Personality 1
PERSONALITY EXAM 2 STUDY OUTLINE
I)
Behavior Therapies
A) General Comments:
1) Basis: based on learning theory, no personality theory
2) Notes:
(a) Empirically based and supported. Has most research evidence.
(b) Talking is not the center of therapy
(c) Therapeutic Relationship is NOT central
3) The WHAT: behavior (instead of mental, cognitive, emotional)
4) The HOW: application of principles of learning theory
5) Principles:
(a) Unconditioned / Conditioned stimulus
(b) Unconditioned / Conditioned response
(c) Generalization
(d) Extinction
6) Founders:
(a) Pavlov, J. B. Watson, Skinner
B) Implosive Therapy
1) Founder: Thomas Stampfl
2) Notes:
(a) is really a combination of both bxial and psychoanalytic theory.
3) Psychopathology:
(a) “The symptoms and defense mechanisms that characterize psychopathology are learned avoidance
responses that serve to reduce anxiety.”
(b) Employs Mower’s Two-Factor theory
(c) A complex series of CSs leads to stronger avoidance bxs; much more resistant to extinction.
4) Therapy:
(a) Content: behavior (i.e., anxiety)
(b) Process:
(i)
use of extinction to extinguish learned avoidance response
(ii)
Counter conditioning: response prevention
(iii)
Catharsis: client imagines as vividly as possible the stimulus scene and is told to experience the
scene completely. If the scene causes anxiety, increase anxiety to break through the defenses.
5) Therapeutic Relationship:
(a) Need not be developed, possible to use tapes or films to produce anxiety scenes
(b) Important to build trust: clinicians help clients remain in anxiety-producing scenes
6) Practicalities:
(a) Therapists must overcome their own dread of producing anxiety in others
(b) Intrapersonal problems = individual therapy
7) Research:
(a) best suited for adults suffering from anxiety and trauma disorders
C) Exposure Therapy
1) Founder: Foa
2) Notes:
(a) combination of respondent conditioning and emotional processing
3) Psychopathology:
(a) anxiety is conditioned response controlled by learning principles
(b) conditioning accounts for acquisition of fear; extinction accounts for fear reduction
(c) Anxiety-based pathologies are conceived of in terms of both traditional behavior therapy and an
emotional processing theory.
4) Therapy:
(a) Goal: to reverse the behavioral conditioning and to correct the patient’s erroneous cognitive and
emotional processes.
(b) Content: anxiety (behavior) and emotional trauma [intrapersonal issues]
(c) Process:
Personality 2
(i)
intentional, prolonged contact with the feared stimulus with response prevention.
(ii)
can be done gradually or all-at-once
(iii)
imaginal or in-vivo exposure
(iv)
counter-conditioning
5) Therapeutic Relationship:
(a) therapist operates like an effective but firm parent
(b) TRUST is essential due to anxiety eliciting stimuli
(c) model confidence and “tough love”
6) Practicalities:
(a) Parallel to implosive therapy
(b) 8 – 12 sessions
(c) homework is assigned
7) Research:
(a) Effective for:
(i)
PTSD, OCD
(ii)
Panic disorder
(iii)
social phobias
(iv)
The TREATMENT OF CHOICE: for specific phobias
D) EMDR
1) Founder: Francine Shapiro
2) Notes: more like a cognitive behavioral treatment
3) Psychopathology:
(a) Human processing system geared toward mental health
(b) When the processing system is blocked, pathology occurs
(c) Traumatic information is blocked and unresolved: locked in the neuropsychology
(d) UNBLOCKING the system will heal the pathology
4) Therapy:
(a) Goal: to unblock the traumatic event
(b) desensitization and cognitive restructuring are by-products of neuropsychological changes in the trauma
(c) consists of eye-movement during thinking of event and associated feelings
5) Therapeutic Relationship:
(a) Client must experience empathy, trust, and safety
(b) However, no empathic statements during trauma processing
6) Practicalities:
(a) Usually few sessions of longer length
(b) usually combined with other treatment methods
(c) provides pro bono services at crisis locations, etc.
7) Research:
(a) for PTSD, effective; greater effect the more controlled the study
(b) the function of the eye movements is not certain.
E) CONCLUSIONS FOR EXPOSURE THERAPIES:
1) Future:
(a) Exposure and EMDR are the most promising
(b) few clinicians use implosive tx
(c) txist resistance to exposure therapies is stronger than client resistance.
F) Systematic Desensitization:
1) Founder: Wolpe
2) Notes: originally called the process reciprocal inhibition (now called counter conditioning). Original research
conducted on cats.
3) Psychopathology: learned anxiety response
4) Therapy:
(a) **Can’t be tense when you’re relaxed.**
(b) Provide rationale
(c) Relaxation training
(d) Anxiety hierarchy
(e) Gradual exposure to conditioned stimuli while relaxed = extinction of anxiety
Personality 3
G)
H)
I)
J)
II)
A)
5) Research: EASY AND EFFECTIVE for treating anxieties and phobias
Assertiveness Training:
1) Uses combination of methods to teach a new behavior: instructions, shaping, behavioral rehearsal, cognitive
restructuring, modeling to change internal and external behaviors
2) To help people assert themselves effectively: not too aggressive, not too passive
Contingency Management:
1) aka: Behavior Modification
2) Behavioral Analysis: discover the reinforcements that are maintaining the behavior and what reinforcers to
provide to learn a new target behavior.
3) Content:
(a) Behavioral Excesses: (e.g., pedophilia, alcoholism)
(i)
Use of punishment and aversive control.
(ii)
Covert sensitization: conditioning is done through the use of thoughts and images.
(iii)
Punishment must be IMMEDIATE and STRONG
(b) Behavioral Deficits (e.g., study behaviors)
(i)
shaping is required
(ii)
token economies, self-management
(iii)
generalization
Cognitive Behavioral Modification:
1) Content:
(a) cognitive processes that are:
(i)
cognitive deficits or excesses
(ii)
inappropriate or ineffective
2) Process:
(a) giving info about what is happening: e.g., bio-feedback
(b) thought-stopping
(c) rational restructuring: changing self-statements
(d) stress inoculation
Effectiveness and Research:
1) Most widely researched branch of therapy today.
2) Age-appropriateness: both for children and adults
3) Effective for couples and families
4) Effective for
(a) Social skills, stress inoculation, relaxation, behavioral parent training
(b) OCD: premier treatment w/ or w/o medication
(c) Panic Disorder
(d) Nocturnal Enuresis
(e) Eating Disorders
(f) And More!!!
Cognitive Therapies:
REBT:
1) Founder: Albert Ellis
2) Notes: No real personality theory.
3) Psychopathology:
(a) S-O-R model: Stimulating event (stimulus), Organismic Thinking, Response
(b) A-B-C model: Activating event, Beliefs, Consequences.
(i)
Consequences are all feelings:
 anxiety, depression, self-esteem, guilt, anger
(c) Irrational Beliefs: are how we upset ourselves and need therapy
(i)
e.g.,: Life is supposed to be fair; I need everyone to love me; I cannot live without him
(ii)
Are ABSOLUTISTIC AND CATASTROPHIC
4) Therapy:
(a) D-E: Dispute irrational beliefs, Effective beliefs
(b) Process:
(i)
uncover irrational beliefs (and corresponding behaviors)
(ii)
replace them with rational beliefs (and corresponding behaviors)
Personality 4
5) Therapeutic Relationship:
(a) focused on instruction and teaching
(b) unconditional positive regard not necessary
6) Practicalities:
(a) fading out; Beck’s therapy is taking hold
7) Research:
(a) equally as effective as other therapies
(b) effective with adolescents
(c) Most pronounced impact on DISRUPTIVE and CONDUCT disorders
B) Cognitive:
1) Founder: Beck
2) Notes: original research focused on depression; conducted much research;
(a) approach was popularized by Burns in Feeling Good
3) Psychopathology:
(a) Cognitive Schemas: how we organize reality cognitively
(b) Maladaptive cognitions, dysfunctional attitudes, depressogenic assumptions
(c) Cognitive Triad: (depression)
(i)
Negative View of: SELF, EVENTS, FUTURE
4) Therapy:
(a) Content:
(i)
Modifying cognitive schemas, etc. and patterns of thinking
(ii)
content-specific hypothesis: each disorder has its own unique set of maladaptive cognitions.
(b) Process:
(i)
Cognitive restructuring: modifying erroneous patterns of thinking
(ii)
Collaborative empiricism: aka Socratic dialogue; therapist leads client in discussion of the
reasonableness of beliefs, asks for evidence, challenges assumptions operating within client’s
schemas.
(iii)
Teaching errors of thinking: i.e., OVERGENERALIZATION, DICHOTOMOUS THINKING.
(c) Homework: boil an egg
5) Therapeutic Relationship: similar to Ellis; therapist is a fellow scientist, philosopher, attempting to find what
is reasonable to think.
6) Practicalities:
(a) Manualized Treatment: step-by-step changes in cognition and behaviors
7) Research:
(a) Depression: equal in effectiveness to other therapies
(i)
TREATMENT OF CHOICE
(b) Anxiety: equal to other dominant therapies
(i)
longer lasting effect than medication alone
(c) Bulemia: TREATMENT OF CHOICE
(d) General: externalizing patients improved more than internalizing patients (w/ depression)
(i)
patients with less resistance improve more.
C) Dialectical Bx Treatment
1) Founder: Marcia Linehan
2) Purpose: for treating borderlines
3) Research: effective and efficient treatment; more promising than previous methods.
III)
Interpersonal Therapies:
A) Transactional Analysis:
1) Founder: Eric Burne
2) Notes: humanistic, cognitive, etc. repackaging of psychoanalytic theory as well
3) Personality:
(a) Ego States:
(i)
Child:
 natural, playful; behavior is immediate, impulsive, and stimulus bound; not mediated by reason.
Contains: needs, wants, feelings, desires
 The most IMPORTANT part of personality; where all the energy comes from (a.k.a., id?)
 temper tantrums, irresponsibility, wishful thinking, spontaneity
Personality 5
(ii)
Adult:
 acts according to logic and reason; decision making; lacks feeling
 mediates believe what we want, what we believe, and what we do
 develops as result of interaction with the environment
(iii)
Parent:
 critical or nurturing
 the shoulds, right and wrong, how something SHOULD be done
 the 2nd state to develop
(b) Hungers: provide the motivation for behaving; biological and psychological drives: food, recognition,
structure, excitement.
(i)
Stroking: psychological drive. Some forms of stroking more rewarding than others. Much of
transactions are attempts at receiving strokes.
(c) Transactions: units of interactions – carry exchanges of strokes. Many different forms:
(i)
Rituals: safest, stylized form of interchange (small-talk)
(ii)
Games: risky, exciting; attempts to achieve a PAY-OFF. Contain Ulterior transactions.
 “Kick-me”, “uproar”, Karpman Triangle (victim, persecutor, rescuer)
 People are good at playing games and finding others who will play games with them
(iii)
Types:
 Complementary: where transactions is sent and received as expected; goes smoothly
 Crossed: send a message and the response is not expected; response may not be appropriate for
the situation.
 Ulterior: when there tare more than two ego states involved. There is a surface interaction that
appears adult  adult, but there is something below the surface of the interaction that is the
REAL message.
(d) Life Positions:
(i)
before children are 8 years old, they develop a concept about their own worth based on
experiences early in life. Predisposes person to healthy or unhealthy life.
(ii)
I’m Ok, you’re ok: The HEALTHY position
(iii)
I’m Ok, you’re not ok: anti-social bx
(iv)
I’m not Ok, you’re ok: depression
(v)
I’m not Ok, you’re not ok: The most difficult position to reach therapeutically.
(e) Life Scripts:
(i)
the Life-Plan: the role that you are playing out in life given your chosen positions and history of
transactions.
4) Psychopathology:
(a) Result of maladaptive life-script based on unhealthy life position as a result of and maintained by games
and crossed / ulterior transactions.
5) Therapy:
(a) Structural Problems: problems in ego-states: overuse, avoidance, interference of ego states
(b) Cross transactions / games / scripts: patterns of transactions and game-playing
(c) Process:
(i)
Structural Analysis: through which patients become more fully conscious of ego states that were
previously confused, contaminated, or excluded.
(ii)
Transactional Analysis: self-defeating transactions are made conscious, leading to full
awareness of unhealthy transactions and life-positions.
(iii)
Adult: use the adult as the healthy mode of decision making
(iv)
CONSCIOUSNESS RAISING: teaching about modes of functioning, ego states, positions,
scripts, etc.
(v)
CHOOSING: so that more healthy forms of transactions can be choosen.
(d) Content:
(i)
Intrapersonal: Anxiety, esteem, responsibility:
 issues depend on life position and dominant ego states (e.g., a parent-dominated person may
experience abundance anxiety b/c of the constant pressure to conform to idealistic expectations)
(ii)
Interpersonal: intimacy & sexuality, communication, hostility, and control:
 interpersonal relationships can be very troubled due to large amount of games and ulterior and
crossed transactions.
Personality 6
(e) Outcome:
(i)
Transcendence: we can REDECIDE our scripts and learn to develop the adult and nurturing
parent.
(ii)
Meaninglessness: countered by acquiring more quality strokes
(iii)
HEALTH: balance of ego-states, fluidity of moving among them. Take the I’m ok, you’re ok life
position.
6) Therapeutic Relationship:
(a) very active, therapist must be genuine adult, no playing games.
7) Practicalities: going out of practice
8) Research: little research for this approach
B) IPT:
1) Founder: Klerman
2) Notes: started as treatment for depression and used for eating disorders
(a) stresses the role of early interpersonal experience AND cognitive-behavioral influences that create and
maintain later depressions.
3) Personality:
(a) is a function of interpersonal relationships
(b) interpersonal assets and skills are developed (or not) due to early childhood attachments and interpersonal
experiences.
4) Psychopathology:
(a) Related to current interpersonal events as well as childhood interpersonal events.
(b) Current sources of depression are in relationships
(i)
loss and abnormal grief, role disputes, role transitions, interpersonal deficits, family disruptions
5) Therapy:
(a) Process:
(i)
assessing depression, interpersonal dimensions, planning the tx
(ii)
work on one or two relational facets (primary problems); focus on here and now or relational
problems
(iii)
termination: intentionally and explicitly brief tx
(iv)
CONSCIOUSNESS RAISING: about teaching ppl skills
(b) Content:
(i)
Intrapersonal:
 anxiety: originates between people; caused by abandonment, rejection, neglect, etc.
 self-esteem: helps prevent reoccurrence of interpersonal rejects, abuse, neglect. The better we feel
about ourselves, the better others will feel about us. Its roots are between us and significant
others.
 responsibility: Independent events (things that could happen to anybody) and Dependent events
(caused by person’s bxs); goal is to accept more responsibility for dependent events and to
acquire skills necessary to prevent or postpone negative dependent events from occurring.
(ii)
Interpersonal:
 intimacy & sexuality: intimate relationships can be the best buffer against loss and grief, but also
a great cause of it. Teach skills necessary to make intimacy rewarding.
 communication: deficits in communication are often at the core of interpersonal problems; teach
appropriate communications skills.
 hostility: EXPRESSED EMOTION (EE); predictor of relapse
(c) Outcome:
(i)
Transcendence: therapy can provide one with the assets necessary to overcome interpersonal
deficits and develop abilities to create and maintain healthy interpersonal relationships.
(ii)
Impulse Control: impulse problems are rooted in interpersonal deficits; regress to oral fixations,
use therapy (oral) to talk out problems.
(iii)
Fulfillment: found in good attachments to others. Positive interpersonal relations are what bring
meaning to life.
6) Practicalities:
(a) Manualized 12-16 week treatment
7) Research:
(a) Very well researched
Personality 7
(b) combination of med and therapy better than therapy alone
(c) effective for depression
(d) maintains treatment gains over time
(e) NIMH collaborative study suggests IPT beneficial and possibly superior to other therapies
(f) Best disorder: DEPRESSION
IV)
Systemic / Family Therapies:
A) General Systems Theory:
1) treats the individual within the system
2) Know terms: boundaries, hierarchical organizations, dynamic steady states, homeostasis, positive / negative
feedback loops, open systems.
3) Different Systemic Approaches:
(a) Modality: a mode of conducting therapy (i.e., group, family, couple)
(b) Treatment Goal: therapy works to improve the SYSTEM not just the individual.
(c) Paradigm Shift: an epistemological and psychological shift from typical perceptions of pathology, etc.
B) Communication / Strategic
1) Founder: Bateson, Haley, Satir (research on double-bind communication)
2) Psychopathology:
(a) system is involved in unclear and / or hostile communication and ambiguous rules
(b) Pathology develops in the IP (Identified Patient) in order to maintain homeostasis in the system.
3) Therapy:
(a) Content:
(i)
rules for relating: the understood or explicit guidelines for communication within a family.
These provide a stable organization for family functioning. Unclear rules = pathology
(ii)
communication:
 Defines relationships: communication contains a message as well as a command which informs
how the communicators are to relate to one another. Congruent content and command = healthy.
 punctuation: determines nature of relationship
 verbal and non-verbal: the more that families rely on non-verbal communication, the more
ambiguous their rules for relating and problems are more likely to arise.
 symmetrical vs. complementary relating: one leader and one follower = complementary relating;
pathology likely to develop in either form.
(b) Process:
(i)
Satir: worked with family to get to communication of primary feelings as opposed to indirect
communications.
(ii)
Haley: (influence by Erickson) focuses on power: power tactics; paradoxical and straight
directives
(c) Outcome:
(i)
Healthy family:
 self-worth of every member is high
 communication is direct, clear, honest
 rules are flexible, human, appropriate, and subject to change
 link to society is open and hopeful
4) Research:
(a) most robust in treating substance abuse
C) Structural
1) Founder: Minuchin
2) Notes: Adolescent delinquent-based treatment
3) Psychopathology:
(a) Too rigid or too loose boundaries (Disengaged or Enmeshed)
(b) Respond to demands to change by developing abnormalities; one member becomes the IP
4) Therapy:
(a) Content:
(i)
Deal with boundaries and family structure.
(ii)
Assess and change rules of relating
(b) Process:
(i)
marking boundaries or making rigid boundaries more healthy
Personality 8
(ii)
reframing: seeing pathology within the system context as opposed to the one person who is
having difficulty. CONSCIOUSNESS RAISING
(iii)
enactments: family enacts typical relational pattern for the therapist
5) Therapeutic Relationship:
(a) Therapist must first JOIN the family system by accommodating to its rules for relating, then change the
system from the inside.
6) Research:
(a) probably effective with substance abuse, psychosomatic, and conduct disorders
D) Family System
1) Founder: Bowen
2) Psychopathology:
(a) Fusions and triangulations interfere with the differentiation of the self from family of origin.
3) Therapy:
(a) Content:
(i)
Fusions: thinking and feeling or of members of the system
(ii)
Triangulations: roping in a third part to deal with the problems of the relational dyad
(b) Process:
(i)
Observation: the ability to step back and look at interactions within the family from an objective,
dispassionate standpoint.
(ii)
De-Triangulization: becoming extricated from triangles
(iii)
Differentiation: become own person, rather than simply product of family interactional patterns
and triangles.
4) Research:
(a) NO RANDOMIZED CONTROLED OUTCOME STUDIES
E) GENERAL CONCLUSIONS
1) Family therapy is effective for:
(a) alcohol dependence, substance abuse, conduct disorder (MOST COST-EFFECTIVE), and
SCHIZOPHRENIA.
2) Increased reliance on academic training