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Clinical therapies3

cross cultural issues, prevention, consultation

QuestionAnswer
What are Caplan's model three types of prevention? Caplan’s Model: Caplan (1964) distinguished between three types of prevention: primary, secondary, and tertiary.
The goal of primary prevention is to reduce the occurrence of new cases of a mental or physical disorder. Primary preventions are aimed at an entire population or group, examples? Examples are a public education program about depression and suicide, a school-based program for fifth graders to prepare them for the transition to middle school, and prenatal care for low-income mothers.
The goal of secondary prevention is to reduce the prevalence of a disorder in the population through early detection and intervention. specific individuals who have been identified as being at elevated risk. Examples? Providing tutoring to elementary school students who are beginning to have academic difficulties and using a screening test to identify individuals at risk for depression and then providing identified individuals with counseling are secondary preventions.
The goal of tertiary prevention is to reduce the severity and duration of a disorder. target people who ­have already received a diagnosis include relapse prevention and rehabilitation programs. Example? Social skills training for patients with schizophrenia, halfway houses, and Alcoholics Anonymous are tertiary preventions.
What are Gordon prevention model types? Gordon’s Model: Gordon’s (1983) model distinguishes between universal, selective, and indicated prevention:
Universal preventions are aimed at entire populations or groups that are not restricted to individuals who are at risk for a disorder. Ex? A drug abuse prevention program for all high school students in a school district is a universal prevention.
Selective preventions are aimed at individuals who have been identified as being at increased risk for a disorder due to their biological, psychological, or social characteristics. Ex? A drug abuse prevention program for adolescents whose parents have a substance use disorder is a selective prevention.
Indicated preventions are for individuals who are known to be at high-risk because they have early or minimal signs of a disorder. Ex? A drug abuse prevention program for adolescents who have experimented with drugs is an indicated prevention.
The Institute of Medicine (Mrazek & Haggerty, 1996) expanded Gordon’s model to create a continuum of care model that includes ? universal, selective, and indicated preventions are restricted to people who have not received a diagnosis. Treatment strategies ppl who have diagnosis, maintenance strategies ppl who received treatment focus on preventing relapse.
Client-Centered Case Consultation: This type of consultation focuses on? a particular client of the consultee who is having difficulty providing the client with effective services (trouble identifying an appropriate treatment). The consultant’s goal is to provide the consultee with a plan that will benefit the client.
Consultee-centered case consultation focuses on the consultee with the goal of ? improving his ability to work effectively w current and future clients. TBI clients from a specific racial/ethnic minority group. The goal of this type of consultation is to improve the consultee’s knowledge, skills, confidence, and/or objectivity.
Caplan identified several factors that contribute to a consultee’s lack of objectivity. One of these is ? theme interference, which occurs when a consultee’s biases and unfounded beliefs interfere with his/her ability to be objective when working with certain types of clients.
Program-Centered Administrative Consultation: This type of consultation involves working with program administrators to ? help them clarify/resolve problems with an existing mental health program. consultant’s goal is to provide admin. w recommendations for dealing w developing, administering, or evaluating.
Consultee-centered administrative consultation focuses on ? improving the professional functioning of program administrators so they’re better able to develop, administer, and evaluate mental health programs in the future.
Mental health consultation differs from collaboration in what ways? consultant has little or no direct contact with a consultee’s client and is not responsible for the client’s outcomes. In contrast, a collaborator usually has direct contact with the client and shares responsibility for the client’s outcomes.
partnership between a team of health providers and a client ,coordinated approach to shared decision making around health and social issues”. most often occurs in primary care settings where it serves three primary functions improvement of patient care, health outcomes for patients, and decreased healthcare costs. IPC has positive effects on clinical outcomes, the process of care/satisfaction. Research -mixed results w quality of life; physical, emotional,social, practices.
IPC is considered to be particularly useful for addressing multiple/complex healthcare needs of older patients. referred to as integrated care in research. evidence integrated care for older patients is associated w improved access to care, satisfaction with services, fewer ER, long-term care.
Efficacy research studies are also known as clinical trials and maximize internal validity (the ability to draw conclusions about the cause-effect relationship between therapy and outcomes) by maximizing experimental control.
effectiveness research studies maximize ? external validity (the ability to generalize the conclusions drawn from the study to other people and conditions) by providing therapy in naturalistic clinical settings
a useful strategy for evaluating treatment outcomes is to first conduct an? efficacy study to determine a treatment’s effectiveness in well-controlled conditions, and then conduct an effectiveness study in “real world” settings to determine its generalizability, feasibility, and cost-effectiveness
Eysenck’s conclusions were challenged by advocates of psychotherapy who pointed out that his study had several methodological flaws. name 1? comparisons were questionable patients were not randomly assigned/ characteristics could account for recovery rates. use of different criteria produced a recovery rate of 83% for patients who participated in psychoanalytic,30% for patients who did not.
Smith, Glass, and Miller (1980) were the first to use meta-analysis to ? combine the results of studies that compared the outcomes of patients who received psychotherapy to the outcomes of patients in either a no-treatment control group or an alternative (non-therapy) treatment group.
normal distribution, 84% of scores are below a standard deviation of? 1.0, and 80% (slightly less than 84%) are below a standard deviation of .85. Note that, for the exam, you just need to remember that an effect size of .85 means average patient who recd psychotherapy was better off than 80% of patients who didn’t.
Howard and his colleagues (1986, 1996) investigated the relationship between the duration of psychotherapy and its outcomes. Based on the results of their research, they developed what two models to describe this relationship? dosage model aka the dose-effect model states there’s a predictable relationship betwn number of therapy sessions and probability of measurable improvement in symptoms. phase model proposes psychotherapy outcomes can be described in terms of 3 phases
Howard and Colleagues: Howard and his colleagues (1986, 1996) dosage model predicts? predicts that 50% of therapy clients can be expected to exhibit a clinically significant improvement in symptoms by 6-8 sessions, 75% by 26 sessions, and 85% by 52 sessions.
what are the 3 phase of Howard and Colleagues phase model on therapy outcomes? initial remoralization phase-first few sessions- increase in hopefulness. remediation phase- next 16 sessions-involves a reduction in sympt. final rehabilitation ph“unlearning troublesome, maladaptive behaviors and establishing new ways of dealing w/life.
What is the implication of Howard and Colleagues phase model on therapy outcomes? different outcome measures should be used during different phases of therapy –measures of subject well-being during the remoralization. severity/frequency of symptoms during remediation phase, and life functioning during rehabilitation phase.
based on their review of the research, Norcross and Lambert (2011) found what about common elements and psychotherapy outcomes? attribute 30% of variability in psychotherapy outcomes to patient contributions, 12% to the therapeutic relationship, 8% to the treatment method, 7% to therapist characteristics, 3% to other factors, and 40% to unexplained variance.
The psychanalyst, Ralph Greenson (1967), was the first to describe the therapeutic relationship as consisting of what 3 components? working alliance, real relationship, and transference-countertransference. Of these, the working alliance (which is also referred to as the therapeutic alliance) has been studied most extensively
What has research found out about the working alliance in adult therapy clients? “the positive relation of the alliance and outcome remains across assessor perspectives, alliance and outcome measures, treatment approaches, patient (intake-) characteristics, face-to-face and Internet-mediated therapies, and countries”
racial/ethnic matching reduced premature termination rates for ??? but not for ? Sue et al. (1991) effects of matching on treatment outcomes varied. reduced premature termination rates for Asian, Hispanic, European American clients but not African American clients. associated with improved treatment outcomes only for Hispanic A.
What is the evidence that matching in terms of factors other than race and ethnicity are more important for therapy outcomes? Comas-Diaz (2012) report that their review of the research indicated that “clinicians’ cultural competence, compassion, and … worldview were more important than ethnic matching between client and clinician” (2012, p. 173).
Researchers have also investigated the effects of a client-therapist match in terms of personality on the process and outcomes of therapy. What has been found? results indicated -client-therapist personality congruence had a positive impact on the clients’ perceptions of the client-therapist alliance but did not have a direct effect on therapy outcomes.
Research by Perez-Rojas et al. (2021) effects of clients’ perceptions of similarity of therapist w the Big5? Perez-Rojas et al. (2021) effects of clients’ perceptions Big5. clients who perceived their therapists as being similar to them in terms of conscientiousness/openness to experience reported stronger relationships/better progress in therapy.
What gender most like to receive meds and therapy in MH last 12 months? women were more likely than men to have taken medication for mental health conditions and to have received counseling or therapy from a mental health professional in the previous 12 months.
percentage of adults who received any mental health treatment (therapy or medication) in the past 12 months was greatest for respondents ages ? 18 to 44 followed by, in order, those 45 to 64 years of age and those 65 years of age and older.
What barriers have limited colleges students from utilizing mh? Most studies on treatment barriers have found that attitudinal barriers are more often cited by college students than are structural barriers
Research results vary with regard to the effects of stigma (an attitudinal barrier) but have shown what? Studies have confirmed that higher levels of stigma are associated with lower willingness to seek mental health treatment and dropping out of treatment prematurely . research- personal (self) stigma has declined, perceived (public) stigma has not changed
Whats the diff between Education versus contact based interventions for mh stigma? Education-based interventions challenge/replace stereotypes/myths about mental illness/treatment with accurate info. Contact-based interv. provide face-to-face or internet-mediated contact with a person who has successfully managed a mental disorder.
who utilize mental health care services at higher rates than sexual majority (heterosexual) men and women do. sexual minority (gay/lesbian and bisexual) men and women utilize mental health care services at higher rates. two to four times more likely than heterosexual men and women to have talked with a mental health professional in the past year.
different racial/ethnic minority groups, who is most likely to use outpatient MH services? Inpatient? highest for respondents who identified themselves as belonging to 2+ racial groups.lowest Asian. inpatient mh services, highest for American Indian or Alaska Native and lowest for respondents who identified themselves as Asian.
annual average use of outpatient mental services from 2008 to 2012 was highest for respondents reporting two or more races followed by, ? respondents who identified themselves as White, American Indian or Alaska Native, Black or African American, Hispanic American, or Asian. Inpatient highest for respondents who identified themselves as American Indian or Alaska Native followed by Black.
The American Psychological Association has concluded that research on psychotherapy outcomes has “demonstrated that courses of psychotherapy reduce overall? medical utilization and expense”.Chiles, Lambert (1999) meta-analysis.participation in psychological interventions-resulted in a medical cost offset. 90% of the studies included had a medical cost offset. Avg cost savings of psych intervention 20%.
cost-utility analysis (CUA) is used to compare the costs of two or more interventions on quality-adjusted life-years (QALYs), which combines measures of gain in the health-related quality and the quantity (duration) of life. QALYs of three treatments for depression: CT and REBT greater cost-utility than fluoxetine but did not differ significantly from each other.
Low SES research drop out may be to? while some studies have linked low socioeconomic status to premature termination, there’s evidence that this relationship is due to transportation difficulties and other factors.
Differences between Alpha versus beta? Alpha bias is the tendency to exaggerate differences between men and women and can reinforce gender stereotypes and justify discriminatory practices. In contrast, beta bias is the tendency to ignore or minimize differences between men and women.
androcentrism, which means “male-centered”means? occurs when male behaviors and traits are considered to be the norm while female behaviors and traits are viewed as deviations from the norm and often as abnormal or inferior.
Routine outcome monitoring (ROM) is also known as feedback-informed treatment and measurement-based care and is considered? to be a transtheoretical and transdiagnostic evidence-based practice
Transdiagnostic treatments are designed to address a range of diagnoses that not only share symptoms but also biological, psychological, and environmental mechanisms that increase the risk for and maintain those symptoms name 3? Emotion-Focused Therapy-Transdiagnostic, ACT, PCIT, Cognitive Behavioral Therapy-Enhanced (CBT-E)
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders is? is an emotion-focused, cognitive-behavioral intervention for anxiety, depression, etc. Neuroticism as the core characteristic shared. Focus on mechanisms assoc. w neuroticism. deficits in emotion regulation and avoidance of intense emotional experiences.
Telepsych works equivalent to Evid based in what disorders? Anxiety disorders, MDD (CBT-Tele may have lower attrition),pain/insom PTSD mostly no difference (therapy alliance prob) Bulimia (pace of recovery slower online)
Stepped care is a model of healthcare delivery with what two fundamental features? First, the recommended treatment should be the least restrictive, but still likely to provide significant health gain. Second, is self-correcting-results/decisions about treatment. changes are made (‘stepping up’) not achieving significant health gain”
Most Restrictive and Intensive Forms of Care in stepped up care? This step is for patients with severe depressive symptoms and consists of voluntary or mandated inpatient care.
Step 2 – Interventions Requiring Minimal Practitioner Involvement in stepped up care? interventions include psychoeducation and course of depression, treatment options, signs of relapse; bibliotherapy as a preventive technique for high risk for depression or are experiencing an increase in symptoms and as an adjunct to other treatments;
results of studies on DMHIs suggest there is a (Digital MH interventions) show? research-to-practice gap- Randomized controlled trials (efficacy studies) confirm they can have outcomes similar to those of face-to-face psychotherapy.
The functional model views a disability as ? views a disability as the cause of a person’s inability to perform his or her function or role at work or elsewhere. It recognizes a person’s medical condition but focuses on identifying what accommodations, modifications to improve the person’s functg
The social model views a disability as a ? a difference rather than abnormality/deficiency and as due primarily to aspects of society that create barriers for people with disabilities (e.g., negative attitudes, discrimination, exclusion). Interventions focus on making societal/enviro changes.
worldview “affects how we perceive and evaluate situations and how we derive appropriate actions based on our appraisal” what are the two dimensions? locus of control and locus of responsibility:
What wolrdview is most associated is characteristic of mainstream American culture? People with an internal locus of control and internal locus of responsibility (IC-IR) believe they are in control of their own outcomes and are responsible for their own successes and failure
People with an internal locus of control and external locus of responsibility (IC-ER) believe? they could determine their own outcomes if given the chance but that others are responsible for keeping them from doing so.
clients who have an IC-ER worldview are likely to be the most challenging for a White therapist who has an IC-IR worldview because? these clients are likely to view the therapist and therapy as sources of oppression and to be reluctant to self-disclose, to want take an active role in therapy, and “to seek action and accountability from a more privileged therapist”
four acculturation strategies are Integration, Assimilate, Separation,Marginalization. Which will reject the majority and retain their own minority? integration strategy retain own minority culture and adopt major. assimilation strategy reject their own minority culture and adopt the majority. separation strategy retain own minority culture and reject the major. marginalization -reject BOTH
unwillingness to disclose personal information to a White therapist may be due to one of two types of paranoia: Functional paranoia and healthy cultural. Under what circumstance would the healthy disclose? minority client willing to w/minority therapist. White therapist unless certain conditions are met – i.e., the therapist discusses cultural paranoia and encourages the client to distinguish between when it is and is not safe to self-disclose.
What type of micros aggression is old fashioned racisim? Microassaults are explicit racial derogations that are usually intentional and meant to hurt the intended victim. They include name-calling and explicit discriminatory acts and are most similar to what is referred to as “old-fashioned” racism.
Describe a microinsult? pathologizing the culture comm styles of people of color and assuming they dangerous or deviant in some way based on the person’s race. Implying that an African American employee was hired only because of affirmative action is a microinsult.
Give a example of a microinvalidation? assuming that members of racial groups are foreigners, dont acknowledge race (color blindness), and asserting it has no effect on a person’s succes/life outcomes (mythmeritocracy).Assume Asian student was not born US and complimenting his “good English”.
Internalized racism is also known as internalized racial oppression and occurs when a person accepts society’s negative beliefs and stereotypes related to his or her own racial group. Colorism is? internalized racism aka color consciousness. “discrimination within a racial group based on skin hue.may also include hair/ eye color .... [In the US/some countries] prefer lighter skin over darker. skin-lightening is a manifestation of colorism.
White privilege occurs at both macro and micro levels: macro level, systemic and consists of the benefits, rights, immunities that Whites have w/i institutions- fav educational opp/housing conditions, health care, salaries. micro level, intrapsychic and interpersonal;sense of entitlement and social valid..
Negative consequences of white priviledge include? distorted beliefs about racism, limited exposure to people of different race. irrational fear of people. It unacknowledged White privilege can interfere with a White therapist’s ability to develop multicultural counseling competencies
etic perspective? believes that behavior is similar across cultures and that the same psychological theories and interventions are appropriate for everyone, regardless of their cultural background.
Autoplastic interventions focus on making changes? in the client so that he or she can successfully adapt to the environment. Strategies aimed at helping a client gain insight into his or her problems or change his or her behavior
Alloplastic interventions focus on? altering the environment or situation to fit the client’s needs, desires, or other attributes. Removing oneself from a stressful situation – for example, by changing jobs
cultural encapsulation” to explain the inability of some mental health professionals to work effectively with members of different cultural backgrounds- what does it look like in MH? culturally encapsulated mental health professionals are insensitive to cultural differences and believe that their own cultural assumptions about what constitutes mental health or normality applies to people from all cultural backgrounds.
Tight cultures have strong social norms and low tolerance for deviant behaviors; loose cultures have weak social norms and high tolerance for deviant behaviors. Most likely due to survival. Name 2? Pakistan, Malaysia, and India as the three “tightest” countries. Mississippi, Alabama, and Arkansas were classified as the three “tightest” state
loose cultures have weak social norms and high tolerance for deviant behaviors, name 2? California, Oregon, and Washington were classified as the three “loosest” states. Estonia, Hungary, and Israel as the three “loosest” countries.
tight cultures, there is greater? conformity to social norms, a tendency to engage in risk avoidance behaviors, and a preference for stability
individuals living in tight states have higher levels of conscientiousness and lower levels of openness to experience than do individuals living in loose states. Loose states? the opposite is true
High-context communication relies heavily on? name a high content ethnic group? group understanding, nonverbal messages, and the context in which the communication occurs and is characteristic of several cultural minority groups. Black ppl! my ppl!
low-context communication relies on the verbal message, is independent of the context, and is characteristic of ? How does this impact therapy? White (mainstream) culture. problems can arise in therapy when the therapist and client have different communication styles. “the fact blacks more by HC cues has led many to characterize them as nonverbal, inarticulate, [and] unintelligent”
diagnostic overshadowing” was initially used to describe the tendency of MH professionals to attribute all of the problems of people who have received a diagnosis of intellectual disability to that diagnosis and overlook other problems . now? the term has been applied to other client characteristics. therapists are exhibiting diagnostic overshadowing when they assume that the presenting problems of gay clients are due to the clients’ sexual orientation without considering other explanations.
Minority stress theory was developed by Meyer (2003) to explain the increased risk for mental health problems among sexual-minority individual. What are the 2 processes? Proximal processes-within the person. include concealment, fear of rejection, and internalized heterosexism; distal processes are external.verbal and physical harassment, prejudice,discrim. applied to other stigmatized minority groups
credibility and gift giving are important when working with Asian American and other non-Western clients. Why? Credibility refers to the client’s perception of the therapist as trustworthy and is determined by ascribed and achieved status: Ascribed status is the position or role assigned to the therapist by the client’s culture. For example, age and gender
Gift giving refers to ? direct benefits that a client perceives received from therapy. providing client w reassurance, sense of hope, normalizing client’s feelings, and using interventions that reduce the client’s depression or anxiety. Do it soon to help reduce early terminat.
Culturally adapted interventions involve? “the systematic modification of an evidence-based treatment (EBT) or intervention protocol to consider language, culture, and context in such a way that it is compatible with the client’s cultural patterns, meaning, and values
adaptation of EBTs has created a “fidelity-adaptation dilemma” that requires psychotherapists to determine to what degree they will adopt “the standardized nomothetic scientific top-down approach. whats the best way? adaptations are more effective when they involve adding features to an intervention than when they involve replacing a component.most beneficial for clients who have the greatest need for them.clients not fluent in English/low levels of acculturation
When working w Blacks, therapists should (a) consider the client’s cultural identity, level of acculturation, and worldview; (b) keep in mind that racism and other environmental factors may be contributors to the client’s presenting problems. AND? empower the client -helping the client acquire the problem-solving skills he needs to control of own life. usually prefer an egalitarian therapist-client relationship and a time-limited, problem-solving approach. multisystems approach-allsocial netw
working w Amer indian be aware that American Indians often adhere to a collateral social system that incorporates the family, community, and tribe, AND? cooperation, sharing, generosity cultural values. family/tribe take priority individual; wellness depends on the harmony of mind, body, and spirit and illness-disharmony; nonverbal over verbal.
What should therapy look like with American Indians? A collaborative, prob-solving, client-centered approach. no highly direct techq. add values and traditional healers. network therapy, which helps empower clients to cope by w relatives, friend
Hispanic Americans often express psychological symptoms as somatic complaints; (d) consider how a client’s religious and spiritual beliefs might inform assessment, diagnosis, and treatment decisions AND? emphasize family welfare over individual welfare; (f) be aware thes families may be patriarchal. stress machismo (male dom),marianismo (femsub).formal style (formalismo) in the initial therapy session but a more personal style (personalismo)
With regard to interventions, Hispanic/Latino American clients are likely to prefer? CBT, SFT, family therapy, and group therapy. Therapyeffective when it incorporates culturally congruent techs ie cuento therapy ( folktales to present models of adaptive beh) and dichos (proverbs and idiomatic expressions to help express their feelings).
Asian Americans - holistic view of mind- body and express psychological prob. as somatic symptoms; (e) be aware that Asian American families tend to be hierarchical apatriarchal, adhere to traditional gender roles, emphasize family over individual and? a fear of losing face and shame are powerful motivators for Asians-impact discussing personal problems and express emotions; (g) maintain a formal style during therapy;.periods of silence- avoid eye contact are expressions of respect and politeness.
With regard to treatment, Asian Americans are likely to prefer cognitive-behavior therapy and other brief structured goal-oriented, problem-focused approaches that focus more on the family than the individual. What about therapist? expect the therapist to be a knowledgeable expert who gives advice and suggests specific courses of action while also encouraging their participation in identifying goals and solutions to their problems.
LGBTQ men and women are more than twice as likely as heterosexual to have mental disorders during their lives;anxiety, depression, and subst misuse.and there is evidence that ?have more mH than gay/ lesbian. bisexual individuals have more mental health problems than gay/lesb
Heterosexual women have higher utilization rates than heterosexual men do, but ? have higher rates than ? gay men-lesbian women
There is also evidence that identifying as a sexual minority is associated with an increased risk for? premature termination from therapy
LGBTQ affirmative therapy, which is characterized by ? “the integration of knowledge and awareness by the therapist of the unique development and cultural aspects of LGBT[Q] individuals, the therapist’s own self-knowledge
Research has confirmed that milestones usually emerge in the same order but that the ages at which they occur are affected by age cohort, with ?experiencing milestones at earlier ages younger cohorts
lesbian women found that, the greater the extent of disclosure to others, the ? greater the women’s self-esteem and positive affectivity and the lower their anxiety.
compared to gay men who reported they had not disclosed, those who said they had recently disclosed were? significantly more likely to report having major depressive disorder and generalized anxiety disorder.
Heterosexism refers to ? the ideological system that denies, denigrates, and stigmatizes any nonheterosexual form of behavior, identity, relationship, or community”
avoid adopting a “sexual orientation blind” perspective ? ignores or denies the unique experiences of LGB individuals. (c) Consider how your own attitudes toward and knowledge. aware that lesbian, gay, and bisexual individuals=gender conforming or r non-conforming
With the exception of neurocognitive disorder, the rates of mental disorders are ? adults than their younger and middle-aged counterparts lower among older
with regard to depression, older adults are more likely to complain about? anxiety? physical and cognitive symptoms than emotional distress (e.g., to complain of frequent headaches, increased pain.report irritability, insomnia, weight loss, and other symptoms associated with anxiety
what does therapy look like for older adults? Be aware? older adults may respond more slowly to therapy and benefit most when treatment is tailored to their cognitive, sensory, and physical needs.Be familiar with normal biological changes associated with increasing age .CBT reminiscence thy
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