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Id- the first and only structure present at birth. Energy in the mind that seeks gratification. Operates on the pleasure principle- seeks
pleasure and avoids pain. Pleasure= need gratification. The id is very immature and irrational as when you were born.
-Illogical -impulsive -has no concept of time -demanding -cannot differentiate b/w reality and fantasy -amoral (no
concept of right or wrong) -raw and primitive
Id is not suited for adaptive functioning only good for the basics of life.
-form of thinking referred to as primary process thinking
o - The id is the primary motivator of personality Is internal
o Component of personality that is completely unconscious and contains all the instincts.
o It is the animalistic portion of the personality that is governed by the pleasure principle.
o demands immediate gratification.
Ego- the second structure [channels movement in the body]
-Almost in direct contact w/ reality- operates on the reality principle
-Opposite of the id---mature, rational, logical, reflective, very much realistic (know what is real and what is not)
-form of thinking referred to as secondary process thinking
-ego exists to give the id what it wants; serves the id [executive of personality that can be found on all levels]
o One of the three parts of the personality
o It is external; the executive of the personality whose job it is to satisfy the needs of both the id and superego by
engaging in appropriate environmental activities.
o Governed by reality principle.
Super ego- the third structure that appears at 4 years of age other super dog who watches the I.
-Moral and ethical guide; operates on the moral principle- the rulebook in your life; judgment about your behavior. Two parts: a)
conscience- punishes you when you do something wrong; mechanism known as guilt b) ego ideal- rewards you when you do
something right; two mechanisms are pride and self-esteem
o One of the three parts of the personality.
o The moral component of the personality that has 2 parts: the conscious and ego ideal.
o Includes moral codes and values.
o Strives for perfection and determines what is right or wrong.
Conscious vs. Unconscious:
1. Conscious processes can be studied directly because they are usually manifested in bx but unconscious material can’t be
studied directly.
2. Unconscious processes are inferred from bx through dr eams, slips of the tongue, post hypnotic suggestions, pr ojective
techniques and symbolic content of psychotic symptoms.
3. The unconscious stor es all memor ies, exper iences, and r epr essed mater ial and needs and motivation.
4. The unconscious is the r oot of all neur otic symptoms and behavior .
Ego-Defense Mechanisms: Unconscious pr ocess that falsify or distor t r eality to r educe or pr event anxiety.
1. If ego is unable to reduce anxiety, the ego may revert to irrational methods (ego defense mechanisms)
2. They are unconscious and distorts personality
Repr ession : most basic defense mechanism; the ego prevents anxiety-provoking thoughts from being entertained at the conscious
level (pulled into the unconscious).
Displacement: what is truly desired is repressed and is replaced by something safer (taking out impulses on a less threatening target)
Denial: denial of some fact despite abundant evidence for its reality (arguing against an anxiety-provoking stimulus by stating it does
not exist)
Intellectualization: an idea that would otherwise cause distress is stripped of its emotional content by intellectual analysis (avoiding
unacceptable emotions by focusing on the intellectual aspects)
Pr ojection : repressing anxiety-provoking truths about oneself and seeing them in others instead, or by excusing one’s shortcomings by
blaming them on environmental or life circumstances (placing unacceptable impulses in yourself onto someone else)
Rationalization: rationally explain or justify behaviors or thoughts that may otherwise be anxiety provoking (supplying a logical or
rational reason as opposed to the real reason)
Reaction For mation : one by which objectionable thoughts are repressed and their opposites expressed (taking the opposite belief
because the true belief causes anxiety)
Regr ession: the person returns to an earlier stage of development (returning to a previous stage of development)
Sublimation: involves diverting sexual or aggressive energy into other channels, ones that are usually socially acceptable and
sometimes even admirable (acting out unacceptable impulses in a socially acceptable way)
Intr ojection: taking in and “swallowing” the values and standards of others
Identification : part of the developmental process by which children learn sex-role behaviors; it can enhance self-worth and protect
one from a sense of being a failure. People who feel inferior may identify themselves with successful causes, organizations, or people
in the hope that they will be perceived as worthwhile.
Compensation: masking perceived weaknesses or developing certain positive traits to make up for limitations
Fr eud’s psychosexual stages of development : Adult personality is formed by the end of the 5th year of life. Each stage has
an erogenous zone. To make a smooth transition, the child must not be under gratified nor over gratified which can cause the child to
be fixated at that stage.
I. Or al Stage: bir th- 2 year s of age
-During the first year the focus is on the lips, tongue, and mouth (erogenous zone- used for gratification) ---eating, swallowing,
sucking.
-this phase was referred to as the oral incorporative phase
-During the second year, the focus is on the teeth, gums, and the jawbone (erogenous zone) ---eating, grinding, biting.
-Fixation during the 1st year (the oral incorporative phase) results in certain behaviors i.e. excessive eating, excessive drinking,
dependency, excessively gullible, excessive smoking
-Fixations during the 2nd year results in individuals who possess oral aggressive traits (bad mouthing, sarcasm, constant complaining,
constant fault-finding, hypercritical, constant nail biting, control manipulation; gossiping, self-starving)
-The oral stage is a stage of Nurturance.
Or al: (birth-1year), infant’s pleasure centers on the mouth, oral gratification
Cr isis: Conflict that becomes dominant during a particular stage of development that can be resolved positively thus strengthening the
ego or resolved negatively thus weakening the ego.
1. Each crisis therefore is a turning point in one’s development.
Infancy (bir th-1): Basic Tr ust vs. Basic Mistr ust
-This is the time when children are most helpless and thus most dependent on adults. If those caring for infants satisfy their needs in a
loving and consistent manner, these infants develop a feeling of basic trust. If parents are rejecting and satisfy their needs in an
inconsistent manner, they will develop a feeling of mistrust.
stages of development:
1. Childhood: (birth to adolescence) survival skills are learned.
2. Young Adulthood: (Adolescence to Age 40) Vocation is learned
3. Middle Age: (40 to later yrs) Most important time of life; philosophical and spiritual values are stressed and the meaning of
life is sought.
J ung’s Analytical Psychology: An elaborate explanation of human nature that combines ideas from histor y, mythology,
anthr opology and r eligion.
J ung’s Collective Unconscious: -boldest, most mystical, and most controversial concept in this theory. It reflects the collective
experiences that humans have had in their evolutionary past and includes traces of pre-human or animal ancestry. Its contents are
essentially the same for all humans.
1. The deepest level of the psyche.
2. Collection of inher ited pr edisposition that humans have to r espond to cer tain events.
3. These predispositions come from the univer sal exper iences humans have had thr oughout their evolutionar y past.
4. Contains all the ar chetypes.
J ung’s Ar chetype: Inher ited pr edisposition to r espond to cer tain aspects of the wor ld. All the archetypes together make up the
collective unconscious.
Per sona- describes one’s public self; the outward manifestation of the psyche that is allowed by a person’s unique circumstances part
of psyche known by other people. mask we put for public to protect ourselves
Anima- female component of the male psyche resulting from the experiences men have had with women; serves two purposes- causes
men to have feminine traits and provides a framework for men to interact with women. biological and psychological aspects of
femininity
Animus- the masculine component of the female psyche; provides women with masculine traits and a framework that guides her
relationship. biological and psychological aspects of masculinity
Shadow- darkest, deepest part of the psyche; inherited from ancestors and contains all animal instincts (people have a tendency to be
immoral, aggressive, and passionate because of this). dark side, our thoughts, feelings and actions that we tend to disown by projecting
tend to disown by projecting them outward.
Self- the component of the psyche that attempts to harmonize all the other components; represents human striving for unity,
wholeness, and integration of the whole personality; when integrated people are said to be self-realized.
Er ogenous Zone: Area of the body that is a source of pleasure. It is the greatest source of stimulation and pleasure during a particular
stage of development.
Fixation: Arrested development at one of the psychosexual stages of development because of the under gratification or over
gratification of a need.
Fixation determines the point to which an adult regresses under stress.
It is the halted development at one of the stages.
stages:
Nor mal Infantile Autism : what Mahler calls the first 3 to 4 weeks of life, infant cannot differentiate itself from mother
1. Unindiffer entiated stage wher e the infant (fir st 3-4 weeks) is unable to undiffer entiate itself fr om the mother .
2. The infant per ceives par ts such as breast, mouth, hands, face rather than a unified self. There are no self or whole objects.
Symbiosis: goes from 3er to 8th month, pronounce dependency of the mother
1. A stage of development of the self-concept
2. Infant doesn’t distinguish between self and other but does distinguish between the good and bad aspects of self and
other image.
3. Baby (3-8 months) has a pronounced dependency on mother . Mom is clearly a partner and not an interchangeable part.
4. Very high degree of emotional attunement with mom.
Separ ation-Individuation Pr ocess: begins in the 4th to 5th month the child experience separation from caregivers but still looks for
them for confirmation and comfort
1. A stage of development of the self-concept.
2. Child begins to distinguish between the self and other and the child’s images of good and bad ar e not integr ated. (“I
hate you” they may mean in at that time but not b/c they always do”)
3. Child may be tor n between stages of dependence and independence.
Goal of psychoanalytic ther apy:
1. Make the unconscious conscious
2. Str engthen the ego so that bx is based on r eality and less on instinctual craving or irrational guilt.
3. Tx consists of going back to these stages and trying to resolve the conflict.
4. For change to occur: clients need to achieve insight AND experience the feelings and memories.
5. Successful analysis is believed to result in significant modification of the individual’s personality and character structure
6. It is oriented towards achievement insight.
Ther apist’s r ole and Function:
1. The therapist must first establish a wor king r elationship; then do a lot of listening and inter pr etation.
2. Teach client meaning of these processes so that they are able to achieve insight into their problems, increase their awareness
of ways to change and thus gain control of their lives.
3. Their function is like helping the client put the pieces of a puzzle together
4. “Blank Screen” approach
Ther apist Client Relationship
Transference: Core of tx process
Fr ee Association: Clients say whatever comes to mind; basic tool to open the door to the unconscious; therapist has to identify
repressed material locked in the unconscious
Interpretation
-involves identifying, clarifying, and translating the client’s material; interpretations are presented when the phenomenon interpreted is
close to unconscious awareness; interpretations should start from the surface and go only as deep as the client is able to go; and
resistance should be pointed out before interpretation is made.
1. Centr al technique in the psychoanalytic ther apy which was developed by Freud.
2. Client is asked to talk about whatever comes to mind trying not to censor any thought.
3. By turning off the censor, a client might find themselves talking about subjects or memories that he/she did not realize were
on his/her mind.
4. Developed to uncover unconscious conflicts.
Inter pr etation: : explaining and even teaching clients the meaning of behavior that is manifested in dreams, free association,
resistance and the therapeutic relation itself
1. A technique in psychoanalytic therapy.
2. Offer s possible explanations for a client’s thoughts, feelings or bxs ultimately helping the client see new per spectives
and alter natives.
3. Acceler ates the process of uncovering unconscious material.
Dr eam Analysis: -road to uncovering unconscious material and giving the client insight into areas of unresolved conflict; therapist
has to uncover disguised meanings by studying symbols in manifest content (dream as it appears)/ latent content (hidden meaning of
dream); dreams provide understanding for clients’ current functioning
Analysis of Resistance
-resistance is the client’s reluctance to bring to the surface of awareness unconscious material that has been repressed; therapists point
out and interpret obvious resistances to decrease the possibility of clients’ rejecting the interpretation and to increase the chance that
they will begin to looks at resistive behavior
A psychoanalytic technique. By the use of fr ee association, the therapist asks the client to r eveal the manifest content (what they
dr eamt) of their dr eam to uncover the latent meaning of their dr eam.
Important procedure to uncover the unconscious
Latent Content of a Dr eam:
A dr eam’s tr ue meaning that is disguised or distor ted into Manifest content
1. The ther apist client r elationship is conceptualized in the “Tr ansfer ence” pr ocess
2. To produce change in the client, transference must be worked through.
3. The therapist becomes a substitute for a significant other in the client’s life.
4. Therapist needs to build a good working relationship with the client so that they feel at ease to express feelings, beliefs,
desires that they have buried inside.
Analysis and Inter pr etation of Tr ansfer ence: gives the client an opportunity to re-experience a variety of feelings that would
otherwise be inaccessible
II. Adler ian Ther apy: (GOAL: REPLACE A MISTAKEN LIFESTYLE W ONE CONTAINING A HEALTHY LEVEL
OF SOCIAL INTEREST/ BX AS PURPOSEFUL AND GOAL ORIENTED)
View of human natur e:
1. Adler saw more the human nature as teleological (pur poseful and goal or iented) than Freud’s deterministic view (by
irrational forces, unconscious motivations and biological and instinctual drives)
2. Humans are motivated by social relatedness rather than by sexual urges.
3. Conscious, rather the unconscious, is the focus of tx.
4. Bx as purposeful and goal oriented
5. People begin to form a view of life somewhere in the first 6 years of living.
6. Human is motivated by social relatedness.
7. Behavior is purposeful ad goal-directed.
8. Consciousness rather than unconsciousness is the focus of therapy.
9. Adler stressed choice and responsibility, meaning in life, and striving for success, completion and responsibility
10. Adler’s theory focuses on inferiority feelings, which he sees as normal and as a source of all-human striving.
11. Around the age of six, our functional vision of ourselves as perfect or complete begins to form into a life goal (fictional
finalism). This life goal unifies the personality and becomes the source of motivation; every effort to overcome inferiority is
now in line with this goal.
12. Adler believed that we have the capacity to interpret, influence and create events.
13. Adlerians put the focus on reeducating individuals and reshaping society.
View of Human Behavior -asserts that humans are motivated by social relatedness, behavior is purposeful and goal-oriented, and
consciousness is the focus on therapy; stresses choice and responsibility, meaning in life, and the striving for success, completion, and
perfection; inferiority feelings are the source of all human striving; humans have the capacity to interpret, influence, and create events.
Individual Psychology: Adler’s term to describe his theory. Used to stress his belief that each person is an integrated whole striving to
attain future goals and attempting to find meaning in life.
Although individuals are unique, they are characterized by inner harmony and striving to cooperate with fellow humans.
Individual Psychology -personality can only be understood holistically and systematically; the individual is seen as an indivisible
whole, born, reared, and living in specific familial, social, and cultural contexts. The focus is on interpersonal relationships than on the
individual’s internal psychodynamics.
Goal Or iented ther apy: Individual psychology maintains that all human bx has a purpose.Therefore, we can only be understood in
light of knowing the purposes and goals towards which we are striving.
Goal Or iented Ther apy -assumes that all human behavior has a purpose; humans set goals for themselves and behavior becomes
unified in the context of these goals; decisions are based on the person’s experiences, on the present situation, and on the direction in
which the person is moving.
Fictional Finalism : Also called “guiding self-ideal and guiding fiction” Fictional future goal to which the person is aspiring and his
or her lifestyle is the means to that end.
Fictional Finalism- imagined or potential goal that guides our behavior (always changes so that you will continue to strive)
Str iving for Super ior ity the ultimate goal for which everyone strives.
1. What Adler called “The fundamental fact of life”
2. According to Adler’s final theoretical position, it is not the search for the power necessary to overcome feeling of inferiority
that motivates humans; rather it is the constant search for perfection or superiority. However, Adler stressed the perfection of
society rather than individual perfection.
3. It is innate.
4. Later, he changed his position that humans aspire toward social rather than individual perfection.
Lifestyle: A person’s core values and beliefs through which a person organizes his or her reality and finds meaning in life events.
That primary means by which one attempts to attain his or her self-created or fictional goals in life.
Social inter est - how much one’s behavior works in the interest of others; the ability to have friendships or work in harmony with
others; the ability to cooperate or share; essentially striving for a better future for humanity.
Mistaken Lifestyle- a lifestyle that minimizes social interest.
Ruling Dominant Type: attempts to rule or dominant others; lifestyles driven by control [control freaks]
Getting Leaning Type: most common type; these people are dependent on others, expect others to satisfy their needs [dependent
individuals]
Avoiding Type: do not attempt to face life’s problems; often succeed by avoiding problems [problem avoiders]
Socially useful type: cooperate with others; face problems; possess social interest [team players]
Collabor ative Ther apist-Client Relationship : Clearly defined goals bw the therapist and client.
Therapist seeks to make person to person contact before addressing the issue. Focus should be on the person not on the problem.
Help client become aware of their assets and strengths rather than deficits (provide support).
Subjective vs. Objective Inter views: Subjective interview is allowing client to tell his or her life story completely as possible.
In objective interview, the therapist acts as a lifestyle investigator seeking info of the clients family system and early childhood
history, seeking to understand their social setting while growing up.
Family Constellation: Adlerian application. Assessment procedure where the therapist asks questions regarding the client’s family
system. Obtained through objective interviewing
Ear ly Recollections: Therapist uses early recollections to assess the person’s belief about the self, others, life and ethics, to assess the
client stance in relation to the counseling relationship, for verification of coping patterns and to assess client’s strengths, assets and
interfering ideas.
III. Existential Ther apy: (GOAL: ENABLE CLIENTS TO ACCEPT FREEDOM & RESPONSIBILITY/CENTRAL
GOAL IS TO INCREASE AWARENESS)
Capacity for Self- Awar eness The Distinctive Capacity that allows us to reflect and decide.
We increase our capacity to live fully as we expand our awareness
Capacity for self-awar eness: humans can make choices because we have self awareness, greater it is greater the possibilities for
freedom
Fr eedom and Responsibility Once we have established our self awareness, we become free beings who are responsible for choosing
the way we life, and thus influencing our own destiny. we are responsible for our lives, actions and failures to take action. Existential
guilt is being aware of having evaded a commitment or having chosen not to choose. We are our choices, living authentically implies
being true to our own evaluation of what is valuable existence for ourselves. Being free and being human are the same
Cr eating One’s Identity and Establishing Meaningful Relationships We should strive to find our own identity without what others
expect from us.
Str iving for identity and r elationships to other s: people are concerned about preserving their uniqueness and centeredness, yet at
the same time, they have an interest in going outside of themselves to relate with other beings and to nature.
Sear ch for Meaning, Pur pose, Values and Goals Whatever Meaning our life has developed is through Freedom and a commitment
to make choices in life in the face of uncertainty.provides the framework for helping clients challenge the meaning in their lives.
Logother apy is designed to help clients find a meaning in life
Awar eness of Death and Non being basic human condition gives significance to living. death provides the motivation for living our
lives fully. Facing the inevitable prospect of death, gives significance to the present. The source for life and creativity.
Anxiety as a condition of Living existential anxiety is conceptualized as the unavoidable result of being confronted with the givens
of being confronted with the givens of existence (death, freedom, existential isolation, and meaninglessness they see anxiety as a
potential source of growth.The awareness of freedom and choice leads to existential anxiety.
Existential Guilt : Condition that grows out of a sense of incompleteness or a realization that we are not what we might have become.
the awareness that our actions and choices express less than our full range as a person.
Existential vacuum : meaninglessness in life leads to emptiness and hollowness, people who fee trapped by emptiness of life
withdraw from the struggle of creating a life with purpose. Often experience when people do not busy themselves with routine and
with work condition where a person’s world seems meaningless and it leads to emptiness and hollowness
Guilt : grows out of a sense of incompleteness, or a realization that we are not what we might have become,
Restr icted Exper ience: These clients have limited awareness of self and are often vague about the nature of their problems.
They may have few if any, options for dealing with life situations and they tend to feel trapped and helpless.
Restr icted existence: limited awareness of themselves, often vague about the nature of their problems, sees few if any options for
dealing with life situations; tend to be trapped or helpless
Rollo May: Phenomenological Wor ld: Tx is a journey taken by the therapist and client into the client’s deep subjective world,
thus the therapist must be in tune with their own phenomenological world.
Influenced by existential philosophers, by the concepts of Freudian psychology, and by many aspects of Alfred’s Individual
psychology.
It takes courage to “be”, and our choices determine the kind of person we become.
There is a constant struggle within us. Although we want to grow toward maturity and independence, we realize that expansion is
often a painful process.
Fr ankl: Logo Ther apy: “Tx through meaning”
Central Theme: Life has meaning under all circumstances (finding meaning in suffering, work, love… etc.)
Victor Fr ankl Developed logotherapy, which means “therapy through meaning”. The central theme running through his works are life
has meaning, under all circumstance: the central motivation for living is the will to meaning: the freedom to find meaning in all that
we think; and the integration of body, mind, and spirit. The aim of therapy is to find meaning and purpose through. Among other
things, suffering, work, and love.
“He who has a why to live for can bear with almost any how” Nietzsche.
Developed logotherapy, which means “therapy through meaning”.
The central theme running through his works are life has meaning, under all circumstance: the central motivation for living is the will
to meaning: the freedom to find meaning in all that we think; and the integration of body, mind, and spirit.
The aim of therapy is to find meaning and purpose through. Among other things, suffering, work, and love.
Ir vin Yalom : he developed on an existential approach to therapy that focuses on four ultimate human concerns: death, fr eedom,
existential isolation, and meaninglessness. He contends that the four givens of existence, that constitute the heart of existential
psychodynamics have enormous relevance to clinical work
Ther apeutic Goals:
1. Enable clients to accept freedom and responsibility.
2. Aim of tx: assist clients in moving toward authenticity and learning to recognize when they are deceiving themselves.
3. Central Goal: to increase client awareness to discover that alternative possibilities exist where none were recognized before.
4. Enable clients to find ways to implement their examined and internalized values in concrete ways.
Ther apist’s Role and Function
1. Presence of Counselor plays a crucial role in tx relationship
2. Focus is on client’s current life situation, not on the past.
3. Therapists are primarily concerned with understanding client’s subjective world and help them come to new understanding
and options.
4. Assists individuals in “unstucking” them
5. Therapy exists to help clients move from the victim’s role. Psychotherapy does not provide a cure for all problems. Clients
are trained to pay attention to the knowledge about themselves that they are aware of but do not necessarily attend. Therapists
encourage their clients to attain self-awareness. Existential therapists work to determine the subjective experiences of their
clients in order to help clients discover new ideals and choices. These therapists focus on helping clients understand why they
are stuck, as in an impasse. In therapy, clients must make a serious appraisal of their personal experiences. Moreover, clients
must own up to the responsibility of who they are in the present. Clients play an active role in existential therapy. After they
admit to being responsible for how they are in their current state, clients are challenged to go into the world in order to
change the way they live. Throughout the course of therapy, clients also indicate which fears, guilt’s, and anxieties they will
examine.
Client- Ther apist Relationship
1. Quality of relationship progresses tx.
2. Therapist and client make a therapeutic alliance that tx is a journey they will both encounter.
3. The relationship between the therapist and the client in existential therapy is an important one. The structure of this
relationship sets the ground for positive change in clients. Therapists and clients embark on a discovery that goes into deep
into the world as lived by the client. Throughout the course of this relationship, therapists must disclose their reactions to
clients with sincere interest and compassion to allow the relationship to develop profoundly.
Application:
Ther apists use of Self
1. Therapists are free to use their individual creativity tailored specifically for each clients needs.
2. When therapists core self and the clients core self meet that is when the counseling process is at its best.
3. the I/thou encounter that allows the deepest self of the therapist to meet the deepest part of the client; it is at this point that the
counseling process is at its best
Clar ifying Client’s Assumptions:
1. Occurs during the initial phase of counseling
2. Counselor teaches client how to reflect on their own existence and to examine their role in creating their problems in living.
3. the initial phase of counseling where counselors assist clients in identifying and clarifying their assumptions in the world;
clients make sense of their existence by examining their values, beliefs, and assumptions to assess their validity.
Explor ing Cur r ent Value System
1. Occurs during Middle phase of Counseling
2. Clients are encouraged to more fully examine the source and authority of their present value system; leads to new insights
and some restructuring of their values and attitudes.
3. middle phase of counseling in which clients are encouraged to more fully examine the source and authority of their present
value system; clients find new insights and restructure their values and attitudes
Implementing Inter nalized Values: Action Oriented Approach
1. Final phase of therapeutic process
2. Helping clients take what they are learning about themselves and put into action (in a concrete way)
3. final phase of counseling which focuses on helping clients take what they learn about themselves and put it into action.
IV. Per son-Center ed Ther apy: CLIENTS ARE THE AGENTS OF SELF-CHANGE
Non-dir ective Counseling: 1st period of approach, Counselor’s creation of a permissive and non-directive climate
Client-center ed tx: Emphasis is now on the client and not on the non-directive approach
Per son-Center ed Tx: Final change to the approach. Clients are the agents of self-change, not the therapist.
Roger s:
Unconditional Positive Regar d: Essential part of person centered tx.
1. The therapist expresses that he or she accepts the client, no matter how unattractive, disturbed, or difficult the client is.
2. Caring is unconditional with no judgments or evaluations of the client’s feelings, thoughts or bxs.
Congr uence
1. A client attribute
2. Therapist must be real and genuine
Empathetic Under standing:
1. Therapist will sense client’s feelings “As if” they were his or her own without becoming lost in those feelings.
2. Cornerstone of Person-Centered Approach
Quality of the Relationship : Quality of therapeutic relationship is the primary agent of growth in client.
Interventions such as listening, understanding, accepting and respecting are to be shown HONESTLY.
V. Gestalt Ther apy (GOAL: INCREASE AWARENESS OF THEIR ENVIRONMENT, ONESELF, ACCEPTING
ONESELF & MAKING CONTACT)
Pr ocess of Reowning par ts of self
1. Rediscovering themselves
2. Process of reowing parts that have been disowned and the unification process
3. Proceed step by step until clients become strong enough to carry on with their personal growth.
Gr ounded in Field Theor y:
1. Organisms must be seen in its environment or in its context as part of the constantly changing environment
2. Consists of both internal and external worlds.
Pr esent Or iented :
1. Present is the most significant tense in this theory
2. Emphasis is on learning to appreciate and fully experience the present moment
3. Therapist asks what and how questions but rarely asks why questions to help client stay in present
4. Client’s past is dealt with by bringing it into the present as much as possible.
Role Playing
1. Empty Chair technique
2. Used to get client to externalize the introject.
3. Client plays both the top dog and underdog
4. Goal is to promote a higher level of integration between the polarities and conflicts.
5. Aim is not to rid oneself of certain traits but to learn to accept polarities.
Making the Rounds Asking a person in a group to go up to others in the group and either speak to or do something with each person
Purpose is to try new risks, to disclose the self, experiment with new bx and to grow and change.
Exagger ation Exer cise Ask clients to exaggerate the movement or gesture repeatedly, which usually intensifies the feeling attached
to the bx and make the inner meaning clearer.
Staying with the Feeling Client is asked to stay with the feeling and not avoid it (confronting the feeling)
Functional Assessment
Offers a blue print for therapist in selection of operant interventions
Yields info about antecedent events, including the time and place of the bx and the people present when bx occurs.
Relaxation Techniques and Systematic Desensitization Clients are taught relaxation techniques to help them cope with stress and
anxiety. Systematic Desensitization : while client is thinking of anxiety-producing events, they are taught to use relaxation techniques
and confront anxiety.
Exposur e Ther apy: single most potent behavioral procedure available for anxiety-related disorders
In Vivo: client exposed to actual feared situation
Flooding: invivo or imaginal exposure for a prolonged period of time
Implosive: FIND
Paradoxical Intention: FIND
EMDR Eye Movement Desensitization and Repr ocessing: Form of exposure therapy designed for post-traumatic stress disorder.
Involves:
Imaginal Flooding
Cognitive Restructuring
Use of rapid, rhythmic eye movements and other bilateral stimulation
Asser tion Tr aining: Increase client’s behavioral repertoire so that they can make the choice of whether to behave assertively in
certain situations. Good for shy or social phobias.
Multimodal Ther apy: BASIC ID: Multimodal tx is an open system that encourages eclecticism
B: (Bx) overt bx that can be measured and observed
A: (affect) emotions, needs, strong feelings
S: (sensation) touch, taste, smell, hear, see
I (imagery) ways we picture ourselves including dreams, memories.
C: (Cognition): opinions, values, insights, philosophies.
I (Interpersonal Relationships)
D: (Drugs) recreational or prescription
Self-contr ol Pr ocedur es: Clients are taught skills they need to manage their lives effectively. Good for control of smoking, drugs or
drinking
Aver sive Counter Conditioning: the counter-conditioning of positive reactions using the response to an aversive (unpleasant)
situation as the incompatible response to reduce unwanted positive-approach reactions
For example, a person addicted to some drug (e.g., heroin, alcohol, tobacco) has positive associations to many aspects of taking the
drug, including such things as pleasant associations to a particular bar and drinking friends, a calming effect associated with lighting
up a cigarette, a reduction of withdrawal symptoms after taking more heroin, or socially approved relaxing of inhibitions associated
with drinking alcohol. These types of positive associations continually make it more probable the person will again use the drug, thus
strengthening the addiction even though the long range effects of Using the drug are undesirable and even aversive. Behavioral
treatment involves aversive counterconditioning to reduce some of the positive associations resulting from the natural source of
reinforcement, as well as helping the client develop alternative reinforcing behaviors. For example, aversive counterconditioning may
involve electric shock paired with photos of young children that elicit undesired sexual arousal.
Cover t sensitization: an undesirable behavior is paired with an unpleasant image in order to eliminate that behavior. undesirable
behaviors can be unlearned under the right circumstances. Covert sensitization is one of a group of behavior therapy procedures
classified as covert conditioning, in which an aversive stimulus in the form of a nausea- or anxiety-producing image is paired with an
undesirable behavior to change that behavior.
Token Economies
Example of Skinnerian Behavioral Therapy that usually occurs within an institutional setting such as psychiatric hospital or a school.
Desirable bx is reinforced by a reward (tokens) that can be subsequently traded for desirable objects or events.
Extinction :Weakening of an operant response by removing the reinforcer that had been following the response during acquisition.
When a response returns to its operant level, it has been extinguished.
Meichenbaum:
Self-Instr uctional Tr aining: Focuses more on helping clients become more aware of their self-talk
Str ess Inoculation Tr aining: Stress management tech. Individuals are given the opportunity to deal with relatively mild stress stimuli
in successful ways, so that they gradually develop a tolerance for stronger stimuli.
Beck: Cognitive Theor y: An Insight Focused tx. Emphasizes recognizing and changing neg. thoughts and maladapting beliefs.
Wolpe: Thought Stopping: used for managing distressing thoughts. self management technique, requires high level of motivation.
Client practice thought-stopping by using STOP or NO or any other distracting technique, like clap or calming imaginary. for
eliminating persistent worry or obsessive thoughts works by training the patient to say "stop" while thinking these thoughts. The
continued interruptions reduce the frequency and intensity of these thoughts.
Cognitive Restr uctur ing: Clients replace ineffective ways of thinking with effective rational cognitions which changes their
emotional reactions to situations.
Ir r ational Thoughts: Change the “Shoulds”, “Musts”, oughts, demands and commands.
1. We fulfill the need to belong by loving, sharing, and cooperating with others.
2. We fulfill the need for power by achieving, accomplishing, and being recognized and respected.
3. We fulfill the need for freedom by making choices in our lives.
4. We fulfill the need for fun by laughing and playing.
Applications:
WDEP System
W: Wants and Needs: Explore client’s needs and perceptions
D: Direction and Doing: discuss client’s direction in life/ where they are going and where their bx is taking them.
E: Evaluation: Asking client to evaluate each component of their total bx and help them make effective choices.
P: Planning and Action: Once they know what they want to change they formulate an action plan.
Bowen:
Multigener alizational Appr oach: multigenerational transmission process describes how small differences in the levels of
differentiation between parents and their offspring lead over many generations to marked differences in differentiation among the
members of a multigenerational family. The information creating these differences is transmitted across generations through
relationships.
Differ entiation Differentiation of self refers to one's ability to separate one's own intellectual and emotional functioning from that of
the family. Bowen spoke of people functioning on a single continuum or scale. Individuals with "low differentiation" are more likely
to become fused with predominant family emotions. (A related concept is that of an undifferentiated ego mass, which is a term used to
describe a family unit whose members possess low differentiation and therefore are emotionally fused.) Those with "low
differentiation" depend on others' approval and acceptance. They either conform themselves to others in order to please them, or they
attempt to force others to conform to themselves. They are thus more vulnerable to stress and they struggle more to adjust to life
changes
Str ategic Appr oaches
J oining Enactment Enactments are a potential common clinical process factor contributing to positive outcomes in many relational
therapies. Enactments provide therapists a medium for mediating relationships through simultaneous experiential intervention and
change at multiple levels of relationships— including specific relationship disagreements and problems, interaction process
surrounding these issues, and underlying emotions and attachment issues confounded with those problems
Restr uctur ing: alteration of the processes and structure that occur in a tree person system or multiple overlapping triangular
configurations. Attempts to alter or stop multigenerational transmission process.
Cr oss-Cultur al Counseling:
The politics of Counseling: Mental Health Implications
1. The clash of worldviews, values and lifestyles is inevitable since it is impossible not to encounter client groups who differ
from us in race, culture and ethnicity
2. To be effective multicultural counselors and therapists, we must not only acquire new understanding but also develop new
culturally effective helping approaches by
a. revamping training programs to include accurate and realistic multicultural content and experiences
b. developing multicultural competencies as core standards for our profession
c. providing continuing education for our current service providers.
3. Professional organizations need to adopt ethical guidelines, codes of ethics, and bylaws that are multicultural in scope to
avoid cultural oppression.
4. The education and training of helping professionals have created the impression that its theories and practices are apolitical
and value-free. Yet, the actual practice of therapy can result in cultural oppression. Therefore, no matter how well intentioned
the helping professional is, he or she is not immune from inheriting the racial biases of his or her forebears (decedents).
5. Because of inherited stereotypes, therapists are prisoners of cultural conditioning. It is imperative that therapists explore their
own stereotypes and images of various minority groups in order not to harm or oppress minority clients.
Consider ations of Mistr ust in Cr oss-Cultur al Counseling: Distrust of white mental health professionals by members of ethnic
minority groups is related to the fact that professionals often misinterpret a healthy adaptive response to racism (cultural paranoia) as
pathology (functional paranoia)
1. Cultur al Par anoia : a healthy reaction to racism, occurs when client does not disclose to a white therapist b/c of fear of being
hurt or misunderstood.
2. Functional Par anoia : “an unhealthy condition that itself is an illness” occurs when client is unwilling to disclose to any
therapist, regardless of race or ethnicity, due to general mistrust and suspicion.
3. Inter cultur al Non par anoia Disclosur e (low functional paranoia, low cultural paranoia): client is willing to self-disclose to
an African American or Anglo therapist. (open and disclosing; African American clients)
4. Functional Par anoia client: (high functional paranoia, low cultural paranoia) non disclosure by clients in this category is
primarily the result of the client pathology. (Clinical issues)
5. Healthy Cultur al Par anoiac (low functional paranoia, high cultural paranoia) clients in this category will self-disclose only
to an African American therapist. Nondisclosure to an Anglo therapist is a reaction to racism that is based on past experience
and/or the current white therapist’s attitudes and beliefs.
6. Confluent Par anoia (high functional paranoia, high cultural paranoia) client in this category is nondisclosing to African
American and Anglo therapists, with nondisclosure being due to a combination of pathology and the affects of racism.
Best Tr eatment
1. Functional Par anoia : one that is most effective in alleviating the client’s pathology
2. Healthy Cultur al Par anoia : confront the meaning of the client’s paranoia and correct presenting problem.
3. Confluent Par anoia : Combines the approaches for functional and healthy cultural paranoia. Very important that the therapist
is from the same racial/ethnic group.
Black Racial (nigr escense) Identity Model: African American Identity Development is directly linked to racial oppression, and
consists of 4 stages: (PEII)
1. Preencounter
2. Encounter
3. Immersion/Emersion
4. Internationalization/Commitment
White Racial Identity Model (Helms 1990): occurs as a white person first acknowledges racism, then relinquishes it, and finally
develops a nonracist white persona. Process involves 6 stages: (CDRPIA)
1. Contact
2. Disintegration
3. Reintegration
4. Pseudo-Independence
5. Immersion-Emersion
6. Autonomy
Psychother apy Guideline
1. Make sure language is not a barrier
2. Identify client’s stage of racial/ethnic identity development and degree of acculturation and assimilation.
3. Attempt to understand client’s worldview
4. Do not evaluate culturally refer to bxs as pathology
5. Recognize that social, money, and political discrimination and prejudice are real problems for minority and lower SES
groups in the U.S.
6. Acknowledge cultural differences
7. Do not over generalize cultural patterns to all members of a particular ethnic, cultural, or class group.
8. Be familiar with APA’s guidelines for Providers of Psychological Service to Ethnic, Linguistic and Culturally Diverse
Population.
Self-Awar eness and the influence of the Ther apist’s Per sonality and Needs
Without a high level of self-awareness, mental health professionals will most likely obstruct the progress of their clients as the focus
of therapy shifts from meeting the needs of the client to meeting the needs of the therapist.
1. **4 ar eas that will intr ude in your ther apeutic wor k
Practitioners MUST be aware of:
1. Their own needs
2. Areas of unfinished business
3. Personal conflicts, defenses and vulnerabilities
4. How these may interfere in their professional relationship
2. **Ther apeutic pr ocess can be blocked:
1. When therapists use their clients, perhaps unconsciously, to fulfill their own needs
2. Out of an exaggerated need to nurture or feel powerful, people sometimes feel they know how others should live.
3. The tendency to give advice and to direct other’s life can be especially harmful in a therapist… leads to excessive dependence
on the part of client and perpetuates their tendency to look outside themselves for answers.
3. Unr esolved per sonal conflicts
1. The critical point is not whether you happen to be struggling with personal questions but how you are struggling with them!
2. If you are unaware of your own conflicts, you will be in a poor position to pay attention to the ways in which your personal
life influences your work with your clients.
3. Personal Therapy for Counselors
Ar guments for per sonal ther apy dur ing tr aining
1. As students begin to practice counseling, they sometimes become aware that they are taking on a professional role that
resembles the role they played in their family.
2. Another reason for undergoing therapy is that most of us have blind spots and unfinished business that may interfere with our
effectiveness as therapists
Multicultur al Issues in Counseling: When working with multicultural clients… it is imperative to use interventions that are
consistent with the values of your client.
Multicultur al Counseling Competencies: A set of knowledge and skills that is essential to the culturally skilled practitioner.
1. Counselor Awareness of Own Cultural Values and Biases
2. Understanding the Client’s Worldview
3. Developing Culturally Appropriate Intervention Strategies
Cultur ally encapsulated counselor : Suffers from mono cultural tunnel vision: Has limited experiences and in many cases
unwittingly impose their values on unsuspecting clients assuming that everyone shares these values.
Infor med consent : involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it.
Main purpose is to increase the chances that the client will get involved, educated, and a willing participant in his or her therapy.
Counselors are required to inform of potential risks, benefits and alternatives to proposed treatment.
Goal is to give clients adequate and continous information so that they anticipate what they will be asked to consent to in treatment.
To work effectively with a minor it is often necessary to involve the parents in the treatment process.
Ethically, the client is your client. They have a right to privacy and confidentiality in the counseling relationship.
Legally, the parent or guardians is your client. They have a legal right to information pertaining to counseling sessions with their
children.
When parents become involved in the counseling process, they have authority over the minors.
Confidentiality: the central right of a client; is the guarantee that disclosures in therapy session will be protected.
However, blanket promises of confidentiality are impossible to make.
Pr ivacy: Clients have the right to expect that communications will be kept within the bounds of the professional relationship.
Professionals must not disclose of any information unless required by law or by the client.
Pr ivileged Communication is a legal concept that generally bars the disclosure of confidential communications in a legal proceeding.
Meaning that counselors can refuse to answer questions in court or refuse to produce a client’s records in court.
Does not apply to group counseling, couples counseling, marital and family therapy, or child and adolescent therapy.
The Jaffee Case: Jaffee vs. Redmond, the U.S. Supreme court ruled that communications between licensed psychotherapists and their
clients are priviledged and are therefore protected from forced disclosure in cases arising under federal law. It was a victory for mental
health organizations b/c it extended the confidentiality privilege.
One of the most difficult tasks therapists must deal with: Deciding whether a particular client is dangerous.
Duty to pr otect suicidal clients : AS part of the informed consent process, therapists must communicate to clients that confidentiality
will be breached if the therapist suspects suicidal bx.
Protecting children, the elderly and dependant adults from harm. Whether working with children and adults in a practice, therapists are
expected to know how to access potential abuse and then report it in a timely fashion.
Confidentiality with HIV/AIDS r elated issues: Therapists need to be very clear in their own minds about the limits of
confidentiality, matters of reporting and their duty to warn and to protect 3rd parties and they need to communicate that professional
responsibilities to their clients from the outset
Applying Tar r asoff as a framework: 3 conditions must be met for 3rd party disclosure
1) Informed Consent (Special client-therapist relationship)
2) Clear and imminent danger
3) Identifiable victim
2. Boundar y Cr ossing: Departure from commonly accepted practices that could potentially benefit clients
3. Boundar y Violation a serious breach that results in harm to clients
Ex. to use hypnosis on a client and to avoid boundary violation, discuss the risks associated with the procedure and try to do it as an
experiment (have the client sign another consent form)
Not all boundar y cr ossing should be consider ed boundar y violations
4. Slipper y Slope: Warning that clinicians need to exercise caution before entering into all types of multiple relationships, even if they
are not harmful in themselves.
5. Social r elationships with clients : From least to greatest chance of being unethical:
1) accepting a clients invitation to a special occasion
2) becoming friends with the client after termination
3) inviting clients to a clinic or open house
Legal in florida after 2 yrs case closed, but code of ethics says never
Scr eening is a 2 way pr ocess: As faculty/Supervisors screen candidates and make decisions on whom to admit, candidates may also
be screening the program to decide if this is right for them.
1. The personal interview was identified as the most effective screening measure currently used.
2. Practicum and internship performances were considered to be the most effective measures of graduate student success.
3. Johnson and Campbell maintain that being competent requires both moral character and personal psychological fitness and
their absence greatly increases both impairment and incompetence.
One of the most important goals for clinical supervisors is to promote the supervisee’s self-awareness and ability to recognize personal
characteristics that could have a negative impact on the therapeutic relationship.
1. When working with multicultural clients… it is imperative to use interventions that are consistent with the values of your
client.
2. Although the DSM IV makes some reference to culture, it deals largely with culture-bound syndromes and does not
adequately take account culture, age, gender, and other ways of viewing health and sickness.
3. Clinicians need to strive toward culturally sensitive diagnostic practices because doing so is ethically required and integral to
effectively delivering services to diverse client groups.
Managed Care, stresses time-limited interventions, cost effective methods, and focused on preventative rather than curative strategies.
Managed Care dictum appears to be “the shorter the better”
One problem with Managed Care is that clients receiving therapy are undertreated, which leads to under diagnosing important
conditions, dangerously restricting hospital admissions, failing to make referrals, and providing insufficient follow-up.
Cr itical Issues Associated with Managed Car e: Four major areas where ethical dilemmas most commonly surface in a managed
care system:
1. informed consent
2. confidentiality
3. abandonment
4. Utilization review: the use of predefined criteria to evaluate treatment necessity, appropriateness of therapeutic intervention,
and therapy effectiveness.
Confidentiality in Managed Car e: Confidentiality cannot be guaranteed as therapists may need to reveal sensitive client info to a 3rd
party who is in a position to authorize initial or additional treatment. Therapists have an obligation to inform clients of such limits on
confidentiality.
The DSM IV is the standard reference for distinguishing one form of mental disorder from another.
Diagnosis Ar gument
Those who oppose the diagnostic model state that the DSM labels and stigmatizes people.
However, those who designed the DSM assert that it classifies mental illnesses, not people.
Ar guments for Psychodiagnosis: Practitioners who favor the use of diagnostic procedures argue that such procedures enable the
therapist to identify a particular emotional or behavioral disorder, which helps design an appropriate treatment plan.
It is a common language and a common frame of reference when working with a professional team.
Ar guments against Psychodiagnosis: Creates dependency, with clients acting if the responsibility for changing their bx rested with
the expert and not with themselves.
1. Much of the practice of couples and family therapy rests on the foundation of “systems theory”, which views psychological
problems as arising from within the individual’s present environment and the intergenerational family system
2. The Family systems perspective is grounded on the assumption that a client’s problematic bx may:
3. serve a purpose or function for the family
4. be a function of the family’s inability to operate productively
5. be a symptom of dysfunctional patterns handed down across generations.
Ethical Consider ations when wor king with Couples and Families: Therapists can respond to ethical dilemmas over conflicting
interests of multiple individuals by identifying the couple or family system as the focus of treatment rather than a single individual as
the primary “client”.
Involuntar y Par ticipation: People can be forced to attend group meetings but not to learn.
Psychological Risks
1. Ethical practice demands that group practitioners inform prospective participants of the potential hazards involved in the
group experience.
2. Group leaders have an ethical responsibility to take precautionary measures to reduce unnecessary psychological risks
3. Members may experience some disruptions in their lives as a result of their work in the group
4. Group participants are often encouraged to be completely open. In this quest for self-revelation, privacy is sometimes
surrendered.
5. A related risk is group pressure. The participants’ right not to explore certain issues or to stop at a certain point should be
respected. Also, members should not be coerced into participating in an exercise.
6. Scapegoating is another potential hazard in groups. Harmful attacks should not be permitted under the guise of “sharing”
7. There is no guarantee that all members will respect the confidential nature of their exchanges.
8. One way to minimize risks in group is to use a contract, in which leaders specify what their responsibilities are and members
specify their commitment to the group by declaring what they are willing to do.
9. One of the most important safeguards is the leader’s training in group process.
10. Leaders have the responsibility of preventing harm to the members. To fulfill this role, group leaders should have a clear
understanding of the boundaries of their competence.
11. Working with an experience co-leader is one good way to learn and also a way to reduce potential risks.
Confidentiality in Gr oups
1. The legal concept of privileged communication generally does not apply in a group setting, unless there has been a statutory
(legal) exemption. Therefore, leaders are responsible to inform the members of the limits of confidentiality, their
responsibilities to other group members, and the absence of legal privilege concerning what is shared in a group.
2. Encouraging confidentiality is a special challenge for counselors who work in a school setting with children and adolescents.
3. Leaders need to reaffirm periodically to the members about the importance of not discussing with outsiders what has
occurred in the group.
Exemptions to Confidentiality
If members pose a threat to themselves or others, the group leader would be ethically and legally obliged to breach confidentiality.
If you work in a psychiatric hospital or correctional institution, the therapist may have to record in a member’s chart certain bxs or
verbalizations that he or she exhibits in the group. They still must be informed that you are documenting their actions.
Ego Defense Mechanisms: Ego Defense Mechanisms helps ego not to become overwhelmed; helps cope with anxiety
They have 2 characteristics: they deny or distort reality or they operate in an unconscious level.
1. Repr ession: one of the most important Freudian processes; involuntary removal of something from consciousness. anxiety
provoking thoughts are held unconscious.
2. Displacement: directing energy toward another object or person (safer target) when the original object or person is
inaccessible. Substitution of an anxiety provoking object for one that is not.Ex. Boss yells at man, man comes home and
kicks dog.
3. Identification : people who feel inferior may identify themselves with successful causes, organizations, or people in the hope
that they will be perceived as worthwhile. with an ideal person or group, or incorporating other’s values to enhance self-
esteem or to minimize that person as a threat.
4. Denial: operates at a preconscious and conscious level; distorting what one thinks, feels or perceives in a traumatic situation.
Reality is denied even with information of its existence.
5. Pr ojection: attributes one’s own feelings to someone else Anxiety provoking thoughts are given to someone or something
else.
6. Undoing: after an unacceptable act, or thinking about doing so, then engages in ritualistic activities designed to undo the
unacceptable act. try to undo an unacceptable action or thought with an acceptable one.
7. Reaction For mation : doing the opposite of what you feel is unacceptable. Exaggerating the opposite of an anxiety
provoking thought.(ex. concealing hate with façade of love)
8. Rationalization: justifies unacceptable bx. give a logical explanation to an incorrect behavior or thought
9. Intellectualizing: also called isolation affect. Ponder about topics such as death, separation, severe illness denial of the
emotions that come with a disturbing thought, Example(death)
10. Regr ession: under severe stress or extreme challenge, individuals may attempt to cope with their anxiety by clinging to
immature and inappropriate bxs. return to earlier stage of development when experience stress
11. Altr uistic Sur r ender : living according to other person’s values to avoid responsibilities.
12. Identification with the aggr essor : internalized values of a feared person.
Divisions of the Mind: The mature adult mind has 3 divisions: an Id, and Ego and a Superego.
The id has 2 means of satisfying bodily needs: reflex actionwish fulfillment
The Ego develops and attempts to match the images of the id with objects and events in the real world. This matching process is
called identification.
Car l J ung
1. Jung studied in depth his own dreams and visions.
2. Jung also believed that dreams reflect both the individual’s personal unconscious and the collective unconscious (deepest
level of psyche containing the experience humans have had in their evolutionary past) of all humanity.
3. Jung and Freud both believed dreams provide a pathway to the unconscious but Jung differs from Freud in their functions
4. Dreams have 2 purposes:
They ar e pr ospective: they help people prepare themselves for the future
Ser ve a compensator y function : working to bring balance between opposites within the person. They compensate the
overdevelopment of one facet of personality.
5. He viewed dreams more as a way to express than as an attempt to repress and disguise.
Libido:
The general life energy that can be directed to any problem that arises is it biological or spiritual.
He referred to it as the “psychic” (Jung’s term for personality), which is focused on various needs whether those needs are biological or
spiritual.
Both conscious and the most substantial unconscious aspects of personality
Creative life force that could be applied to the continuous psychological growth of the person.
Pr inciple of Equivalence first law of thermodynamics that states the amount of energy in a system is essentially fixed
(conservation of energy) and if removed form one part of the system it will show up in another. applied to thepsychic: it means so
much psychic (libido) energy is available
Pr inciple of Entr opy second law of thermodynamics which states a constant tendency exist towards equalizing the energy system as
it relates to psychic energy: A tendency exist for all components of the psychic to have equal energy Psychic balance is extremely
difficult to achieve and must be actively soughtIf balance is not sought the personality balance will be uneven
Pr inciple of Opposites Similar to Newton’s contention that “for every action there is an equivalent and opposite reaction”
1. Ego: According to Jung the ego is everything which we are conscious and entails the functions responsible for everyday life
(thinking, feeling, remembering and perceiving).
2. Per sonal Unconscious
1. Consist of materials that were once conscious but are repressed or forgotten, or were vivid enough to make a
conscious impression at first.
2. Contains clusters of emotionally loaded thoughts called complexes (is a personally disturbing constellation of
ideas connected by common feeling tone.) They have a disproportionate influence on one’s behavior.
Wor d Association Test (a technique he used to study complexes): It consisted of reading 100 words one at a time and having a
person respond as quickly as possible with a word of his or her own. It is a tool to tap the unconscious in search of complexes.
3. Collective Unconscious: Reflects the collective experiences that human have had in their evolutionary past
“deposit of ancestral experiences from untold millions of years, echo of prehistoric events to which each of us adds an infinitesimally
small amount of variation and experiences” Carl Jung. These experiences are called archetypes: Inherited predisposition to respond
emotionally to certain aspects of the world
Per sona , aspect of the psychic that is display publicly, it includes the many roles one must play function in society
Anima, female component of the male psychic. It serves 2 purposes: it causes men to have feminine traits such as intuition,
tenderness, sentimentality… etc. and it provides a framework within which men interact with women
Animus, male component of the female psychic. It furnishes the women with male traits such as independence, aggression,
adventuresomeness… etc. and also with a framework that guides her relationship with men.
The collective unconscious is by far the most important and influential part of the psyche and its inherited predispositions seek
outward manifestation (archetypes)
Analytical Psychology
An elaborate explanation of human nature that combines ideas from history, mythology, anthropology and religion.
Stages of Development
Childhood (birth to adolescence) libidinal energy is invested in learning how to walk, talk and other skills necessary to survival
Young Adult (adolescence to 40) libidinal energy is invested in learning a vocation, getting married, relating to community life
Middle Age (40 to last years of life) libidinal energy is invested in philosophical and spiritual pursuits, most important stage is more
concern with wisdom and life’s meaning.
Alfr ed Adler
Or gan Infer ior ity: people are especially vulnerable to disease in organs that are less developed or “inferior” to other organs.
These biological deficiencies cause problems in the person’s life because of the stresses put on them by the environment.
These organic weaknesses inhibit the person from functioning normally, and therefore, must be dealt in some way.
Compensation: Because the body acts as an integrated unit, a person can “compensate” for a weakness either by concentrating on its
development or by emphasizing other functions that make up for weakness.
Feelings of Infer ior ity In 1910, Adler shifted his emphasis from actual organ inferiority to subjective inferiority, also called feelings
of inferiority. Adler pointed out that all humans start life with feelings of inferiority because we are completely dependant on adults
for survival. He stressed aggression and power as a means of overcoming feelings of inferiority.
Feelings of Infer ior ity as Motivational
Adler’s theory focuses on inferiority feelings. Instead as seeing this as a weakness, feelings of inferiority motivate us to strive for
mastery, success (superiority) and completion.
Even though, feelings of inferiority act as a stimulus for all positive growth, they can also cause neurosis.
Inferiority Complex: is a psychological condition that exists when a person is overwhelmed by feelings of inferiority to the point at
which nothing can be accomplished.
Mistaken Lifestyles
Any lifestyle that is not aimed at socially useful goals is a mistaken lifestyle.
Adler delineated 4 types of people who were labeled according to their degree of social interest.
Ruling Dominant Type; attempts to dominate or rule people
Getting-leaning Type; expects everything from others and gets everything he or she can from them
Avoiding Type; who “succeeds” in life by avoiding problems (such as a person avoids failure by never attempting anything)
Socially Useful Type; confronts problems and attempts to solve them in a socially useful way.
The first 3 types have faulty or mistaken lifestyles because they lack proper social interest.
Faulty lifestyles originate in childhood at the same time that a healthy lifestyle originates.
Adler descr ibed 3 childhood conditions that tend to cr eate a faulty lifestyle.
Physical Infer ior ity: actual physical weakness
Spoiling or Pamper ing: conditions that causes a child to believe it is the responsibility of others to satisfy his or her needs.
Neglecting: causes the child to feel worthless and angry and to look on everyone with distrust.
Adler considered pampering as the most serious of parental errors.
View of the Unconscious: Adler denied the very foundation of Freudian Psychoanalysis (the importance of repressed traumatic
experiences)
Bir th Or der : According to Adler, Birth order and one’s interpretation of their position within the family have a great deal to do with
how adults interact in the world.
Fir st bor n: This child is the focus of attention until the birth of a sibling “dethrones” him or her. The loss felt by the first-born child
when the second child is born creates bitterness that causes problems later in life. The most troublesome birth position.
Second bor n: This child is very ambitious because he or she is constantly attempting to catch up and surpass the older sibling. Of all
the birth orders, Adler believed that the second-born was the best.
Youngest bor n: The second worst position after the first born. This child is often spoiled and therefore loses courage to succeed by
his or her own efforts.
Only Child: This is like a first born child but that has never been dethroned. Only children are often sweet, affectionate and charming
in order to appeal to others. Adler did not consider this position as harmful as the first-born position.
Dr eam Analysis: Adler agreed with Freud on the importance of dreams but disagreed with Freud’s interpretation of them.
Adler believed that the primary purpose of dreams was to create emotions that could be used by dreamers to support their mistaken
lifestyles. Dreams, then, were analyzed to learn about the lifestyles of the dreamers.
Exter nalization : the tendency to view everything of importance occurring outside of oneself.
Exter nalization: Horney referred to the tendency to view everything of importance occurring outside of oneself as “Externalization”.
It is defined as the “tendency to experience internal processes as if they occurred outside oneself and, as a rule, to hold these external
factors responsible for one’s difficulties.
View of Penis envy: . In her early writings, Horney did accept a version of Freud’s belief that anatomy is destiny.
Later, however, she rejected this belief, emphasizing cultural determinates of personality instead.
For example, Horney said women often do aspire to be more masculine in a male dominated society but is not because they have penis
envy. Rather being masculine in a male-dominated society is the only way to gain power.
Horney stated that men also have womb envy, men resent women more and therefore they depreciate them, also the emphasis on
performance causes hidden anxiety bout the size of their penis and try to posses as many women as they can, but they are not attracted
to women that are their equals or superior.
Self-Analysis: Process of self-help that Horney believed people could apply to themselves to solve life’s problems and to minimize
conflict.
Er ik Er ikson
1. Is the ego’s job to organize one’s life and to ensure continuous harmony with one’s physical and social environment. His entire
theory can be viewed as a description of the ego gaining or losing strength
2. Ego psychology:
a. He stressed the autonomy of the EGO, instead of a servant of the ID
b. He gave the ego properties and needs of its own.
c. It is the ego who is our source of identity and self-awareness.
3. Anatomy and destiny: agreed with Freud that gender influences on personality, but also one’s culture, societal influences, he
believed that masculine and feminine traits complement each other, nether is better
4. Ego Integr ity: Satisfaction with Life and the lack of fear of death, dominates the last stage
ego psychology: theoretical system that stresses the importance of the ego as an autonomous part of the personality instead of viewing
the ego as merely the servant of the id. (Deemphasizes the importance of the id to personality development).
EPIGENERIC PRINCIPLE: the sequence in which the stages occurs. This principle states that anything that grows has a ground
plan and that out of this ground plan the parts arise, each part having its special ascendancy, until all parts have arisen to form a
functioning whole”. the personality characteristics that become salient during any particular stage of development exist before that
stage and continue to exist after that stage
1-Erickson saw life as consisting of eight stages, which stretch from birth to death.
2-The sequences of the eight stages are genetically determined and are unalterable.
3-All of these eight stages are present in rudimentary form at birth.
4-As each personality characteristic unfolds, it is incorporated into characteristics that developed during the previous stage, thus
creating a new configuration of personality characteristics.
CRISIS: conflict that becomes dominant during a stage that can be resolve positive (strengthening the ego) or negative (weakening
the ego)
1-Each stage of development is characterized by a crisis; that is turning point.
2-Each crisis has a possible positive or negative resolution.
3-A positive resolution contributes to strengthening the ego and therefore to greater adaptation.
4-A negative resolution is one stage lowers the probability that the next crisis will be resolved positively.
5-According to Erikson each crisis exists in three phases: immature phase, critical phase, and resolution phase.
6-Although they are biologically determined but it is the social environment that decides what kind of resolution is achieved.
Cr isis exists in 3 phases: (ICR)
4. Immatur e phase: where it is not the focal point of personality development
5. Cr itical phase: where because of a variety of biological, psychological, and social reasons it is the focal point of personality
development
6. Resolution phase: where the resolution of the crises influences subsequent personality development.
RITUALIZATION AND RITUALISMS
Ritualization is cultural approved patterns of everyday behavior that allow a person to become an acceptable member of society.
They provide a set of boundaries between acceptable and unacceptable behavior. Positive solution to a crisis.
Ritualism ’s are inappropriate or false ritualizations, and they are the causes of much social and psychological pathology.
.
Gor don Allpor t
Tr aits: mental structure that initiates and guides reactions and thus accounts for the consistency in one’s behavior
7. For Allport, traits: Are the unit of measure capable of ‘living syntheses. They were for him actual biophysical structures.
8. He defined tr aits as “a neuropsychic structure having the capacity to render many stimuli functionally equivalent, and to initiate
and guide equivalent (meaningfully consistent) forms of adaptive and expressive behavior. In other words, a trait causes a person
to respond in similar environmental situations in a similar way.
9. Traits develop through a combination of innate needs and learning.
10. Traits account for the consistency in human behavior.
11. People’s traits organize experiences because people confront the world in terms of their traits.
12. Traits will guide behavior because people can respond to the world in terms of their traits.
13. Traits can not be observed directly.
14. Allport theorized that traits provided the structure, the uniqueness, and the motivation that characterize a person’s personality For
Allport, a person’s traits create a possible range of responses to a given situation but are the nature of the situation itself that
determines which if the potential behavior actually occurs.
15. Allport believed that different situations, although similar, can arouse trait-related behavior to varying degrees. For that Allport
was an early interactionist (the one who believes that behavior always result from the combined influence of person variables and
situation variables), not a pure trait theorist.
Tr ait (gener al) ar e not habits (specific): The trait of cleanliness synthesizes a number of specific habits, like brushing teeth, taking
a shower
Tr aits (gener al) ar e not attitudes (specific): the trait of aggressiveness synthesizes the aggressive reactions towards strangers,
animals, world affairs, and the like, another difference is that attitudes imply evaluation and traits are responsible of behavior and
cognitions whether or not evaluation is involved.
Types of Tr aits:
1. Common tr aits – traits used to describe a group of individuals. Each trait can be possessed to almost any degree, still no
to people react the same under exactly the same circumstance. are those shared by several individuals. When traits are used to
describe a group
2. Individual tr aits – later he changes it to per sonal disposition: The unique way that a particular trait manifests itself in the
personality of a particular person. those posses by a particular individual and also the way in which a particular trait, such as
aggressiveness, manifests itself in a particular individual’s personality.
Car dinal Dispositions – “Ruling passion” that influences almost everything a person does. Only a few individual possess a cardinal
disposition. : Christlike, Dionysian, Faustian, Machiavellian, Quixotic, and Sadistic
Centr al Dispositions – The 5 to 10 characteristics that summarize a particular person’s personality. Those qualities about a person
that you would mention in a letter of recommendation. Each person possess surprisingly few central dispositions
Ex. might be punctuality, neatness, creativity and persistence.
Secondar y Dispositions - More specific than cardinal or central dispositions but still more general than habits and attitudes, a
secondary disposition may be a person’s preference for certain types of food or clothing or may be a person’s preference for
flamboyant clothing or for sweet food.
Psychophysical System
According to Allport, the term Psychophysical reminds us that personality is neither exclusively mental nor exclusively biological.
The organization entails the operation of both body and mind, inextricably fused into a personal unit.
Char acter : Allport was bother by the term character bc it implied the moral judgment of a person, such as when it is said that a person
has “good character”.
Allport believed that character was a description of a person that includes a value judgement. A person’s character can be “good” or
“bad” whereas a personality can not.
Temper ament: One of the raw material from which personality is shaped. Temperament is the emotional component of the
personality.
Type: Category into which one person can be placed by another person. To label a person as an “aggressive type” is to place him or
her in a descriptive category based on bx.
Functional Autonomy: Motive that existed once for some practical reason later exists for its own sake. In other words, a motive that
was once a means to an end becomes an end in itself. Allport’s most famous and controversial concept.
In other words, past motives are not functionally related to present motives.
Requir ements for an adequate theor y of motivation:
1. It must recognize the contemporary nature of motives. “Whatever moves us must move us now”.
2. It must allow for the existence of several types of motives.
“Motives are so diverse in type that we find it difficult to discover the common denominator”.
3. It must recognize the importance of cognitive processes.
4. It must recognize that each person's pattern of motivation is unique.
Functional Autonomy – is the termed used by Allport to refer to his motivational concept which he defined as “any acquired
system of motivation in which the tensions involved are not the same kind of as the antecedent tensions from which the
acquire system developed”.
1. He believed that once these motives become part of the proprium they are pursued for their own sake and not for external
encouragement or rewards.
2. These motives become self-sustaining because they become part of the person.
Types of functional autonomy
1. Pr eser vative functional autonomy: repetitious activities that we perform blindly, they once had a purpose but no longer.
2. Pr opr iate functional autonomy: individual’s interest, values, goals, attitudes and sentiments. Important motives around
which one organizes one’s life, such motives are independent of the conditions that originally produced them.
Is governed by three principles:
a. Pr inciple of or ganizing ener gy – energy that once was used for survival can be changed into concern for the
future when survival is not longer an issue.
b. Pr inciple of master y and competence – there is an innate need for healthy adult to increase
their efficiency.
c. Pr inciple of pr opr iate patter ing – all motives must be compatible with the total self (The
Proprium) which is the frame of reference that determines what is worth pursuing in life and what is not.
Religion: Although Allport believed that a religious orientation characterizes a healthy personality, however, embracing some forms
of religion was beneficial and embracing other forms was harmful.
Extr insic Religion : is unhealthy religion.
It is a superficial religion that is participated in for entirely selfish, practical reasons.
Intr insic Religion: is healthy religion.
Religion that seeks a higher meaning and purpose in life and provides possible answers to the many mysteries that characterize human
existence.
Tr aits only provide a predisposition to behave in certain way, and the behavior does not simply appear without appropriate
environmental stimulation.
Factor analysis: Complex statistical technique based on concepts of correlations to discover and investigate personality traits
For Eysenck, factors themselves are subjected to additional analysis to discover what he calls super factor s or types. Higher-order
factor that explain a number of correlated traits or first-order factors
Analysis of Tr aits
Cattell’s
Sour ce tr aits – traits that constitute a person’s personality structure and are thus the ultimate causes of behavior.
a. constitutional sour ce tr aits genetically determined
b. envir onmental-mold sour ce tr aits shaped by one’s culture, determined by experience
c. They are considered the basic elements of personality, in that everything we do is influenced by them.
d. All individuals possess the same source traits but do so in varying degrees.
e. 16PF - Sixteen Personality Factor “first order traits”, which he believed are the major source traits which appear at
about age of 4.
Sur face tr aits – outward manifestations of source traits. These are the characteristics of a person that can be directly
observed and measured.
Ability Tr aits - traits that determines how effectively a person works towards a desired goal.
One of these is intelligence which he distinguished between fluid intelligence (largely innate problem solving ability)
and cr ystallized intelligence. (Comes from formal education or general experience)
Temper ament Tr aits – these are genetically determined characteristics that determine a person’s general “style and tempo”.
They determine the speed, energy, and emotions with which a person responds to a situation.
Dynamic Tr aits – determines why a person responds to situations. Dynamic traits set the person in motion toward some
goal; they are the motivational elements of personality.
1. Er g – is a dynamic, constitutional source trait. Other theorist refers to these as drives, needs, or instincts. It provides
the energy for all behavior.
2. Metaer g- is a dynamic source trait with an environmental origin, secondary or learned drives.
Psychopathology
Cattell suggested two reasons for psychopathology:
1. An abnormal imbalance of the normal personality traits
2. The possession of abnormal traits that are not found among normal individuals; of which he isolated 12 abnormal traits
that can be used to described various types of neuroses and psychoses.
Eysenck suggested the difference is only in quantitatively; that is neurotics have abnormal high scores on one or more
superfactors, in particular on P and/or N.
B.F. Skinner
Skinner recognized 2 categories of bx: respondent and operant.
Oper ant bx: Behavior that cant be linked to any known stimulus and therefore appears to be emitted rather than elicited. Controlled
by the events that follow it. Skinner’s work was mainly on operant bx.
Respondent Bx: Bx that is elicited by a known stimulus. Controlled by the events that precedes it
Shaping: If the response we want to strengthen is not in the organism’s repertoire, it is shaped into existence. (If the desired response
does not occur naturally, it can be shaped into existence using differential reinforcement and successive approximations.
Shaping has 2 components: Differential reinforcement which means that some responses are reinforced and some are not, and
Successive Approximations, which means the responses that are reinforced are those that are increasingly close to the response
ultimately desired.
Shaping: gradual development of a response that an organism does not normally make. Shaping requires differential reinforcement
and successive approximations .
According to operant theory, the best way to teach a complex skill is to divide it into basic components and gradually shape it into
existence one small step at a time.
Extinction : Weakening of an operant response by removing the reinforcer that had been following the response during acquisition.
When a response returns to its operant level, it has been extinguished.
Can be regarded as the counterpart of acquisition (gaining)
Therefore, rewarded bx persists and “non-rewarded bx extinguishes.
Extinction is important in the Skinnerian view of bx modification. “Reinforce desired bx and ignore undesirable bx.
Skinner viewed Extinction as the proper method of dealing with undesirable bx, not punishment.
Reinfor cement is equated with a drive reduction; any stimulus that causes drive reduction is said to be a reinforcer. A reinforcer can
be primary, in which it satisfies a need related to survival, or it can be secondary.
A secondary reinforcer is a previously neutral stimulus that has been consistently paired with a primary reinforcer. A mother, for ex.
To learn one must want something, notice something, do something and get something.
Conflict : Situation in which two or more incompatible response tendencies exist simultaneously.
Appr oach Appr oach Conflict : Situation that exists when a person must chose between two equally attractive goals.
Avoidance-Avoidance Conflict : Situation that exists when a person must chose between two equally aversive goals.
Appr oach-Avoidance Conflict : Situation that exists when a person is both attracted to and repelled by the same goal.
Double Appr oach Avoidance Conflict : Situation that exists when a person has both positive and negative feelings about two goals.
Fr ustr ation Aggr ession Hypothesis: Originally the contention that frustration always leads to aggression and aggression results only
from frustration. Later modified to state that aggression is only one of several possible reactions to frustration.
Four Cr itical Tr aining Situations of Childhood: Dollard and Miller agreed with Freud that most neurosis originate in early
childhood. they believed this situations have a profound influence on adult personality.
Feeding Situation: The conditions under which hunger drive is satisfied will be learned and generalized into personality attributes.
Could lead to neurotic conflict. Ex. if children are fed when active, they will become active people
Cleanliness Tr aining: The way toilet training is done can have a profound influence on the child’s emerging personality. Could lead
to Neurotic Conflict.
Ear ly Sex Tr aining: Fear of sexual thoughts and activities is learned in childhood. Could result in neurotic conflict.
Anger Anxiety Conflicts: If not handled properly, could result in neurotic conflict.
B E
Bandur a Obser vational Lear ning: learning that results from attending something independently from reinforcement.
•According to Bandura and Mischel humans learn what they attend to, therefore, for them, learning is a perceptual process.
•No reinforcement is needed.
•Experiment with Bobo Doll
Vicar ious r einfor cement : reinforcement that comes from observing the negative consequences of another person’s behavior.
Vicar ious punishment: reinforcement that comes from observing the positive consequences of the other person.
•Bandura notes that the ability to learn by observing the consequences of other people’s behavior not only enhances survival but also
makes life less tedious.
•Social cognitive theor ist state that certain processes influence what we attend to, what is retained, how what is learned translate into
behavior, and why it is translated into behavior. Bandur a descr ibed four such pr ocesses.
1. Attentional Pr ocesses: determine what we can and do attend to.
* Includes aspects of the environment that influence attention, such as complexity, distinctiveness and prevalence of stimulation.
* Certain characteristics of models determine the extent to which they are observed.
* Observer characteristics, like sensory capacity (blind and deaf people do not respond the same.
* Consequences of past behavior.
2. Retentional Pr ocesses: determine which experience is encoded in memory
We retain actual cognitive pictures of what we experienced or we retain the words that described the experience.
* Delayed Modeling: refers to the fact that there is often a long delay between when something is learned observationally and
when that learning is translated into behavior.
3. Motor Repr oduction Pr ocesses: determine what behavior can be performed; need to have the motor apparatus and to be capable,
one can be injured, fatigue or ill.
4. Motivational Pr ocesses: determine the circumstances under which learning is translated into performance; learning will not be
translated into performance unless there is an incentive to do so. Person learns from observing the consequences of his behavior
(direct reinforcement) or from others (vicarious reinforcement)
A per son must obser ve something, r emember what was obser ve; be able to per for m behavior necessar y to r epr oduce what was
obser ved and want to r epr oduce them
Vicar ious r einfor cement: reinforcement that comes from observing positive consequences of another person’s bx.
Vicar ious punishment : punishment that comes from observing the negative consequences of another person’s bx.
Accor ding to social cognitive theor y, what is observed is learned, certain processes influence what is attended to, what is retained,
how what is learned is translated into bx, and why it is translated into bx.
Mind-Body Relationships: Although social cognitive theory gives cognitive events a prominent role as causative agents, it does not
accept psychophysiological dualism. thoughts are higher brain processes rather than psychic entities that exist separately from brain
activity
Geor ge Kelly
(Constr uct System: collection of constructs used by a person at any given time to construe events in his or her life)
The Eleven Cor ollar ies:
1. Constr uction Cor ollar y: Constructs are formed on the basis of the recurring themes in one’s experience
2. Individuality Cor ollar y: Each person is unique in his or her manner of construing experiences
3. Or ganization Cor ollar y: constructs are arranged in a hierarchy from most general to most specific
4. Dichotomy Cor ollar y: each construct has 2 poles, one of which describes characteristics the events to which the construct is
relevant have in common, the other of which describes events without those characteristics. (ex. if one pole describes beautiful
things, the other will describe ugly things)
5. Choice Cor ollar y: people will choose a contruct that will either further define or extend their construct system
6. Range Cor ollar y: construct is relevant to only a finite range of events
7. Exper ience Cor ollar y: States that mere passive experience is unimportant. It is the active construing of experience that
ultimately results in more effective construct system
8. Fr agmentation Cor ollar y: as a construct system is being tested, revised or extended, certain inconsistencies in bx may result.
9. Modulation Cor ollar y: states that construct system is more likely to change if the constructs contained in it are permeable.
10. Commonality Cor ollar y: people can be considered similar not because of similar physical experiences but bc they construe their
experiences in similar fashion.
11. Sociality Cor ollar y: to engage in constructive social interaction with another person, one must first understand how that person
construes his or her experiences. Only then can one play a role in that person’s life.
Eleven Cor ollar ies
1. Constr uction Cor ollar y: person anticipates events by constructing their replications
2. Individuality Cor ollar y: persons differ from each other in their construction of events
3. Or ganization Cor ollar y: person organizes their construct in order to reduce contradiction and increases predictable
efficiency.
4. Dichotomy Cor ollar y: each construct has two poles
5. Choice Cor ollar y: people will chose a construct that will ether defined (application of previously effective construct to new
but similar experience)or extend (new construct that, if validated will further expand the construct system
6. Range Cor ollar y: construct is relevant to only a finite range of events
7. Exper ience Cor ollar y: mere passive experiences are unimportant, it is the active, construing of experience that ultimately
results in a more effective construct system
8. Modulation Cor ollar y: construct system is more likely to change if the constructs contained in it are permeable (easily
assimilates new experiences)
9. Fr agmentation Cor ollar y: As a construct system is tested, revised or extended, certain inconsistencies may occur.
10. Commonality Cor ollar y: people can be similar not for physical experiences but for similar construction of their experiences.
11. Sociality Cor ollar y: to engage in constructive social interaction with another person, one must first understand how that
person construes their experiences, seeing the world through the other person’s eyes; awareness of the other person’s
expectations.
Cr eativity Cycle: innovative ideas are sought. Employed when a person seeks innovative solutions to problems or a fresh way of
construing experiences.
Loosened Constr uction Phase: loosening of construct system to let in new constructs
Tightened Constr uction Phase: after the new idea is discovered is evaluated
Test Phase: new idea is tested and if is validated, and it becomes part of the construct system; of not is disregard and a new cycle
begins
Car l Roger s
Actualizing Tendency: “Self-actualization” in which the organism has one basic tendency and striving-to actualize, maintain and
enhance the experiencing organism.
Rogers further postulated that there is one central source of energy in the human organism; a tendency toward fulfillment, toward
actualization, toward the maintenance and enhancement of the organism.
Rogers was aware that people sometimes act negatively; such actions result from fear and defensiveness.
Incongr uency
exists when people no longer use their Organismic valuing process as a means of determining if their experiences are in accordance
with their actualizing tendency. If people do not use their own valuing process for evaluating their experiences, then they must be
using someone’s “introjected values” in doing so.
That is, conditions of worth have replaced their Organismic valuing process.
Introjected Values: Conditions of Worth that are internalized and become the basis for one’s self-regard.
Modes of Existence
Alienation: Separation from nature, other people, or oneself that results in feelings of loneliness, emptiness or despair. a person can be
separated from one or more of the modes of existence
Fr eedom: Not the absence of negative conditions, but the potential to set future-oriented goals and then act in accordance with them. :
we get freedom through self-awareness, expanding consciousness
Responsibility: Because we are free to choose our own existence, we are also entirely responsible for that existence. We can praise or
blame no one but ourselves for whatever we become as people. goes hand in hand with freedom
Ontology: Study of being. Within Existentialism, ontological analysis is directed at understanding the essence of humans in general
and of individuals in particular.
Phenomenological: study of intact, meaningful conscious experience without dividing it or reducing it for study or analysis
Authenticity: the effort to live one’s live in accordance with freely chosen values rather than imposed.
Inauthenticity is causally related to neurotic anxiety and guilt and the feelings of loneliness, ineffectiveness, self-alienation, and
despair.
Death : is the ultimate state of nonbeing, is the source of great anxiety. This source of anxiety is part of the human existence and can’t
be avoided. The awareness of death, however, can add vitality to life by motivating a person to get as much out of life as possible in
the limited time available.
Thr ownness: Also called facticity, destiny, and ground of existence. circumstances of our lives over which we have no control. Such
facts include the biological, historical, and cultural events that characterize his or her life.
Human Dilemma : capacity of human to see themselves as objects which things happen as well as subjects who act on things by
interpreting, valuing, projecting into the future and transforming them, thereby give them meaning
Intentionality: the fact that mental events are directed toward objects outside of themselves.
Through intentionality that a relationship between objective and subjective reality is formed.
Anxiety and Guilt: to be human we need to experience them, if they are avoided and not deal in a conscious, constructive manner,
they become neurotic
Anxiety: Anxiety is the experience we have when our existence as an individual is threatened. Anxiety is a normal component of
healthy life.
Guilt: Feeling we have when we realize we are not living up to our full potential.
Nor mal Anxiety: Anxiety that results from the revisions of one’s value system and from the awareness of one’s inevitable death.
Taking risks causes normal anxiety.
Neur otic Anxiety: Anxiety that results form not being able to deal adequately with normal anxiety.
Nor mal Guilt : Feeling experienced when one recognizes the difference bw what one is and what one could be. Normal guilt is
unavoidable.
Neur otic Guilt: If normal guilt is not recognized and dealt with constructively, it can overwhelm a person, causing him or her to
block out the very experiences conducive to personal growth.
Natur e of Love: May described four types of love and stated that authentic love is a blending of the four
1. Sex: attraction based on biology requires only sexual activity with a partner.
2. Er os: union and sharing with one’s lover goal is to prolong the loving experience as long as possible.
3. Philia: friendship that holds two people together when Sex and Eros are not involved
4. Agape: caring without getting anything in return. Unselfish giving
Advanced Abnor mal Psychology
**Disor der s usually fir st diagnosed in Infancy, Childhood or Adolescence**
MENTAL RETARDATION: IQ below 70 Coded on Axis II. Significantly below-average intellectual functioning paired with
deficits in adaptive functioning such as self-care or occupational activities, appearing before age 18. (can you bathe?, can you feed
yourself?)
Mild Mental Retar dation: IQ 50-55 to 70
80%. develops social and communication skill, reach 6 grade level, can live successfully in the community
Moder ate Mental Retar dation: IQ 35-40 to 50-55
10% population. some communication skills, second grade level, able to perform un-skill, or semi-skill work. Can attend to
personal care. Benefit from vocational training with moderate supervision
Sever e Mental Retar dation: IQ 20-25 to 35-40
3-4% of the population. little or no communication skill, perform simple task under supervision. Adapt well to life in the
community in group homes or with their families.
Pr ofound Mental Retar dation: IQ 20-25 to below
1-2 % population. an identified neurological condition, impairments in Sensorimotor skill, need constant aid and supervision
LEARNING DISORDERS
All reading, writing and mathematical disorders start after 2nd grade.
Reading Disor der : Dyslexia. Reading performance is significantly below age norms. In addition, this disability cannot be caused by a
sensory difficulty such as trouble with sight or hearing.
Symptoms: difficulties with word recognition, reading and spelling, invert letters, when reading out loud add, omit or distort
pronunciation of words which interferes with academic achievement.
Believed to be hereditary: common among 1st degree biological families of individuals with learning disabilities.
Occurs to 4% of school age children in the US
When coding: If there is a neurological or other general medical condition or sensory deficit present, it should be coded on Axis III.
60-80% are males
Not correlated with low intelligence
Intervention: Dyslexia therapy consists of teaching inverted letter in alphabet
Disor der of Wr itten Expr ession : writing performance is significantly below age norms.
Symptoms: Difficulties in the individual’s ability to compose written text AEB grammatical, punctuation errors, poor
paragraph organization, multiple spelling errors, and excessively poor handwriting that fall below expected chronological age.
Some language and perceptual motor disorders may accompany
Differential Diagnosis: spelling and handwriting alone does not meet criteria for Developmental Coordination Disorder
Developmental Coor dination Disor der is a marked impairment in the development of motor coordination.
Younger children display walking, crawling, tying shoelaces, zippering pants.
Older children have difficulties with assembly puzzles, playing ball, etc,
Diagnosis is made if difficulties are not due to a general medical condition.
Treatment of Choice should be occupational therapy. With treatment they will eventually grow out of it.
COMMUNICATION DISORDER
Expr essive Language Disor der : Expressive language (what is said) is significantly below Receptive Language (What is understood)
Symptoms: limited vocabulary, making errors in tense, difficulties recalling words, producing sentences (short-term recall is
limited). Occurs in 10-15% of children.
Diagnosed by age 3; more common in boys
Determined by standardized individually administered tests of expressive language development
Treatment: may be self-corrected and may not require special intervention.
Differential Diagnosis: Phonological Disorder
Phonological Disor der : failure to use developmentally expected speech sounds that are appropriate for the individual’s age and
dialect.
Errors in sound production, organization, etc. (sound for rabbit=wabbit)
Omission of sound (ex. target=targe)
Lisping is particularly common
May recover spontaneously by age 8
Stutter ing: disturbance in the normal fluency and time pattern of speech that is inappropriate for the individual’s age.
Symptoms: repetition, long pauses, circumlocution, excess of physical tension.
Stress and anxiety exacerbate symptoms (some twitching may accompany)
Onset-2-7 yrs
Recovery: 20-80% recover; others recover spontaneously before 16 years of age.
Treatment: Parent training about how to talk to their children; regulated-breathing method, pharmacology (verapamil,
haloperidol)
Autistic Disor der : Pervasive developmental disorder characterized by significant impairment in social interactions and
communication and by restricted patterns of bx, interest, and activity. (Social Withdrawal and Inappropriate affect)
Three major characteristics of autism are: impairment in social interactions, impairment in communication and restricted bx, interests
and activities.
Onset is prior to the age of 3
50% children never speak at all
Echolalia (repeating the speech of others… How are you? How are you?)
Pronoun Reversal-refers to themselves in 3rd person… Avoid first person pronouns (he, she or you)
Neologisms: made up word (ie Milk = Moyee)
Obsessive-Compulsive & Ritualistic Acts
If you can get a child with autism to speak then there is a better prognosis. Practicing for 6 hrs daily.
In school, they experience difficulty with transition from one subject to the other.
Etiology: EEG studies enlarged brains; damage in the cerebellum which fails to enable them to shift attention quickly.
30% of autistic individuals suffer from epileptic seizures.
Therapy: Haloperidol (Haldol) controls the aggression, self-mutilation but not the lack of social skills.
Asper ger Disor der : involves a significant impairment in the ability to engage in meaningful social interaction and restricted and
repetitive stereotyped bxs but lacks the severe delays in language or other cognitive skills characteristic of people with autism.
Mild form of autism
Can maintain social contact. Usually confused as being shy. Answers are elaborate and thorough (adult vocabulary)
Problems with intimacy and close peer relationships.
Treatment includes behavioral approaches that focus on skill building and behavioral treatment of problem bxs
Childhood Disintegr ative Disor der : Normal development after the first 2 years followed by a decline of social, language and motor
skills. Perfect baby until age 2
Etiology: No specific cause has been identified.
Treatment involves behavioral interventions to regain lost skills and behavioral and pharmacological treatments to help
reduce behavioral problems.
Rett’s Disor der : A progressive Neurological disorder that primarily affects girls.
Characterized by constant hand-wringing, increasingly severe mental retardation and impaired motor skills, all of which appear
AFTER a normal start in development.
Head growth decelerates between ages 5 and 48 months.
Social skills will decline between age 1 and 3 and then partially improve.
Etiology: Believed to be caused by a genetc disorder involving the x chromosome.
Treatment: focuses on teaching self-help and communication skills and on efforts to reduce problem bxs.
ELIMINATION DISORDERS
Encopr esis (feces): Persistent passage of feces into inappropriate places; voluntary or intentional
At least one event a month for at least 3 months.
Onset is at least age 4
1% of 5 year olds
More common in males than in females
Not due to a general medical condition
2 subtypes: with constipation and overflow incontinence (leakage), and without Constipation and Overflow Incontinence.
Enur esis (ur ine): Repeated voiding of urine into bed or clothes
2 a week for at least 3 consecutive months causing impairment in school, occupational, or other area of importance.
Onset at least age 5
Subtypes: Nocturnal only, diurnal only, and nocturnal and diurnal.
Dementia Due to Pick’s Disease: prominent primitive reflexes: Snout, Suck, Grasp. Onset: 50-60 years of age; rare neurological
condition; lasts 5-10 years.
Stimulants: amphetamine, cocaine, nicotine and caffeine. Makes us more alert and energetic. Can elevate mood
1. Cocaine/Amphetamine Intoxication : Maladaptive behavioral or psychological changes (euphoria or affective blunting;
hyper-vigilance, impaired judgment; tachycardia or brady-cardia; pupilary dilation; nausea and vomiting; confusion; seizures.
2. Cocaine/Amphetamine Withdr awal: Fatigue, vivid unpleasant dreams; insomnia or hyper-somnia, increased appetite;
psychomotor agitation or retardation.
3. Caffeine intoxication: restlessness, nervousness, excitement, insomnia, flushed face, diuresis, gastrointestinal disturbances,
muscle twitching, rambling flow of thought or speech, increased heart rate or cardiac arrhythmia, agitation
4. Nicotine withdr awal: Significant distress or impairment in functioning. Signs of dysphoric or depressed mood, insomnia,
irritation or anger, anxiety, difficulty concentrating, , restlessness, decreased heart rate, increased appetite or weight gain.
Therapeutic Strategies: Antiabuse-injects this med and drinking alcohol will make the person sick.
•Better prognosis correlates with a precipitating event; acute (brief duration), late onset, female gender, no family history and good
pre-morbid adjustment.
Positive Symptoms:
•Delusions – false beliefs that they firmly held despite the existence of evidence that suggests the contrary.
•Grossly Disorganized– (appearance is disheveled; agitated; displaying inappropriate sexual behavior) or Catatonic Behavior –
decrease flow of psychomotor activity; reduced reactivity to environmental stimuli.
Negative Symptoms – affective flattening, blunted; avolition – restricted initiation of goal-directed behavior.
Schizophrenogenic Mother: Early theorist regarded family relationships, especially those between a mother and her son, as crucial in
the development of schizophrenia. At one time the view was so prevalent that the term Schizophrenogenic Mother was coined for the
supposedly cold and dominant, conflict-inducting parent who was said to produce schizophrenia in her offspring. These mothers were
characterized as rejecting, overprotective, self-sacrificing, and impervious to the feelings of others, rigid and moralistic about sex, and
fearful of intimacy.
2. Hallucinations: Sensory experiences in the absence of any stimulation from the environment.
Types:
Auditory. most common
Visual
Olfative
Tactile
Gustatory
3. Disor ganized speech: loosening of association, incoherence
4. Gr ossly Disor ganized: agitated, catatonic bx.
Negative Symptoms: the absence or insufficiency of normal bx.
1. Flat affect (little or no emotions)
2. Alogia (lack of meaningful speech)
3. Anhedonia (inability to experience pleasure, lost of interest or pleasure)
4. Avolition (inability to take action or to become goal oriented)
Disor ganized Symptoms:
1. Disorganized Speech (problems organizing ideas and in speaking so that a listener can understand)
2. Bizarre Behavior
Other Symptoms:
1. Catatonia
Neologisms: New words formed by combining words in common usage. Nonsense words.(Their appearance usually guarantees
Schizophrenia)
Subtypes:
295.30 Paranoid Type
A) Preoccupation with one or more delusions or frequent auditory hallucinations.
B) None of the following is prominent: disorganized speech, disorganized or catatonic behavior , or flat or inappropriate affect.
2. delusions and auditory hallucinations;
3. on the defense if they are aggressive its bc they think that you are attacking them.
4. Delusions of grandeur or persecutory (that other people are seeking to do him/her harm.
5. Their cognitive skills and affect are relatively in tact.
6. Have a better prognosis than other types of schizophrenia.
295.10 Disorganized Type
A) All of the following are prominent:
• Disorganized speech
• Disorganized behavior
• Flat or inappropriate affect
B) The criteria are not met for Catatonic Type.
1. disorganized speech, loose associations, flat affect, disorganized bx.
2. They are self-absorbed. A lot of time is spent looking at the mirror.
3. If hallucination or delusions are present, they do not have a central theme, but are more fragmented.
4. Previously known as: hebephrenic
295.20 Catatonic Type
The clinical picture is dominated by at least two of the following:
A) Motoric immobility as evidenced by catalepsy or stupor
B) Excessive motor activity
C) Extreme negativism or mutism
D) Peculiarities of voluntary movement as evidenced by posturing, stereotyped movements, prominent mannerisms, or prominent
grimacing.
E) echolalia or echopraxia
1. restricted voluntary movement, excessive purposeless movement, bizarre posture, echolalia (repeat or mimic the words of others)
or echopraxia (repeat or mimic the movements of others); Gumby-like, can be molded.
Specifier s:
The following specifiers can be applied only after at least 1 year has elapsed since the initial onset of active-phase symptoms. During
this initial 1-year period, no course specifiers can be given.
7. Episodic with Inter episode Residual Symptoms: the course is characterized by episodes in which criterion A for Schizophrenia
is met and there are clinical significant residual symptoms between the episodes. With Prominent Negative Symptoms can be
added if prominent negative symptoms are present during these residual periods.
8. Episodic with No Inter episode Residual Symptoms: the course is characterized by episodes in which criterion A for
Schizophrenia is met and there are no clinically significant residual symptoms between the episodes.
9. Continuous: characteristic symptoms of criterion A are met throughout all of the course. With Prominent Negative Symptoms
can be added if prominent negative symptoms are also present.
10. Single Episode In Par tial Remission: ther e has been a single episode in which criterion A for Schizophrenia is met and some
clinically significant residual symptoms remains. With Prominent Negative Symptoms can be added if these residual symptoms
include prominent negative symptoms.
11. Single Episode In Full Remission: there has been a single episode in which criterion A for Schizophrenia has been met and no
clinically significant residual symptoms remain.
12. Other or Specified Patter n: This specifier is used if another or an unspecified course pattern has been present.
affective flattening, blunted, avolition (no emotion) restricted initiated of goal-directed bx. (Emotional and social withdrawal,
apathy and poverty of speech and thought)
Differential Diagnosis
•295.40 Schizophreniform Disorder – symptoms present for at least one month but less than 6 months.
•295.70 Schizoaffective Disorder – an uninterrupted period of disturbance in which a mood episode and active phase symptoms
occur concurrently & during which hallucinations and/or delusions have occurred for at least 2 weeks in the absence of mood
symptoms (e.g. can be disorganized, flat affect, catatonic behavior)
•297.1 Delusional Disorder – non-bizarre delusions ; behavior is not bizarre; however, may depict tactile and olfactory hallucinations
related to the delusion; for a period of 1 month (ie. I can smell my wife has been with another man). persistent belief system contrary
to reality (delusion) but no other symptoms of schizophrenia for a period of at least one month.
Tend not to have flat affect, anhedonia, or other negative symptoms of schizophrenia; importantly they may become socially isolated
because they are suspicious of others.
D.D. with Schizophr enia : The “imagined events could be happening but aren’t” whereas in schizophrenia “the imagined events aren’t
possible”
Onset is relatively late; avg. age is 40-49.
1. Er otomanic Type: the delusion that another person is in love with the individual, usually of higher status. Typical stalkers.
2. Gr andiose Type: having some great power, insight or talent. (sometimes a special relationship to a deity or famous person)
3. J ealous Type: delusion is that their partner has been unfaithful.
4. Per secutor y Type: being conspired against, cheated, spied on, followed, poisoned, drugged, maliciously maligned,
harassed… etc. Most common sub-type of delusions.
5. Somatic Type: delusions of bodily functions or sensations. (ex. emits a foul odor from the mouth or body, theres an internal
parasite… etc.)
6. Mixed type: No one delusional theme predominates.
7. Unspecified Type: delusion can not be clearly determined.
•298.8 Brief Psychotic Disorder – delusions; hallucinations; disorganized speech and/or behavior for at least 1 day but less than 1
month returning to pre-morbid level of functioning.
Schizophrenias
•297.3 Shared Psychotic Disorder (Folie a Deux) – a delusion that develops in an individual who is involved in a close
relationship with another person who already has a Psychotic Disorder with prominent delusions whereby the individual
shares either in whole or in part the delusion of the primary case.
•293.xx Psychotic Disorder due to [General Medical Condition] – a transient or recurrent condition, which cycles with
exacerbation and remission of the underlying medical condition, that may involve delusions or hallucinations. There must
be a evidence of a physiological consequence subsequent to a physical exam or lab result.
•Substance-Induced Psychotic Disorder – prominent hallucinations or delusions with evidence of a physical exam or lab result
indicating that the symptoms developed within 1 month of substance intoxication or withdrawal and does not occur during
the course of delirium.
•298.9 Psychotic Disorder NOS – symptoms that have lasted less than 1 month, but have yet remitted, hence no criteria is for
Brief Psychotic Disorder, auditory hallucinations w/o other characteristics, postpartum psychosis, nonbizarre delusions with
mood overlap, conditions that are unable to determine whether it is primary to a medical condition.
Treatment: Neuroleptics (“taking hold of the nerves”) affecting the positive symptoms and to a lesser extent the negative symptoms.
Antipsychotic meds, such as clozapine, risperidone, and olanzapine, have several side-effects such as grogginess, blurred vision, dry
mouth, lip smacking, chewing movements leads to non compliance of med use.
Important to note that different meds are effective with different people and to a different degree.
Behavioral approaches such as token economy (most effective) as well as social skills training, family tx, vocational rehabilitation etc.
Family ed and vocational rehabilitation appear to be the two interventions most helpful for people with schizophrenia.
MOOD DISORDERS:
Group of disorders involving severe and enduring disturbances in emotionality ranging from elation to severe depression.
Mood Episodes
Major Depr essive Episode: Depressed mood and/or loss of interest or pleasure in usual activities that suggest significant impairment
in functioning. Two weeks duration or more.
Symptoms: Fatigue, diminished capacity to concentrate; insomnia or hyper-somnia; weight loss/gain; psychomotor agitation
or retardation; feeling listless.
In therapy, if client is depressed, therapy should engage the client’s senses (visual, auditory… etc.)
Manic Episode: Elevated, expansive, or irritable mood, impaired functioning, hospitalization, and/or psychotic features; one week or
longer . May cause psychotic symptoms.
Symptoms: Inflated sense of self, decreased need for sleep, more hyperactive than usual, flight of ideas, extreme involvement
in pleasurable activities (e.g. buying sprees, sex, foolish investments)
Hypomanic Episode: Abnormal, persistent elevated, expansive or irritable mood. At least four days in duration. A less severe
version of a manic episode that does not cause impairment in social or occupational functioning.
Mixed Episode: Rapidly alternating symptoms of Mania and major Depression; impaired functioning, hospitalization, and/or
psychotic symptoms. At least one week in durationMajor Depressive Episode: most commonly diagnosed and most severe
depression.
Major Depr essive Disor der : One or more Major Depressive Episodes for 2 consecutives months; symptoms somewhat age-related.
(No history of Manic, Hypomanic, or Mixed Episode)
•Dysthymic Disorder is characterized by chronic, less severe depressive symptoms that have been present for many years.
Bipolar Disorders
* occurs less often than Depression 1% of the population
Dysthymic Disor der : milder and fewer symptoms that major depressive episode but lasts longer
Chronic depressed mood for 2 or more yrs in adults and 1 or more years in children and adolescents.
Tip: If client doesn’t remember the onset of the symptoms than its probably dysthymia.
There must NEVER be a period of more than 2 months in which the person is symptom free and depressive symptoms are not severe
enough to meet the criteria for major depressive episode.
Can graduate into depression=double depression
Etiology
Physiological Hypothesis: Catecholamine Hypothesis – Depression is due to a deficiency in neuroephinephrine.
•Tricyclic Drugs: group of anti-depressants that their molecular structure prevents some of the reuptake of both norepinephrine and
serotonin by the pre-synaptic neuron after it has fired (ie. Imipramine)
•Monoamine Oxidase (MAO) Inhibitor: increase the levels of both serotonin and norephinephrine in the synapse by keeping the
enzyme MAO from deactivating the neurotransmitters (ie. Parnate)
a) MAO – prevents the disactivation of neurotransmitters to occur in an attempt to facilitate the flow of neorephinephrine
and/or serotonin (agonist). So when a neuron release norephinephrine or serotonin from the terminal button, a pumplike reuptake
mechanism immediately begins to recapture some of the neurotransmitters released and before they are received by the postsynaptic
receptor.
b) Tricyclic drugs block this reuptake process (antagonist). (ie. Tofranil & Elavil)
c) Selective Serotonin Reuptake Inhibitors (SSRIs) Prozac and Zoloft
Psychological Hypothesis: Learned Heplessness – Depression is a result of prime exposure to uncontrollable negative events coupled
with an attributional style that views negative events as a direct result of internal, stable, and vital factors. Most recent findings
research suggests that Depression is linked to a sense of hopelessness.
Social Hypothesis
•Beck’s Cognitive Triad: Views depression as the result of negative illogical statements about oneself, the current situation and the
future. The self-statements reflect cognitive errors misgeneralizations of selective abstractions and depressogenic schemas which are
enduring cognitive structures that develop during childhood as the result of early negative events that can be elicited later based on
similar events. Thinking errors in depressed people negatively focused in 3 areas: themselves, their immediate world, and their future.
•Research: Depression is 2-3 more common in women than men; more frequent among members of the lower SES and young
adults.
•Bipolar II Disorder: One or more Major Depressive Episodes and at least one Hypomanic Episode.
1. Never had a Manic or Mixed Episode, more common in females
2.
3. Bipolar Disorders: occurs less often than depression (1% of population) and includes Bipolar I, II, and cyclothymia.
Cyclothymic Disor der : Chronic (at least 2 years) mood disorder characterized by alternating mood elevation and depression levels
that are not as severe as manic or major depressive episodes
•Symptoms: Fluctuating hypomania and depressed mood for 2 or more years in adults, 1 or more years in children and adolescents.
•Etiology: Genetics, stressful life events.
•Treatment: Lithium, family therapy
•Prognosis: usually recurrent; most cases individual returns to a pre-morbid level of functioning following the episodes. Rapid cycling
of symptoms is associated with a poor prognosis.
Suicide Statistics
•High risk associated with previous attempt (40-80% of cases).
•High Risk Categories: White race, older, male gender, feelings of “hopelessness”, and Major Depression.
•Highest rate of Completed Suicide is for White males, aged 70 and over.
•Risk for Adolescents increases when Depression is combined with Conduct Disorder (or substance use).
•Highest rate of Suicide Attempts: Age 24-44
•Greatest increase in suicide attempts in recent years: ages 15-19
•3X as many women ATTEMPT to kill themselves
•Men are 4-5X more likely to kill themselves; men select guns; women pills which may contribute to lower rate of completed suicide.
•Suicide incidence in the US is highest during the spring and summer months.
•Being divorced or widowed increases suicide
risk by 4-5X
ANXIETY DISORDERS
Panic Attack
A discrete period of intense apprehension, fear, tension that develops abruptly and usually peaks within 10 minutes.
Symptoms include accelerated heart rate, sweating, chest pain, nausea, dizziness
Have client perform physical exam to rule out physiological symptoms
In therapy it is essential to have the client identify the trigger that sets off the panic attack
Agor aphobia: anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help
may not be available in the event of a panic attack.
These individuals will not leave the comfort of their own home but only with people they know and trust (familiarity)
300.01Panic Disor der without Agor aphobia : Recurrent unexpected panic attacks. At least one attack has to be followed by 1 month
of:
Persistent concern about having another attack
Worry about the implications of the attack (will I lose control)
Significant change in bx
Treatment: Vivo Exposure (flooding) and imipramine/SSRI
Differential Diagnosis: Hyperthyroidism, Heart Condition, Agoraphobia (fear of open spaces; anxiety about being in a
situation that would lend itself to a panic attack)
300.29 Specific Phobia: Previously known as simple phobia. Marked and persistent fear of a specific object that interferes with daily
life functioning.
Person is aware that the fear is excessive or unreasonable
Treatment: responds well to invivo and imagery
Subtypes:
Animal Type: has a childhood onset
Natural Environment Type (storms, water, heights) childhood onset
Blood Infection-Injury Type (medical procedures, blood, injections)
Situational Type: (tunnels, bridges, driving, elevators, enclosed places)
Other type
300.23 Social Phobia: Marked and persistent fear of one or more social or performance situations in which the person is exposed to
unfamiliar people or to possible scrutiny (humiliation)
Person avoids performance situation; impedes daily functioning
If the individual is under 18, to diagnose it must occur for at least 6 months.
Person is aware the fear is unreasonable
Treatment: vivo-exposure, practicing.
300.02 Gener alized Anxiety Disor der : Marked by excessive anxiety about multiple agents or activities for at least 6 months more
day than not in which the person finds difficult to control the worry.
Symptoms: restlessness, easily fatigued, irritability, muscle tension, sleep disturbance. Symptoms are disproportionate to the
feared event
Treatment: CBT, benzo’s…
300.3Obsessive Compulsive Disor der : Anxiety Disorder involving unwanted, persistent, intrusive thoughts and impulses as well as
repetitive actions intended to suppress them.
It has to be severe enough to cause significant distress and are to consume more than one hour a day or interferes with the person’s
normal routine.
Obsession: (excessive thoughts) recurrent intrusive thoughts or impulses the client seeks to suppress or neutralize while recognizing
they are not imposed by outside forces.
Compulsion: (Ritualistic Bx) Repetitive, ritualistic, time-consuming bxs or mental acts a person feels driven to perform
SOMATOFORM DISORDERS(soma: means body) : Pathological concerns of individuals with the appearance or functioning of
their bodies, usually in the absence of any identifiable medical condition. There is no identifiable medical condition causing the
physical complaints.
Somatoform disorders and dissociative disorders used to be categorized under one general heading, hysterical neurosis.
These disorders are intangible; difficult to measure and observe.
•Symptoms:
•4 pain Symptoms (head, stomach, back, )
•2 Gastrointestinal symptoms (nausea, bloating)
•1 Sexual symptom (excessive menstrual bleeding; sexual indifference)
•1 Pseudo-neurological symptom (urinary retention; double vision)
•Presented in a colorful exaggerated terms
•Lacking factual information
•Depressed and Anxious moods are common
•Undergo numerous procedures
•Seek advise from numerous physicians concurrently
•Chronic condition that fluctuates but rarely remits completely
•United States: Rarely diagnose men; Greece & P.R. have higher frequency
Hypochondr iasis: Somatoform disorder involving severe anxiety over the belief that one has a disease process without any evident
physical cause.
Symptoms: : Patient’s symptoms are often magnified because of their increased arousal associated with their perceptions.
Somatic symptoms such as abdominal aches and pains are common in children but should not be diagnosed with hypochondriasis
unless the child has a prolonged preoccupation with having a serious illness.
If a person suffering from major depressive episode is preoccupied with excessive worries of physical health; a separate diagnosis of
hypochondriasis is NOT made if these worries occur ONLY during the major depressive episode. However, since depression often
occurs secondary to the hypochondriasis, then both depression and hypochondriasis can be diagnosed.
Somatization Disor der (for mer ly known as Br iquet’s syndr ome): presence of physical symptoms that suggest general medical
condition and are not fully explained by a general medical condition, a substance or other mental disorders; symptoms are NOT
intentionally produced.
To differentiate between Hypochondriasis and Somatization Disorder is the fear or anxiety that one feels with probably having a
disease n hypochondriasis whereas with Somatization one might be concerned with the symptoms but they do not feel anxious and try
to figure out what the symptoms mean.
Complaints begins before age 30, extends over a period of years, and is characterized by a combination of pain, gastrointestinal,
sexual and pseudoneurological symptoms.
Symptoms:
4 pain symptoms (head, stomach, back, joints, etc.)
2 Gastrointestinal symptoms (nausea, bloating, vomiting, diarrhea, etc.)
1 sexual symptom (excessive menstrual bleeding, sexual indifference, erectile dysfunction)
1 pseudoneurological symptom (urinary retention, double vision, paralysis, difficulty swallowing, deafness, seizures, etc.)
To diagnose: ALL symptoms must be present!
Manifestations of symptoms:
Presented in colorful exaggerated terms (magnified)
Specific factual info is often lacking (superficial; no detail and inconsistent)
Anxiety symptoms and depressed moods are very common and may be the reason they are seen in a mental health setting.
Undergo numerous procedures.
They seek advice from numerous doctors concurrently, which may lead to complicated and sometimes hazardous combinations of
treatments.
A chronic condition that fluctuates but rarely remits completely.
In the U.S.: rarely diagnosed in men, found more in women. In P.R. & Greece have higher frequency of men diagnosed with this
disorder.
Treatment: slight dose of meds, such as antidepressants drugs as well as CBT and supportive therapy. Focus is to get
individual to interpret bodily functions.
Undiffer entiated Somatofor m Disor der : One or more physical complaints that cant be explained by a medical condition or
substance causing significant distress or impaired functioning for AT LEAST 6 months.
Diagnose with this disorder if they don’t meet full criteria for Somatoform Disorder.
Conver sion Disor der : The term conversion was popularized by Freud, who believed that the anxiety resulting from unconscious
conflicts somehow was “converted into physical symptoms to find expression”. According to Freud, this allowed the individual to
discharge some anxiety without actually experiencing it.
1. Defined: physical malfunctioning, such as blindness, paralysis or difficulty speaking, suggesting neurological impairment but
with no organic pathology to account for it.
2. Believed to be maintained by primary gain (to reduce anxiety and to keep any conflict out of awareness; getting out of
something) and secondary gain (external benefits are obtained or duties and responsibilities are evaded; receiving attention).
3. Occurs under stress.
4. Onset: Late childhood to early adulthood (rarely before age 10 or after age 35)
5. If it appears during Middle or old age, the probability of an occult neurological or other general medical condition is high.
6. Mimics somatoform disorders
7. Causes: According to Freud an individual experiences a traumatic event (that must be escaped), the resulting conflict and
anxiety are unacceptable, causing the person to repress the conflict, making it unconscious. The anxiety continues to increase
and the person “converts” it into physical symptoms (primary gain). The individual receives lots of attention and sympathy
and may be allowed to avoid a difficult situation or task (secondary gain)
Subtypes:
With Motor symptom or Deficit (paralysis, impaired coordination, urinary retention, lump in throat, etc.)
With Sensory Symptom or Deficit (loss of touch or pain sensation, double vision, blindness, deafness, and hallucinations)
With Seizures or Convulsions (with voluntary motor or sensory components)
With Mixed Presentation (more than one category are evident)
Treatment: a principal strategy is to identify and attend to the traumatic or stressful life event, and remove, if possible sources
of secondary gain. Catharsis is a reasonable first step.
Pain Disor der : Somatoform disorder featuring TRUE PAIN but for which psychological factors play an important role in onset,
severity exacerbation or maintenance of the pain.
1. Presence of serious pain in one or more areas that warrant attention.
2. Pain causes clinically significant distress or impairment in functioning.
3. Symptoms are not intentionally feigned and are actually felt and are real.
4. Pain is not accounted for by a mood, anxiety, or psychotic disorder and does not meet criteria for Dyspareunia (pain
associated with sexual intercourse).
Etiology: Can be caused by a psychological distress, such as cancer.
Subtypes:
Pain Disor der Associated with Psychological Factor s (when psychological factors are judged to play an important role in the
maintenance of the pain)
Pain Disor der Associated with Both Psychological Factor s and Gener al Medical Condition (used when both psychological and
general medical condition (ex. cancer) are judged to play an important role in maintaining the pain)
Specifiers: Acute (less than 6 months) and Chronic (6 months or longer)
Pain Disor der Associated with a Gener al Medical Condition (Note: not considered a mental disorder and coded on axis III; used to
facilitate differential diagnosis; must locate the location, such as lower back or pelvic; “completely healed but still feels pain”)
Body Dysmor phic Disor der : Somatoform Disorder featuring a disruptive preoccupation with some imagined defect in appearance
(“imagined ugliness”); causes significant distress or impairment in functioning, preoccupation is not accounted for by another disorder
(ex. anorexia, bulimia “because of just fatness”)
1. Correlated with Anorexia.
2. Obsessions of the body.
3. Complaints surround: hair thinning, acne, wrinkles, scars, facial asymmetry.
4. Preoccupations: size, shape, nose, eyes, mouth, teeth, jaw, chin, cheeks, head, ears.
5. Many people with this disorder become fixated with mirrors or completely avoid mirrors.
6. Suicidal ideation, suicide attempts and suicide itself are frequent consequences of this disorder.
7. People with BDD also have “ideas of reference”, which means they think everything that goes on in the world somehow is
related to them, in this case, to their imagined defect.
8. Michael Jackson suffers from this disorder
9. May undergo numerous surgical procedures and enhancements that may actually worsen the disorder.
10. A disorder that frequently co-occurs with BDD is OCD. A separate diagnosis for OCD is given only when the obsessions or
compulsions are not restricted to concerns about appearance.
Onset: Usually begins during adolescence but can being during childhood. However, the disorder may not be diagnosed for many
years because individuals are reluctant to reveal their symptoms. Can begin gradually or abruptly. (if onset occurs during childhood its
b/c of verbal and physical abuse)
Equally common in men and women
Prevalence of BDD in the community is unknown (since some individuals are reluctant to reveal their symptoms or seek help for this
disorder)
Condoned by society (increase of plastic surgery; becoming the norm)
Treatment: Wont see the distortion in the mirror but by a picture.
FACTITIOUS DISORDERS
Factitious Disor der s: Nonexistent physical or psychological disorder faked for no apparent gain except possibly sympathy or
attention.
Intentional production of physical or psychological signs or symptoms to adopt the patient role.
They want self-pity.
Person with the disorder is likely to present symptoms in a highly dramatic way but be vague and inconsistent in providing details.
Factitious Disor der by Pr oxy (someone else; aka Munchausen’s Syndrome by Proxy) is the intentional production or faking of
physical or psychological symptoms in another person who is under the individual’s care. For instance, a mother, may purposely
makes her child sick to become primary care giver and get attention and pity from others. Can occur with a child or elderly person. An
atypical form of child abuse.
Malinger ing involves the deliberate faking of a physical or psychological disorder in an attempt to obtain an external reward
(financial compensation, prescribed meds, privileges, etc.) Differs from Factitious Disorders in that Malingering, the person is
consciously motivated by an external incentive whereas factitious disorders, the person is unaware of the motivation behind the
factitious bx and external incentives are absent.
In school, present in children when they want to get something.
DISSOCIATIVE DISORDERS
Are highly unusual.
Essential feature is a disruption in the usually integrated functions of consciousness, memory, identity, or perception. The disturbance
may be sudden, gradual, transient or chronic.
Dissociative exper iences can be divided into two types:
Deper sonalization (your perception are altered so that you temporarily lose the sense of your own reality)
Der ealization (situation in which the individual loses his or her sense of reality of the external world)
Dissociative Amnesia (formerly known as Psychogenic Amnesia): Inability to recall important personal info usually of traumatic or
stressful nature, that can’t be attributed to normal forgetfulness.
Localized Amnesia : person fails to recall events that occurred during a particular period of time, usually the first few hrs following a
traumatic event (ex. the uninjured survivor of a car accident, in which a member has been killed, may not be able to recall anything
that happened from the time of the accident until 2 days later).
Selective Amnesia : the person can recall some, but not all the events during a particular period of time (ex. a combat veteran can
recall some parts of a series of violent combat experiences).
Dissociative Fugue (formerly Psychogenic Fugue): Sudden, unexpected travel from home or work, with the inability to recall one’s
past. Confused about their personal identity or sometimes an assumptions of a new identity can occur (if a new identity does occur, it
is usually more uninhibited or outgoing than the former “real” identity)
1. Fugue literally means “flight”
2. Most individuals just take off and later find themselves in a new place without any recollection on why or how they got there.
3. Usually escaping an intolerable situation.
4. Onset is usually related to traumatic, stressful, or overwhelming life events.
5. Seldom occurs before adolescence; usually occurs in adults.
6. Single episodes are most commonly reported and may last from hours to months.
7. Recovery is usually rapid but Dissociative Amnesia may persist following the fugue.
8. “Amok” (running amok) is a distinct dissociative disorder not found in western cultures in which individuals, in a trance-like
state, brutally assault and sometimes kill people or animals. If the person is not killed themselves, he/she will probably not
remember the episode. Seen more in males.
9. Individuals with various culturally defined “running syndromes” may have symptoms that meet diagnostic criteria for
Dissociative Fugue. These conditions are characterized by a sudden onset of high level of activity, a trance-like state,
potentially dangerous bx in the form of running or fleeing, and resulting in exhaustion, sleep and amnesia. Running disorders
(except for amok) are seen more in women, as with most dissociative disorders.
Dissociative Identity Disor der (DID; formerly Multiple Identity Disorder): The presence of 2 or more distinct identities or
personality states that each has its own pattern of perceiving, relating to and thinking about the environment.
1. Each personality takes over the person’s bx and the person is unable to recall important personal info during the episode.
2. (ex. movie two faces of eve)
3. A person may adopt as many as 100 new identities.
4. The person that becomes the patient and asks for treatment is usually the “host” identity. The first personality to seek
treatment is seldom the original personality of the person. Usually the host personality develops later.
5. The transition from one personality to the other is called a switch. The switch is almost instantaneously and occurs under
extreme stress.
6. Physical transformations such as posture, facial expressions, patterns of facial wrinkling, and even physical disabilities may
emerge during a switch.
Etiology: almost every patient presenting this disorder reports that they were horribly abused as children.
DID is rooted in a natural tendency to escape or “dissociate” from the unremitting negative affect associated with severe abuse.
The more passive identities tend to have more constricted memories, whereas the more hostile, controlling or “protector” identities
have more complete memories.
More diagnosed in adult females than adult males and females tend to have more identities than do males.
In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
Treatment: goal is to reintegrate personality. Hypnosis is often used to help reintegrate personality. Long-term
psychotherapy can also be used.
Deper sonalization Disor der : Feeling detached from, and as if one is an outside observer of one’s mental processes or body whereby,
reality testing remains intact.
1. The person may feel as if they are living in a dream or in a movie.
2. There may be a sensation of being an outside observer of one’s own mental processes, one’s body, or parts of one’s body
(looking outside in).
3. Sometimes the individual may have difficulty describing their symptoms and may fear that they are “Crazy”
4. People may also have an alteration in the way they perceive things such as the size and shape of objects and people may seem
unfamiliar or mechanical.
Onset can occur during adolescence or adulthood (mean age is 16) although the disorder may be have an undetected onset in
childhood.
When they enter treatment, they usually go in for anxiety, panic or depression.
Correlated with chronic physical abuse and trauma.
Hypoactive Sexual Desir e: Deficiency or absence of sexual fantasies and desire for sexual activity which causes marked
distress/interpersonal difficulty. (absence of anything that involves sexual stimulation)
1. Difficult to diagnose; might have to evaluate it by the frequency of sexual activity.
2. 50% of patients that go to sexual clinics for help complain of hypoactive sexual desire.
3. Most frequently found in women, men complain about sexual dysfunction.
4. More frequently it develops after a period of adequate sexual interest, in association with psychological distress, stressful life
events, or interpersonal difficulties.
5. Can be caused by life stressors.
6. May be episodic or continuous. Episodic pattern of loss of sexual desire occurs in some in relation to problems with intimacy
and commitment.
Treatment: can include sensate focus and non-demand pleasuring.
Sexual Aver sion Disor der : Extreme and persistent dislike of sexual contact or similar activities.
1. Avoidance of all or almost all genital sexual contact with a sexual partner.
2. This person is comfortable with kissing and groping but has problems with exposure of genitals. Almost like if they were
disgusted with sex.
3. In some cases, the principal problem might be panic disorder or PTSD.
Treatment: Treating the panic disorder or anxiety might be the first necessary step when treating this disorder.
Female Sexual Ar ousal Disor der : Recurrent inability in some women to attain or maintain adequate lubrication and swelling sexual
excitement responses until completion of sexual activity.
Women do not feel as impaired by this as men do.
This disorder may result in painful intercourse, sexual avoidance and the disturbance of marital or sexual relationships.
Male Er ectile Disor der : Recurring inability to attain, maintain until completion of the sexual activity, an adequate erection.
Occurs in the arousal stage.
Sexual activity that involves TWO, will not be able to perform. Can achieve an erection during masturbation or on awakening.
Treatment: can consist of sensate focus and non-demand pleasuring, meds such as Viagra, injections of vasodilating drugs
such as papaverine, or prostaglandin, implants or penile prostheses, vacuum device therapy.
Female Or gasmic Disor der Recurring delay or absence of orgasm in some women following a normal sexual excitement phase,
relative to their prior experience and current stimulation. Also know as inhibited (female) orgasm.
1. Diagnosis should be based on clinician’s judgement that the woman’s orgasmic capacity is less than would be reasonable for
her age, sexual experience, and the adequacy of sexual stimulation she receives.
2. To diagnose, the most essential component is that orgasm never or almost never occurs.
3. As a therapist, must obtain a very long sexual history.
4. Commonly seen in women.
5. The most common complaint among women who seek therapy for sexual problems.
6. Most Female Orgasmic Disorders are lifelong rather than acquired.
7. Lifelong Female Orgasmic Disorder may be treated with explicit training in masturbatory procedures.
8. May be more prevalent in younger women.
Male Or gasmic Disor der : Persistent or recurring delay in or absence of orgasm following a normal sexual excitement phase during
sexual activity that the clinician, taking into account the person’s age, judges to be adequate in focus, intensity and duration.
Aka: blue balls
Although aroused at the beginning of a sexual encounter, the thrusting gradually becomes a chore rather than a pleasure.
Male Orgasmic Disorder can also occur in association with other Sexual Dysfunctions, such as Male Erectile Disorder. If so, both
should be noted.
Pr ematur e Ejaculation: The persistent or recurrent onset of orgasm and ejaculation with minimal sexual stimulation before, on, or
shortly after penetration and before the person wished it.
More common than erectile dysfunction
Most men that complain of premature ejaculation typically climax no more than 1 or 2 minutes after penetration, compared with 7 to
10 minute in individuals without this complaint.
A perception of lack of control over orgasm, however, may be the more important psychological determinant of this complaint.
Treatment of choice is sensi-focus. Homework is refraining from sexual intercourse, stop and start technique.
Sexual Pain Disor der : Genital Pain in either males or females, before, during, or after sexual intercourse.
For some, sexual desire is present and arousal and orgasm are easily attained, but the pain of intercourse is so severe that sexual bx is
disrupted.
Includes Dyspareunia and Vaginismus.
No physiological abnormalities present.
Causes distress to the person with the disorder and their partner.
Dyspar eunia: Defined: Pain or discomfort during sexual intercourse.
Can occur in both males or females.
No physiological abnormalities present. Only diagnosed if no medical reasons for pain can be found. More of a psychological
condition
Vaginismus Recurrent or persistent voluntary contraction of perineal muscles surrounding the outer third of the vagina when vaginal
penetration with penis, finger, tampon, or speculum is attempted. A more common problem.
Par aphilias: Recurrent, intense sexually arousing fantasies, sexual urges, or bxs generally involving:
Nonhuman objects
The suffering or humiliation of oneself or one’s partner
Children or other non-consenting persona that occur over a period of at least 6 months
Paraphilias are very wide (umbrella) contains all 3 of sexual dysfunctions.
Paraphilias may be in fantasy without action or acted upon.
1. Exhibitionism : Sexual gratification attained by exposing one’s genitals to unsuspecting strangers for a period of at least 6
months.
2. Additionally, the person has acted on these sexual urges, or the sexual urges cause marked distress.
3. Anxiety produced disorders that are done to self-soothe. The thrill is the risk of getting caught.
4. Mostly found in men.
5. Sometimes the individual masturbates while exposing himself (or while fantasizing exposing himself).
6. If the person acts on these urges, there is generally no attempt at further sexual activity with the stranger.
7. The desire or arousal may be the surprise or shock of the observer.
8. Onset usually occurs before age 18, although it can begin at a later age.
9. Fetishism: Over a period of 6 months, intense sexually arousing fantasies or urges involving the use of non-living objects
(ex. panties)
10. The person with Fetishism frequently masturbates while holding, rubbing, smelling the fetish object or may ask the sexual
partner to wear the object during their sexual encounters.
11. Usually the fetish is required or strongly preferred for sexual excitement, and in its absence there may be erectile dysfunction
in males.
12. An object that is used for genitalia stimulation such as a vibrator is not a fetish objects because it was designed for that
purpose. As well as articles of female-clothing used in cross-dressing (ex. Transvestic Fetishism)
13. Once established Fetishism tends to be chronic.
14. Fr otteur ism : Over a period of 6 months of bxs involving the touching and/or rubbing against a non-consenting person.
15. The bx usually occurs in crowded places from which the individual can more easily escape arrest (on a bus)
16. These individuals have a lot of planning and strategizing characteristics.
17. Someone who will not draw attention to oneself.
18. Pedophilia : Over a period of at least 6 months, recurrent intense sexually arousing fantasies, sexual urges, or bxs involving
sexual activity with a prepubescent child or children (generally age 13 years or younger)
19. The person is at least 16 years and at least 5 years older than the child or children
20. Specifiers: Sexually attracted to Males, Sexually attracted to Females, Sexually Attracted to Both.
21. 2 Types of Pedophilias:
22. Type I are good with kids. They build strong trust worthy relationships with kids.
23. Type II are aggressive. Fear is injected in the child.
24. Activities are usually excused or rationalized as if they are educating the child, that the child derives sexual pleasure from
them, or that the child was sexually provocative. Many individuals with pedophiliac tendencies are do not experience
significant distress or remorse.
Gender Identity Disor der (used to be called Transsexualism): Psychological dissatisfaction with one’s own biological gender, a
disturbance of one’s identity as a male or female.
The primary goal is not sexual arousal but rather to live the life of the opposite gender.
Onset in children: age 2-4 years.
Before sex reassignment surgery, the person is told to dress and live in alternate persona for at least one year.
Gender Identity Disorder (during childhood), Gender Identity Disorder (during adolescence/adulthood).
By adolescence to early adulthood, 75% males report homosexual or bisexual orientation.
Feel trapped in the wrong body
EATING DISORDERS
is more frequently found (90%) in families with upper-middle and upper-class SES, who live in a socially competitive environment.
Children of parents who are perfectionist and controlling are more likely to develop this disorder.
20% die of an eating disorder w/ 50% dying of suicide.
Anor exia Ner vosa: Eating disorder characterized by re-current food refusal leading to dangerously low body weight.
Failure to maintain normal weight for age and height, intense fear of gaining weight, denial of seriousness of current low body weight
(body dysmorphia), amenorrhea (3 consecutive cycles). In prebubertal females, menarche may be delayed by the illness.
If this individual seeks help it’s because of family’s concerns or they seek help on their own because of their subjective distress over
the somatic and psychological consequences/problems of starvation.
Subtypes: Restricting Type (not engaged in binge-eating or purging bxs; restricts food intake) or Binge- Eating/Purging Type:
self-induced vomiting, laxatives, diuretics or enemas.
Onset: Ages 14-18; rarely occurs in females over 40 years of age. Onset may be associated with stressful life events.
Hospitalization may be required to restore weight and to address fluid and electrolyte imbalances.
Differential Diagnosis: Medical conditions, Major Depression, Body Dysmorphic Disorder.
1. Differential Diagnosis with Bulimia Nervosa is that unlike Anorexia Nervosa, Binge eating/purging type, individuals with
Bulimia Nervosa are able to maintain body weight at or above minimally normal level.
2. Comorbid with mood disorders (anxiety disorders and depression)
3. 50 % of those with Anorexia Disorder die of Suicide.
4. The “typical” family characteristics of someone with anorexia is successful, hard-driving, concerned about external
appearances, and eager to maintain harmony.
5. Goal of Anorexia in therapy is to restore the patient’s weight to a point that is at least within low-normal range.
6. If body weight is below 70% the average or if weight has been lost rapidly, inpatient treatment would be recommended.
7. For restricting anorexics the focus of treatment must shift to their marked anxiety over becoming obese and losing control of
eating as well as to their undue emphasis on thinness as a determinant of self-worth, happiness, and success. CBT is effective.
Additionally, every effort is made to include the family to accomplish the therapeutic goals.
Bulimia Ner vosa: One of the most common psychological disorders on college campuses. Eating disorder involving recurrent
episodes of uncontrolled excessive (binge) eating followed by compensatory action to remove the food (ex. deliberately vomiting,
laxative abuse, excessive exercise).
To qualify for diagnosis, this must occur for at least 2 a week for 3 months.
The hallmark of bulimia nervosa is eating larger amount of food, typically junk food, than most people would eat under similar
circumstances.
Two types (subtypes): Pur ging type: self-induced vomiting, laxative abuse, diuretic or enemas or Non-pur ging type: inappropriate
compensatory bxs such as fasting or excessive exercise.
Individuals with Bulimia Nervosa typically are within normal weight range, although some may be underweight or overweight.
May appear with a chubby face from the repeated vomiting.
Causes an electrolyte imbalance
May also have caluses or cuts in fingers or hands from the insertion in the mouth to purge.
Comorbid with anxiety or mood disorders.
Onset: Late adolescence or early adulthood. (older than Anorexia)
Course is variable (chronic or intermittent; periods of remission longer than 1 year are associated with better long-term outcome).
Differential Diagnosis: Anorexia Nervosa, Kleine-Levin Syndrome, Major Depression, Body Dysmorphic Disorder.
Treatment: CBT is effective.
SLEEP DISORDERS
One out of every 4 Americans report getting less than 7 hours of sleep daily during the work week.
Primary sleep disorders are those in which another mental disorder, a general medical condition or a substance is NOT responsible for
the sleep disorder.
Sleep disorders are divided into two major categories: dyssomnias and parasomnias.
Dyssomnias are problems is getting to sleep or in obtaining sufficient quality sleep. Includes Primary Insomnia, primary hypersomnia,
Narcolepsy, Breathing-related sleep disorder, Circadian Rythum Sleep Disorder and Dyssomnia NOS.
1. Pr imar y Insomnia: Difficulties initiating or maintaining sleep for at least one month.
a. Onset: most usually during a time of psychological, medical or social stress. Typically begins in young adulthood or
middle age and is rare in childhood or adolescence.
b. Characteristic symptoms of Primary Insomnia are intermittent wakefulness, fatigue, concentration problems,
irritability
c. Treatment: Perhaps the most common treatment for insomnia is meds such as sleeping pills or benzos etc.
d. Psychological treatments include stimulus control in which adults are instructed to only use the bed for sleeping and
for sex and not for work or any other anxiety-provoking activities (such as watching the news) Additionally, CBT,
Cognitive relaxation techniques, progressive relaxation techniques, and paradoxical intention.
2. Pr imar y Hyper somnia: Excessive sleepiness for 1 month and as evidenced by prolonged sleep or daytime sleep episodes
that occur daily.
a. The duration of sleep may last from 8 to 12 hours and often followed by difficulty awakening in the morning.
b. People with this condition often appear sleepy and may even fall asleep in the clinician’s waiting area.
c. Onset is anywhere between 15 and 30 years of age with a gradual progression over weeks to months.
d. The course is then chronic and stable, unless treatment is initiated.
e. Treatment: physicians usually prescribe a stimulant such as methylphenidate (Ritalin), amphetamine, or modafinil.
Psychological treatment for other dyssomnias is not usually addressed unless it consists of counseling or support
groups that assist in managing the psychological and social effects of disturbed sleep.
3. Nar colepsy: Involves sleep attacks with cataplexy (a sudden loss of muscle tone) and or REM sleep that occurs daily for at
least 3 months.
a. People with Narcolepsy periodically progress right to the dream sleep stage almost directly from the state of being
awake.
b. Two other characteristics distinguish people who have narcolepsy which are Sleep paralysis or hypnagogic
hallucinations.
c. Low-stimulation, low activity situations typically exaggerate the degree of sleepiness.
d. Sleep episodes generally last 10-20 minutes but can last up to an hour if uninterrupted.
e. People with this disorder generally tend to develop mood and anxiety disorders as well as substance-related
disorders.
f. Individuals with Narcolepsy may appear sleepy during the clinical interview and may actually fall asleep in the
waiting area or examination room.
g. Onset after age 40 is unusual.
h. Treatment: Stimulants and Counseling and/or support groups.
5. Cir cadian-Rhythm Sleep Disor der (formerly Sleep-Wake Cycle): Sleep disruption leading to excessive sleepiness or
insomnia due to a mismatch between the sleep wake schedule required by the person and his environment.
a. Two types: Jet Lag Type (occurs during flying; time zones) and Shift work type (occurs in those who work at night)
b. Treatment: includes trying to move bed-time later as opposed to moving bedtime earlier, scheduling shift changes
such as going from day to evening schedules) and bright light therapy.
6. Dyssomnia (NOS): Disturbances in the amount, quality and timing of sleep “Restless Legs syndrome”
Par asomnias: are abnormal bxs such as nightmares or sleep walking that occur during sleep. Includes Nightmare Disorder, Sleep
Terror Disorder, Sleepwalking Disorder, and Parasomnia NOS
1. Nightmar e Disor der (formerly Dream Anxiety Disorder): Upon awakening the person is oriented, alert and is able to vividly
recall of frightening dreams. Dream content most often focuses on imminent physical danger to the individual (pursuit,
attack, injury), or the perceived danger may be more subtle such as personal failure or embarrassment.
a. Course: Nightmares often begin between ages 3 and 6 years. Most children who develop a nightmare problem tend
to outgrow it
b. Occurs during REM sleep and the person is alert, oriented and able to recall the dream.
2. Sleep Ter r or Disor der : Person screams upon wakening with intense fear, and signs of autonomic arousal such as
tachycardia, rapid breathing, and sweating. No details of the dream can be recalled.
a. Usually begins during the first 3rd of the major sleep episode and last 1-10 minutes.
b. For the diagnosis to be made, the individual must experience clinically significant distress or impairment.
c. Sleep Terror begin during deep NREM sleep
d. Psychopathology is more likely to be associated with Sleep Terror Disorder in adults than in children.
e. Onset: In children between ages 4-12 years and resolves spontaneously during adolescence. In adults, it begins
between ages 20-30 with episode waxing and waning over time.
3. Sleep Walking Disor der : Walking during Sleep in which the person can be awoken but with great difficulties; if the person
is awakened, he or she will typically not remember what happened.
a. It is not true that waking a sleep walker is dangerous.
b. Primarily a problem during childhood although it can occur in adults (small percentage of adults suffer from this).
Children who sleepwalk will usually grow out of it.
c. Occurs during NREM sleep
d. Factors such as extreme fatigue, previous sleep deprivation, use of sedative or hypnotic drugs and stress have been
implicated to cause Sleep walking.
IMPULSE-CONTROL DISORDERS
Inter mittent Explosive Disor der : Serious Acts of assault or destruction of property in which the degree of aggressiveness is grossly
out of proportion to any precipitating psychosocial stressor. Extremely difficult to treat in the absence of meds.
Kleptomania: Stealing of objects not intended for personal use or monetary value but used to alleviate a tension that precipitates the
event. Ex. Winona Ryder
Pyr omania: Purposeful fire setting on more than one occasion to alleviate tension which precipitates the event. Person feels a tension
or arousal before setting a fire and a sense of gratification or relief while the fire burns
Tr ichotillomania :Recurrent pulling out of one’s hair to relieve tension (scalp, eyebrows, eye lashes… etc.) Comorbid with OCD.
PERSONALITY DISORDERS
1. Personality Disorders are Characterized by a stable enduring pattern of bx that deviate from the expectations of the person’s
culture, is pervasive and inflexible, has an onset in adolescence or early adulthood and causes distress or impairment.
2. Personality Disorders: the person with the personality disorder does not feel distress or impairment to themselves but those
around them do.
3. Are included in Axis II (personality disorders and mental retardation)
4. To diagnose under the age of 18, symptoms must be present for at least 12 months EXCEPT for Antisocial Personality
Disorder which cannot be diagnosed until age 18 (but has to have a history of symptoms since age 15)
5. The dimensional versus categorical debate over the nature of personality disorders can also be described as a debate between
DEGREE and KIND.
6. Some personality disorders are diagnosed more frequently in men than in women bc the symptoms are interpreted by
clinicians in different ways depending on the gender of the person with the symptoms.
Par anoid Per sonality Disor der : Suspicion of others, preoccupied with unjustified doubts of others loyalty and trustworthiness.
Generally respond in a hostile, argumentative manner.
Question everything, reveal very little about themselves.
World is unjust and unsafe.
Always blaming others. Tend to be unforgiving.
CBT treatment of choice.
More common in males
Events that have nothing to do with these individuals they interpret them as personal attacks.
Very sensitive to criticism and have an excessive need for autonomy.
Tx: important to establish a meaningful alliance between the client and the therapist.
Schizoid Per sonality Disor der : Indifferent to interpersonal relationships and restricted emotional range.
They are loners-people that enjoy solitary activities (run the projector at the movies)
Low libidos, comfortable not interacting with others. Attracted to solid activity.
Rarely seen in therapy.
Flat, robotic, logical and pragmatic language.
They seem “aloof” “cold” or indifferent to other people.
Might see one through marital tx. (or because of a crisis)
Term Schizoid: people who have a tendency to turn inward and from the outside world.
Homelessness seems more apparent with people with this personality disorder
Consider themselves to be observers rather than participants.
Schizotypical Per sonality Disor der : Interpersonal Deficits, eccentricities in cognition, perception and bx, ideas of reference
(significant events relate to them), odd beliefs, magical thinking (they are telepathic), restricted capacity for close relationships.
Unusual Belief systems.
Typically socially isolated, in addition they behave in ways that would seem unusual to many of us and tend to be suspicious and to
have odd beliefs.
DD with Schizophrenia is that they (SPD) are able to test reality (see the illogic of their ideas) whereas schizophrenics are not.
Illusions is also different; they may feel as if someone else is in a room whereas schizophrenia they might think someone else “is” in
the room.
Co-morbid with Major depressive disorder
Genetic research and an overlap in symptoms suggests a common relationship between schizophrenia and schizotypical personality
disorder.
Antisocial Per sonality Disor der : Tend to have disregard for rights of others, violations of other, must be 18 years of age with a
history of pre-existing symptoms since age 15.
Tend to be irresponsible, impulsive and deceitful.
Don’t have the slightest sense of guilt or remorse.
The most dramatic of individuals a clinician will see.
Substance abuse is common (83%)
Conduct Disorder is a precursor for Antisocial Personality Disorder
Two major theories for causation: Under arousal hypothesis (engage in risk-taking bxs to stimulate cortical system) and the
fearlessness hypothesis.
Tx: can be difficult because they rarely identify themselves as needing help. Parent training is most common treatment strategy for
children with conduct disorder.
Criteria for psychopathy emphasize PERSONALITY and criteria for Antisocial Personality Disorder emphasize BX.
Bor der line Per sonality Disor der : Instability in interpersonal relationships, have a frail self-image, and explosive effect, their bxs are
marked by impulsivity, splitting, intense fear of abandonment, reckless and at times engages in high risk bxs.
Anger disproportionate to the event. Impulsive and addictive qualities. Threaten Suicidality and or self-mutilation bxs such as cutting,
burning, or punching themselves.
They are intense; going from anger to depression in a split second.
Comorbid with Major Depression.
Eating disorders are also common, especially bulimia.
Also diagnosed with substance use disorder. (to self-medicate)
They have an underlying current of addiction.
Lead tumultuous lives
Chronic feeling of emptiness.
One of the most common personality disorders
Bxs in BPD overlap those seen in PTSD.
Tx: Meds such as antidepressants can help with the mood, DBT (dialectic Behavioral therapy)
Histr ionic Per sonality Disor der s: Excessive emotionality and attention-seeking bxs; is seductive and presents a shallow expression
of emotions; often dramatic in nature.
Center of attention at all times and becomes angry when not.
Tend to be vain
They seek reassurance and approval constantly and may become upset or angry with others when they do not attend to them or praise
them.
Tend to be impulsive and have great difficulty delaying gratification.
View situations in global, black and white terms.
They manipulate others through emotional crises, using charm, sex, seductiveness, or complaining.
Causes: research believes that histrionic personality disorder is co-morbid with antisocial personality disorder.
Tx: modify attention-seeking bxs, and helping resolve issues with problematic interpersonal relationships.
Nar cissistic Per sonality Disor der : Individuals are characterized by a demonstration of grandiosity, need for admiration and lack of
empathy for others. (child-like egocentric bxs)
Preoccupation with fantasies of unlimited success, power, brilliance, beauty or ideal love.
Belief that they are special and can only be understood by, or should associate with, other special or high-status people.
Exploits others to achieve ends.
Is often envious of others or feels that others are envious
Arrogant manner
Frequently depressed, when they fail to live up to their expectations.
Causes: failure to model empathy by parents early in the child’s development.
Tx: focuses on their grandiosity, their hypersensitivity to evaluation and their lack of empathy toward others.
Treatment is often initiated for the depression.
Avoidant Per sonality Disor der : Social inhibition, feelings of inadequacy and are hypersensitive to negative evaluations.
They remain shy, inhibited and avoid interpersonal contact fearing negative evaluations, despite their desire for social involvement.
They are asocial because they are interpersonally anxious and fearful of rejection.
Feel chronically rejected by others and are pessimistic about their future.
Tx: behavioral interventions to treat anxiety and social skills problem, systematic desensitization and behavioral rehearsal.
Dependent Per sonality Disor der : A need to be taken care of, submissive and clingy bxs and often display a fear of separation.
Rely on others to make ordinary decisions and important ones.
Behavioral characteristics are submissive, timidity and passivity.
DD with Avoidant Personality Disorder: both have feelings of inadequacy, sensitivity to criticism, and need for reassurance. However
people with Avoidant Personality Disorder respond to these feelings by avoiding relationships whereas Dependent Personality
Disorder respond by clinging to relationships.
Causes: some believe that death or abandonment of parent leads to dependent personality disorder.
Goal of tx: is to gradually make the person more independent and personally responsible
Obsessive-Compulsive Per sonality Disor der : Preoccupation with orderliness, perfectionism, and interpersonal control.
These people are good workers.
Obsessive with “things done the right way”
Poor interpersonal relationships
Rigid and Stubborn.
Tx: Help the individual relax or use distraction techniques to redirect the compulsive thoughts.