cultures: have strong social norms and low tolerance for deviant behaviors
-greater conformity to social norms, tendency to engage in risk avoidance behaviors, and a preference for stability
Loose cultures: have weak social norms and high tolerance for deviant behaviors
-greater willingness to act in ways that deviate from social norms and engage in risk-taking and innovative behaviors and a greater openness to change
tightness-looseness is related to the ecological and human-made challenges that nations and states have historically encountered
-ex. those with a history of high population density, greater vulnerability to natural disasters and disease, and scarcity of resources are likely to become tight because they need strong norms and punishments for deviant behaviors to ensure their survival
--while nations and states without these challenges survive with weaker norms and acceptance of deviant behaviors
Gelfand and colleagues looked at 33 nations and 50 states
--Pakistan, Malaysia, and India as three "tightest" countries and Estonia, Hungary, and Israel as the three "loosest" countries
--Mississippi, Alabama, and Arkansas were the three "tightest" states and California, Oregon, and Washington were classified as the three "loosest" states
people living in tight states have higher levels of conscientiousness and lower levels of openness to experience than individuals living in loose states, while the opposite is true for those living in loose states Evidence-based practices: the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences
Empirically supported treatments: slightly differ from above, refer only to treatments that have been found to be effective by scientific research that meets certain criteria
Culturally adapted interventions: involve the systematic modification of an evidence-based treatment (EBT) or intervention protocol to consider language, culture, and context in such a way that it is compatible with the client's cultural patterns, meaning, and values
-adaptations may include incorporating content that's culturally appropriate and relevant (ex. issues related acculturation, racism, and religion and spirituality) and/or altering the format and delivery of treatment so that it's culturally compatible (ex. delivering the treatment in a client's native language, adopting a culturally compatible interpersonal time, and including indigenous healers in treatment delivery)
Adaptations of EBTs has created a fidelity-adaptation dilemma that requires psychotherapists to determine.to what degree they will adopt the standardized top-down approach that demands fidelity in its implementation and the idiographic bottom-up approach that demands sensitivity and responsiveness to each person's unique needs
some research has concluded that evidence shows that culturally adapted interventions provide benefit to intervention outcomes, but this added value is more apparent in the research on adults than on children and youths
-studies have found that adaptations are more effective when they involve adding features to an intervention than when they involve replacing a component of an intervention and that culturally adapted interventions are more beneficial for clients who have the greatest need for them
--ex. clients who are not fluent in English and clients with low levels of acculturation guidelines for working with members of several culturally diverse groups are below:
African Americans:
-consider the client's cultural identity, level of acculturation, and worldview
-keep in mind that racism and other environmental factors may be contributors to the client's presenting problems
-be aware that the client's extended kinship network is likely to include nuclear and extended family members, friends, members of their church and community
-know that roles within African American families are often flexible and that male-female relationships tend to be egalitarian
-empower the client by, for example, helping the client acquire the problem-solving and decision-making skills they need to control their own life
interventions: African American clients usually prefer an egalitarian therapist-client relationship and a time-limited, problem-solving approach
-Boyd-Franklin recommends using a multisystems approach which involves intervening in numerous systems and at multiple levels that include the individual, their immediate and extended family, non-blood relatives and friends, church and community services, and social service agencies
American Indians:
-consider the client's cultural identity, level of acculturation, and worldview
-identify possible environmental contributors (e.g., discrimination, poverty, acculturation conflicts) to the client's presenting problems
-be aware that American Indians often adhere to a collateral social system that incorporates the family, community, and tribe
-recognize that cooperation, sharing, and generosity are important cultural values and that the interests of the family and tribe take priority over the interests of the individual
-be aware that American Indians are likely to regard wellness as depending on the harmony of mind, body, and spirit and illness as the result of disharmony
-eep in mind that American Indians tend to place more emphasis on nonverbal than verbal communication, consider listening to be more important than talking, and view direct eye contact as a sign of disrespect and a firm handshake as a sign of aggression
-foster a collaborative therapeutic relationship and build trust by demonstrating familiarity with and respect for the client's culture and admitting any lack of knowledge
Interventions: collaborative, problem-solving, client-centered approach that avoids highly directive techniques and incorporates American Indian values and traditional healers is usually preferred
-LaFronboise, Trimble, and Mohatt recomment using network therapy, which helps empower clients to cope with life stresses by mobilizing relatives, friends, and tribal members to provide support and encouragement
Hispanic/Latino Americans:
-consider the client's cultural identity, level of acculturation, and worldview
-identify possible environmental contributors (e.g., discrimination, poverty, acculturation conflicts) to the client's presenting problems
-determine the client's beliefs about the nature of their presenting problems and be aware that Hispanic Americans often express psychological symptoms as somatic complaints
-consider how a client's religious and spiritual beliefs might inform assessment, diagnosis, and treatment decisions
-keep in mind that Hispanic/Latino Americans tend to emphasize family welfare over individual welfare
-be aware that Hispanic/Latino American families may be patriarchal and stress machismo (male dominance) and marianismo (female submissiveness)
-adopt a formal style (formalismo) in the initial therapy session but a more personal style (personalismo) in subsequent sessions
Interventions: likely to prefer CBT, solution-focused therapy, family therapy, and group therapy
-therapy may be most effective when it incorporates culturally congruent techniques like cuento therapy (use of folktales to present models of adaptive behavior and dichos (use of proverbs and idiomatic expressions to help clients express their feelings)
Asian Americans:
-consider the client's cultural identity, level of acculturation, and worldview
-identify environmental factors that may be contributors to the client's presenting problems
-be aware that differences in acculturation within families may be a source of conflict
-determine the client's beliefs about the contributors to his or her presenting problems and be aware that Asian Americans often have a holistic view of mind and body and express psychological problems as somatic symptoms
-be aware that Asian American families tend to be hierarchical and patriarchal, adhere to traditional gender roles, and emphasize family needs over individual needs
-keep in mind that a fear of losing face and shame are powerful motivators for Asian Americans and may affect their willingness to discuss personal problems and express emotions
-maintain a formal style during the course of therapy
-be aware that, for Asian American clients, periods of silence and avoidance of eye contact are expressions of respect and politeness.
Interventions: likely to prefer CBT and other brief structured goal-oriented, problem-focused approaches that focus more on the family than the individual
-also likely to expect the therapist to be a knowledgeable expert who gives advice and suggests specific courses of action while also encouraging their participation in identifying goals and solutions to their problems
LGBTQ: men and women are 2x more likely to have a mental disorder in their lives (especially anxiety, depression, and substance misuse) than heterosexual men and women
-also have unique concerns that may be a target of therapy
--coming out and internalized heterosexism
---most LGB individuals report being aware they were different than others during childhood, but median age for being aware of sexuality is between 13-15 - some studies found the more wider they disclosed their identity, the greater their self-esteem and positive affectivity and lower their anxiety, other studies found that disclosure to students/staff associated with greater in-school victimization but also higher levels of self-esteem and decreased depression
--internalized heterosexism (internalized homophobia): internalization of negative messages by LGBTQ about their own identity - identified as a component of minority stress and linked to anxiety, depression, increased risk for suicide, alcoholism, and other substance misuse
-Be aware of the effects of stigmatization and heterosexism on the lives of LGB individuals.
-Recognize that same-sex attractions and behaviors are normal variants of human sexuality but avoid adopting a "sexual orientation blind" perspective that ignores or denies the unique experiences of LGB individuals.
-Consider how your own attitudes toward and knowledge of LGB issues might impact your assessment, diagnosis, and treatment of lesbian, gay, and bisexual clients.
-Distinguish issues related to sexual orientation from those related to gender orientation, and be aware that lesbian, gay, and bisexual individuals may act in gender conforming or gender non-conforming ways.
-Recognize the effects of intersectionality on the lives of LGB individuals - i.e., the effects of such factors as race/ethnicity, culture, gender, age, class, and disability and the interaction of these factors with sexual orientation.
Experts stress of combining EBP with culturally competent services - for LGBTQ clients, means providing affirmative therapy (integration of knowledge and awareness by the therapist of the unique development and cultural aspect of LGBTQ individuals, therapist's own self-knowledge, and translation of this into effective and helpful therapy skills at all stages)
--ex. when using CBT with someone, important to distinguish between maladaptive thoughts and thoughts that reflect a normal response to stigmatization they have experienced
Older Adult Clients: with exception of neurocognitive disorder, the rates of mental health disorders are lower among older adults than their younger and middle-aged counterparts
-many older adults experience mental health problems (anx/dep most common) and their symptoms may differ from younger adults
--ex. with depression, older adults more likely to complain about physical and cognitive symptoms than emotional distress and to report irritability, insomnia, weight loss, and other symptoms associated with anxiety
-Consider how your own attitudes and beliefs about aging might impact your assessment and treatment of older adults.
-Be aware that the heterogeneity among older adults surpasses that seen in other age groups, and recognize how gender, age, race/ethnicity, sexual orientation, and other factors may affect the experience and expression of psychological problems of older adults.
-Be familiar with normal biological changes associated with increasing age (e.g., changes in sensory acuity and cognitive functioning) and be able to distinguish between normative changes and changes due to physical illness or medications.
-Be aware that older adults respond favorably to a variety of types of psychotherapy but that some interventions have been found to be particularly effective for older adults with certain disorders (e.g., cognitive-behavior therapy and reminiscence therapy for depression).
-Acquire the knowledge and skills needed to make culturally sensitive adaptations to interventions that increase their effectiveness for older adults
--ex. modifying an intervention process and/or content (slowing pace of therapy, increasing number of sessions/decreasing frequency, accommodating heating loss, addressing physical illness/grief/cog decline and other problems that are experienced more often by older than younger adults)
Treatment: research found that effects of psychotherapy are comparable for older and younger adults but that older adults may respond more slowly to therapy and benefit most when treatment is tailored to their cognitive, sensory, and physical needs distinguishes between five stages of identity development:
1. Conformity:
-People have either neutral or negative attitudes toward members of their own minority group and other minority groups
-positive attitudes toward members of the majority group
-accept negative stereotypes of their own group and consider the values and standards of the majority group to be superior
-prefer a therapist from the majority group and view a therapist's attempts to help them explore their cultural identity as threatening.
2. Dissonance: As the result of exposure to information or events that contradict their worldview, people in this stage question their attitudes toward members of their own minority group, other minority groups, and the majority group.
-they're aware of the effects of racism and are interested in learning about their own culture
-may prefer a therapist from the majority group but want the therapist to be familiar with their culture, and they're interested in exploring their cultural identity.
3. Resistance and Immersion:
-People in this stage have positive attitudes toward members of their own minority group, conflicting attitudes toward members of other minority groups, and negative attitudes toward members of the majority group.
-unlikely to seek therapy because of their suspiciousness of mental health services
--When they do seek therapy, they're likely to attribute their psychological problems to racism and prefer a therapist from their own minority group.
4. Introspection: During this stage, people question their unequivocal allegiance to their own group and are concerned about the biases that affect their judgments of members of other groups.
-They've become comfortable with their cultural identity but are also concerned about their autonomy and individuality.
-may prefer a therapist from their own minority group but are willing to consider a therapist from another group who understands their worldview, and they're interested in exploring their new sense of identity
5. Integrative Awareness:
-People are aware of the positive and negative aspects of all cultural groups.
-They're secure in their cultural identity and are committed to eliminating all forms of oppression and becoming more multicultural.
-Their preference for a therapist is based on similarity of worldview, and they're most interested in strategies aimed at community and societal change. does not describe sequential stages of identity development but, instead, proposes that a person's racial identity may vary across time and situations.
-developed for African American individuals and defines African American racial identity as the significance and qualitative meaning that individuals attribute to their membership within the Black racial group within their self-concepts
Also distinguishes between four dimensions of racial identity:
-Racial salience: the extent to which a person's race is a relevant part of his/her self-concept at a particular point in time and in a particular situation.
--ex. race may become more salient for a person when they witnesses or experiences discriminatory behavior or is the only African American in a restaurant, classroom, or other social setting.
-Racial centrality: the extent to which a person normatively defines themselves in terms of race and is affected by the importance of race to the person relative to other identities such as gender and religion.
--ex. for some African American women, gender may be more important than race for their identities while, for others, the opposite may be true. ---In contrast to salience, centrality is relatively stable across situations.
-Racial regard includes private and public regard.
--Private regard refers to the extent to which a person feels positively or negatively toward African Americans and how positively or negatively they feel about being an African American.
--Public regard refers to the extent to which a person feels that others view African Americans positively or negatively.
---Private and public regard are not necessarily related and a person can have, for example, negative private and public regard or positive private regard and negative public regard.
-Racial ideology: refers to a person's beliefs and opinions about the ways African Americans should live and interact with society.
--(a) nationalist ideology: view the African American experience as being unique and believe African Americans should control their own destinies with minimal input from other groups.
--(b) oppressed minority ideology: emphasize the similarity of the oppression experienced by African Americans and members of other minority groups, and they're interested in forming coalitions with other groups.
--(c) assimilationist ideology: emphasize similarities between African Americans and the rest of American society and believe that African Americans should work within the system to change it.
--(d) humanist ideology: emphasize the similarities of all humans, give race low centrality, and are more concerned with issues facing the human race such as peace, poverty, and climate change.
a person's ideology may depend on the context
-ex. believe that African Americans should patronize African American-owned businesses as often as possible (nationalist ideology) but also think that African Americans should have more social contact with White individuals (assimilationist ideology)
propose that the four dimensions of racial identity can help clarify why individuals respond to similar situations differently.
--ex. two African American adults with similar regard and ideology may act differently in the same situation because race has high salience for one person in that situation but low salience for the other person. gay and lesbian identity development are most fully realized when self-identity, perceived identity, and presented identity coincide
distinguishes between four stages:
1. Sensitization: occurs during childhood and is characterized by feeling different from same-sex peers.
-ex. Young girls may feel that they're not feminine or pretty and are more independent and aggressive than other girls are
-ex. young boys may say they're less interested in sports and less aggressive than other boys and are more interested in art, reading, and other solitary activities.
2. Identity Confusion: begins in middle or late adolescence when individuals start to feel sexually attracted to individuals of the same sex and suspect that they're gay or lesbian.
-This suspicion leads to uncertainty and anxiety which they attempt to alleviate with denial, avoidance, repair (attempting to change), redefinition (viewing homosexual feelings as a phase), or acceptance.
3. Identity Assumption: The transition occurs when the person begins to accept a gay or lesbian identity
-usually between 19 and 21 years of age for males and between 21 and 23 years of age for females.
-Individuals in this stage seek out social and sexual relationships with gays or lesbians and disclose their sexual orientation to gay and lesbian peers and adults and to some heterosexual family members and friends.
4. Identity Commitment: People in this stage have internalized a gay or lesbian identity, accepted homosexuality as a way of life, and are comfortable disclosing their sexual orientation to heterosexual individuals including family members, friends, and coworkers. originally developed as an intervention for depression and is now considered an evidence-based treatment not only for depression but also for bipolar disorder, generalized anxiety disorder, anorexia nervosa, bulimia nervosa, schizophrenia, obsessive-compulsive disorder, PTSD, and a number of other disorders
based on the assumption that psychological disturbance is due largely to maladaptive cognitive schemas, automatic thoughts, and cognitive distortions:
-(a) Cognitive schemas: core beliefs that develop during childhood as the result of experience and certain biological factors such as biological reactivity to stress.
--Schemas are enduring, can be maladaptive or adaptive, and are revealed in automatic thoughts.
--proposed that different disorders are associated with different maladaptive schemas, which are also known as cognitive profiles.
---ex. the cognitive profile for depression consists of negative beliefs about oneself, the world, and the future.
-(b) Automatic thoughts: verbal self-statements or mental images that come to mind spontaneously when triggered by circumstances and intercede between an event or stimulus and the individual's emotional and behavioral reactions
--can be positive or negative.
---Negative automatic thoughts are characterized by a distortion of reality, emotional distress, and/or interference with the pursuit of life goals and can contribute to psychological distress
----Practitioners of CBT often have clients record negative automatic thoughts outside therapy in a Dysfunctional Thought Record (DTR) whenever they feel their mood is worsening. When using a DTR, the client records the event or situation that led to an unpleasant emotion, the automatic thoughts that preceded the emotion, the type of emotion and its intensity on a scale from 0 to 100, an alternative rational response to the automatic thought, and the outcome (the emotion and any change in behavior elicited by the rational response).
-(c) Cognitive distortions are systematic errors in reasoning that often affect thinking when a stressful situation triggers a dysfunctional schema that, in turn, affects the content of automatic thoughts.
-Common distortions include arbitrary inference, selective abstraction, dichotomous thinking, personalization, and emotional reasoning:
--Arbitrary inference involves drawing negative conclusions without any supporting evidence.
--Selective abstraction involves paying attention to and exaggerating a minor negative detail of a situation while ignoring other aspects of the situation.
--Dichotomous thinking is the tendency to classify events as representing one of two extremes - for example, as a success or a failure.
--Personalization involves concluding that one's actions caused an external event without evidence for that conclusion.
--emotional reasoning is reliance on one's emotional state to draw conclusions about oneself, others, and situations.
The primary goals of CBT are to correct faulty information processing and to help patients modify assumptions that maintain maladaptive behaviors and emotions
Practitioners of CBT adopt an active, structured approach and use a variety of cognitive and behavioral techniques to achieve these goals.
-Cognitive techniques include redefining the problem, reattribution, and decatastrophizing
-behavioral techniques include activity scheduling, behavioral rehearsal, exposure therapy, and guided imagery (which is used to facilitate relaxation and decrease anxiety and pain).
An essential feature of CBT is its reliance on collaborative empiricism, which is a collaborative therapeutic alliance between the therapist and client in which they become coinvestigators as they examine the evidence to accept, support, reevaluate, or reject the client's thoughts, assumptions, intentions, and beliefs
Another feature is the use of Socratic dialogue, which involves asking the client questions that are designed to clarify and define the client's problems, identify the thoughts and assumptions that underlie those problems, and evaluate the consequences of maintaining maladaptive thoughts and assumptions. attributes psychological disturbances to irrational beliefs, which tend to be absolute (or dogmatic) and are expressed in the form of 'must's,' 'should's,' 'ought's,' 'have to's,' etc. and lead to negative emotions that largely interfere with goal pursuit and attainment
-ex. "I must do well on all of the important projects I take on; if not, I'm an inadequate person" and "You must take care of me when I need you to do so; if not, you're not a good person"
Ellis uses an A-B-C-D-E model to explain psychological disturbance and the process of change in therapy:
-A is an activating event
-B is the client's irrational belief about that event
-C is the emotional or behavioral consequence of that belief
-D is the therapist's use of techniques that dispute the client's irrational belief
-E is the effect of these techniques, which is the replacement of the irrational belief with a more rational one.
Practitioners of REBT use a variety of cognitive, behavioral, and emotive techniques, including active disputation of irrational beliefs, rational-emotive imagery, systematic desensitization, and skills training.
Research has found that REBT is an effective treatment for depression, anxiety, conduct problems, anger, and several other disorders and conditions based on the assumptions that psychological pain is both universal and normal and is part of what makes us human and that psychological inflexibility causes psychological problems and is characterized by a rigid dominance of psychological reactions over chosen values and contingencies in guiding action
distinguishes between clean and dirty pain:
-Clean pain is also known as clean discomfort and refers to natural levels of physical and psychological discomfort that are inevitable and cannot be controlled.
-Dirty pain is also known as dirty discomfort and refers to the emotional suffering that's caused by attempts to control or resist clean pain.
The main goal of ACT is to increase psychological flexibility, which involves addressing six core processes that foster acceptance, mindfulness, commitment, and behavior change and counter the processes that contribute to psychological inflexibility:
-Experiential acceptance counters experiential avoidance and is the active and aware embrace of private experiences without unnecessary attempts to change their frequency or form
-Cognitive defusion counters cognitive fusion and is the ability to distance oneself from one's thoughts and feelings and view them as experiences rather than reality.
-Being present counters attentional rigidity to the past and future and involves being in contact with whatever is happening in the present moment.
-Awareness of self-as-context counters attachment to the conceptualized self. It's the ability to view oneself as the context in which one's thoughts and feelings occur rather than as the thoughts and feelings themselves.
-Values-based actions counter unclear, compliant, or avoidant motives and depend on the ability to use one's freely chosen values to guide one's behaviors.
-committed action counters inaction, impulsivity, and avoidant persistence and refers to a commitment to continue to act in ways consistent with one's values in the future, even when faced with obstacles.
Interventions target these six processes and include metaphors, mindfulness strategies, and experiential exercises. ACT is considered to be an evidence-based treatment for a number of conditions including chronic pain, psychosis, depression, anxiety disorders, and obsessive-compulsive disorder. Mindfulness refers to moment-to-moment awareness of one's experience without judgment
has been incorporated into several therapeutic approaches including ACT and DBT and is the core strategy of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT).
MBSR was originally developed to make mindfulness meditation available and accessible in a Western medical setting while remaining true to the essence of Buddhist teachings
-It's used to help people cope with stress, pain, and illness and consists of an eight-session group program that focuses on teaching participants several mindfulness meditation practices including awareness of breathing, yoga, and sitting and walking meditation.
MBCT combines elements of MBSR and CBT.
-It was originally developed as a method for treating recurrent depression and research has confirmed that it's an effective treatment not only for depression but also for a number of other conditions including anxiety, chronic pain, and insomnia.
-The primary goal of MBCT is to enable clients to become self-aware, so they can learn to de-centre from distressing thoughts, feelings, bodily sensations and behaviours.
- It incorporates psychoeducation, mindfulness meditation practices, and cognitive-behavioral techniques and, like MBSR, usually consists of an eight-session group program.
Based on their meta-analysis of research on mindfulness-based interventions, Khoury and his colleagues (2013) have concluded that they're effective for treating both psychological disorders and physical/medical conditions but are more effective for psychological disorders, especially depression, anxiety, and stress.
-There's no clear consensus about the mechanisms that are responsible for the effectiveness of mindfulness-based interventions, but several mechanisms have been proposed and received some research support.
Holzel and her colleagues (2011) conclude that the primary mechanisms are attention regulation, emotion regulation, body awareness, which is awareness of one's internal states, and decentering, which is also known as reperceiving and is the ability to separate oneself from one's thoughts and emotions and view them objectively as transient mental events. financeIn June 2020, Front Row Entertainment had the opportunity to expand its venue operations by
purchasing five different venues. To finance this purchase, Front Row issued $1,500,000 of 6%,
5-year bonds on July 1, 2020. The bonds were issued for$1,378,300 and pay interest semiannually on June 30 and December 31.
**Required:**
Assume that Front Row uses the effective interest method of amortization and the annual
market rate of interest was 8%.
a. Prepare an amortization table through December 31, 2021. (Note: Round to the nearest
dollar.)
b. Prepare the journal entry required at December 31, 2020.
c. How will the bonds be shown on the December 31, 2020 balance sheet? 10th Edition•ISBN: 9780134700724Elliot Aronson, Robin M. Akert, Samuel R. Sommers, Timothy D. Wilson525 solutions
2nd Edition•ISBN: 9781464113079David G Myers901 solutions
3rd Edition•ISBN: 9781319070502 (1 more)C. Nathan DeWall, David G Myers956 solutions
10th Edition•ISBN: 9780134641287 (1 more)Elliot Aronson, Robin M. Akert, Timothy D. Wilson525 solutions
