1
Q
Hypothalamus
A
♣ Regulates body systems: breathing, eating, sleeping, thirst
♣ Sends signals to pituitary to produce oxy, end, dop, and ser
♣ Controls ANS
♣ Center for emotional response and bx
2
Q
Amygdala
A
- makes associations
- face recognition
- responsible for the influence of emotional states on sensory inputs
- produces sensory perceptions
3
Q
Hippocampus
A
- info from short to long term memory
- part of the temporal lobe
- if damaged can result in loss of memory
- shrinks with stress
4
Q
Cingulate Gyrus
A
♣ Long ridge separating frontal lobes
♣ Gear-shifter (thought/thought, bx/bx)
♣ Excessive worries (over rigidity)
♣ Regulates limbic system/emotional brain
♣ Drives body’s conscious response to unpleasant experiences
♣ Prediction/avoidance of neg stim
5
Q
Prefrontal Cortex
A
- the analytical part of the brain that helps you make decisions
- active when you experience kindness, feel compassion, meditate, & feel happy
6
Q
Cortisol
A
stress hormone
7
Q
Insula
A
- integrates the mind & body
- positivity & meditation is associated with a thicker insula
- senses ones feelings
8
Q
Vagus Nerve
A
♣ Nerve of compassion
♣ Calms down body & boosts immune system
♣ Associated w/oxytocin
♣ Detects & regulates happiness & empathy
9
Q
Sympathetic Nerves
A
travel to organs to produce stress-activity for times of emergency
10
Q
The prefrontal cortex and cerebral networks work together to release:
A
- oxytocin (feeling trust and empathy),
- endorphins (runner’s high, masks feelings of pain),
- dopamine (reward), and
- serotonin (feeling “on top”, feeling safe)
11
Q
Similarities between stress and fear:
A
o Involve hypothalamus, thalamus, hippocampus, amygdala, prefrontal cortex
o Involve neurobiological responses in response to threatening stimuli (incl. autonomic/somatic reflexes)
o Involve apprehension & hyperarousal
12
Q
Both stress and fear involve the following major brain structures:
A
Thalamus, Hypothalamus, Prefrontal Cortex, Amygdala, Hippocampus
13
Q
Differences between stress and fear:
A
o Stress: Response to adverse stimuli o Fear: ♣ Fear conditioning is learned ♣ Response to perceived threat of harm or danger ♣ Responses: FFF/Play dead
14
Q
3 Types of Cognitive Distortions
A
Automatic thoughts
Maladaptive assumptions
Negative schemas
15
Q
Automatic thoughts
A
Most superficial: all-or-nothing thinking, overgeneralization, mental filter, discounting the positive, jumping to conclusions, magnification, emotional reasoning, “should” statements, labeling, personalization and blame
16
Q
Maladaptive assumptions
A
If/then statements
17
Q
Negative schemas
A
Preconceived beliefs about self
18
Q
3 Areas that Treatment Reports Cover
A
Symptoms
Goals
Interventions
19
Q
Getting approval from managed care companies requires:
A
Medical necessity (DSM5) Appropriate treatment
20
Q
3 Key assumptions shared by managed care and CBT approaches:
A
♣ Symptoms are problem
♣ Symptom relief is goal
♣ Treatment must be evidence based to reduce symptoms
21
Q
Though CBT, patients evaluate their distorted thinking in 2 ways:
A
Guided Discovery
Behavioral Experiments
22
Q
10 Basic Principles of CBT:
A
- CBT is based on an ever-evolving formulation of patients’ problems and an individual conceptualization of each patient in cognitive terms
- CBT requires a sound therapeutic alliance
- CBT emphasizes collaboration and active participation
- CBT is goal oriented and problem focused
- CBT initially emphasizes the present
- CBT is educative, aims to teach the patient to be their own therapist, and emphasizes relapse prevention
- CBT aims to be time limited
- CBT sessions are structured
- CBT teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs
- CBT uses a variety of techniques to change thinking, mood, and behavior
23
Q
CBT is based around the:
A
cognitive model which states that people’s emotions, behaviors, and physiology are influenced by their perception of events
24
Q
Core Beliefs
A
most fundamental, rigid, overgeneralized, global
25
Intermediate Beliefs
rules, attitudes, assumptions
26
2 types of methods for treating PTSD:
Core interventions
| Interventions as needed
27
Gestalt: Relationship
o I/thou
o Who therapist is as person/ what therapist is doing
o Presence, authenticity, gentleness, direct self-expression
o Therapist does not interpret
28
Gestalt: Concept
o Stresses the “here and now”; direct (as opposed to talked-about) experiencing
o Awareness and integration of the fragmented parts of the personality
o Individuals understood by relationship with environment
o Clients have capacity to do their own seeing, feeling, sensing, and interpreting
o 5 major channels of resistance:
Introjection (acceptance of others’ beliefs/standards w/o assimilating into one’s own personality)
Projection (disown certain aspects of ourselves by ascribing them to the environment; opposite of introjection)
Retroflection (turning back onto ourselves something we would like to do, or have done, to someone else)
Confluence (sense of the boundary between self and environment is lost)
Deflection
29
Gestalt: Goals
♣ Do own seeing, sensing, interpreting
♣ Put together fragmented parts of personality
♣ Attain awareness of present experiences, environment, & self
♣ Identify unfinished business interfering w/present through re-experiencing
30
Gestalt: Techniques
♣ Experiments w/in I/thou relationship
♣ Personal engagement w/client to come increase freedom, awareness, & self-direction (less directing, more guiding)
♣ Empty chair: Good for confrontation with conflicting parts of the self
31
Psychoanalytic: Relationship
Anonymous
| Blank screen for projection
32
Psychoanalytic: Concepts
♣ Analysis of transference/countertransference essential
♣ Human nature is deterministic
• Focus on irrational forces
• Biological drives
• Unconscious motives
♣ Development of ego: Differentiation/individualization of self
♣ Past clues = Present problems
♣ Lock of dev. of personality = psychopathology
33
Psychoanalytic: Goals
o Make unconscious known
o Growth of ego Analysis of resistance/transference
o Allow ego to solve unconscious conflicts
o Restructuring of personality helps solve immediate problems
o Increase awareness, intellectual insight
34
Psychoanalytic: Techniques
```
o Maintain analytic framework
o Free association
o Analysis of resistance in therapy
o Interpretation of client’s life patterns
o Analysis of transference
o Dream analysis
```
35
Adlerian: Relationship
o Mutual respect
o Both active in therapy
o Build trust/rapport
o Focus attention on quality of therapeutic relationship
36
Adlerian: Concepts
o Social psychology
Influenced more socially than biologically
Humans motivated by social interest
Sense of belonging
o Positive view of human nature
o Psycho issues not illness; discouragement
o Consciousness is center of personality
People are in control of own fate
o Present = Perceived past; early memories influence present
37
Adlerian: Goals
o Identify, change mistaken beliefs about self; faulty assumptions
o Overcome discouragement
o Foster social interest
o Create socially useful goals (collaboratively)
o Create sense of equality with others
38
Adlerian: Techniques
```
o More attention to the subjective experiences of client than using techniques
o Empathetic attending, encouragement, summarizing
o Lifestyle assessment
o Encouraging task setting & commitment
o Identifying & clarifying goals
o Immediacy & confrontation
o Acting as if
o Spitting in the client’s soup
o Catching oneself
o The push-button technique
o Externalization
o Avoiding traps
o Use of stories and fables
o The miracle question
o Interpretation of the family constellation
o Exploring early memories
o Suggestion / Advice
```
39
Existential: Relationship
o Collaborative
o Attention is given to the client’s immediate, ongoing experience (esp. interaction b/w therapist & client)
o Bond is very important
o Therapists are fully present
o Strive to create caring relationship w/ clients
o Use appropriate self-disclosure
40
Existential: Concept
o Affirms looking at unique human characteristics
o Givens of Life
Mortality
Meaninglessness
Choice, freedom, & responsibility
Uncertainty
Guilt & existential guilt
Anxiety & existential anxiety
Relationships
Isolation & aloneness
o The significance of our existence is never fixed
Re-creation of self through projects
Forces us to recognize the realities of mortality
Humans have the capacity for self-awareness
Preservation of uniqueness and identity
We know ourselves in relation to knowing & interacting with others
Clients address ultimate concerns rather than coping with immediate problems
o Death; awareness of it gives significance to living
o Anxiety as motivation for change
41
Existential: Goals
o Identify ways not fully living authentic life
o Make choices that will lead to full capabilities
o Exploration of the existential “givens of life”
o Remove roadblocks to meaningful living
o Help identify meaning and purpose in life
o Widen clients’ perspectives on choice, and accept the freedom and responsibility
42
Existential: Techniques
o Understanding client’s current experience, not on techniques
o Adapt interventions to own personality and style; pay attention to what each client needs
o Help clients become aware of their choices and their potential for action
43
What theories are part of Humanistic theories?
Person Centered
Existential
Gestalt
44
What theories are part of Cognitive-Behavioral theories?
```
CBT
CR
REBT
Behavioral Therapy
Reality Theory
```
45
What theories are part of Post Modern theories?
Feminist Theory
Narrative Therapy
Solution-Focused
46
Person-Centered: Relationship
o Therapeutic relationship most influential determinants of therapy outcome
o Therapists should be genuine, have non-possessive warmth, accurate empathy, unconditional acceptance of and respect for the client
o Therapist’s attitudes and belief in the inner resources of the client create the therapeutic climate for growth
o Therapists do not set the goals of therapy
47
Person-Centered: Concept
o Positive view of humanity that sees the person as innately striving toward becoming fully functioning
o Client primarily brings about change
Clients have the resourcefulness
Does not need interpretation & direction from therapist
Through growth, wholeness, spontaneity, and inner-directedness
o Emphasizes fully experiencing the present moment, learning to accept oneself, and deciding on ways to change
o Clients value being understood & accepted more likely to explore feelings, thoughts, behaviors, and experiences
48
Person-Centered: Goals
o Provide a climate of safety and trust so client can become aware of blocks to growth through self-exploration
o Assist client in moving towards more openness, greater self-trust, more willingness to evolve
o Enable the client to better cope with present and future problems through growth
49
Person-Centered: Techniques
o Therapy techniques are secondary to the therapist’s attitudes
o Minimizes direct techniques, interpretation, questioning, probing, diagnosis, and collecting history
o Maximizes active listening and hearing, empathetic understanding, presence, reflection of feelings, and clarification
o Accurately understand client’s subjective world
o Focus on client’s perceptions of reality
50
Behavior Therapy: Relationship
o Need a good, working relationship
o Therapist:
Flexible relationship styles to enhance treatment outcomes
Conceptualize problems behaviorally & use relationship to bring about change
Explore alternative courses of action and consequences
Active & directive
Consultants & problem solvers
o Clients must also be active in therapy the entire time, are expected to carry out therapeutic activities both in and out of therapy.
51
Behavior Therapy: Concept
o Behavior is the product of learning.
o We are both the product and producer of our environment.
o Contemporary behavior therapies encompass a variety of conceptualizations, research methods, and treatment procedures to explain and change behavior.
o These central characteristics unite the field of behavior therapy:
a focus on observable behavior,
current determinants of behavior,
learning experiences to promote change, and
rigorous assessment and evaluation.
o Precise treatment goals diverse strategies for goals evaluation of outcomes
o Therapy focuses on behavior change in the present and on action programs.
o Behaviors are measured before and after intervention
52
Behavior Therapy: Goals
o Create specific goals in therapy in concrete, measurable, and objective terms
o Increase personal choice
o Create new conditions for learning
o Eliminate maladaptive behaviors & learn more effective behavior
53
Behavior Therapy: Techniques
o Behavioral treatment interventions are individually tailored to the specific problems of the client.
o Any technique that can be demonstrated to change behavior may be incorporated in a treatment plan.
o Relaxation, mindfulness, being present, acceptance
o systematic desensitization & exposure therapies
o EMDR
o Social skills training
o Self-modification programs
o Role playing, behavior rehearsal, guided practice, modeling, feedback, & homework
54
REBT: Relationship
o Warm relationship between therapist and client is not essential
o Only unconditional positive regard is needed
o Therapist
Does not blame or condemn clients
Teaches clients how to avoid rating and condemning themselves
Functions as a teacher, client as the student
o Clients expected to actively practice changing their self-defeating behavior and converting it into rational behavior
55
REBT: Concept
o Assumes thinking, evaluating, questioning, doing, practicing, and re-deciding are at the base of behavior change
o Didactic and directive model
o Therapy is a process of reeducation
o Based on the assumption that a reorganization of one’s self-statements will result in a corresponding reorganization of one’s behavior
o Although emotional disturbance is rooted in childhood, people keep telling themselves irrational and illogical sentences.
o The approach is based on the ABC theory of personality (A= actual event, B= belief system, C= consequence)
56
REBT: Goals
o Eliminate self-defeating outlook on life and acquire a more rational and tolerant
philosophy
o Clients are taught that the events of life themselves do not disturb us, rather, our interpretation of events is what’s critical
o Clients are taught to substitute preferences for demands
57
REBT: Techniques
o Eclectic; use a variety of cognitive, affective, and behavioral techniques, tailoring them to the clients
o Borrows many methods from behavioral therapy
o Disputing irrational beliefs
o Cognitive homework
o Changing one’s language
o Use of humor.
o Emotive techniques include: rational emotive imagery, role playing, and shame-attacking exercises.
o Also include operant conditioning, self-management strategies, and modeling.
o Techniques are designed to get clients to critically examine their present beliefs and behavior. Highly directive, persuasive, and confrontational.
58
CT: Relationship
o Collaborative
o Therapists are continuously active, interactive, & strive to engage the client’s participation
o Quality of therapeutic relationship is related to therapy outcomes
59
CT: Concept
```
o Cognitions (internal dialogue) are the major determinants of how we feel and act
o Changing cognitions = changing behavior and feelings
o How we monitor and instruct ourselves & interpret events shed light on dynamics of disorders
o Psychological problems = faulty thinking, making incorrect inferences, failing to distinguish b/w fantasy and reality
```
60
CT: Goals
o Goal is to change the way clients think by using their automatic thoughts to reach their core schemata (system of organizing and perceiving information) and begin to introduce the idea of schema restructuring
o Clients learn to discriminate between their own thoughts and the events that occur in reality
o Consists of changing dysfunctional emotions and behaviors by modifying inaccurate and dysfunctional thinking
61
CT: Techniques
o Techniques used to identify and test the client’s misconceptions and faulty assumptions
o Guided discovery: helps clients understand the connection between their thinking and the ways they feel and act.
Socratic dialogue: clients encouraged to gather & weigh evidence to support beliefs
62
CBT: Relationship
o Collaborative
o Therapists are continuously active, interactive, & strive to engage the client’s participation
o Quality of therapeutic relationship is related to therapy outcomes
63
CBT: Concept
o Complex, multifaceted intervention that is a preventative and treatment-based approach
o Posit that clients must notice and become aware of how they think, feel, behave, & the impact they have on others before they can change their behavior
o To elicit change, clients need to interrupt the scripted nature of their behavior so that they can evaluate their behavior in various situations
64
CBT: Goals
o Help clients become aware of their self-talk and the stories they tell about themselves
o Interrupt downward spiral of thinking, feeling, behaving, & teaching them more adaptive ways of coping using the resources they bring to therapy
65
CBT: Techniques
o Stress inoculation training involves collaborative goal setting that nurtures hope, direct-action skills, and acceptance-based coping skills
o Designed to be applied to present/future problems
o 3 stage model for stress inoculation training:
♣ 1) conceptual-educational phase
♣ 2) skills acquisition and skills consolidation phase
♣ 3) application and follow-through phase
o Establish therapeutic alliance
o Conceptual framework to educate about ways of responding to many stressful situations
o Teach new set of coping self- statements
o Relaxation methods
o New self-statements & applying new skills
66
Reality Therapy: Relationship
o Therapist is involved & creates a warm, supportive, & challenging relationship
o Demonstrate involvement with & concern for the client
o Once a solid relationship is established, the therapist confronts clients with reality & consequences of actions
o Avoids criticism, refuses to accept client excuses for not following through, & does not easily give up on clients
67
Reality Therapy: Concept
o Grounded on the basic premise of choice theory, which asserts that we are self-determining human beings
♣ We choose our total behavior
♣ We are responsible for how we act, think, feel, and our physiological states
♣ Acting and thinking are chosen behaviors and should be the focus of therapy
♣ No matter how dire, people always have a choice
♣ Personal responsibility and on dealing with the present
o Rejects the medical model of psychoanalytic therapy and concepts
o We are not born blank slates waiting to be externally motivated by forces in the external world
o Change our acting and thinking = influence feeling & physiological state
o Behavior is our attempt to control our perceptions of the external world so they fit our internal & need-satisfying world
o All behavior is aimed at satisfying the needs for survival, love, belonging, power, freedom, and fun
o Total behavior includes: acting, thinking, feeling, & the physiology that accompanies actions
o We all possess the same 5 human needs, but we all fulfill them differently
68
Reality Therapy: Goals
o Find better ways to meet needs for survival
o More effective & responsible choices related to wants and needs
o Behavioral change, personal growth, improvement, enhanced lifestyle, & better decision making
o Accept personal responsibility for their lives & learn ways to regain control of life
o Challenged to examine what they are doing, thinking, & feeling to determine if there is a better way to function
69
Reality Therapy: Techniques
o Therapists assist clients in the continual process of evaluating the effectiveness and appropriateness of their current behavior
o The therapist does not determine what behaviors clients should change. Clients decide what to change then formulate a plan to facilitate desired changes.
o Counseling consists of specific procedures that lead to change in behavior
♣ Based on the assumption that human beings are motivated to change when:
• 1) they determine that their current behavior is not getting them what they want
• 2) they believe they can choose other behaviors that will get them closer to what they want
o Techniques are generally summarized in the WDEP model:
♣ W= wants: exploring wants, needs, and perceptions
♣ D= direction and doing: focusing on what clients are doing and the direction that this is taking them
♣ E= evaluation: challenging clients to make an evaluation of their total behavior
♣ P= planning and commitment: assisting clients in formulating realistic plans and making a commitment to carry them out
70
Feminist: Relationship
o Based on empowerment/egalitarian, deliberately equalizing the power base b/w client & therapist
o The therapist/client relationship models how to identify & use power responsibly
o Emphasis is given to authentic connection b/w the therapist and client
o Therapist works to demystify therapy & include the client as active partner
o Collaboration = genuine partnership with clients.
71
Feminist: Concept
o 8 different philosophies underlying feminist practice:
♣ Liberal, cultural, radical, socialist, postmodern, women of color, lesbian, and global/ international
♣ Each have differing views on sources of oppression how bring about social transformation
o Focus on issues of diversity, the complexity of sexism, & social context in understanding gender issues
o Challenges male-oriented assumptions re:what is a mentally healthy individual
♣ Problematic symptoms can be viewed as coping/survival strategies rather than pathology
o Gender neutral, flexible, interactional, & life-span oriented
o Gender-role expectations profoundly influence our identity from birth
♣ Impact of these are identified so clients can critically evaluate & modify early messages of gender-role behavior
o Based on 6 principles: the personal is political, commitment to social change, women’s and girl’s voices are valued, egalitarian relationship, focus on strengths & a new definition of psychological distress, & all types of oppression are recognized
o Clients are not to blame for personal problems largely caused by dysfunctional social environments, but are responsible for working toward change
72
Feminist: Goals
o Therapists teach clients to recognize how they define & relate to others are influenced by gender-role expectations
o 6 goals of feminist therapy are: equality, balancing independence and interdependence, self-nurturance, empowerment, social change, and valuing and affirming diversity
o Work to empower all people to create a world of equality
o Both individual & societal transformations are crucial goals of therapy
o Help men and women recognize, claim, & embrace personal power
o Social transformation
73
Feminist: Thechniques
o Technically integrative approach that tailors interventions to meet client strengths
o Use techniques from other therapies: use of therapeutic contracts, homework, bibliotherapy, therapist self-disclosure, empowerment, role-playing, cognitive restructuring, reframing, relabeling, and assertiveness training.
o Also include gender-role analysis and intervention, power analysis &intervention, and social action
o Feminist therapists have challenged assessment and diagnostic procedures because they are often influenced by the –ism’s
Diagnosis of mental illness becomes secondary to the identification and assessment of strengths, skills, and resources
74
Solution-Focused: Relationship
o Collaborative venture
o Climate of mutual respect, dialogue, inquiry, and affirmation
o Therapist:
♣ Is understanding & accepting to allow client to tap own resources
♣ Adopt a “not-knowing” position to put clients are experts of own lives
♣ Don’t assume they know more about the life of clients than client
o Clients are the primary interpreters of their own experiences.
o Clients establish own goals & preferences
75
Solution-Focused: Concept
o Realities are socially constructed; no absolute reality
♣ Therapists should not impose their vision of reality or values on client
o Optimistic assumption people are healthy, competent, resourceful, & possess ability to construct solutions
♣ Therapist’s not-knowing = client constructing own solution
♣ Complex problems do not necessarily require complex solutions
o There are exceptions to every problem, talking about exceptions = solutions
o Attention is paid to what is working; clients are encouraged to do these
o Change is constant and inevitable, small change = other changes = “solution momentum” > problem momentum
o Little attention is paid to pathology or diagnostic labeling
o Societal standards & expectations are internalized = constrain/narrow client living
76
Solution-Focused: Goals
o Develop useful treatment goals & potential solutions
o Therapists help show clients how they can use the strengths and resources they already possess to construct solutions.
o Client is able to recognize the competencies they possess
o Client recognizes what is working & uses these build on their potential, strengths, and resources
77
Solution-Focused: Techniques
o Techniques focus on the future & how best to solve problems rather than on understanding the cause of problems.
o Movement from problem-talk to solution-talk; focus on keeping therapy simple and brief
o Client externalizes problem & focus on strengths or unused resources
o Utilize pre-therapy change, exception questions, the miracle question, scaling questions, homework, and summary feedback (therapist points out particular strengths that clients have demonstrated)
o Through the use of the miracle question, solution-focused therapists help clients identify goals and potential solutions
78
Narrative: Relationship
o Collaborative venture
o Therapist:
♣ Is understanding & accepting to allow client to tap own resources
♣ Adopt a “not-knowing” position to put clients are experts of own lives
♣ Don’t assume they know more about the life of clients than client
♣ Seeks to understand clients’ lived experience & avoid efforts to predict, interpret, or pathologize
♣ Assists client in experiencing an ability to act in the world
o Clients are the primary interpreters of their own experiences.
79
Narrative: Concept
o The stories that people tell are about the creation of meaning and they are true to the people who tell them.
o Realities are socially constructed; no absolute reality
♣ Therapists should not impose their vision of reality or values on client
o Optimistic assumption people are healthy, competent, resourceful, & possess ability to construct solutions
♣ Therapist’s not-knowing = client constructing own solution
♣ Complex problems do not necessarily require complex solutions
o Change begins by deconstructing the power of cultural narratives, then co-construction of new life of meaning
o Discussion of how a problem has been disrupting, dominating, or discouraging
o Clients invited to view their stories from different perspectives & then co-create an alternative life story
o Societal standards & expectations are internalized = constrain/narrow client living
80
Narrative: Goals
o Separate clients from their problems so that they don’t adopt a fixed view of their identities
o Find evidence to support a new view of themselves as being competent enough to escape the dominance of a problem & encouraged to consider what kind of future could be expected from the competent person that is emerging
o Invite clients to describe their experience in fresh language, which opens up new vistas of what is possible
o Client recognizes what is working & uses these build on their potential, strengths, and resources
81
Narrative: Techniques
o Emphasizes the quality of the therapeutic relationship and the creative use of techniques within the relationship.
o Externalizing, mapping effects, deconstruction, co-authoring alt. stories, building audience as witness to emerging preferred story
Grad School
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