Counseling Theor ies and Pr actice

I. Psychoanalytic Ther apy

Psychoanalytic View of Per sonality: Human behavior is shaped by early childhood exper iences and dr iven by power ful
unconscious for ces.

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

Development of Per sonality (Accor ding to Fr eud)

1. The three areas of social and personal development which are love and tr ust, dealing with negative feelings, and
developing a positive acceptance of sexuality are all grounded in the fir st 6 yr s of life.
2. The foundation on which later personality development is built.

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

II. Anal Stage: 2-4 year s old

Erogenous zone: anal sphincter muscle
-Pleasurable activity: going at will (spontaneous release of ________)
-the first half is concerned with expulsion.
-Fixation during the anal expulsion- phase leads to anal expulsive traits
-These individuals are sloppy, disorganized, messy, and financially irresponsible.
-Fixation during the anal retention- phase leads to anal-retentive traits
-Characteristics include stinginess, extremely neat, organized, perfectionists, methodical, rigid with rules, schizoid personality- distant
loners
-The anal stage is about Control (Rules/Boundaries)
-This is the stage where behavioral problems originate; there needs to be a balance (leads to problem behaviors or resistance)
-Anal aggressive trait (or personality): defiance, problems with authority figures; the act of defiance returns control back to the
individual.
Anal: (1-3years), child’s pleasure centers on the anus, anal gratification, and independency.

III. Phallic Stage: 4-6 year s old

-Erogenous zone: the genitals
-Pleasurable Activity: sexual curiosity and exploration
-Oedipus complex: boy falls in love with the mother and resents the father (manhood equals strength here; penis is symbolic for
power)
-Young boy fears that father will castrate him and make him impotent, powerless, ineffective---castration anxiety- powerlessness-
fearful and uneasiness of boy that daddy will find put and become upset.
-castration anxiety leads to identification.
Identification: the unconscious borrowing of traits that we admire in someone into our own personality— children learn appropriate
gender (sex) roles through this i.e. little boys learn to act like boys.
Electra complex- girl falls in love with the father and competes with the mother for daddy’s attention.
Penis Envy- the young girl’s jealousy of the mother for having (being with) the father
-Penis envy ends with identification
~These situations (stages) lead to later intimate relationships.
-This stage in one word is Intimacy.
-People develop healthy attitudes toward satisfying healthy interpersonal relationships.
-Fixation here will lead to difficulty in establishing and maintaining satisfying intimate relationships.
-Fixations: difficulty with trust, self-guardedness, promiscuity, use someone for sexual gratification
-Intimacy issues can be traced to the phallic stage.
Phallic: (3-6years) child’s pleasure centers on the genitals, sexual desire for parent opposite sex

IV. Latency Stage: 6-11 year s old

-Latent- hidden (Oedipal & Electra pushed into the unconscious)
-children are encouraged to engage in rough and tumble play to release the energy from the complexes.
-Social Accommodation- the ability to relate well with peers (children learn to relate to people with different personalities)
-Social Subordination- the ability to relate to/with figures of authority (children recognize legitimate authority figures)
-Intimacy issues can be traced to the phallic stage.
Latency: (6-puberty) child represses sexual interest and develops social and intellectual skills, socialization
V. Genital Stage: 12-adulthood
Erogenous zone: whole body
-genital refers to healthy mature functioning; the prior stages were prerequisites for this stage.
Genital: (puberty-onward) sexual reawakening, source of sexual pleasure comes from outside the family,
Er ikson’s Psychosocial Stages of Development: Psychosocial gr owth and psychosexual gr owth take place together and
at each stage we face the task of establishing equilibr ium between our selves and our social wor ld.

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.

Ear ly Childhood (1-3): Autonomy vs. Shame and Doubt

-Children rapidly develop a wide variety of skills; they learn how to hold on and let go; children “willfully” decide to do something or
not

Pr eschool Age (4-5): Initiative vs. Guilt

-During this stage, children began to explore what type of person they can become; children test limits to determine what is
permissible and not.

School Age (6-11): Industr y vs. Infer ior ity

-Children learn the skills necessary for economic survival and skills that allow them to become productive members of their culture;
children learn social skills.

Adolescence (12-20): Identity vs. Role Confusion

-Transition stage b/w childhood and adulthood children must commit themselves to some strategy in life (an identity)

Young Adulthood (20-24): Intimacy vs. Isolation

-Being able to love and work effectively; young adults seek intimate relationships with others

Adulthood (25-64): Gener ativity vs. Stagnation

-An attempt to pass on the circumstances that caused such a life to the next generation.

Old Age (65-death): Ego Integr ity vs. Despair

-These individuals look back on a rich, constructive, happy life and do not fear life. They have a feeling of completion and fulfillment.

J ung’s per spective on per sonality development

Our present personality is shaped by who and what we have been and what we aspir e to be in the futur e.

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.

Object Relations Theor y:

1. A form of analytic Tr eatment that involves explor ation of inter nal unconscious identifications and inter nalizations of
exter nal objects.
2. Object Relations are interpersonal relationships as they are represented intr apsychically (mentally)
Otto Ker nber g:
Kohut: self-psychology, emphasis on how we use interpersonal relationships to develop our own sense of self
Mitchell: the relational model is based on the assumption that therapy is an interactive process between client and therapist;
countertransference actually provides a rich source of information about client’s character and dynamics..
Contempor ar y Object-Relations Theor y (Mahler )
Mahler studied the interaction between mother and child for the first 3 stages of life.

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

Application of psychoanalytic ther apy

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

Manifest Content of a Dr eam

1. What a dream appear s to be about to the dreamer
2. A level of content of dreams.
Dr eam Wor k:
1. Var ious mechanisms that distor t a dr eam’s latent content into manifest content.
2. Two important types of dream work is condensation and displacement.
Analysis of Resistance:
Patients unwillingness to ponder and r epor t anxiety-pr oducing thoughts dur ing the ther apeutic pr ocess.
Freud believed that resistance was highly informative b/c it suggested what the troublesome topics were for the patient.
Therapists point out and interpret the most obvious resistances to lessen the possibility of client’s rejecting the interpretation and to
increase the chance the client will look at their resistive behavior.
Analysis and Inter pr etation of Resistance is any idea, attitude, action or feeling that fosters the status quo and gets in the way of
change
Analysis of Tr ansfer ence: - It allows clients to achieve here-and-now insight into the influence of the past on their present
functioning; interpretation allows clients to work through old conflicts that keep them fixated and retards their emotional growth.

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]

Bir th Or der and Sibling Rivalr y:

1. One of the topics that Adler studied in order to understand personality.
2. He believed that different birth orders created different situations to which kids must adjust and that adjustment may have an
influence on personality development.
3. Sibling Rivalry influence individuals through out life.
4. He studied the family system because it is the first social world of a person.
Bir th Or der and Sibling Relationships- birth order is one’s position in the family
-Fir st bor n: only child in a unique and enviable privileged position; child is pampered; center of attention (like it as adults; tend to
have a happy, secure existence)
-Second bor n : never experiences position of power of firstborn; does not experience dethronement like firstborn; tend to be
competitive because of standard set by firstborns; oriented to the future; more ambitious and driven.
-Last bor n : no shock of dethronement; usually pampered because he/she is the baby of the family, very spoiled, immature as adults,
and not hard strivers
-Only child: child never loses position of power; remain as center of attention; mature and exhibit adult-like behaviors early; never
learned to share/cooperate; may have difficulties in areas outside the home

Over gener alization : Holding extreme beliefs on a single incident

Minimization: Perceiving a situation in a lesser light

Ther apeutic Goals:

1. Major Goal is to replace a mistaken lifestyle with one containing a healthy level of social interest.
2. Main Aim: to develop the client’s sense of belonging and to assist in the adoption of bxs and processes characterized by
community feeling and social interest.
3. Counseling process focuses on providing info, teaching, guiding and offering motivation to discouraged clients.
4. Learning to correct faulty assumptions and conclusions is central to tx.
Ther apists Function and Role:
 1. A major goal is to make a comprehensive assessment by gathering info on the client’s:
2. Family Constellation: to aid the therapist on the client’s major areas of success and failure and the influences that have made
an impact on the client’s role in the world.
3. Early Recollections: are also used by the therapist as a diagnostic tool which allows us to see a brief pic of how we see
ourselves and others and what we anticipate for our future.
4. After recollections are analyzed and interpreted, one can identify the successes and failures in client’s life.

Ther apist-Client r elationship :

Equals: based on cooperation, mutual trust, respect, confidence and alignment of goals.
Characterized by 2 people working together towards specific agreed upon goals.

Applications of Adler ian Ther apy

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.

Assessment of Per sonality (Per sonality Pr ior ities) SCCP

1. To assess the client’s dynamic, the therapist analyzes the personality priorities (similar to ego defense mechanisms) the client
uses
2. A first line defense used when perceived stress or difficulty.
3. Superiority: use of leadership or any other avenue to make them feel superior.
4. Control: not to be humiliated they will socially distance themselves.
5. Comfort: avoids anything that implies stress or pain.
6. Please: will go to great lengths to win approval. .

III. Existential Ther apy: (GOAL: ENABLE CLIENTS TO ACCEPT FREEDOM & RESPONSIBILITY/CENTRAL
GOAL IS TO INCREASE AWARENESS)

Philosophical Appr oach :

Existential tx can best be described as a philosophical approach that influences a counselor’s therapeutic practice.
Existential psychotherapy is neither independent nor separate school of tx, nor is it a neatly defined model with specific techniques
The belief is that we are authors of our own lives, we are free and responsible for our own choices.

1. It is a philosophical approach that influences the counselor’s practice.

2. Existential ideas and themes that have significant implications for the existentially oriented practitioner:
a. It rejects the deterministic view of human nature.
b. It emphasizes our freedom to choose what to make of our circumstances.
c. It is based on the assumptions that we are free and therefore responsible for our choices.
d. A basic premise is that we are not the victims of circumstances, because largely we ware what we choose to be.
e. A major aim of therapy is to encourage clients to reflect on life, to recognize their range of alternatives, and to decide
on them.
f. The therapist is not there to provide a cure. The client is not sick instead they are sick of life and unable to live a productive
life.
g. Existential therapy is the process of searching for the value and meaning of life.
6 Basic Dimension of the Human Condition

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

Br oadley: Actualizing Tendencies (Self-Actualization):

1. Innate Tendency in all humans to maintain and enhance themselves.
2. The driving force in everyone’s life.
3. A directional process of striving toward realization, fulfillment, autonomy, self-determination, and perfection without moving
away from relationships, interdependence, connection or socialization.
4. B/c of this, the therapist places primary responsibility on the client.

Ther apeutic Goals:

1. Focus is on the person, not on the presenting problem.
2. Aim is not merely to solve problems but to assist clients in their growth process, so that they can better cope with problems
they are now facing and future problems.
3. Aims towards a greater degree of independence and integration of the individual.
4. Encourage these characteristics: openness to experience, a trust in themselves, internal source of evaluation, a willingness to
continue growing.
5. Encouraging these characteristics is the basic goal.
Ther apists Function and Role:
1. Therapists use themselves as an instrument of change.
2. Therapists attitude is more important to create change within the client than techniques.
3. Generally don’t take history, ask leading questions, do not evaluate and don’t decide the frequency or length of tx.
4. Therapists must be congruent and empathetic and accepting
5. Need to stay in HERE and NOW
6. Function is to be present and accessible to clients and to focus on their immediate experience.
Ther apist-Client Relationship
1. The relationship exhibited between the therapist and client is very important. Therapists are responsible for creating
environments where clients are free to grow and change. Exploration results from the helping relationship between therapist
and client. Both parties are equal; the client does not have to succumb to a superior therapist. Clients are able to drop
pretenses and become more real.
2. The necessary and sufficient conditions for therapeutic personality change is on the quality of the relationship
3. Equal relationship between Therapist and Client.
Per son-Center ed Applications:

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.

Client’s Self-Assessment : Best source of knowledge is through the clients themselves

Make sure that tx is collaborative process involving the client (if client prefers assessments, then the therapist will follow their lead)

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.

Fr itz Per ls:

Unfinished Business: When figures emerge from the background but are not completed and resolved, individuals are left with
unfinished business, which can be manifested into resentment, rage, hatred, pain, anxiety, grief, guilt and abandonment.
Bc feelings are not experienced in awareness they linger in the background and are carried into present interfering with effective
contact with oneself and others.
Unfinished business: Issues, which are incomplete or unresolved. These issues are often manifested in emotions such as resentment,
rage, hatred, pain, anxiety, guilt, grief, and abandonment. Since these feelings are not completely expressed in consciousness, they can
impede contact between individuals harboring them. Unless these feelings are dealt with, they continue to persist. Roger also believed
that unfinished business could be manifested through the physical body.
Ex: A middle-aged woman whose mother was brutally murdered by her lover has trouble sustaining intimate relationships with men.
No man is ever good enough for her because she is too afraid to allow the relationship to get too serious.

Dr eam Wor k : (Reliving)

1. This approach to dream work is the intent to bring dreams back to life and relive them as they are happening now.
2. Dreams serve as an excellent way to discover personality voids by revealing missing parts and client’s methods of avoidance.
Bodily Exper ience/Blockages
1. In this theory, attn is given to where energy is located, how it is used and how it can be blocked.
2. Blocked energy is another form of resistance
3. Can be manifested by tension in body, posture, by looking away when talking, by not breathing deeply, etc.
Five Major Channels of Resistance in Gestalt Ther apy
1. Intr ojection : Tendency to uncritically accept others beliefs without assimilating them as your own.
Naively acknowledge beliefs of others without adapting them to match who we really are. It seems that we accept whatever beliefs
other people have of us with no criticism. These beliefs remain foreign to us because we never truly understand them. With no
interest, people accept what the environment gives and never really figure out what they would like or need.
Ex: A teenage boy goes along with the opinions of his dominant father. Since the father is a doctor, he believes his son should follow
along in his footsteps. The boy has a passion for music, would rather become a musician but he goes on to medical school, and
becomes a cardiologist
2. Pr ojection: Reverse of Introjection; attributes of our personality that are inconsistent with our self-image are discarded and
put into other people.
The opposite of Introjection. People take those aspects from themselves that they do not like and assign them to the environment,
more specifically to other people. By doing this, people are prevented from taking responsibility for their own feelings. They also
avoid facing who they really are.
Ex: A very opinionated politician always makes a point in asserting that he is neither homophobic nor racist. He is very critical of his
opponents for not doing more to reach out to these minority populations and accuses them of being homophobic and racist.
3. Retr oflection: Doing to oneself what we want like someone else do to us.
People reverse the actions that they would like to do to other people on themselves or they revert to themselves what they would like
people to do them. People cannot become engaged with their environment while using retroflection.
Ex: A young child who is severely disciplined engages in self-injurious behavior from fear of lashing out at the domineering parent
4. Deflection: process of distraction so that it is difficult to maintain a sustained sense of contact (ex. overuse of humor)
Distraction makes it more difficult to maintain contact. Contact is diffused with questions instead of statements, generalizations, and
excessive humor. As a result of deflection, people do not have fulfilling emotional experiences. These individuals are the voices for
other people.
Ex: A person who uses humor excessively instead of trying to address serious issues. Everything becomes a joke in order to avoid
facing what is serious and hard to deal with.
5. Confluence: an absence of conflicts, or a belief that all parties experience the same feelings or thoughts (ex. those with a
high need to be liked)
Unclear distinction between an individual and the environment. With relationships, conflicts are nonexistent and everyone is believed
to maintain similar
Thoughts and feelings. People do not make their own emotions or beliefs known and instead carry on with the beliefs of other people.
Ex: Several workgroups are created to complete proposals for an upcoming project. Every group is assigned two team leaders. All
group members go along with the team leaders and never make objections even when they disagree with the ideas.

Ther apeutic Goals:

1. Attaining awareness and with it greater choice
2. Awareness includes knowing the environment, oneself, accepting oneself, and being able to make contact. Awareness
emerges from genuine contact between client and therapist.
3. Client will move toward awareness, gradually assume ownership for their experience, develop skills and acquire values,
become more aware of all their senses, accept responsibility, move from outside support to internal support, be able to ask for
and get help from others.

Ther apist’s Role and Function:

1. Direct and confrontational (using interventions, experiments)
2. Assist clients in developing their own awareness and experiencing how they are in the present moment
3. Encourage clients to adopt an experimental attitude toward life where they can try out new bx and notice what happens.
4. Must establish an environment conducive to change.
5. Pay attn to client’s body language; place emphasis on relationship between language patterns and personality
6. Listen to client’s metaphors
7. Storytelling can be the heart of the therapeutic process
8. Therapist pay attn to non-verbal bx.
Ther apist and Client r elationship
1. I/Thou Relationship
2. Therapist emphasis on client’s sensory perceptions:
3. Therapists pay attention to client’s non-verbal bx
4. Therapist’s Style: Direct and Confrontational:
5. Therapists use direct and confrontational tech. using interventions and experiments.
Applications:
Exer cises vs. Exper iments:
1. Experiments: An essential component of this theory that is also a foundation for practical learning. Experiments result out of
the exchanges between therapists and clients. It is an opportunity for behavioral expressions for clients. They are unique and
unplanned.
2. Ex: A troubled student engages in role-playing with her therapist on confronting one of her professors. The student plays
herself while the therapist pretends to be her professor.
3. Exercises are ready made techniques that are sometimes used to make something happen in a tx session or to achieve a goal.
4. Experiments grow out of interaction between the client and therapist
5. Aimed at facilitating a client’s ability to work through the stuck points of his or her life (unfinished business)
Imposing, Competing and Confr onting 3 ther apeutic styles
Imposing: Therapist holds control and power
Competing: give and take between client and therapist
Confr ontation: therapist is interested in the whole being of the client. Done in an inviting way in which clients can examine their bxs,
attitudes, and thoughts.

Inter nal Dialogue (top dog vs. under dog)

1. Therapists pay close attn to splits in personality.
2. Top dog is righteous, authoritarian, moralistic, demanding, bossy and manipulative.
3. The “critical parent” with the “Shoulds” and “Oughts”
4. Underdog manipulates by playing role of victim, defensive, apologetic, helpless, and weak; the one that is irresponsible and
 finds excuses.
5. They are both always in constant struggle for control and are rooted in the mechanism of introjection.
6. Internal Dialogue helps explain why resolutions and promises go unfulfilled and why one’s procrastination

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.

Rever sal Exer cise

Ask clients to act the reverse than the way they are
By doing this, they can take the plunge into the very thing that is fraught with anxiety and make contact with those part of themselves
that have been submerged and denied.

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)

VI. Behavior Ther apy: CLASSICAL CONDITIONING, OPERANT CONDITIONING

B.F. Skinner :: Adhered to an approach called Radical Behaviorism. He denied both the concept of personality and the use of
theories as research tools.

Classical Conditioning: Learning that creates a response through pairing

Ex. Dog Salivation when Bell Rang
Type of conditioning studied by Ivan Pavlov and used by Watson as a model for his version of behaviorism

Oper ant Conditioning: BF Skinner)

1. A type of learning in which bxs are influenced mainly by the consequences that follow them. .
2. If reward is present (a reinforcement), bx occurring again is higher
3. If no reward or stimuli is present, bx occurring again is lowered.
4. For skinner, actions that are reinforced tend to be repeated and those that are not tend to be extinguished.

J oseph Wolpe: Systematic Desensitization:A form of exposure therapy:

1. Attempts to reduce client anxiety through relaxation techniques and progressive exposure to feared stimuli
2. Often combined with modeling: process of learning bx by imitating others, especially authority figures.
3. In some cases, people are asked to only imagine feared stimuli (imaginal exposure) or invivo exposure which you actually
experience the stimuli feared.

Action-Or iented Appr oach :

1. Rather than simply talking about problems. Clients are required to do something to bring about change.
2. Clients monitor their bxs both during and after tx, learn and practice coping skills and role play new bx.
3. Clients carry out tasks in daily life or hw assignments, are a basic part of this approach.
Emphasizes teaching Self-Management : Emphasizes teaching clients the skills they need to live their lives effectively.

Ther apy Goals:

1. Goals are clear, concrete, quantifiable and mutually developed; therefore they must be written and numbered.
2. General goal is to increase personal choice and to create new conditions for learning.
3. Determining goals entails a negotiation between client and therapist that results in a contract that guides the course of tx.
Ther apist’s Role and Function :
1. Therapists are Active and function as consultants and problem solvers
2. Use techniques such as summarizing, reflection, clarification and open-ended questioning.
3. Role modeling for the client.
Ther apist-Client Relationship
1. Collaborative Relationship
2. But progress is made bc of specific behavioral techniques rather than the actual relationship.
Applications:
Positive/Negative Reinfor cement and Punishment
Goal of Punishment is to decrease bx
+ Reinforcement: Adding a FAVORABLE stimuli to increase bx (token economy, watch more tv)
– Reinforcement: Removing an AVERSIVE stimuli to increase bx (taking away chores for good bx)
+ Punishment: Adding an AVERSIVE stimuli to decrease bx (adding a chore as punishment)
Punishment: Removing a FAVORABLE stimuli to decrease bx (taking away phone for bad bx)

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.

VII.Cognitive Behavior al Ther apy

Alber t Ellis: REBT
1. People contribute to their own psychological problems as well as to specific symptoms by the way they interpret events and
situations
2. Assumption is that cog, emotions, and bxs interact significantly and have a reciprocal cause and effect relationship
3. Emphasizes the role of social interest in determining psychological health.

ABC Theor y of Per sonality

A: event, fact, or the bx or attitude of a person
B: Belief about A
C: Emotional and bx consequences
A does NOT cause C; instead B causes C
Therefore, we are responsible for creating our own emotional reactions and disturbances.

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.

Ther apeutic Goals:

1. Teach clients how to separate evaluation of their bxs from the evaluation of ourselves-their essence and totality-and how to
accept themselves in spite of imperfections
2. REBT: teach clients how to change their dysfunctional emotions and bxs into healthy ones.
Ther apists Function and Role:
1. Show clients that they have incorporated irrational beliefs. Clients learn to change rigid “musts” into preferences
2. Demonstrate to client that they are keeping their emotional disturbances active by continuing to think illogically and
unrealistically
3. Help modify their thinking and abandon their irrational beliefs
4. Therapist must dispute core of irrational belief.
Ther apist-Client Relationship :
 1. Tx is an educational process
2. Therapist is the teacher and the client is the student
Application
Addr essing Ir r ational Thoughts
1. Ar bitr ar y Infer ences: thinking worst case scenarios
2. Selective Abstr action : forming conclusions on one event
3. Over gener alization : extreme beliefs on the basis of a single event
4. Magnification : perceiving a situation in a greater or lesser (minimization) degree than what it really is.
5. Per sonalization: relating external events to themselves
6. Labeling and Mislabeling: portraying one’s identity on the basis of imperfections and mistakes made in past.
7. Polar ized Thinking: Thinking or categorizing experiences in either or extremes or all or nothing terms.

VIII. Reality Ther apy:

William Glasser : Choice Theor y:
1. Underlying problem in most clients is the same they are either involved in a present unsatisfying relationship or lack
relationships.
2. We are not born blank states waiting to be externally motivated by the environment. Rather we are born with 5 needs:
survival, love and belonging, power of achievement, freedom or independence and fun.
3. The only person whose behavior we can control is our own.
4. All we can give another person is information.
5. All long-lasting psychological problems are relationship problems.
6. The problem relationship is always part of our present life.
7. What happened in the past has everything to do with what we are today, but we can only satisfy our basic needs right now
and plan to continue satisfying them in the future.
8. We can only satisfy our needs by satisfying the pictures in our Quality World.
9. All we do is behave.
10. All behavior is Total Behavior and is made up of four components: acting, thinking, feeling and physiology.
11. All Total Behavior is chosen, but we only have direct control over the acting and thinking components. We can only control
our feeling and physiology indirectly through how we choose to act and think.
12. All Total Behavior is designated by verbs and named by the part that is the most recognizable.

These basic needs ar e:

1. the need to survive,
2. the need to belong,
3. the need to gain power,
4. the need to be free
5. the need to have fun
The ways in which we fulfill psychological needs can be summar ized as follows:

    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.

Char acter istics of Reality Ther apy:

1. Therapy focuses quickly on the unsatisfying relationship or lack of, which is often cause of clients’ problems.
2. Therapists don’t listen very long to complaining, blaming, and criticizing.
3. Each person is responsible for what they do.
4. Keep therapy in present; avoids focusing on symptoms; rejects the traditional views of mental illness.
Avoids focusing on symptoms: Focusing on client’s symptoms protects the client from facing reality that their suffering is due to
their choice.

Ther apeutic Goals:

1. Primary goal is to help clients get connected or reconnected with the people they have chosen to put in their quality world.
2. Help them learn better ways of fulfilling their needs (5)
Ther apist’s Function and Role
1. Therapist functions as an advocate
2. Creates a good relationship with client
3. Teach client to engage in self-evaluation
4. Instills in client that no matter how bad things are, there is hope.
Ther apist/Client r elationship: Teacher/Student relationship. Mentoring Process

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.

Systems Theor ies and Methods

Er ic Ber ne: Tr ansactional Analysis He said that verbal communication, particularly face to face, is at the centre of human social
relationships and psychoanalysis. when two people encounter each other, one of them will speak to the other. This he called the
Transaction Stimulus. The reaction from the other person he called the Transaction Response. The person sending the Stimulus is
called the Agent. The person who responds is called the Respondent.
Transactional Analysis became the method of examining the transaction wherein: 'I do something to you, and you do something back'.
Ber ne also said that each per son is made up of thr ee alter ego states:
1. Par ent: This is our ingrained voice of authority, absorbed conditioning, learning and attitudes from when we were young.
We were conditioned by our real parents, teachers, older people, next door neighbours, aunts and uncles, Father Christmas
and Jack Frost. Our Parent is made up of a huge number of hidden and overt recorded playbacks. Typically embodied by
phrases and attitudes starting with 'how to', 'under no circumstances', 'always' and 'never forget', 'don't lie, cheat, steal', etc,
etc. Our parent is formed by external events and influences upon us as we grow through early childhood. We can change it,
but this is easier said than done.
2. Adult: Our 'Adult' is our ability to think and determine action for ourselves, based on received data. The adult in us begins to
form at around ten months old, and is the means by which we keep our Parent and Child under control. If we are to change
our Parent or Child we must do so through our adult.
3. Child: Our internal reaction and feelings to external events form the 'Child'. This is the seeing, hearing, feeling, and
emotional body of data within each of us. When anger or despair dominates reason, the Child is in control. Like our Parent
we can change it, but it is no easier.
Par ent is our 'Taught' concept of life
Adult is our 'Thought' concept of life
Child is our 'Felt' concept of life

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.

Bar r ier s to Effective Cr oss-Cultur al Counseling:

1. Cultur e-bound values: individual centered, verbal/emotional/behavioral expressiveness, communication patterns from client
to counselor, openness and intimacy, analytic/linear/verbal(cause-effect) approach, clear distinctions between mental and
physical well-being
2. class bound values: strict time schedule, ambiguous or unstructured approach to problems, seeking long-range goals or
solutions
3. language var iables: use of standard English and emphasis on verbal communication
Implications for clinical pr actice:
1. distinguish between behaviors indicative of a true mental disorder and those result from oppression and survival
2. do not personalized the suspicions of a client, if u become defensive, insulted or angry, it will be reduction of effectiveness
3. monitor own reactions and question your beliefs. Be willing to understand and overcome your steriotypes, biases, and
assumptions about other cultural groups
4. be aware that other marginalized group may consider your credentials insufficient
5. be ready to refer a client, be aware of limitations.
Cr oss-Cultur al Communication/Counseling Styles:
Nonver bal communication
1. Pr oxemics: perception and use of personal and interpersonal space
2. Kinesics: bodily movements
3. Par alanguage: vocal cues that individuals use to communicate (loudness, pauses, silences, hesitations, rate,)
4. High-low context communication : HC: less words to communicate, faster more economical/ LC: changes rapidly and easy.
US is a LC culture, African Am are HC.
The way people communicate varies widely between, and even within, cultures. One aspect of communication style is language usage.
Across cultures, some words and phrases are used in different ways. For example, even in countries that share the English language,
the meaning of "yes" varies from "maybe, I'll consider it" to "definitely so," with many shades in between.
Another major aspect of communication style is the degree of importance given to non-verbal communication. Non-verbal
communication includes not only facial expressions and gestures; it also involves seating arrangements, personal distance, and sense
of time. In addition, different norms regarding the appropriate degree of assertiveness in communicating can add to cultural
misunderstandings. For instance, some white Americans typically consider raised voices to be a sign that a fight has begun, while
some black, Jewish and Italian Americans often feel that an increase in volume is a sign of an exciting conversation among friends.
Thus, some white Americans may react with greater alarm to a loud discussion than would members of some American ethnic or non-
white racial groups

Amer ican Indians

1. speak softly/ slower
2. indirect gaze when listening or speaking
3. interject less, seldom offer encouraging communication
4. delayed authority (silence)
5. manner of expression: low-keyed, indirect
Asian Amer icans and Hispanics
1. speak softly
2. avoidance eye contact when listening or speaking to high-status persons
3. similar rules
4. mild delay
5. low-keyed, indirect
Whites
1. speak loud/fast to control listening
 2. greater eye contact when listening
3. heads nods, nonverbal markers
4. quick responding
5. objective, task oriented
Blacks
1. speak with affect
2. direct eye contact, prolonged when speaking, but less when listening
3. interrupts turn taking when can
4. affective, emotional, interpersonal

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.

Identity Development Models:

Racial/Cultur al Identity Development Model: 5 stages that people experience as they attempt to understand themselves in terms of
their own culture, the dominant culture, and the oppressive relationship between the two cultures: (CDRIS)
Stage 1: Conformity
Stage 2: Dissonance
Stage 3: Resistance and Immersion
Stage 4: Introspection
Stage 5: Synergetic Articulation and Awareness

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.

The cultur ally skilled counselor :

1) Scientific mindfulness: Counselor formulates hypothesis about the symptoms of a culturally different client rather than quickly
diagnosing.
2) Dynamic Sizing or the ability to generalize and when to adapt an individualized approach. Dynamic Sizing ensures that the
counselor avoids stereotyping while, at the same time, recognizes the potential impact of cultural factors.
3) Cultur e Specific Exper tise: the counselor is aware of their own cultural values and biases and has specific knowledge about the
culture of their clients and about culturally appropriate interventions.

Counseling Differ ent Ethnic Gr oups:

1. Culturally diverse groups do just as well as Anglo clients however, as a group, African Americans have less favorable
outcome than the rest.
2. Ethnic matching of therapist with client increased the number of tx sessions and have clear benefits for treatment outcome for
Asian Americans only.
3. African Americans and American Indians OVERUTILIZE mental health service, while Asian Americans and Hispanics
UNDERUTILIZE them.
4. Members of ethnic and cultural minority groups are more likely than Anglo clients to terminate therapy PREMATURELY.
5. Premature termination of African American clients of white therapists is due to cultural mistrust, lack of confidence in the
therapist’s credibility.

Afr ican Amer icans:

1. Largest ethnic Minority Group in the U.S.
2. Prefer a humanitarian perspective, which are more people than thing oriented.
3. There is usually an extended family
4. Roles tend to be flexible in families and relationships b/c men and women tend to be more egalitarian.
5. Church is an important part of the family and should be integrated into the process of tx.
Tr eatment of choice: Family tx, especially extended family systems therapy
Gener al Guidelines when wor king with Afr ican Amer icans:
1. Use more directive techniques and focus more concrete solutions to problems than on providing complex explanations about
the problem.
2. Be willing to adopt an ecostructural Perspective that considers and addresses the social, political and socioeconomic
influences on bx.
3. Adopt an egalitarian perspective
4. African Americans are more likely to seek mental health services for administration matters (school, legal problems) for
medication and to obtain answers about questions about community resources.

Amer ican Indians

1. Are more likely to exhibit a spiritual and holistic orientation to life that emphasizes harmony with nature and that regards
illness as the result of disharmony.
2. Place greater emphasis on the extended family and the tribe than on the individual.
3. Perceives time in terms of personal and seasonal rhythms rather than in terms of the clock or calendar and be more present
than future oriented.
4. Exhibit a strong sense of cooperation and generosity
5. Consider listening more important than talking
Tr eatment of Choice: Network Therapy: incorporates the family and community into the treatment plan.
Guidelines for wor king with Amer ican Indians:
1. Adopt a collaborative, problem solving approach that avoids high directive techniques.
2. Eye contact is considered a sign of disrespect.
3. Model self-disclosure and indicate desire for reciprocity without pushing the client to self-disclose.
4. Consider incorporating elders, medicine people and other traditional healers into the treatment process.
Asians
1. Research on Asian refugees and immigrants has produced: Social displacement theor y, which proposes that these
individuals experience a period of elation and optimism upon arriving to the U.S. but this period is likely to be followed by
frustration, depression and confusion.
2. An important source of stress among members of this group are: Intergenerational Conflicts resulting from different degrees
of acculturation by family members.
3. Research also suggests that up to 50% of southeast Asian refugees may be suffering from PTSD.
4. Somatic Symptoms are often the direct result of adjustment to stress and change and may be indicative of a serious chronic
illness. (Express stress through somatic symptoms such as back pain, headaches… etc.)
Tr eatment Appr oach for Asians: A directive, structured, problem-solving approach that focuses on alleviating specific
symptoms is usually preferred. (they believe they perceive the therapist as a knowledgeable expert and authority figure)
Gener al Guidelines for wor king with Asian clients:
1. Emphasize formalism in tx (ex. address family members in a way that reflects their status, respect conversational distances)
2. Be aware of the role of Shame and obligation in Asian Cultures.
Hispanics: Casas and Vazquez (1989) note that Hispanics:
1. Emphasize family welfare over individual welfare
2. Consider discussing intimate personal details with strangers (ex. A therapist as highly unacceptable, and believe that
problems should be handled within the family or other natural support systems)
3. Therapist should be Active and Directive and to adopt a multimodal approach that focuses on the client’s bx, affect,
cognitions, interpersonal relationships, biological functioning, etc.
Tr eatment of choice for Hispanics: Family therapy b/c it reinforces their view of familismo and the extended family.
Elements from Hispanic Culture: “Language switching” is okay during treatment with Hispanic clients.
Involves two approaches: Isomorphic reinforcement of cultural traits: refers to using a traditional technique in its original form,
while departures from Isomorphism involve adapting the technique to better match therapeutic goals (ex. cuento (folktale)
therapy: based on the principles of social learning theory and makes use of traditional Puerto Rican folktales.
Gener al Guidelines when wor king with Hispanic Clients:
1. Emphasize “Personalismo” (except during initial contacts when “formalismo” is preferred)
2. Be familiar with Folk cures that are not recognized by the Westerm medical community.
3. Be aware that Hispanic families are patriarchal (males) and that sex roles tend to be relatively inflexible. Avoid making
suggestions that compete with the belief in “machismo” and “marianismo” (female) (standards for masculine and feminine
bx).
Ethics and Pr ofessional Conduct
Unethical vs. Unpr ofessional Behavior :
Professionalism has some relationship to ethical bx, yet it is possible to act unprofessionally and still not act unethically.
Ex. not returning a client’s call promptly might be viewed as unprofessional but it would probably not be considered unethical (unless
it was an emergency).
**Sexual intimacy between clients and counselor is considered unethical, unprofessional, immoral and illegal.

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

Tr ansfer ence and Counter tr ansfer ence

Tr ansfer ence: Defined as the unconscious process whereby clients project onto the therapist, past feelings or attitudes that they had
toward significant people in their lives.
Counter tr ansfer ence: Any projection by a therapist that can potentially get in the way of helping a client
Can either be constructive or destructive element in the therapeutic relationship

Clar ifying your values and Their Role in Your Wor k

1. When to r efer a client : There are areas in which the therapist’s values and those of his or her client clash to such extent that
the therapist questions his or her ability to function in a healthy way.
2. Values per taining to Sexuality: It is vital to ask yourself if you can counsel people who are experiencing conflict over their
sexual choices if their values differ dramatically from yours.

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.

Legal Aspects of Infor med Consent

1. Capacity (client has ability to make rational decisions)
2. Compr ehension of Infor mation (therapist must give info. to client in a clear way and check to see if they understand it)
3. Voluntar iness (the client is acting on their free-will and is competent to give consent)
The more the client knows about how therapy works, including the roles of both client and therapist, the more clients will benefit from
the therapeutic experience.
Informed consent is also a means of empowering the client.

The content of Infor med Consent

1. The Therapeutic Process
2. Background of the therapist
3. Costs involved in therapy
4. The length of therapy and termination
5. Consultations with Collegues
6. Interruptions in Therapy
7. Benefit and Risks of Therapy
8. Alternatives to Traditional Therapy
9. Tape-recording or videotaping Sessions
10. Clients’ Right to Access to their Files
11. Rights pertaining to Diagnostic Classifying
12. The nature and Purpose of Confidentiality
Infor med Consent and Wor king with Childr en and Adolescents
The right to treatment
The general rule is that parents are entitled to general information from the counselor about the child’s progress in counseling.
Informed consent of parents or guardians may not be legally required when a minor is seeking counseling for:
1. Dangerous drugs or narcotics
2. Sexually transmitted Diseases
3. Pregnancy and Birth Control
4. Examination following alleged sexual assault of a minor over 12 years of age
School counselor s: it is not necessary to obtain parental consent unless a state statue requires this.

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.

Malpr actice Liability in Counseling

Malpr actice: the failure to render professional services or to exercise the degree of skill that is ordinarily expected of other
professionals in a similar situation. Malpractice is a legal concept involving negligence that results in injury or loss to the client.

In the case of suicide, 2 factors determine a practitioners liability

For eseeability: assessing the level of risk
Reasonable Car e: once an assessment of risk is made, it is important to document that appropriate precautions were taken to prevent
a client’s suicide.

pr ecautions against a malpr actice suit

1. personal and professional honesty and openness with clients.
2. Providing quality professional services to clients is the best preventative step you can take.
3. Know the ethical and legal standards and follow them to prevent legal actions.
Risk management: the practice of focusing on the identification, evaluation and treatment of problems that may injure clients, lead to
filling an ethics complaint, or lead to a malpractice action.
Based on the assumption that practitioners can control their exposure to lawsuits and licensing complaints by monitoring their bx.

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.

Exemptions to Pr ivileged communication

1. To conduct a psychological examination appointed by the court
2. To make an assessment of foreseeable risk of suicide
3. When the client files for malpractice
4. Any civil action that client claims mental condition as a claim or defense
5. When client is under the age of 16 and the therapist believes the child is a victim of child abuse.
6. When the therapist determines that the client is in need of hospitalization for a mental or psychological disorder
7. When criminal action is involved.
8. When info is made a court issue in a court action
9. When clients reveal information to commit a crime or when they have been assessed as dangerous to society.
Clients may waive their privilege if they choose to. If clients sign a form waving their privilege then, therapist will have to disclose
private info that otherwise might have been protected in court proceedings.

The Duty To War n and to Pr otect

The duty to Protect and to Warn (potential victims)
Identify those clients who are likely to do physical harm to 3rd parties
Protecting 3rd parties from those clients judged potentially dangerous
Treating those clients who are dangerous
Most states permit to breach confidentiality to warn or protect victims.

The Tar asoff Case: Duty to Warn

Therapists have legal and ethical responsibilities to the clients, and they also have legal obligations to society.

Counselors must also:

Take reasonable precautions in record keeping and collegial consultations that will most dramatically reduce the chances of successful
malpractice suits

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

Ethical and legal consider ations in AIDS r elated Cases

Disclosure must be justifiable before breaching confidentiality to inform 3rd parties.

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

Rational Suicide/ End of life issues

Suicide: A free and Rational Choice?
Rational Suicide: a person has decided-after going through a decision making process and without coercion from others-to end his or
her life because of extreme suffering with a terminal illness.
Cr iter ia for r ational suicide:
1. Person considering suicide has an unremitting and hopeless condition
2. Person is acting under his or her own free will
3. Person has engaged in a sound decision making process.
For those counselors whose belief systems do not condone rational suicide or physical assisted suicide, the ethical course for them to
follow is to refer the client to another professional qualified to assist the client.

Dual and Multiple Relationships

1. Bar ter ing for ser vices: Exploitative implications when entering a bartering relationship with a client/patient. One should refrain in
FL. from entering a bartering relationship. Bartering is exchanging services in lieu of paying a fee

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

Ethical Issues in Tr aining Ther apists

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.

Evaluating Knowledge, Skills and Per sonal Functioning

Program’s Obligations:
1. Attend to the possibility that their trainees personal problems might lead to harm of others.
2. Make sure that trainees are not harming clients or others under their care.
3. Attend to the possibility that trainees may misuse their influence.
4. Evaluate whether trainees are performing services responsibly, competently and ethically
5. Articulate a clear set of professional standards
 6. Evaluate trainees based on these relevant and established requirements.
Ethical Issues in Clinical Super vision
1. Supervision is an integral part of training helping professionals and is one of the ways in which trainees acquire the
competence needed to fulfill their professional responsibilities.
2. Supervision is perhaps the most important component in the development of a competent practitioner.
3. Supervision is a well defined area that is rapidly becoming a specialized field in the helping professions.
4. Supervision is not psychotherapy: Your supervisor can recommend or refer to enter therapy BUT can’t provide therapy; no
dual relationships.
5. Supervisor can’t be a friend, family, therapist; no dual relationships.
6. Should supervisee be in therapy, supervisor can’t ask what’s going on in therapy.
Goals of Super vision
1. To enhance the skills and knowledge of the supervisee
2. To ensure the welfare of the supervisee’s clients
3. To serve as a gate keeping function for the profession.
4. To empower the supervisee to self-supervise and carry these goals as an independent professional.
Cr itical Issues in Clinical Super vision
1. (Supervisors) Balancing the rights of clients, the rights and responsibilities of supervisees, and the responsibilities of
supervisors to both supervisees AND their clients.
2. Many of the ethical standards pertaining to the client-therapist relationship also apply to the supervisor supervisee
relationship. (Informed consent in supervision)
3. Supervisors are ultimately responsible both ethically and legally for the actions of their trainees.
4. Clinical Supervisors have a position of influence with their supervisees; they operate in multiple roles as teacher, mentor,
consultant, counselor, sounding board, adviser, administrator, evaluator, recorder, and empowerer.

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.

Ethical Pr actices of clinical super visor s

1. Performance evaluation and monitoring supervisee’s activities.
2. Confidentiality in Supervision (Supervisors cant tell the world you were their supervisee; breach of confidentiality)
3. Ability to work with alternative perspectives
4. Session boundaries and respectful treatment
5. Orientation to professional roles
6. Expertise/competency issues
7. Disclosure to clients
8. Modeling ethical bx and responding to ethical concerns
9. Crisis coverage and intervention
10. Multicultural sensitivity toward clients and supervisees
11. Dual Roles
12. Termination and follow up issues
13. Differentiating supervision from psychotherapy
14. Sexual Issues
Legal Aspects of Super vision
1. Infor med consent : clients need to be fully aware that they are seeing a trainee
2. Confidentiality and its limits: Supervisee cant talk about their client outside of the context of supervision. Clients and
supervisees need to be informed about the limits of confidentiality, including those situations in which supervisors have a
duty to warn or to protect.
3. Liability: supervisors bear the legal right of the supervisee and can be sued for malpractice.
Ethical Issues in Minor ity Counseling and Assessment

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.

Counseling in Managed Car e Envir onment

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.

Managed Car e and Malpr actice

Ethically, therapists must not abandon their clients, and they have the responsibility to render competent services.
Legally, it appears that practitioners employed by a managed care unit are not exempt from malpractice suits if they claim they didn’t
receive the standard of care they required.
Therapists can’t use the limitations of managed care plan as a shield for falling to render crisis intervention, to make appropriate
referrals, or to request additional services from the plan.

Assessment and Diagnosis as Ethical and Pr ofessional Issues

Assessment consists of evaluating the relevant factors in a client’s life to identify themes for further exploration in the counseling
process.
Diagnosis, which is sometimes part of the assessment process, consists of identifying a specific mental disorder based on a pattern of
symptoms that leads to a specific diagnosis found in the DSM manual.
Psychodiagnosis is a general term covering the process of identifying an emotional or behavioral problem and making a statement
about the current status of a client.
Differ ential Diagnosis is the process of distinguishing one form of mental disorder from another by determining which of two (or
more) disorders with similar symptoms the person is suffering from.

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.

Author s position on Assessment and Psychodiagnosis

1. They prefer a “co-diagnosis” which is the result from a collaborative effort between the therapist and the client
2. Diagnosis becomes a process of thinking “about” the client “with” the client.
3. When working with a managed care system, using the DSM IV is a reality that most practitioners must accept.
Ethical and Legal Issues in Diagnosis
1. Some insurance carriers will not pay for treatment that is not defined as an “illness” for which treatment is medically
necessary. Some therapists may just put a diagnosis on a ins. Claim to be reimbursed making this practice unethical and
maybe illegal.
2. With some managed care systems, a therapist may call the company with a diagnosis. A tech then looks up “Appropriate”
treatment strategies to deal with the identified problem. This raises significant ethical issues as important treatment decisions
may be made by a nonprofessional who has never seen the client.
3. Competence is another central ethical issue in making assessments. Students need to learn the clinical skills necessary to do
screening and referral, which is a form of diagnostic thinking.
4. Practitioners can harm clients if they treat them in restrictive ways because they have diagnosed them on the basis of a pattern
of symptoms. Therapists can actually behave toward clients in ways that make it difficult for clients to change.

Ethical Standar ds in Couples and Family Ther apy

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”.

Values in Couples and Family Ther apy

1. There are several ways that family therapists make undue use of their influence because of their particular biases, values or
attitudes.
2. Need to try to establish a balance relationship with each person in the relationship (Couple)
3. We don’t tell them what to do; just give options.
4. Family therapists shouldn’t decide how members of a family should change
5. The role of the family therapist is to help family members see more clearly what they are doing, to help them make an honest
evaluation of how well their present patterns are working for them, and to help and encourage them to make necessary
changes.

Confidentiality in Couples and Family Ther apy: Confidentiality is maintained unless:

1. when mandated by law, such as in cases of physical or psychological child abuse, incest, child neglect, or abuse of the
elderly,
2. when it is necessary to protect clients from harming themselves or to prevent a clear and immediate danger to others
3. when the family therapist is a defendant in a civil, criminal or disciplinary action arising from therapy
4. when a waiver has previously been obtained in writing.
Infor med Consent in Couples and Family Ther apy
1. Before each individual agrees to participate in family therapy, it is essential that the counselor provide:
2. info about the purpose of therapy,
3. typical procedures,
4. possible risks and benefits, fees,
5. limits of confidentiality,
6. rights and responsibilities of clients and therapists,
7. the option that any family member may withdraw at any time,
8. and what can be expected from the therapist
Ethical and Confidentiality Issues in Gr oup

Ethical Issues in Group Membership

Scr eening and Selection of Gr oup Member s: Group leaders are faced with the difficult task of determining who should be included
in a group and who should not. Thus, some type of screening, which involves interviewing and evaluating potential members, is often
employed to select suitable members.
Yalom lists the following as poor candidates for a heterogeneous outpatient intensive therapy group: brain-damaged people, paranoid
individuals, hypochondriacs, those who are addicted to drugs and alcohol, acutely psychotic individuals, and antisocial personalities.
Cr iter ia for inclusion : the client’s level of motivation is the most important variable.
From Yalom’s perspective, groups are useful for people who have problems in the interpersonal domain, such as loneliness, inability
to make or maintain intimate contacts, feelings of unlovability, fears of being assertive, and dependency issues. Clients who lack
meaning of life, who suffer from diffuse anxiety, who are searching for an identity, who fear success, and who are compulsive
workers might also benefit from group experience.
ACA: “… counselors select members whose needs and goals are compatible with goals of the group, who will not impede the group
process, and who well-being will not be jeopardized by the group experience.
Screening is most effective when the leader interviews the members and the members also have an opportunity to interview the leader.
When screening is not available, the leader should use the first group session to screen participants and to present informed consent
guidelines.

Pr epar ing Gr oup Par ticipants

Yalom believes that leaders should advocate exploring group members’ misconception and expectations, predicting early problems,
and providing a conceptual framework that includes the guidelines for effective group bx. As part of member preparation, the
authors include a discussion of values and limitations of group, the psychological risks involved in group participation, and ways of
minimizing these risks.

Involuntar y Par ticipation: People can be forced to attend group meetings but not to learn.

Fr eedom to Leave a Gr oup

1. Procedures for leaving a group should be explained during the initial session.
2. Clients have a responsibility to the leader and to other members to explain why they want to leave. Reason being is because it
can be deleterious to members to leave without having been able to discuss they considered threatening or negative in the
experience.
3. Such a termination can be harmful to the group cohesion, for the members who remain may think that they caused a
particular member’s departure.

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.

Confidentiality with minor s

Before any minor enters group, it is good practice to get a written consent from the parents.
Group leaders should discuss, in the initial session, the concerns about confidentiality and how it will be maintained to ensure the
child will have trust in the counselor.

Values in Gr oup Counseling

1. Group counselors need to consider when it is appropriate to expose their beliefs, decisions, life experiences, and values.
2. Certain bxs of leaders reveal their values:
3. demonstrating of the person of the client
4. avoiding responding to sarcastic remarks with sarcasm
5. being honest with members rather than harboring hidden agendas
6. avoiding judgment and labeling of members, instead describing the bx of members
7. stating observations and hunches in a tentative way rather than dogmatically
8. letting members who are difficult know how they are affecting them in a nonblaming way
9. detecting their own countertransference reactions
10. avoiding misuse of their power
11. providing both support and caring confrontations
12. avoiding meeting their own needs at the expense of the members

Uses and abuses of gr oup techniques

1. Using techniques with which they are unfamiliar
2. Using techniques to enhance their power
3. Using technique whose sole purpose is to create intensity because of the leader’s need for intensity.
4. Using techniques to pressure members, even when they have expressed a desire not to participate in an exercise
Ethical Issues and Roles of Counselor s Wor king in the Community
Community Agency includes any institution-public or private, non-profit or for profit-designed to provide social and psychological
services.
Community Wor ker s include social workers, community organizers and developers, psychologists, psychiatrists, nurses, counselors,
couples and family therapists, and human service workers.
Community Counselor s: diverse pool of human service workers whose primary duties include serving individuals with in the
community in a variety of community groups.
The community appr oach focuses on way of changing the environmental factors causing individual problems.
requires practitioners to design interventions that go beyond the office.
Have to be flexible and creative; culturally sensitive when performing interventions

Activities that make up a compr ehensive community counseling model:

1. Direct client services focus on outreach activities (face to face)
2. Indirect client services consist of client advocacy (behind the scenes)
3. Direct community services focus on preventative education
4. Indirect community services attempts to change the social environment by influencing public policy
Community Counseling calls for counselor s that ar e:
1. Familiar with resources with in the community that they can refer clients to if necessary (211 broward, 311 dade)
2. Have a basic knowledge of the cultural background of their clients
3. Possess skills that can be used as needed by clients
4. Have the ability to balance various roles as professionals
5. Have the willingness to be advocates for policy change in the community.
Roles of Community Ser vice Counselor s
1. Advocates
2. Change Agents
3. Consultants and Advisors
Theor ies of Per sonality
Sigmund Fr eud: Believed human behavior is primarily instinctive and motivated mainly by unconscious process
Tapping the unconscious Mind
(Freud believed that the major tools for investigating the unconscious mind were free association, dream analysis, analysis of everyday
experiences, and humor)
Fr ee Association
Freud called Free Association the “fundamental rule of psychoanalysis”.
Free Association: the central technique in psychoanalytical therapy; clients are asked to say whatever comes to mind. When clients
block or disrupt associations serve as clues to the therapist that those are anxiety-arousing material.
Resistance: patient’s unwillingness to ponder and report anxiety-producing thoughts during the therapeutic process (such as during
Free Association).
Dr eam Analysis
According to Freud, a dream is caused when the events of the day activate acceptable impulses in the unconscious mind, causing them
to seek conscious expression.
Dream Analysis: Dreams have 2 levels of content. They are latent content and manifest content. Latent content are hidden motives,
wishes or fears that are transformed into manifest content, which is the content the dreamer dreams. This process is called dream
work.
The two most important types of dream work are condensation and displacement.
*Condensation occurs when a dream represents several ideas at the same time.
*Displacement occurs when an unacceptable dream-thought is replaced by a thought that is symbolically equivalent but is acceptable
such as when penises become objects such as baseball bats or flagpoles.
Slips of the tongue that have come to be known as Freudian Slips are also thought to reveal unconscious motives.

Consciousness and the Unconsciousness

Unconscious can’t be studied directly but is inferred from bx. To identify the unconscious includes the following:
Dreams, which are symbolic representations of unconscious needs, wishes and conflicts.
Slips of the tongue (Freudian slip) and forgetting (ex. a familiar name)
Posthypnotic suggestions
Material derived from projective techniques
The symbolic content of psychotic symptoms.

Life and Death Instincts

1. Instinct is central to the psychoanalytical approach for they serve the purpose of survival of the individual and the entire
human race. Instincts orient us towards growth development and creativity.
2. All instinct associate with the preservation of life is called the life instinct (Eros) and the psyche energy associated with
them collectively is called libido.
3. Death instinct (Thanatos) stimulates a person to return to the inorganic state that preceded life. (Freud believed that the
death instinct, which is responsible for aggression, was the tendency toward self-destruction turned outward).
4. All instinct associate with the preservation of life is called the life instinct (Eros) and the psyche energy associated with
them collectively is called libido.

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.

The Super ego, once fully developed, has 2 subdivisions.

The conscience: internalized experiences for which the child had been consistently punished.
The ego ideal: internalized experiences for which the child had been consistently rewarded.
 1. Id : Has two means of satisfying bodily needs: reflex action and wish fulfillment.
2. Ego: Main goal is to match the images of id to real world.
3. Super ego: Conscience – the internalized experiences of which the child has been consistently punished

Psychosexual Stages of Development

The adult personality is formed by the end of the 5th year of life.
Each stage has an erogenous zone associated with it, which is the greatest source of stimulation and pleasure during that particular
stage of development.
To make a smooth transition from one psychosexual stage to the next, the child must be neither undergratified nor over gratified, both
of which cause the child to be fixated at that stage.
A fixation occurs when a substantial amount of psychic energy remains cathected in images of objects that can satisfy the needs
corresponding to a particular stage of development.
1. Or al Stage: first year: pleasure is on the mouth
2. Anal stage: second year of life: pleasure is on the anus.
3. Phallic Stage: 3-6 years: pleasure is on genitals, Oedipus, Electra complex
4. Latency stage: 6-12 Years: repression of sexual interest and developing of social and intellectual skills.
5. Genital stage: Puberty-death: sexual reawakening , source of sexual pleasure is someone out of the family

Or al Stage: the first yr of life

Mouth is the primary erogenous zone.
Someone who becomes fixated at this stage is either a:
*Oral incorporated character: (fixated at earlier oral stage) character type that such a person spends considerable time engaged in
activities such as eating, kissing, smoking and listening.
*Oral Sadistic character: (fixated at later oral stage) character type that such a person is orally aggressive and may be a fingernail biter
or sarcastic.

Anal Stage: the 2nd yr of life

Anal area is the primary erogenous zone.
Fixation at the first part of the anal stage creates a:
*Anal-expulsive character: Such a person may have trouble with bowel control and may be overly generous.
*Anal-retentive character: Such a person may suffer from constipation and may be stingy.

Phallic Stage: third to the fifth yr of life.

The phallus is the primary erogenous zone.
The phallic stage is the scene of the Oedipus complex, the resolution of which, Freud believed, has a profound influence on adult life.
Male Oedipus complex is when the boy loves his mother and sees his father as a rival.
Female Oedipus complex is when the girl discovers she lacks a penis and blames her mother for her deficiency. The rejection of the
mother is coupled with an attraction for the father. Also called the Electra Complex
However, the love for her father is also coupled with envy because he has something she doesn’t. This is referred to as Penis Envy.
For Freud, the resolution of the Female Oedipus complex occurs when the female eventually has a baby, especially a male baby.
Boys suffer from castration anxiety: the boy develops the fear of losing his sex organs because they are assumed to be responsible for
the conflict between him and his father.

Latency Stage: 6th year to about the 12th.

During this stage libidinal energy is sublimated.
Sexual activity is repressed and activities focus towards learning and athletics.

Genital Stage begins at puberty.

Time when full adult personality is formed.

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”

Each of Jung’s concepts has a polar opposite

For Jung the goal of life, is to seek a balance between the polar opposites.

Components of per sonality:

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.

Shadow, animalistic urges that characterized our pre-human existence

Self psychic is balance, self realization. Is the component of the psyche that attempts to harmonize all the other components.
When this integration is achieved, the person is said to be self-realized.

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.

Eight Per sonality Types

1. Sensing extr over t : only concern with objective facts, they are touchy and like to be around people, good companion
2. Thinking extr over t : lives by fixed rules and expects that everyone else do so, dogmatic, cold, rational
3. Feeling extr over t : responds emotionally to objective reality, respectful of authority and tradition
4. Intuiting extr over t : sees in internal reality a multitude of possibilities, little concern with convictions or morality of others
5. Sensing intr over t : give their own meaning to sensory experiences
6. Thinking intr over t : they follow their own thoughts regardless of how unconventional and dangerous to others may be, only values
the few friends that understand they internal frame of reference, criticism is rejected, they are cold, inflexible, arbitrary and even
ruthless
7. Feeling intr over t : emphasizes the feelings that experience provides, poor communication with others, they are egotistical and
unsympathetic, cold indifferent, no need to impress anyone.
8. Intuiting intr over t : the implications of internal images are explored thoroughly, they are mystic, daydreamer, produce new and
strange ideas, is the most aloof, distant and misunderstood, view as eccentric genius.

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.

Str iving for Super ior ity

Adler referred to the striving for Superiority as the fundamental fact of life.
In his final theoretical positions, Adler retained striving for superiority as the master motive but he changed from striving for
individual superiority to striving for a superior or perfect society.

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.

Safeguar ding Str ategies

Adler believed that neurotics use “safeguarding strategies” to protect what little self-esteem and illusions of superiority a mistaken
lifestyle can generate. Adler’s safeguarding strategies are similar to Freud’s ego defense mechanisms.
1. Excuses: yes but and if only talk; protects a weak sense of worth and deceives neurotics and those around them, that they are
more worthy than they really are.
2. Aggr ession : consisting of accusation, depreciation and self-accusation
Depr eciation : tendency to overvalue owns accomplishments and to undervalue the accomplishments of others. It has two
types: Idealization: Use of standards so high that no real person could possibly live up to those standards
Solicitude: neurotics act as other people are incapable of caring for themselves, they constantly offer advised
demonstrate concern; generally treat other people like children
Accusation: Tendency to blame others for his or her shortcoming, and to seek revenge against them.
Self-Accusation : Involves: Cursing oneself, reproaching oneself, self-torture and suicide, by injuring themselves neurotics
really attempt to hurt or at least get the attention of other people.
According to Adler neurotic’s major goal is to make those thought to be responsible of their misfortune suffer more than they do.
3. Distancing: consisting of moving backward, standing still, hesitating, experiencing anxiety… etc.
Moving Backwar d : Safeguarding a faulty lifestyle by reverting to a more secure one, often involves: attempted suicide, fainting,
migraines, refusal to take food, alcoholism, and crime to obtain the attention of others, to gain some control over them, and to avoid
social responsibility,
Standing Still: An evil circle has been drawn around the patient, which prevent him from moving closer to reality, from facing the
truth, often involves: insomnia, incapacity for work, weak memory, masturbation and impotence.
Hesitating: Vacillating when faced with difficult problems, often involves: coming late, retracting one’s step, destroying work done,
leaving things unfinished.
Constr ucting Obstacles: A neurotic creates obstacles like: compulsions, fatigue, sleeplessness, constipation, headaches.
Exper iencing Anxiety: Often feel fearful of undertaking like leaving home, separating from a friend, applying for a job.
Exclusion Tendency: to avoid problems they live within narrow limits: unemployed until adult, postponing marriage, doing poorly in
school, maintaining only social ties to family members.

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.

Kar en Hor ney

Basic evil: parents behaviors that undermines a child’s security
List of such behavior s: indifference, rejection, hostility, obvious preference for a sibling, unfair punishment, ridicule, humiliation,
erratic behavior, unkept promises, isolation of the child from others.
Basic hostility: Feelings generated in a child when his needs are not satisfied, child who is abused by the parents.
Basic anxiety: The child is caught between the dependence on the parents and the hostility towards them. As a result the child must
repress the hostility feelings towards the parent to survive. These repress feelings are motivated by feelings of helplessness, fear, love,
or guilt. When feelings of hostility towards the parent are repressed; it is generalized to the entire world, everything and everyone is
dangerous. Basic anxiety is the feeling of being alone or helpless in a hostile world.

Real and Idealized Self:

each human is born with a healthy r eal self that is conductive to normal personality growth. If people live in accordance with their real
selves, they are on the road to self-realization.
The view of real self can be distorted by basic evil.
Idealized self is the condition which develops as children become alienated from their real selves as they experience basic evil.
When a person’s life is directed by an unrealistic self-image, the person is driven by what should be, rather than what is they are driven
by the tyr anny of the should that displaces the real self in the neurotic personality.

Exter nalization : the tendency to view everything of importance occurring outside of oneself.

Adjustments to Basic Anxiety

Because Basic Anxiety causes feelings of helplessness and loneliness, the person experiencing it (basic anxiety) must find ways to
keep it to a minimum.
Horney described 10 strategies for minimizing basic anxiety the she called the “neurotic trends” or neurotic needs.
The normal person, in fact, has many or all of these needs and pursues their satisfaction freely.
The neurotic person makes one of these needs the focal point of life.
Unlike the normal person, the neurotic person’s approach to satisfying one of these needs is out of proportion to reality,
disproportionate in intensity, and indiscriminate in application, and when the need goes unsatisfied, it stimulates intense anxiety.
The 10 Neur otic Tr ends:
Need for Affection and Approval
Need for Partner who will run one’s life
Need to Live One’s Life Within Narrow Limits
Need for Power
Need to Exploit Others
Need for Social Recognition and Prestige
Need for Personal Admiration
Need for Ambition and Personal Achievement
Need for Self-Sufficiency and Independence
Need for Perfection and Unassailability

Moving Towar d, Against, or Away fr om People

Horney summarized her list of 10 Neurotic needs into 3 major adjustment patterns
Moving Towar d People (compliant type)
Adjustment to basic anxiety that uses the need to be wanted, loved, and protected by other people.
Horney referred to the person using this adjustment technique as the compliant type.
Although a person may adjust to basic anxiety by moving toward people, the person is still basically hostile. Thus the compliant
person’s friendliness is superficial and is based on repressed aggressiveness.
Moving Against People (hostile type)
Adjustment to basic anxiety that uses the tendency to exploit other people and to gain power over them.
Horney referred to the person using this adjustment technique as the hostile type.
Moving Away fr om People (detached type)
Adjustment to basic anxiety that uses the need to be self-sufficient.
Horney referred to the person using this adjustment technique as the detached type.

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.

Auxiliar y Appr oaches to Ar tificial Har mony

Blind Spots: Denying or avoiding certain aspects of the experience because they are not in accordance with one’s life EXAMPLE: if
we see ourselves as intelligent were are going to overlook experiences that suggest the contrary,
Compar tmentalization: applying different values to different situations EXAMPLE: we can be very Christians at home; we can be
ruthless at work.
Rationalization: Give logical but erroneous reasons to excuse a conduct that could produce anxiety EXAMPLE: A compliant type
must offer excuses for an aggressive act and vice versa.
Excessive Self-Contr ol: denying emotional involvement, minimizes failure by living in a narrow, predictable range of events
EXAMPLE: person that will never be carried away with happiness, rage, excitement, self pity
Ar bitr ar y Rightness: Choose a non clear solution just to end a debate, takes a stand that becomes the truth and therefore can not be
challenged. Elusiveness: Highly indecisive, lack of commitment, never wrong, postpones decisions to avoid failure EXAMPLE: after
treating someone badly they will feel remorse.
Cynicism: person does not believe in nothing, therefore immune to the disappointment to be wrong, nothing is worth commitment.
EXAMPLE: You can do as you please as long as you don’t get caught.

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

Eight Stages of Per sonality 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.
Ear ly Childhood (1-3): Autonomy vs. Shame and Doubt
-Children rapidly develop a wide variety of skills; they learn how to hold on and let go; children “willfully” decide to do something or
not
Pr eschool Age (4-5): Initiative vs. Guilt
-During this stage, children began to explore what type of person they can become; children test limits to determine what is
permissible and not.
School Age (6-11): Industr y vs. Infer ior ity
-Children learn the skills necessary for economic survival and skills that allow them to become productive members of their culture;
children learn social skills.
Adolescence (12-20): Identity vs. Role Confusion
-Transition stage b/w childhood and adulthood children must commit themselves to some strategy in life (an identity)
Young Adulthood (20-24): Intimacy vs. Isolation
-Being able to love and work effectively; young adults seek intimate relationships with others
Adulthood (25-64): Gener ativity vs. Stagnation
-An attempt to pass on the circumstances that caused such a life to the next generation.
Old Age (65-death): Ego Integr ity vs. Despair
-These individuals look back on a rich, constructive, happy life and do not fear life. They have a feeling of completion and fulfillment

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.

Cattell and Eysneck

Contemporary Developments: The Big Five
A theory of personality called the “Big Five” or sometimes the “the five-factor model”, has generated considerable interest among trait
theorists.
OCEAN
Openness to exper ience: imaginative or practical, interested in variety or routine, independent or conforming, conservative or liberal,
creative or uncreative, conventional or original, curious or uncurious.
Conscientiousness: organized or disorganized, careful or careless, disciplined or impulsive, lazy or hardworking, late or punctual,
aimless or ambitious, quitting or persevering, negligent or conscientious.
Extr aver sion : sociable or retiring, fun-loving or sober, affectionate or reserved, passionate or unfeeling, loner or joiner, quiet or
talkative, passive or active.
Agr eeableness: softheaded of ruthless, trusting or suspicious, helpful or uncooperative, generous or stingy, lenient or critical, good-
nature or irritable.
Neur oticism : calm or anxious, secure or insecure, self-satisfied or self-pitying, self-conscious or comfortable, emotional or
unemotional, vulnerable or hardy.

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.

Eysenck’s Super factor s

Neur oticism (vs. stability)
Extr over sion (vs. introversion)
Psychoticism (not a major role of healthy individuals, but of those with neurotic disorder and those who would be diagnosed
with psychotic disorders).
Dysthymic: severely disordered introverted neurotics, whose symptoms included anxiety, sensitivity, fatigue, exhaustion
Hyster ic: severely disordered extroverted neurotics, whose symptoms included hysterical conversions (non-neurological paralysis,
blindness
Cattell's 16 Per sonality Factor s
War mth open and warmhearted versus aloof and critical
Reasoning abstract versus concrete
Emotional Stability calm and stable versus high-strung and
Dominance aggressive versus passive
Liveliness enthusiastic versus serious
Rule Consciousness moralistic versus free thinking
Social Boldness uninhibited versus timid
Sensitivity sensitive versus tough-minded
Vigilance suspicious versus accepting
Abstr actedness imaginative versus practical
Pr ivateness pretentious versus unpretentious
Appr ehension insecure versus complacent
Openness to Change liberal versus traditional
Self-Reliance leader versus follower
Per fectionism compulsive and controlled versus indifferent
Tension driven and tense versus relaxed and easy going

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.

Differ ence between Pr imar y and Secondar y Reinfor cer

Pr imar y Reinfor ces are related to survival and include food, water, oxygen, elimination and sexual activity.
Secondar y r einfor cer are stimuli that are originally biologically neutral and thus not reinforcing but acquire reinforcing properties
through their association with a primary reinforcer.
According to Skinner, most human bx is governed by secondary reinforcer.
Secondary reinforcer that do not depend on a particular motivational state are called “generalized reinforcer”

Reinfor cement Schedules:

1. Fixed Inter val Reinfor cement Schedule FI : organism is reinforced by a response that is made following a specific period of
time.
2. Fixed Ration Reinfor cement Schedule FR : organism must make X number of responses before it is reinforced.
3. Var iable Inter val Reinfor cement Schedule (VI): reinforcement every 10 seconds for ex.
4. Var iable Ratio Reinfor cement Schedule (VR): organism is reinforced on the basis of an average number of responses.
Super stitious Behavior : develops under noncontingent reinforcement in which the organism seems to believe that a relationship
exists between its actions and reinforcement, when in fact no such relationship exists.
Contingent reinforcement: Situations in which a certain response must be made before a reinforcer is obtained; that is, no response, no
reinforcer.
Reinforcement that occurs regardless of what the animal is doing is called “noncontingent reinforcement”.
Superstitious Bx results from noncontingent reinforcement.

Reinfor cement Contingencies

Positive Reinfor cement: type of reinforcement that occurs when a response makes available a primary or secondary positive
reinforcer.
A positive reinforcement occurs when a response adds a primary or secondary positive reinforcer to the situation.
Negative Reinfor cement : type of reinforcement that occurs when a response removes a primary or secondary negative reinforcer.
A negative reinforcement occurs when a response removes a primary or secondary negative reinforcer from the situation.
A primary negative reinforcer is a stimuli that is potentially harmful to the organism such as an extremely loud noise, a bright light, or
an electric shock.
All negative reinforcement involves an escape contingency which is a situation in which an organism must respond in a certain way to
escape from an aversive stimulus.
Secondary negative reinforcer: negative reinforcer that derives its reinforcing properties through its association with a primary positive
reinforcer.
Both primary and secondary negative reinforcement involve escaping from an aversion situation.
Avoidance: Avoidance contingency: situation in which the organism can avoid an aversive stimulus by engaging in appropriate
activity.
For ex., opening an umbrella prevents getting wet, which is aversive.
With an avoidance contingency, the organism’s bx prevents it from experiencing a negative reinforcer.

J ohn Dollar d and Neal Miller

Hull’s Theor y of Lear ning
1. Skinner defined a reinforcer as anything that modified either the probability of a response or the rate of responding.
2. He said that for a stimulus to be reinforcer it must reduce a drive. Therefore, Hull had a “Drive reduction” theory of learning:
Constitutes reinforcement in Hull’s theory of learning.
3. The cornerstone of Hull’s theory is the concept of “habit”: an association between a stimulus and a response.
4. If a stimulus (S) leads to a response (R), which, in turn, produces a reinforcer, the association between that stimulus (S) and that
response (R) becomes stronger.
5. Hull’s theory is referred to as an S-R theory of learning.
Dr ive: A drive is any strong stimulus that impels an organism to action and whose elimination or reduction is reinforcing. Drives may
be internal, such as hunger or thirst, or they may be external, such as loud noise or intense heat or cold.
1. A drive may be primary, in that it is directly related to survival-for ex., hunger, thirst, pain, sex and elimination-or it may be
secondary, or learned, such as fear, anxiety, or the need to be successful or attractive.
2. Drive is the motivational concept in Miller and Dollard’s theory; it is the energizer of personality.
3. Impels an organism to action.
Cue: A cue is a stimulus that indicates the appropriate direction an activity should take.
1. Cues guide bx; whereas drive energizes bx.
2. Cues determine when we respond, where we respond and which response we make.
Response: Any overt or internal action elicited by a stimulus.

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.

Displacement Miller’s experiment

When the object of aggression was not available to the animal, it aggressed toward a substitute object-that is, the doll.
Thus, displaced aggression was demonstrated.

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.

Alber t Bandur a and Walter Mischel

Recipr ocal Deter minism: Personal variables, environmental variables and behavior interact with each other
P

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.

Fr eedom vs. Deter minism

1. Bandura rejects the notion that humans are autonomous, that is free to act independently of the environmental and personal
influences impinging on them. He also rejects the notion that humans respond mechanistically to those influences.
2. Bandura’s accepts reciprocal determinism in which people can influence their behavior and their environment. People can even
produce unique thoughts and actions “through their capacity to manipulate symbols and engage in reflective thought, people can
generate novel ideas and innovative actions that transcend their past experiences.
3. Bandura is a soft determinist; that is he believed cognitive processes such as intention, motives, beliefs, and values intervene
between experience and behavior, view humans as teleological or goal oriented
4. The capacity to exercise control over one’s thought processes, motivation and action is a distinctively human characteristic.
Fr eedom vs. Options: Freedom is defined as the number of options available to people and their right to exercise them. Anything that
reduces a person’s options, then limits their freedom.
Fr eedom : number of options available to people and the right to exercise them
Factor that can limited per sonal fr eedom:
1. Deficiencies in knowledge and skills
2. Perceptions of self-inefficacy
3. Internal standards that are to stringent
4. Social sanctions: person’s opportunities because of his race, gender, sexual orientation, social class, religion.
Chance Encounter s and Life Paths: Chance Encounters are unintended meeting of persons unfamiliar to each other. Bandura
believed that chance encounters can significantly impact one’s life and provide another reason for the unpredictability of human
behavior. unintended, unplanned, accidental meeting that can change the life of those involved, is an additional way in which the
environment can influence people and their behavior

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.

CPC Cycle: activities engage in by an individual confronted with a novel situation.

Cir cumspection Phase: propositional construct, several are analyzed to interpret the situation, thinking is hypothetical and tentative,
can be labeled cognitive trial and error
Pr eemption Phase: chose one construct that seems relevant to deal with the situation
Contr ol Phase: person decides which pole of the dichotomous construct is most relevant to the situation.

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

Inter pr etation of Tr aditional Psychological Concepts

Motivation : Kelly believed that humans are born motivated. It is viewed as a jackass theory of motivation because motivation is
viewed as inherent. Unlike other theorist that believes that people need to be set in motion by something, Kelly believed that people
are born motivated. for Kelly was same as life
Anxiety: The primary function of construct system is to accurately anticipate events, anxiety is evidence of a failed construct system
and therefore, requiring modification The ability to predict the future accurately is everyone’s goal. The extent to which our
predictions are invalid is the extent to which we experience anxiety.
Anxiety is caused by the by the uncertainty that results when one’s construct system does not permit the accurate construing of life’s
experiences.
Hostility: Kelly defined hostility as the “continued effort to extort validation evidence in favor of a type of social prediction which as
already proven itself a failure”. attempt to validate a prediction that has been proven to be erroneous. An unwillingness to give up an
ineffective construct system.
Hostility is related to anxiety, when our construct system has failed and anxiety is inevitable, one may refuse to accept this fact and
attempt to demand validation from the environment. Such demands characterize hostility.
Aggr ession; an aggressive individual opts to extend his construct system. Rather than define it. He or she seeks adventure rather than
security. Opposite of hostility, it is an attempt to expand with many experiences
Kelly defined aggression as the “active elaboration of one’s perceptual field”. Thus, according to Kelly, the aggressive individual opts
to extend his construct system rather than define it.
Kelly sees aggression the opposite of hostility.
Guilt is the emotions felt when one acts contrary to the role he or she typically plays in relation to a significant other or a group in his
or her life. It has nothing to do with good or evil.
Core role structure refers to the roles we play while interacting with the relevant individuals and groups in our lives.
Guilt arises when the individual becomes aware that he is alienated from the roles by which he maintains his most important
relationships to other persons.
Guilt has to do with the inconsistency with which one interacts with significant people or groups in one’s life. This inconsistency
causes us guilt.
Thr eat: the feelings one experience when one’s core constructs are invalidated
Kelly defined threat as the “Awareness of imminent comprehensive change in one’s core structures”
Core structures are constructs for predicting external events on which we rely heavily. These core structures are used to make sense
out of life.
When these core structures suddenly seem no longer validated by experience, we feel threatened.
Threat can also be caused by the anticipation of one’s death.
Furthermore, threat is not only caused by negative events.
Fear : feeling one has when a relatively unimportant construct is about to be invalidates, thus requiring a minor change in one’s
construct system.
“Fear is like threat, except that, in this case, it is a new incidental construct, rather than a comprehensive construct that seems to take
over”
Defined as: feeling one has when a relatively unimportant construct is about to be invalidated, thus requiring a minor change in one’s
construct system.
Unconsciousness
Constructs with low cognitive awareness are considered more or less as unconscious.
There are 3 types of constructs with low cognitive awareness: preverbal, submerged, and suspended.
Preverbal Constructs: construct formulated early in one’s life, before language was adequately developed. Although such a construct
can’t be labeled verbally it can still be used to construe one’s experiences.
Lear ning: Any change is one’s construct system with the goal of increasing its predictive efficiency.
Reinfor cement: Changed reinforcement to Validation: Results when a construct or a construct system successfully anticipates an
experience.

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.

Phenomenological Field: Emer gence of the Self:

Phenomenological Field: that portion of experience of which an individual is aware. It is this subjective reality, rather than physical
reality that directs a person’s bx.
Emer gence of Self: At first infants do not distinguish between events in the phenomenological field; the events all blend
together… gradually, through experiences with verbal labels such as “me” and “I”, a portion of the phenomenological field becomes
differentiated as the self. At this point, a person can reflect on him or herself as a distinct oject of which he or she is aware.
Need for Positive r egar d
• Part of the socialization process of children is to learn there are things that they can and cannot do. Most often parents will male
positive contingent on desirable behavior on the part of their children. This creates a condition of wor th. In other words,
approval become conditioned upon the child behaving in a way that is of the parent approval, if not approval is withheld.)
Children internalize these conditions which in term become a conscience, or superego, guiding the children’s behavior even
when parents are not present.
• Once internalized children develop the need to view themselves positively: the need for self-r egar d. (That is they develop their
own conditions of worth. Therefore the only way they can see themselves positively is by acting in accordance with someone
else’s values that they have internalized.)
• Whenever there are conditions of worth in children’s lives, they may be forced to deny their own evaluations of their
experiences in favor of someone else evaluation, this causes an alienation between people’s experiences and their self. The
result is the experience of what he called the condition of incongr uence. Roger believed that it is this condition of worth that is
the heart of all human problems.

Unconditional Positive Regar d:

Experience of Positive Regard without conditions of worth. In other words, positive regard is not contingent on certain acts or
thoughts.

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.

Non-dir ective for m of ther apy:

Emphasized clients’ ability to solve their own problems if they were given the proper atmosphere for doing so.

Abr aham Maslow

Hier ar chy of Needs Maslow centered his theory of motivation on the hierarchy of needs. It is the arrangement of the needs from the
lowest to highest in terms of their potency.
1. Physiological needs: most basic cluster of needs, water, food, oxygen, sleep, elimination and sex
2. Safety Needs: second cluster of needs, order, security, and predictability
3. Belonging and love needs: third cluster of needs, affiliation with others and for the feeling of being loved
4. Esteem needs: fourth cluster, status, prestige, competence, and confidence
5. Self-Actualization: When all the needs are been adequately satisfied, the person experiences self-actualization
Char acter istics of Self actualizing People
1. Per ceive r eality accur ately and fully: characterized by B-cognition, unusual ability to detect spurious, fake, dishonesty and
judge people correctly and efficiently
2. Demonstr ate a gr eater acceptance of themselves, other s and natur e in gener al: lack of defensiveness, phoniness, they don’t
have guilt, anxiety or shame; they accept the way they are.
3. Exhibit spontaneity, simplicity and natur alness: true to their feelings, they don’t act accordance with social rules
4. Tend to be concer n with pr oblems r ather than themselves: committed to some task, cause or mission
5. Have a quality of detachment and a need for pr ivacy: don’t need constant contact with others
6. Ar e Autonomous: more dependent of inner than outer world
7. Exhibit a continued fr eshness of appr eciation: experience events with pleasure
8. Have per iodic mystic or peak exper iences: low peak experiences are effective, practical people, the high peak are poetic,
transcendent and mystical.
9. Tend to identify with all human kind: feeling of fellowship is towards everyone, they have a genuine desire to help humanity
10. They develop deep fr iendships with only a few individuals: look for other self-actualizers they are few but reach and deep
11. Tend to accept democr atic values: no class, race, age, color distinctions
12. Str ong ethical sense: even they are not conventional they know ethical implication of their actions
13. Well develop unhostile sense of humor : don’t make fun of others, they do of themselves
14. They ar e cr eative: open to experience, spontaneous
15. Resist encultur ation: nonconformist, stick to their values
Tr ansper sonal Psychology: Also called fourth fource psychology:
Psychology that examines the human relationship to the cosmos or to something “bigger than we are” and the mystical, spiritual, or
peak experiences that the realization of such relationship produces.

Rollo Reese May

Existentialism: Philosophy that studies the essence of human nature. The emphasis is on freedom, individuality and
phenomenological experience. May’s theory is most compatible with existential philosophy

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

Mathematics Disor der : Mathematics performance is significantly below age norms.

Symptoms: deficit in semantic verbal memory (left hemisphere); immature strategies for solving arithmetic problems;
impaired visuospatial skills resulting in misaligning numbers in columns or making place-value errors (right hemisphere).
Believed to occur because of an abnormal genetic component of the left and right hemisphere.
Treatment of Learning Disorders: Intervention should be placed in the classroom.

MOTOR SKILLS 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)

PERVASIVE DEVELOPMENTAL DISORDERS

People with Pervasive developmental disorders all experience problems with language, socialization, and cognition.
Includes: Autistic Disorder, Asperger’s disorder, Rett’s disorder, childhood disintegrative disorder and pervasive developmental
disorder-not otherwise specified.

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.

FEEDING AND EATING DISORDER OF INFANCY OR EARLY CHILDHOOD

Pica: Persistent eating of nonnutritive substances for a period of at least one month (common in pregnant women)
1. The typical substances ingested tend to vary with age: Infants and younger children typically eat paint, plaster, string, hair, or
cloth. Older children may eat animal droppings, sand, insects, leaves or pebbles. Adolescents and adults may consume clay or
soil.
2. Bx must be developmentally inappropriate and not part of a culturally sanctioned practice.
Rumination Disor der : also known as cow disease.
1. Repeated regurgitation and re-chewing of food for a period of at least one month following a period of normal functioning.
2. Partially digested food is brought up into the mouth without apparent nausea, retching, disgust or associated gastrointestinal
disorder.
3. Bx is not associated with gastrointestinal or medical condition.
Feeding Disor der of Infancy or Ear ly Childhood
1. Persistent failure to eat with significant failure to gain weight over at least one month.
2. Not attributed to any medical condition
3. Onset must be before the age of 6.
4. Equally common in males and females
TIC DISORDERS
Disruption in early development involving motor movements or vocalizations
Tour ette’s Disor der : Multiple motor and at least one or more vocal tics during the illness
Vocal tics often include the involuntary repetition of obscenities.
Onset is before age 18
Treatment: Social Skills training, relaxation training and meds (haloperidol, pimozide and clonidine)

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.

DELIRIUM, DEMENTI, AMNESTIC AND OTHER COGNITIVE DISORDERS

Amnestic Disor der : dysfunction of memory due to a medical condition, confusion, disorientation.
Delir ium: impair consciousness with reduce ability to focus, sustain or shift attention, show disorganized patterns of thinking.
A) Disturbance of consciousness (reduced awareness of the environment and attentional difficulties)
B) A change in cognition, such as a language disturbance, or a perceptual disturbance not accounted for by a dementia.
C) Rapid development, like over the course of a few hours or days, and fluctuation during the course of a day.
D) Evidence of presence of a medical condition causing it, it could be: a General Medical Condition, a Substance Intoxication, or
caused by more than one etiology
Dementia: multiple cognitive deficits severe enough to hinder social and occupational activities, and representing a significant decline
from a previous level of functioning. Gradual onset and continuing decline.
Char acter istics of dementia :
1. Failure to finish task
2. Forgets names
3. unable to recall past events
4. display impulsive control problems
Dementia of the Alzheimer ’s Type (most common ) Cognitive deficits that develop gradually and steadily
Predominant is the impairment of memory, orientation, judgment, and reasoning.
Brain tissue irreversibly deteriorates.
Death occurs approximately between 10-12 years after onset
“Wasting Away” Main psychological changes: The main physiological change in the brain, evident at autopsy, is an atrophy
of the cerebral cortex, first the entorhinal cortex and the hippocampus, and later the frontal, temporal and parietal lobes. As neurons
and synapses are lost, the fissures widen and the ridges become narrower and flatter.
Subtypes are with early onset (before 65), with late onset (after 65), without behavioral disturbance, with behavioral
disturbance (wandering, agitation)
Etiology: B-amyloid (waxy protein deposit) build up. Associated with enlarged ventricles reduced levels of neuratransmiter
acetylcholine, expoture to toxins, repeted head injury, infection, injuries
Heredity: increased risk for 1st degree relatives
Other causes: Encephalitis, Meningitis, HIV/AIDS, nutritional deficit
Preventative strategies: Aspirin, Vitamin E, good diet, exercise, keep brain alert.
Meds include Aricept (produces less side effects), Excelon patch, Namenda (the latest)
Best time to talk to them is in the morning. Short-term memory is lost first.
Treatment of Alzheimer : Cognex inhibits the enzyme that breaks down acetycholine (side effects: toxic to liver), Hydergine,
research indicates that estrogen may improve the memory and attentional capabilities and Family therapy.
Frontal-Temporal (Cortical Dementia)

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.

Frontal-Sub Cortical Dementias:

Dementia Due to Huntington’s Chor ea: occurs because of inbreeding (genetic disorder) and it’s a fatal disease. Causes non-rhythmic
jerky movements.
Dementia Due to Par kinson’s disease: causes the automatic nervous system to shut down. Slow progressive neurological condition
that causes muscle tremors, akinesia (inability to initiate movement)
Hydrocephalus: can lead to Dementia “Water on the brain” (excessive water in the cranium because of brain shrinkage). Reversible by
surgery.
Dementia due to Vascular Dementia : second most common (strokes); It is the progressive brain disorder that is second only to
Alzheimer as a cause of dementia.
Dementia due to Cr eutzfeldt-J akob Disease (Mad Cow Disease): extremely rare. Caused by transmissible agents known as prions.
It is confirmed only by Biopsy or Autopsy. Onset is between 40-60 yrs of age. Symptoms include fatigue, anxiety, problems with
appetite, sleep or concentration. Irregular EEG.

SUBSTANCE RELATED DISORDERS

Dependence: defined as a pattern of repeated self-administration that can result in tolerance, withdrawal, and compulsive drug taking
bxs.
Applies to all categories EXCEPT caffeine.

Cr iter ion for Dependence

•1: Tolerance Tolerance maybe classified as a pattern of compulsive substance use which is taken in larger amounts over a longer
period than was originally intended (e.g. I’m only going to have a 2 drink maximum – individuals becomes intoxicated).
- With Physiological Dependence
- Without Physiological Dependence
•2a: Maladaptive Behavioral Change (with physiological & cognitive concomitants)
•2b: Utilizing the substance to avoid withdrawal, commonly throughout the day.
•3: Individual may express a continued desire to cut down use.
•4: Spends a great deal of time obtaining the substance, using or recovering from its effects.
•5: Most of the individual’s activities revolve around the substance.
•6: Individual may retreat from family and friends because of use
Substance Abuse: Substance Abuse criterion does not include tolerance, withdrawal, or a pattern of compulsive use. Instead its
focus is on the har mful consequences of repeated use (e.g. poor work performance, lack of family responsibilities, repeated
absences).
•Person will continue to use despite a history of undesirable and recurrent social and/or interpersonal consequences (e.g. divorce,
fights, law infractions)
Substance Intoxication : Irreversible psychosocial changes that take place under the influence of the ingested substance (e.g. impaired
judgment, moodiness, impaired social/occupational functioning).
Substance Withdr awal: Symptoms of withdrawal vary according to the substance used; however, most symptoms appear to be the
opposite observed during intoxication.

Distinguish between Dependence and Abuse:

Dependence: 3 or more symptoms in a 12 month period (e.g., tolerance, withdrawal, persistent efforts to cut down, activities reduced
or given up)
Abuse: 1 or more symptoms in a 12-month period (e.g., substance-related legal problems, use when physically hazardous).
Depr essants: These substances result in behavioral sedation and can induce relaxation. Include alcohol and the sedative hypnotic and
anxiolytic drugs in the families of barbiturates (Seconal) and benzodiazepines (valium, Halcion). Benzo’s are anti-anxiety drugs.
Hallucinogens: Alter sensory perception and can produce delusions, paranoia, and hallucinations. Marijuana and LSD are included in
this category.

Substance r elated disor der s ar e divided into:

Depr essants: alcohol, barbiturates, and benzodiazepines. Decrease central nervous system activity, help us relax
1. Alcohol Intoxication : Maladaptive behavior/psychological changes (inappropriate sexual or aggressive behavior, mood
lability, and slurred speech, in-coordination, unsteady gait, impaired memory and stupor.
2. Alcohol Withdr awal: Autonomic hyperactivity, hand tremor, insomnia, nausea or vomiting, transient hallucinations,
psychomotor agitation, anxiety and grand mal seizures.
3. Alcohol-Induced Dementia : Symptoms of Dementia with greater impairment of visuospatial memory (versus verbal
memory) May show some improvement in symptoms after 5 years of sobriety.
4. Alchol-Induced Per sisting Amnestic Disor der (Kor sakoff’s Syndr ome) Memory impairment involving inability to learn
new information or recall previously learned information (anterograde amnesia most severe, especially for declarative
memories; retrograde amnesia affects recent memories more than remote); confabulation.

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.

Opiates: heroin, codeine, and morphine. Relieve pain, induce sleep

1. Opioid intoxication: Maladaptive behavioral or psychological changes papillary constriction or dilatation, drowsiness or
coma, slurred speech, impairment of attention or memory.

Hallucinogens: marijuana (Cannabis), and LSD. Senses are distorded

1. Hallucinogen intoxication : Maladaptive behavioral or psychological changes ( intensification of perceptions, hallucinations,
feelings of depersonalization, and illusions. Sigs of dilatation of pupils, increase heart rate, sweating, palpitations, blurring of
vision, tremors and incoordination.
2. Cannabis intoxication: Maladaptive behavioral or psychological changes ( euphoria, anxiety, impaired judgment) signs of
bloodshot eyes, increased appetite, dry mouth, increased heart rate.

Therapeutic Strategies: Antiabuse-injects this med and drinking alcohol will make the person sick.

SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS

In Schizophrenia, Schizophreniform Disorder, Schizoaffective Disorder, and Brief Psychotic Disorder, the term Psychotic refers to:
• delusions,
• any prominent hallucinations,
• disorganized speech,
• Disorganized or catatonic behavior.
In Psychotic Disorder Due to General Medical Condition and Substance-Induced Psychotic Disorder, the term Psychotic refers to:
• Delusions, or only
• Hallucinations (not accompanied by insight)
In Delusional Disorder and Shared Psychotic Disorder, the term Psychotic refers to:
• Delusions.
Schizophrenia: Duration of symptoms for at least 6 months with a least one month of 2 or more active-phase symptoms
•Onset – late teens & mid 30s (Late Onset: after 45)
•Etiology – Genetic component; dopamine hypothesis; brain abnormalities (enlarged ventricles; hypofrontality)
•Familial Pattern: 1st degree relatives: 10x >
•Treatment – Antipsychotic drugs; skills training (social, self-care, cognitive); family intervention (ie. improved communication and
reduce negative expressed emotion).

•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.

•Hallucinations – auditory (most common); visual; olfactory; tactile

•Disorganized Speech – loosening of association; incoherence

•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.

295.xx Schizophr enia

Schizophrenia is a disorder that last for at least 6 months and includes at least 1 month of active-phase symptoms. There must be
presence of two or more of the following symptoms:
1. Delusions: disturbances in thinking
2. Hallucinations: disturbances in perception
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (affective flattening, alogia, or avolition)
For a significant period of time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal
relations, or self-care are markedly below the level achieved prior to the onset, or in childhood/adolescence period there is a failure to
achieve expected level of interpersonal, academic, or occupational achievement.
Occurs mostly between early and mid 20s.
Runs in families (1st degree relatives 10 times more likely)
Older onset (after 45; unusual): worst prognosis
Treatment: antipsychotic drugs, skills training (social, self-care, cognitive), family intervention
Positive Symptoms: More obvious symptoms. Excess of normal sensations.
1. Delusions: false beliefs that they firmly held despite the existence of evidence that suggests the contrary. Delusions of
Grandeur: on a mission to end world starvation is common in schizophrenia.
Types:
Delusions of Grandeur
Delusions of Persecution
Delusions of Reference
Delusions of Thought Broadcasting
Delusions of Control
Thought Withdrawal
Capgras’s Syndrome

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.

295.60 Residual Type

A) Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.
B) There is continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms
a. listed on criterion A for Schizophrenia, present in an attenuated form.
have experienced at least one episode of schizophrenia but positive symptom-free but still displays negative symptoms. Can
include social withdrawal, bizarre thoughts, inactivity, and flat affect
295.90 Undifferentiated Type
The symptoms that meet general criteria (question 1) are present, but the criteria are not met for the Paranoid, Disorganized, or
Catatonic Type.

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.

Depr essive Disor der s

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)

•Children: somatic complaints; irritability, social withdrawal.

•Elderly: Distractibility, memory loss, reduced appetite and other common symptoms.
Differential Diagnosis for the elderly: with depression the older patients wont have energy to talk whereas with Dementia the elderly
will confabulate stories

Double Depr ession: Major depressive episodes and dysthymic disorder

1. Dysthymic disorder often develops first
2. Associated with severe psychopathology
3. Associated with a problematic future course
Dsythmic v.s. Major Depressive Disorder
•Major Depressive Disorder consists of 1 or more discrete Major Depressive Episodes that can be distinguished from a person’s
“usual” functioning.

•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 Disor der s

•Bipolar I Disorder: One or more Manic or Mixed Episodes.

1. Single Manic Episode – (Manic Only)

2. Most recent Episode Hypomanic (previous 1 manic or mixed episode)
3. Most Recent Episode Manic (previous 1 Major Depressive, Manic or Mixed episode)
4. Most Recent Episode Mixed (previous 1 Major Depressive, Manic or Mixed episode)
5. Most Recent Episode Depressed (previous- 1 Manic or Mixed Episode)

•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

Generally people can recognize their obsessive thoughts and impulses

Specifier: With poor insight: for those who fail their obsession or compulsions are excessive or unreasonable.
Treatment: Combination of exposure and Clomipramine/SSRI
309.81Post Tr aumatic Str ess Disor der
Diagnosis r equires symptoms of more than one month (re-experiencing, avoidance, increased arousal) after exposure to severe
trauma.
Specifiers: Acute (symptoms are less than 3 months), Chronic (symptoms are 3 months or more), With Delayed Onset (6 months have
past between the traumatic event and the onset of symptoms)
Treatment:
Acute phase: exposure, relaxation, and cognitive restructuring
Chronic Phase: CBT
Late Onset: Poorer prognosis
Acute str ess disor der :

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.

1. Misinterpretation of bodily symptoms.“Disorder of Cognition and Perception”

2. Research indicates that Hypochondriasis is frequently co-morbid with anxiety and mood disorders including similar age of
onset, personality characteristics, and runs in families.
3. The essential problem is anxiety but the expression of the disorder is different in that the individual is preoccupied with
bodily symptoms, misinterpreting them as indicative of illness or disease.
4. Doctor-shopping and deterioration in doctor-patient relationships are common.
5. Almost always a hypochondriac will see a mental health practitioner AFTER the family physician has ruled out realistic
medical conditions as a cause.
6. Once these patients are cleared of any medical condition, symptoms usually stop or it may splinter.
7. Duration of at least 6 months
Distinction: Individuals who fear developing a disease are different from those who have a fear of having a disease. Fears in
developing a disease (avoidance of contagion) is classified as illness phobia. With illness phobia they will specify what they have
(they are convinced) whereas with hypochondrias symptoms are general.
Etiology: History of family illness (can run in families; can be learned), injury or illness during childhood. Precipitating
Factor: seems to develop in the context of a stressful life event, such as death of someone close to the individual.
Onset: any age: most common young adulthood
Occurs both in men and women
Treatment: CBT: cognitively challenging illness related to misinterpretations of physical sensations and demonstrating how
patients can “Create”symptoms by focusing on areas of the body. Psychoeducational; to help them differentiate physiological disorders
from psychological disorders and medical treatment to alleviate anxiety.

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”)

Onset: Any age

No difference in cultural variation.
Females appear to experience certain chronic pain conditions, most notable migraine and tension-type headaches and musculoskeletal
pain, more often than do males.
Treatment: Give up unproductive methods to control pain; participate in activities despite pain; not allowing pain to
determine lifestyle; ask them to depart from pain symptoms.

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.

SEXUAL AND GENDER IDENTITY DISORDERS

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.

4. Br eathing-Related Sleep Disor der

a. Sleep disruption, leading to excessive sleepiness or insomnia due to an obstructive or central sleep apnea syndrome.
b. Sleep Apnea is a disorder involving brief periods when breathing ceases during sleep.
c. types of Apnea:
i. Obstructive Sleep Apnea: causes snoring at night. Obesity is often associated with OSA. Most common in
males.
ii. Central Sleep Apnea: Occurs due to cerebral vascular disease, head trauma, and degenerative disorder.
Causes the person to wake up frequently at night but tend not to report excessive daytime sleepiness.
 iii. Mixed Sleep Apnea: combination of both OSA and Central sleep apnea.
d. Treatment: focuses on helping the person breath better during sleep. For some, recommending weight loss is
necessary.
e. For mild or moderate cases of OSA, treatment involves either a medication that helps stimulate respiration or the
Tricyclic antidepressants or a mechanical device such as the continuous positive air pressure machine, that improves
breathing.

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.

3 clusters of Personality Disorders

Cluster A: Odd/Eccentric Bxs. (Paranoid Personality Disorder, Schizoid Personality Disorder, Schizotypical Personality Disorder)
Cluster B:Dramatic, Emotional or Erratic Bxs: (Antisocial Personality Disorder, Borderline Personality Disorder, Histronic
Personality Disorder, Narcissistic Personality Disorder)
Cluster C : Anxiety or Fearfulness (Avoidant Personality Disorder, Dependent Personality Disorder, Obsessive-Compulsive
Personality Disorder)

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.