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ACP COMPS EXAM STUDY GUIDE Cheat Sheet (DRAFT) by

2025 ACP COMPS EXAM STUDY GUIDE FOR THE FINAL

This is a draft cheat sheet. It is a work in progress and is not finished yet.

SOCIOC­ULT­URAL: CULTUR­E/D­IVE­RSITY

- Sue & Sue racial identity stages: features of a person in each stage
- JW Berry model of accult­uration
- Culturally encaps­ulated vs culturally humble therapist stance
- Basic terms: implicit bias, privilege, stereo­type, microa­ggr­ession
- Culturally specific commun­ication differ­ences: high/low context, high/low structure, formal­/in­formal
- Importance of accult­uration assessment & culturally tailored treatment for approp­riate groups
- Cultural mediation of child develo­pment: Vygotsky model of culture mediating langua­ge/­cog­nitive develo­pment
- Differ­ential risk of health condit­ions, including suicide in various ethnic­ities

Sue & Sue Racial Identity Stages

Confor­mity:
Accepting and preferring the dominant culture's values, potent­ially devaluing one's own racial identity (leave the old to conform to the new)
Dissonance & Apprec­iating:
Beginning to question dominant culture beliefs, recogn­izing racism, and developing a greater unders­tanding of one's own culture (quest­ioning the new, and apprec­iating the old)
Resistance & Immersion:
Embracing one's own racial heritage, rejecting dominant culture values, and potent­ially feeling anger towards the dominant group (resis­tance to the new and emersion to the old)
Intern­ali­zation:
Also called Integr­ative Awareness. Integr­ating a positive sense of racial identity while recogn­izing and apprec­iating other cultur­es ­(in­ter­nalize & value both)
Also known as the Minority Identity Develo­pment Model

JW Berry Model of Accult­uration

Assimi­lation:
When indivi­duals do not maintain their cultural identity and seek regular intera­ction with other cultures (e.g., changes in language prefer­ence; adoption of dominant attitudes and values)
Separa­tion:
When indivi­duals place value on their original culture and wish to avoid intera­ction with people from other cultures (e.g., not dating outside the race)
Integr­ation
When people maintain their original cultural identity while also intera­cting with people from other cultures (e.g., speak english at work/ school and Spanish at home)
Margin­ali­zation:
When people do not maintain their cultural identity and do not seek intera­ction with people from other cultures
Those who remain the margin­ali­zation stage tend to not do as well
(Social perspe­ctive)

Culturally Encaps­ulated vs Culturally Humble

 
therapist stance

Basic terms:

Implicit bias:
Subtle, often uncons­cious, prejudices influence indivi­duals' judgements towards members of different social groups 
Privilege:
An unearned advantage granted based on group membership
Stereotype
A stereotype is an oversi­mpl­ified and often inaccurate belief or assumption about a group of people. Stereo­types can be harmful and lead to discri­min­ation and prejudice
Microa­ggr­ession:
Everyday subtle intera­ctions or behaviors that commun­icate bias toward histor­ically margin­alized groups. (e.g., a faculty member of color being mistaken for a service person or being forced to choose male or female when completing basic forms)

Culturally Specific Commun­ication Differ­ences

high/low context
high/low structure,
formal­/in­formal

Cultural Assessment

 
Importance of accult­uration assessment & culturally tailored treatment for approp­riate groups

Cultural mediation of child develo­pment

Vygotsky's Socioc­ultural Theory
Believed cognitive develo­pment is influenced by cultural and social factors.
He emphasized the role of social intera­ction in the develo­pment of mental abilities (e.g., speech and reasoning in children).
Srongly believed that community plays a central role in the process of “making meaning.”

Risk in Ethnic­ities

 
Differ­ential risk of health condit­ions, including suicide in various ethnic­ities

Cognit­ive­/Af­fective Basis of Behavior

Learning: Classi­cal­/Re­spo­ndent Condit­ioning

Condit­ioned Response (CR):
A learned response
Uncond­itioned Response (UR):
A unlearned response (e.g., reacting to loud noises, pain, cold, smells, food)
Condit­ioned Stimulus (CS):
A neural stimulus paired with the US that leads to a CR
Uncond­itioned Stimulus (US):
A stimulus that automa­tically triggers a response (UR) without prior learning (e.g., loud noises, pain, cold, smells, food)
Neutral Stimulus(NS):
A stimulus before condit­ioning. Will become a CS after condit­ioning
Example: An US naturally triggers an UR, while a CS, after being paired with the US, elicits a CR
The smell of food (US) naturally makes you hungry (UR), but after pairing a bell with the food, the bell alone (CS) can make you hungry (CR).

Example

Habitu­ation

The uncond­itioned stimulus (US) no longer elicits the uncond­itioned response (UR)
e.g., a person who moves to a home near a train track eventually becomes accustomed to the noise of passing trains (uncon­dit­ioned stimulus). After a few weeks, they no longer startle or wake up (uncon­dit­ioned response) when the trains pass by.
Habitu­ation always involves the uncond­itioned stimulus, not the condit­ioned stimulus

Counte­rco­ndi­tioning & Exposure to Fear

Counter- condit­ioning:
Weakening the malada­ptive condit­ioned response (e.g., fear) by streng­thening an incapable or antago­nistic response (e.g., relaxa­tion)
Example Afraid of Dogs:
Old response: “Fear when they see a dog.” Interv­ention: Person it taught to pet a calm dog while simult­ane­ously practicing relaxation techni­ques. New Response: Over time, they associate dogs' relaxation and calm rather than fear
reciprocal inhibi­tion:
Based off this principle that two incomp­atible responses cannot be experi­enced at the same time, but rather, the stronger response will inhibit the weaker (e.g., fear will inhibit pleasure)
Interventions:
Systematic desens­iti­zation; Sensate focus; Assert­iveness training; and Aversive counte­rco­ndi­tioning

Systematic Desens­iti­zation & Exposure to Fear

Systematic Desensitization:
gradual hierarchy of graded exposure from easy to hard over time. Usually paired with relaxa­tio­n/s­afety (hence a form of counte­rco­ndi­tio­ning)
Used for:
Simple phobias
Research:
The research emphasized that prolonged and intense exposure treatments are more effica­cious for specific phobias.
Scenario:
Imagine you're scared of something, like a big dog. Instead of just jumping right into it, you take tiny steps to get used to it without feeling scared.
First:
You learn how to calm down and feel relaxed, like taking deep breaths
Then:
You start with something small, like looking at a picture of a dog
Next:
You might watch a video of a dog
After that:
You might stand near a dog, but not touch it yet
Finally:
You get brave enough to pet a dog, but only when you’re feeling calm and relaxed

Classical Extinction & Exposure to Fear

Classical Extinc­tion:
A behavioral process that occurs when a condit­ioned response to a stimulus gradually weakens or disappears
Example:
If a dog is condit­ioned to salivate at the sound of a bell, but the bell is rung repeatedly without food, the salivation response will eventually diminish
habituation:
A learning process where an organism gradually reduces their response to a repeated stimulus or situation that is not harmful or dangerous
Interventions:
In Vivo Exposure or Exposure with Response Prevention (ERP); Exposure in imagin­ation

Exposure with Response Prevention (ERP)

ERP (in-vivo exposure):
Exposure to various feared stimuli, gradual or intense, with active prevention of client's usual anxiety mitigating behavior
Used for:
OCD (excessive hand washing), specific phobias, and PTSD
Gradual Exposure:
Start with less distre­ssing situations and gradually progress to more challe­nging ones.
Example:
A person with OCD who fears contam­ination might be exposed to something they believe is dirty (like touching a doorknob), but instead of immedi­ately washing their hands (the compul­sion), they are encouraged to wait and experience the anxiety without performing the ritual.
Response Preven­tion:
Prevent indivi­duals from engaging in their usual compulsive behaviors or rituals while they are exposed to the feared situation.
Example:
Client with dirt/germ phobia must dip hands in mud and sit with dirty hands with therapist until nervous system calms down. Therapist usually actively reframes extreme thinking and overlo­oking of positive or mastery aspects to balance experi­ence.
Habitu­ation:
Allow anxiety to decrease over time through repeated exposure and response preven­tion.
Flooding:
Intense exposure to the worst aspect of fear. Goal is to take a habitu­ation effect.
Used for:
Specific phobias. Strong evidence for post-rape for clients who choose this.
CBT:
Anxious thoughts are often extreme, black-­and­-white, and catast­rophic. Therapists help reframe them, assess pros/cons, realit­y-test, or use experi­ments to challenge fears. This is especially useful for GAD, where varied triggers make desens­iti­zation imprac­tical.

How & When to Apply Counte­r-C­ond­iti­oning

Reciprocal Condit­ioning/ Reciprocal Inhibi­tion- Based:
pairs a competing positive experience (safety, mastery, pleasure) with anxiety to offset anxiety's negative impact (sensate focus, assert­iveness training, systematic desens­iti­zation)
Aversive Condit­ioning (Classical Extinc­tion):
pairs an unpleasant experience (mild-­strong electric shock, gross imagery, nausea) with a high reward, undesi­rable behavior, which is hard to stop
Examples of Aversive Condit­ioning
alcohol misuse/ Antabuse -> nausea
binge eating/ disgusting imagery of maggots on it -> icky food, loss of appetite
erection with images of children/ electric shock-> sexual focus on child less appealing & exciting

Extinction Paradigm for Classical Condit­ioning

Extinction paradigm:
Refers to the process of reducing or elimin­ating a learned behavior by withho­lding the reinfo­rcing conseq­uences that previously maintained it
Example- Think of Pavlov's dog:
If the bell (CS) is rung repeat­edly, but without food (US) following, the dogs will eventually stop salivating (CR) to the bell

Schedules of Reinfo­rcement

Fixed-­Ratio (FR):
Reinfo­rcement delivered after varying amounts of time
Examples:
A factory worker gets paid for every 10 items they manufa­cture; A child gets a sticker for every 5 pages read
Variab­le-­Ratio (VR):
Reinfo­rcement delivered after an unpred­ictable number of responses
Examples:
Slot machines: wins occur unpred­ictably after a varying number of spins; Fishing: catching a fish is unpred­ictable and depends on the number of attempts
Fixed-­Int­erval (FI):
Reinfo­rcement delivered after an unpred­ictable number of responses
Examples:
A student is rewarded for completing a task after a set amount of time (every 20 mins); Receiving a paycheck every two weeks
Variab­le-­Int­erval (VI):
Reinfo­rcement delivered after varying amounts of time
Examples:
Random social media notifi­cat­ions; Checking for email, as the times that new emails come are unpred­ictable
Rates of responding (highest to lowest) -> variable ratio (VR), fixed ratio (FR), variable interval (VI), then fixed interval (FI)
Ratio Schedules:
Based on the number of times a behavior occurs. The more the behavior happens, the more reinfo­rcement is possible. Higher rates in responding
Interval Schedules:
Based on time passing, reinfo­rcement only becomes available after a set period, and the behavior only needs to happen once after that time
Variable Reinfo­rce­ment:
Higher rates in responding because the reinfo­rcement is unpred­ictable
Fixed Reinfo­rce­ment:
Lower rate in responding because it's more predic­table
Patterns of responding
Fixed Schedules
Result in pauses after reinfo­rce­ment. result in more steady response rates. When graphed, this pattern is smooth. Fixed interval (FI) schedule results in the longest pauses after reinfo­rcement
Variable Schedules
Result in more steady response rates. When graphed, this pattern is smooth.
Reinfo­rce­ment: Fixed = Predic­table; Variable= Unpred­ictable
Schedules: Ratio = number of times; Interval = passage of time

TIP: Schedules of Reinfo­rcement

To help remember the order of the schedules, keep in mind first that linking reinfo­rcement to the actual behavior (i.e., ratio) is stronger than linking it to the passage of time (i.e., interval). Next, remember unpred­ict­ability (variable) keeps the subject guessing and trying harder than predic­tab­ility (fixed).

Primary vs Secondary Reinfo­rcers

Primary Reinfo­rcer:
Stimuli that are inherently reinfo­rcing, meaning they satisfy a basic biological need without any prior learning or associ­ation (e.g., food, water, sleep, shelter, safety, pleasure, sleep & sex)
Secondary Reinfo­rcers (also called Condit­ioned Reinfo­rcers):
Stimuli that become reinfo­rcing through associ­ation with primary reinfo­rcers or other secondary reinfo­rcers (e.g., money, grades, tokens, praise)
What is the differ­ence?
A secondary reinforcer is a stimulus reinfo­rcing after being paired with a primary reinfo­rcer, such as praise, treats, or money. Responding to the secondary reinforcer is a learned behavior, not a born reflex

Positi­ve/­Neg­ative Reinfo­rce­men­t/P­uni­shment

Positive Reinforcement:
Involves adding something positive or desirable to increase the likelihood of a specific behavior occurring again
Example
Giving a dog a treat after they sit on command is positive reinfo­rcement
Negative Reinforcement:
Involves removing something aversive or undesi­rable to increase the likelihood of a specific behavior occurring again
Example
Taking away chores for a child if they clean their room is negative reinfo­rcement
Positive Punishment:
Involves introd­ucing an unpleasant stimulus or conseq­uence after an unwanted behavior occurs
Example
A parent gives a child extra chores as punishment for poor grades
Negative Punish­ment:
Involves removing something desirable after an undesi­rable behavior.
Example
A parent takes away a child's phone for not doing their homework
Positive = add stimulus
Negative = remove stimulus
Reinfo­rcement = increase / maintains behavior
Punishment = decrease behavior

Differ­ential Reinfo­rcement of Other Behaviors

DRO:
Combines extinction of one behavior and reinfo­rcement of another behavior to shift a habit
Example
Reinforce taking time to meditate or exercise to lower anxiety while exting­uishing use of sedative medication
Withhold reinfo­rcement for challe­nging behavior:
e.g., A hypera­ctive child is ignored (withh­olding reinfo­rce­ment) when she speaks out of turn (extin­ction)
Providing reinfo­rcement for an approp­riate replac­ement behavior:
e.g., Reinfo­rcing (providing reinfo­rce­ment) when she waits for her turn to speak, is engaged in on-task behavior, raises her hand to ask questions, or remains seated
Also known as DRI (diffe­rential reinfo­rcement of incomp­atible responses) or DRA (diffe­rential reinfo­rcement of altern­ative responses)

Operant Extinction Paradigm

Operant Extinction Paradigm:
When reinfo­rcement is first removed, there may be an intense upsurge in the problem behavior - it's necessary to hang in there and ignore that to avoid giving in with an interm­ittent reinfo­rcement
Operant Extinction Paradigm: (Remove Reinfo­rce­ment)

Extinction Burst

Extinction Burst:
An increase of behavior that occurs when a behavior that has been reinforced in the past is no longer reinforced
Example:
A child who typically cries to get attention may start crying more intensely or for longer periods when attention is no longer given
Example:
A person who has been reinforced for a particular behavior (like asking for something repeat­edly) might increase their requests when the reinfo­rcement is no longer provided

Latent Learning (Tolman)

Latent Learning: (also known as incidental learning)
The subcon­scious retention of inform­ation or skills without reinfo­rcement or immediate behavioral change
e.g., Tolman conducted experi­ments with rats in mazes. Rats that explored the maze without any rewards still formed cognitive maps of the maze. When a reward was later introd­uced, these rats navigated the maze more effici­ently than those without prior exposure, demons­trating latent learning.

Zeigarnik Effect

Tendency to remember unfinished or interr­upted tasks better than completed ones
This phenomenon occurs because incomplete tasks create a state of mental tension, which keeps them active in our memory until they are completed
e.g., Students who interrupt their study sessions to perform unrelated activities may remember the material better than those who finish study sessions without breaks.

Impact of Sleep on Learning & Memory

Sleep is the time where we consol­idate the things we learned

Develo­pment Across the Lifespan

Genetic Disorders

Genetic Disorder
Cause
Impact
Down’s Syndrome
Extra Chromosome 21 (3 vs 2)
Intell­ectual disabi­lity, physical defects, hearing loss, immune & cardiac systems weak
Tay Sachs Disease
Can’t metabolize fats due to missing enzyme, hexosa­min­idase-A
To avoid neural damage, must avoid foods with high fat
Phenyl­ket­onuria (PKU)
Can’t metabolize phenyl­alanine due to enzyme deficiency
Intell­ectual disabi­lity, other neurol­ogical problems. Must avoid hi protein foods with PA
Sickle Cell Disease
Red blood cells sickle shaped, get stuck in capill­aries
No oxygen to tissue, resulting pain hard to handle
Cystic Fibrosis
Recessive - 25% chance when 2 carriers conceive: Aa+Bb-> ab, gene shows symptoms
Thick, sticky mucous clogging lungs/gut, infections destroy lung tissue, shortens life
Klinef­elter’s Syndrome
Males with an extra X chromosome (XXY)
physical, psycho­log­ical, and develo­pmental symptoms, including infert­ility, reduced muscle mass, increased height, and learning diffic­ulties. Abnormal develo­pment of secondary sex charac­ter­istics (breast develo­pment, small testicles, high-p­itched voice.)
Turner Syndrome
Females with the absence or partial absence of one X chromosome
physical and develo­pmental issues, such as short stature, underd­eve­loped sex organs, infert­ility, heart and kidney problems, and learning diffic­ulties. Girls with Turner Syndrome may also have a distinct physical appear­ance, such as a webbed neck, low hairline at the back of the neck, and drooping eyelids.
Fetal Alcohol Syndrome
Teratogen agents in alcohol
delayed growth, physical deform­ities, delayed motor develo­pment, decreased intell­igence, learning disabi­lities, short attention span, restle­ssness, irrita­bility, hypera­ctivity
Intersex Conditions
A group of disorders where sexual develo­pment is different than the normal binary of male or female develo­pment

Critical vs Sensitive Periods

Critical Periods
Limited time periods when certain experi­ences are necessary for the proper develo­pment
Impact:
if the experience is missed, the ability or trait may never develop
Sensitive Periods
Important and flexible periods when the brain is more receptive to experi­ences
Impact:
can still have a signif­icant impact on develo­pment, however catch up is possible

Object Permanence vs Object Constancy

Object perman­ence:
Birth - 2 y/o
The unders­tanding that an object continues to exist even when it is not seen (10 mos), in sensor­imotor stage
Object constancy:
2 - 3 y/o
The ability to maintain the image of the mother when she is not present, as well as to unify the good and bad into a whole repres­ent­ation
object perman­ence: Piaget’s stages in cognitive and intell­ectual develo­pment
object constancy: Mahler stages of develo­pment

Ainsworth Attachment types

Secure
Are warm respon­sive. When exposed to the stranger, these infants seek closeness and contact with the mother, may show moderate distress upon separa­tion, and greet the mother with enthusiasm when she returns. It is hypoth­esized that a parenting style of sensitive and responsive caregiving is associated with secure attachment
Avoidant
Do not seek closeness and contact with the mother, treat the mother like strangers rarely cry when she leaves the room, and ignore her on her return. They may even prefer the stranger over the mother. It is believed that a caregiving style an aloofness and distance, or intrus­ive­ness, and overst­imu­lation is associated with avoidant attachment
Ambivalent
Are clingy and become upset when the mother leaves the room. When the mother returns, the babies are happy and reesta­blish contact, but they show their ambiva­lence by then resisting the mother’s comforting behaviors. They may cry, kick, or squirm to get away. Ambivalent babies do little explor­ation and appear angry toward both the mother and the stranger
Disorg­anized:
No clear strategy in dealing with the mother. They may be unresp­onsive when the mother returns. At times, they may avoid and resist the mother. At other times, they may freeze and stop moving when their mother comes near

Effect of Extreme Neglect

 

Medical Work Up

 
Role medical work up to rule out medica­l/m­edi­cation issues

Pseudo­-de­mentia vs dementia

Dementia (NCDs)
symptoms:
Progre­ssive cognitive decline; often deny memory issues
testing:
treatment:
Irreve­rsible deteri­oration
Pseudo­dem­entia
Cognitive impairment in older adults due to depres­sion, mimicking a neuroc­ogn­itive disorder (NCD).
symptoms:
Slower processing speed, difficulty with concen­¬tr­ation and attention, psycho­motor retard­ation; Patients acknow­ledge memory loss;
testing:
treatment:
Cognitive function improves once depression is treated

Fluid vs Crysta­llized Intell­igence

Crysta­llized
Semantic memory (facts, vocabu­lary). Preserved with age.
Fluid
Processing speed, proble­m-s­olving. Declines with age (slower reaction time, fine motor speed, hand-eye coordi­nat­ion).
Healthy Aging
Mental capacity remains intact, but processing slows

Sleep Changes Over the Lifespan

Functions of REM Sleep:
Psycho­logical restor­ation; Memory consol­idation & emotional proces­sing; Brain develo­pment; Dreaming (often bizarre and illogical)
Newborns:
50%
5-year­-olds:
50-25%
Older adults:
18%
REM sleep decreases with age

Freud’s Psycho­sexual Develo­pmental Stages

Age Period
Psycho­sexual
Main Features
Birth - 1.5 year
Oral
Sucking, chewing, & biting
1.5 - 3 year
Anal
Anus, bladder control
3 - 6 year
Phallic
Genitals, mastur­bation
6 - Puberty
Latency
Sexual feelings
Puberty - Adult
Genital
Sexual interest

Freud vs. Erikson

 
Freud
Erikson
Age
Psycho­sexual Stage
Psycho­social Crisis
Strength
1st year
Oral
trust vs. mistrust
Hope
1-3
Anal
autonomy vs. guilt
Will
3-5/6
Phallic
industry vs. inferi­ority
Purpose
5/6-12
Latency
identity vs. role confusion
Competence
12-18
Genital
intimacy vs. isolation
Fidelity
18-35
  
genera­tively vs. stagnation
Love
35-60
  
integrity vs. despair
Care
60+
    
Wisdom

Piaget Stages of Cognitive Develo­pment

Sensorimotor Stage:
Infants experience the world through senses and actions. Object permanence, the unders­tanding that an object continues to exist even when it is not seen
Preoperational Stage:
Children begin to use symbols and language to represent objects and ideas, but their thinking is still primarily egocentric and concrete. They struggle with concepts such as conser­vation, which is the idea that the amount of substance remains the same even when its appearance changes
Concrete Operat­ional Stage:
Children begin to think logically about concrete events and objects. They can understand conser­vation and begin to grasp concepts such as revers­ibi­lity, classi­fic­ation and cause-­and­-effect relati­onships
Formal operational
Adoles­cents and adults are able to think abstractly and reason hypoth­eti­cally. They can engage in complex proble­m-s­olving and can understand multiple perspe­ctives
Stage
Age
Goal
Sensor­imotor
Birth to 18-24 months
Object permanence
Preope­rat­ional
2 to 7 years old
Symbolic thought
Concrete operat­ional
7 to 11 years
Logical thought
Formal operational
Adoles­cence to adulthood
Scientific reasoning
(attention to pre operations vs concert operations as per (conse­rva­tio­n/i­rre­ver­sib­ility; centra­tion, intuitive thinking, accomm­odation vs assimi­lation)

Assimi­lation vs. Accomm­odation (Piaget)

Schemas:
A way of organizing distinct pieces of knowledge within the human mind. They help us make sense of the past and plan for the future (e.g., Objects, Abstra­ctions, Concepts, Actions)
Centra­tion:
The tendency to focus on one aspect of a problem at a time (e.g., example, a young child will have difficulty seeing his mother in both a mother role and sister role to his aunt. The child cannot process her having two roles.)
Assimi­lation:
The process of taking in a new experience and incorp­orating it into existing cognitive structures or schemas (e.g., a child may label a horse as a dog because it fits their schema of four-l­egged animals.)
Accomm­oda­tion:
The adjustment of existing schemas to make sense of new inform­ation. This process occurs when existing schemas cannot explain new experi­ences (e.g., when a child sees a cat for the first time, they may need to create a new schema for cats that is distinct from their existing schema for dogs)
Assimi­lation & Accomm­oda­tion:
Two Processes constantly work together in develo­­pment of new schemas and the refinement of existing ones. It is essential for cognitive develo­­pment, as it enables indivi­­duals to contin­­uously learn and adapt to their enviro­­nment

Kohlberg stages of moral develo­pment

Stages
Age
Descri­ption
Pre-Conventional Stage
4-10
Obedience & punishment orient­ation (How can I avoid punish­ment?); Self-i­nterest orient­ation (What's in it for me? aiming at a reward)
Conven­tional Stage
After 10
Interp­ersonal accord and conformity (Social norms, good boy-good girl attitude); Authority and social­-order mainta­ining orient­ation (Law and order morality)
Post-Conventional Stage
After 13
Social contract orient­ation (Justice and the spirit of the law); Universal ethical principles (Princ­ipled consci­ence)

Erickson’s Stages

Age
Conflict
Resolution
Culmin­ation in Old Age
Infancy (0-1 year)
Basic trust vs. mistrust
Hope
Appreciation of interdependence and relatedness
Early childhood (1-3 years)
Autonomy vs. shame
Will
Acceptance of the cycle of life, from integr­ation to disint­egr­ation
Play age (3-6 years)
Initiative vs. guilt
Purpose
Humor; empathy; resilience
School age (6-12 years)
Industry vs. Inferi­ority
Competence
Humility; acceptance of the course of one's life and unfulf­illed hopes
Adoles­cence (12-19 years)
Identity vs. Confusion
Fidelity
Sense of complexity of life; merging of sensory, ogical and aesthetic perception
Early adulthood (20-25 years)
Intimacy vs. Isolation
Love
Sense of the complexity of relati­ons­hips; value of tenderness and loving freely
Adulthood (26-64 years)
Genera­tivity vs. stagnation
Care
Caritas, caring for others, and agape, empathy and concern
Old age (65-death)
Integrity vs. Despair
Wisdom
Existe­ntial identity; a sense of integrity strong enough to withstand physical disint­egr­ation

Gilligan’s Theory of Moral Develo­pment

Self-I­n-R­elation Model:
Woman's sense of self is primarily developed and understood through her relati­onships with others
The relational paradox:
Seeking connection while at the same time keeping important parts of oneself out of connection
Gilligan's Stages of Ethic of Care
Stage
Goal
Pre-conventional
Goal is individual survival
Transition is from selfis­hness to respon­sib­ility to others
Conven­tional
Self sacrifice is goodness
Transition is from goodness to truth that she is a person too
Post-conventional
Principle of nonvio­lence: do not hurt others or self

Biological Basis of Behavior

Functions of the Brain Areas

Cerebral Cortex
Involved in many high-level functions, such as reasoning, emotion, thought, memory, language and consci­ousness
Frontal Lobe:
the largest portion of the brain (about ⅓ of the entire brain) divided into prefrontal cortex, premotor area, and motor area
Parietal Lobe:
Primary sensory areas that process somato­sensory inform­ation, sensations of touch, pain, heat, and propri­oce­ption.
Temporal Lobe:
Auditory proces­sing, memory inform­ation retrieval, and involved in emotional behavior. Connected to limbic system (hippo­campus, amygdala, etc).
Occipital Lobe:
Visual percep­tion, visual interp­ret­ation, and reading
Prefrontal Cortex (PFC)
Integr­ation center for all sensory inform­ation and executive functions (decision making, planning, working memory, person­ality expres­sion, social behavior, speech and language). Person­ality center
Broca's area
Controls the muscles that produce speech and language compre­hension
Wernicke's Area
Language compre­¬he­nsion = receives auditory signals from the ear and processes them to understand the meaning of spoken words
Limbic System (Primitive brain)
Regulates emotions (basic survival instin­cts), influences memories/ learning, and motivation (basic drives)
lobes, main struct­ure­s/i­mpa­irments if they get damaged

Divisions of the Brain

Forebrain:
Processes sensory inform­ation, helps with reasoning and proble­m-s­olving, and regulate autonomic, endocrine, and motor functions
Midbrain:
Helps to regulate movement and process auditory and visual inform­ation
Hindbrain:
Helps regulate automatic functions, relay sensory inform­ation, and maintain balance and equili­brium
Types of scans used for the brain/­purpose of each scan

Circadian Rhythms

Circadian Rhythm:
Natural, internal processes that regulate the timing of physio­logical functions, such as sleep-wake cycles, hormone release, and body temper­ature
Suprac­hia­smatic Nucleus (SCN)
A small brain region in the hypoth­alamus that acts as the body's master biological clock, regulating circadian rhythms like sleep-wake cycles, hormone release, and other physio­logical functions
Pineal gland
Helps control the circadian cycle of sleep and wakefu­lness by secreting melatonin
How do they interact?
The SCN sends messages to the pineal gland, which triggers the release of melatonin at night and triggers the release of cortisol and other hormones to help you wake up in the morning

Scans Used for the Brain

Type
Purpose
Uses
MRI
More expensive, detailed images possible with enhanced soft-t­issue resolution to pick up more subtle structural issues. Uses magnetic resonance
tumors, strokes, dementia, epilepsy, Alzhei­mers, Parkin­son's
CT Scan
Quick, cost-e­ffe­ctive images of basic struct­ures, very useful as first-line assessment in emerge­ncies to identify brain issues that need emergent care (brain bleeds, etc). Uses radio
blood clots or internal brain injuries
PET Scan
Detailed metabolic picture of brain function. Can give info about low (Alzhe­imer's, stroke/ blood vessel damaging affecting function) or high (brain tumor or other inflam­matory or cancer) related process. Uses radioa­ctive dye
Alzhei­mer's, stroke, tumors, or cancer

Post-C­onc­ussion Syndro­me/­Sym­ptoms

Aftere­ffects of Head Trauma
Can cause memory impair­ments (post-­tra­umatic amnesia, persistent memory deficits), executive functi­oning distur­bances, and person­ality changes
Phineas Gage Case (1848):
The most well-known case of frontal lobe dysfun­ction. His injury led to drastic person­ality changes, later associated with "­fro­nto­tem­poral dement­ia."­
Aftere­ffects of Concus­sions
May result in a short-term loss of consci­ous­ness, antero­grade amnesia (diffi­culty forming new memories), and retrograde amnesia (loss of past memories)
Common symptoms:
Dizziness, headache, fatigue; Difficulty concen­tra­ting, memory deficits; Irrita­bility, anxiety, insomnia; Heightened sensit­ivity to noise and light; Hypoch­ond­riacal concerns

Etiolo­gy/­tre­atment of Movement Disorders

Defini­tion:
Abnormal repetitive movements
Basal Ganglia:
The reservoir of our over-l­earned motor patterns, like riding a bike, automatic daily habits, backing out of the driveway, etc.
Hypokinetic:
Slow or reduced movements (e.g., parkin­son's disease, dementia with lewy bodies)
Hyperkinetic:
Excess or involu­ntary movements (e.g., huntin­gton’s diseas­e/c­horea, tremors, tics/ tourette's syndrome)
Tourette’s Syndrome:
A neurol­ogical disorder charac­terized by repeti­tive, sudden, and involu­ntary movements or sounds (tics)
Brain Area:
basal ganglia, frontal lobes and cortex
Comorbidities:
OCD; ADHD; Anxiety, Autism
Parkin­son’s Disease:
Damage to the Substantia Nigra, caudate nucleus, and putamen, the dopamine rich brain areas of the mid -brain where it's essential for movement and mood regula­tion. Some people can progress to severe depres­sion, difficulty moving with a cue, and progress to psychosis
Possible Cause:
Bacterial infections (e.g., from foodborne pathogens) may travel via the Vagus nerve, leading to inflam­mation and degene­ration
Symptoms:
Movement diffic­ulties (tremors, rigidity, slowed initia­tion); Depres­sion, psychosis in severe cases
Preval­ence:
Increasing signif­icantly (e.g., Michael J. Fox as a well-known case)
Treatment:
Taking L Dopa (a dopamine precursor) to build up missing dopamine can replace some of the lost dopamine, at least tempor­arily, to slow down progre­ssion and ameliorate symptoms. Music Therapy may aid movement and mood regulation; Deep Brain Stimul­ation (DBS) surgical tx for severe cases; Other psycho­pha­rma­cology (Carbi­dopa; dopamine agonists, enzyme inhibi­tors; amanta­dine; Antich­oli­ner­gics)
Huntington Chorea:
Degene­ration of basal ganglia neurons, resulting in uncont­rol­lable, jerky movements (chori­eform movements) and speech outbursts, and progre­ssive cognitive decline
Cause:
Genetic disorder causing degene­ration of basal ganglia neurons
Symptoms:
Choreiform (jerky, involu­ntary movements); Speech outbursts; Progre­ssive cognitive decline
Onset:
Typically 40–50 years; often passed down before symptoms appear
Treatment:
No cure available
(Parki­nson’s, tics, OCD)

Delirium

Delirium:
A distur­bance in attention and awareness (e.g., reduced orient­ation to the enviro­nment). Cognitive distur­bance (e.g., memory problems, disori­ent­ation, language diffic­ulties, visuos­patial abilities, or perceptual distur­bance)
Features:
Rapid onset and fluctuates (typically worse at night). May involve halluc­ina­tions or bellig­erence requiring meds like Haldol (antip­syc­hotic)
Causes:
Infections (e.g., UTI in elderly), medication reactions, intoxi­cation/ withdr­awal, brain chemistry disrup­tion, or toxic exposures
Course:
Only diagnosed when there is evidence that the symptoms have a physio­logical cause
Treatment:
If the cause is found and removed, it is usually reversible

Aphasias

Aphasia:
Loss of Speech or Language Compre­hension
Receptive Aphasia (Werni­cke’s Aphasia):
Damage to the left temporal lobe (Werni­cke’s area) impairs language compre­hen­sion. The person may speak in gibberish but remain unaware of their incohe­rence. Temporal lobe damage can also affect semantic and long-term memory
Expressive Aphasia (Broca’s Aphasia):
Damage to the posterior frontal lobe (Broca’s area) affects speech produc­tion. The person unders­tands language and knows what they want to say but struggles to verbalize it, causing frustr­ation
Conduction Aphasia:
Damage to the neural pathways between the 2 ares. The message does not get through from Wernicke's area (what you want to say) to Broca's area (actually physically saying it)
Global Aphasia:
Widespread damage affecting both compre­hension and speech produc­tion, severely impairing commun­ication
Damage in all areas interferes with the ability to repeat verbal phrases, but for different reasons

Wernicke’s Enceph­alo­pathy (WE)

Cause:
By thiamine (vitamin B1) defici­ency; most commonly associated with chronic AUD; Malnut­rition; Eating disorders; Hypere­mesis gravid­arum; Prolonged IV therapy; Gastro­int­estinal disorders
Symptoms:
Confusion (mental status changes, disori­ent­ation, difficulty concen­tra­ting); Ataxia (impaired coordi­nation, difficulty walking); Ophtha­lmo­plegia (eye movement abnorm­ali­ties, nystagmus, double vision)
Treatment:
Immediate Thiamine Replac­ement; Address Underlying Cause (e.g., AUD)
When Is It Revers­ible?
If treated early WE is potent­ially revers­ible, with improv­ement in symptoms within days to weeks. If untreated or chronic, it can progress to Korsak­off’s Syndrome (KS), a severe and often irreve­rsible condition charac­terized by profound memory loss and confab­ulation (fabri­cated memories)
Korsak­off's Syndrome:
If WE progresses to Korsak­off's syndrome, the memory and learning deficits may be more persistent and less likely to fully reverse
AUD = alcohol use disorder
Early Treatment is Key

Neurot­ran­smi­tters Functions & Effect

Neurot­ran­smitter
Behavior or Disease Related
Acetyl­choline (ACh)
Learning and memory; Alzhei­mer's Disease's muscle movement in the peripheral nervous system (+ ACh = spasms. - ACh = paralysis)
Dopamine (DA)
Motiva­tion; Reward circuits; Motor circuits involved in Parkin­son's disease; Schizo­phrenia Dysreg­ulation is involved in bipolar disorder (manic episodes) and depres­sion.
Norepi­nep­hrine (NE)
Arousal; Depression
Serotonin (5HT)
Depres­sion, Aggres­sion; Schizo­phrenia behavior
GABA
Anxiety disorders, Epilepsy; Major inhibitory neurot­ran­smitter in the brain
Glutamate
Learning; Major excitatory neurot­ran­smitter in the brain
Endogenous Opioids
Pain; Analgesia (inability to feel pain); Reward
KEY TERMS:
Mania: arousal, aggression
ADHD: learning, memory
Addiction: reward

Disorders & Neurot­ran­smi­tters

Mood Disorders (Depre­ssion, Bipolar Disorder, Anxiety)
Serotonin (5-HT):
Regulates mood, anxiety, and emotional stability. Low levels are linked to depres­sion, anxiety disorders, and mania
Dopamine (DA):
Associated with motiva­tion, reward, and pleasure. Dysreg­ulation is involved in bipolar disorder (manic episodes) and depression
Norepinephrine (NE):
Plays a role in alertness, energy, and stress response. Low levels contribute to depression and fatigue, while high levels are linked to anxiety
Glutamate (Glu):
The brain’s main excitatory neurot­ran­smi­tter. Imbalances are associated with bipolar disorder, depres­sion, and schizo­phrenia
GABA:
The primary inhibitory neurot­ran­smi­tter, promoting relaxation and reducing excita­bility. Low GABA levels are linked to anxiety disorders and mood instab­ility
Psychotic Disorders (Schiz­oph­renia)
Dopamine (DA):
Excessive dopamine activity is associated with positive symptoms (hallu­cin­ations, delusions). Low dopamine is linked to negative symptoms (apathy, cognitive deficits)
Glutamate (Glu):
Dysfun­ction in glutamate signaling, partic­ularly at NMDA receptors, may contribute to schizo­phrenia symptoms
GABA:
Impaired function can contribute to cognitive and sensory processing deficits in schizo­phrenia
Memory and Cognitive Function
Acetylcholine (ACh):
Essential for learning and memory. Low levels are associated with Alzhei­mer’s disease and other dementias
Glutamate (Glu):
Crucial for synaptic plasticity and memory formation. Dysreg­ulation is linked to neurod­ege­ner­ative disorders (Alzhe­imer's, Parkin­son's, ALS, Huntin­gton's, Fronto­tem­poral dementia, ataxias)
Dopamine (DA):
Supports working memory and executive function. Impair­ments are observed in Parkin­son’s disease and schizo­phrenia
Sleep Regulation
Serotonin (5-HT):
Plays a role in sleep onset and regulation of REM sleep
GABA:
Promotes relaxation and inhibits wakefu­lness, essential for deep sleep
Melatonin:
A hormone influenced by serotonin, regulating the sleep-wake cycle
Orexin (Hypocretin):
Promotes wakefu­lness; defici­encies are linked to narcolepsy

Uses & side effects of major psycho­tropic drugs

 
(anti-­psy­cho­tics, anti-d­epr­ess­ants, mood stabil­izers, stimul­ants, sedatives)
Examples: Tardive dyskin­esia, akathisia, anti-c­hol­inergic effects
Withdrawal effects of drugs & substances
Including substances especially dangerous to withdraw from

Uses & side effects of major psycho­tropic drugs

 
(anti-­psy­cho­tics, anti-d­epr­ess­ants, mood stabil­izers, stimul­ants, sedatives)
Examples: Tardive dyskin­esia, akathisia, anti-c­hol­inergic effects
Withdrawal effects of drugs & substances
Including substances especially dangerous to withdraw from

Withdrawal effects of drugs & substances

 
Including substances especially dangerous to withdraw from
  

Assessment & Diagnosis

Fluid & Crysta­llized Intell­igence on WAIS

Senior Scores in the WAIS:
Scores on the processing speed index (PSI) decline more signif­ica­ntly; Scores on the verbal compre­hension index (VCI) stay the same*
Crysta­llized Intell­igence-
Older adults find vocabu­lary, inform­ation, and compre­hension the easiest of the subtest and scores on the subtests may only begin to show a decline in the 70’s
Fluid Intell­igence-
The perfor­mance subtests are therefore experi­enced as the most difficult, with subtest scores beginning to decline in the 30’s or 40’s

Releasing Test Results

The Ethics Code defines test data as: "raw and scaled scores, client­/pa­tient responses to test questions or stimuli, and psycho­logists notes and recordings concerning client­/pa­tient statements and behavior during an examin­ati­on"
Psycho­logists should release test data to the client or to whomever is designated on a client's release of inform­ation form.
From an ethical perspe­ctive, psycho­logists may refuse to release the data if they believe doing so would cause "­sub­sta­ntial harm, or the misuse or misint­erp­ret­ation of test data."
If a client has not signed a release of inform­ation, psycho­logists may only release data if mandated by law or a court order.
Releasing test results: when ok to release raw data, honor client’s choice to receive data/note obsole­scence if tests are old when test results are released

Purpose of Projective Tests

Purpose of Projective Tests
The premise underlying projective testing is the projective hypothesis
Projective Hypothesis
When persons are presented with unstru­ctured stimuli to interpret or elaborate upon, it is believed that they project material from their uncons­cious onto the stimuli. Thus their interp­ret­ations and elabor­ations will reveal uncons­cious material from their psyche, such as repressed wishes, conflicts, and preocc­upa­tions

Differ­ential diagnosis of Pediatric disorders

 

Differ­ential of psychotic disorders

 
Schizo­-af­fective vs Schizo­phrenia vs (Bipolar) Mood disorder vs Delusional Disorder

Differ­ential Diagnosis of Anxiety Disorders

 
Social Anxiety Disorder vs Genera­lized Anxiety Disorder vs OCD vs OC person­ality disorder

Treatment, Interv­ention

Domestic Violence

 
Safety Issues

Depression Treatment

 

Anxiety Disorders Treatment

 

Bipolar Disorder:

 
genetic etiolo­gy/­tre­atment, including psycho­pha­rma­cology.

Psycho­dynamic

 
Basic psycho­dynamic defense mechan­isms. Freud vs Adler

Group Therapy

Group Stages
Yalom has proposed that process groups evolve through three stages
Initial Stage:
Partic­ipation is hesitant. The group discusses topics of little personal signif­icance and searches for common­ali­ties. Members give and seek advice. In this stage, group members typically talk to the therap­ists, rather than with one another
Second Stage:
Conflict among group members. Rebellion toward group leaders. Attempts at dominance.
Third Stage:
If the second stage is succes­sfully negoti­ated, the gThe develo­pment of closeness, intimacy and cohesion. Group members talk freely with one another
Yalom's 12 Therap­eutic Factors:
Instil­lation of Hope:
Members recognize other member's improv­ement and develop optimism for their own improv­ement
Univer­sality:
Members realize that they are not alone in their feelings, impulses, thoughts, and problems
Imparting inform­ation:
Education and advice provided by the group members and therapist
Altruism:
Members boost their self-e­steem and sense of value and signif­icance by helping other group members
Family dynamics re-ena­cted:
The opport­unity to re-enact family dynamics within the safety and corrective manner of a group setting
Develo­pment of social­izing techni­ques:
Provides an enviro­nment for group members to have social develo­pment, tolerance, empathy, and other interp­ersonal skills
Imitative behavior:
Group members expand their own knowledge and skills by observing other member's self-e­xpl­ora­tion, working through, and personal develo­pment
Interp­ersonal learning:
Input: members gain personal insight about their interp­ersonal impact through feedback provided by other members. Output: members provide an enviro­nment that allows members to interact in a more adaptive manner and practice new skills
Cohesi­veness:
Gives members a sense of trust, accept­ance, belonging, and security
Catharsis:
Members release strong feelings or suppressed emotions about past or present experi­ences
Existe­ntial factors:
Members accept respon­sib­ility for their life decisions – by living 'exist­ent­ially', members learn how to accept respon­sib­ility without escaping from them
Self-u­nde­rst­anding:
Members gain insight into psycho­logical motivation underlying behavior and emotional reactions
Fostering cohesion in groups
Cohesi­veness is the most important. Encourages accept­ance, intimacy and unders­tan­ding, and honest expression (even conflict towards member and leaders)
Group Norms
Therap­ist’s Role: Shape the group into a therap­eutic social system. Establish group norms (rules­/gu­ide­lines) through direct and indirect influence

Structural vs Strategic Family Therapy

Structural Therapy
Theory of Change:
Change occurs through restru­cturing the family’s organi­zation
Role of the Therapist:
Therapist is active and involved. Helps the family understand how family structure (relat­ion­ships and hierar­chies) can be changed, the impact of rituals and rules, and how new patterns of intera­ction can be integrated into the family
Treatment Goals:
Restru­cture family system to allow for symptom relief and constr­uctive proble­m-s­olving; Change dysfun­ctional transa­ctional patterns and create new ways of relating; and Help create flexible boundaries
Phases of Therapy:
Beginning:
Join with family; both accomm­odate to and challenge rules of family system; assess­men­t/m­apping of hierarchy, alignm­ents, and bounda­ries; reframing of problem to include whole system
Middle:
Highlight and modify intera­ctions; utilize enactments of issues to challenge partic­ipants and unbalance system
End:
Review progress made; reinforce structural change; provide tools for future
Strategic Therapy
Theory of Change:
Change occurs through action­-or­iented directives and parado­xical interv­entions
Role of the Therapist:
Therapist delivers directives that facilitate change, partic­ularly around patterns of commun­ica­tion. Focuses on solving proble­m/e­lim­inating symptoms. Designs a specific approach for each person’s presenting problem
Treatment Goals:
Solve the presenting problems & Change dysfun­ctional patterns of intera­ction
Phases of Therapy:
Beginning:
Define the problem; determine how the client unders­tands the problem; assess family’s destru­ctive patterns of relating and commun­icating the continued problem; state goals – what behaviors need to change and what would be the signs of change
Middle:
Review attempted solutions; assign ordeals; prescribe the problem; relabel behavior; instruct client to respond to the problem in a new way
End:
Plan for mainte­nance of new behavior; plan for future challe­nges; emphasize positive changes made

Rational Emotive Behavioral Therapy (REBT)

Major compon­ents:
Direct instru­ction, persuasion and logical disput­ation
Emotional distur­bances:
Thought to result from irrational beliefs. Ellis believed that one's beliefs about the event result in the conseq­uences
ABC Model (inter­ven­tion):
Helps clarify the role of cognition in behavior:
A =
the activating event
B =
the belief
C =
the conseq­uence or emotio­nal­/be­hav­ioral outcome
DEF (treat­ment):
The DEF component is the result of therapy
D =
the disputing interv­ention
E =
the adoption of a more effective philosophy
F =
the new feelings

CBT vs. ACT

CBT:
Focuses on identi­fying and changing negative thought patterns and behaviors, providing structured solutions to current problems
ACT:
Focuses on identi­fying and changing negative thought patterns and behaviors, providing structured solutions to current problems

Trauma

 
post-t­rauma interv­entions recomm­ended vs contra­ind­icated

Interv­ention Levels

Primary Prevention
Prevents the problem or disorder from occurring altogether (e.g., mammog­rams, hotlines, aggres­sively treating children with conduct disorder to prevent the develo­pment of antisocial person­ality disorder)
Secondary Prevention
Involves early identi­fic­ation of and aggressive treatment for a disorder or problem that already exists (e.g., mammog­rams, hotlines, aggres­sively treating children with conduct disorder to prevent the develo­pment of antisocial person­ality disorder)
Tertiary Prevention
Targeted at minimizing the long-term conseq­uences of a chronic condition (e.g., vocational rehabi­lit­ation and day treatment centers for clients with schizo­phr­enia, and 12-step programs for alcoholics or addicts)
Community Psychology
bringing mental health care into the community instead of just relying on hospitals and clinics
Prevention →
Stopping mental health problems before they start
Treatment →
Helping people who are struggling
Rehabi­lit­ation →
Supporting people in recovery

Etiolo­gy/­tre­atment of movement disorders

 
(Parki­nson’s, tics, OCD)

Ethical, Legal, & Profes­sional Issues

First Response to Observed Unethical Behavior

What should be the first action?
Attempt to resolve the issue by bringing it to the attention of that individual if an informal resolution appears approp­riate and confid­ent­iality will not be violated 
What is not approp­riate for informal resolu­tion?
  When it can violate any confid­ent­iality rights that may be involved
What if it’s unsucc­essful or not approp­riate?
Psycho­logists take further action (e.g., referral to ethics committees or licensing board) unless such action conflicts with confid­ent­iality rights in ways that cannot be resolved

Multiple Relati­onships

When do multiple relati­onship occur?
A multiple relati­onship exists when a therapist enters into a non-pr­ofe­ssional relati­onship with a current client, or with someone close to the client (e.g., the client's boyfriend or sister)
When should a psycho­logist not enter into a multiple relati­onship?
If it might impair the psycho­log­ist's object­ivity, compet­ence, or effect­ive­ness, or if it might harm or exploit the other party.
Is a multiple relati­onship unethical?
The Ethics Code explicitly states that a multiple relati­onship is not in and of itself unethical
When is a multiple relati­onship unethical?
"­Mul­tiple relati­onships that would not reasonably be expected to cause impairment or risk exploi­tation or harm are not unethi­cal­" 

Conflict of Interest

3.06 Conflict of Interest : Psycho­logists refrain from taking on a profes­sional role when personal, scient­ific, profes­sional, legal, financial, or other interests or relati­onships could reasonably be expected to:  (1) impair their object­ivity, compet­ence, or effect­iveness in performing their functions as psycho­logists or  (2) expose the person or organi­zation with whom the profes­sional relati­onship exists to harm or exploi­tation.

Informed Consent

When is informed consent required?
When psycho­logists engage in research, assess­ment, therapy, counse­ling, or consul­tation
What kind of language should they consider?
The language used must be reasonably unders­tan­dable to the clients
What is an exception to this requir­ement?
When laws or govern­mental regula­tions mandate conducting these activities without consent (e.g., in a court-­ordered evalua­tion, consent is not obtained. The client is, however, informed of the purpose of the evaluation and limits of confid­ent­iality)
Who signs informed consent for a minor?
Psycho­logists must obtain permission from a legally authorized person (e.g., legal guardian). Psycho­logists have a respon­sib­ility to protect the client’s rights and well-b­eing, even if the law does not require them to get consent from a legally authorized person.
Do you need informed consent from a client who is mandated by court?
When someone is required by a court to receive psycho­logical services (like therapy or an evalua­tion), the psycho­logist must: Explain the services; Clarify that it’s mandatory; and Discuss confid­ent­iality limits
Do you need a written informed consent for mandated services?
Psycho­logists must record that informed consent (or assent) was given—­whether it was written or spoken. At minimum, a psycho­logist should note in the client’s records that they explained the inform­ation and the client understood it.

Treating Minors (Record Release/ Informed Consent)

Who consents to treatment?
Legal guardi­an/­parent or 12+ if mature and potential harm to client if the guardian is aware
Who holds privilege?
If 12 y/o signs consent and is the holder of privilege (psych­ologist and client assert privilege together)

Informed Consent in Human Studies

Code 8.02 Informed Consent to Research
Ensures partic­ipants understand what they’re signing up for and can make an informed decision
Purpose & Process
Explain what the study is about, how long it will take, and what partic­ipants will do
Voluntary Partic­ipation
Partic­ipants can choose to join or leave at any time
Conseq­uences of Leaving
Any potential impact of withdr­awing should be explained
Risks & Confid­ent­iality
Inform partic­ipants of any risks, discom­fort, or limits to privacy
Potential Benefits
Explain what, if anything, partic­ipants might gain from the research
Confid­ent­iality
Clarify what inform­ation will be kept private and what won’t
Incentives
If partic­ipants are paid or rewarded, they should know upfront
Contact for Questions
Provide a person they can reach out to with concerns
Deception
Resear­chers still need to get consent
Experi­mental Treatments
Additional details must be included:
: Clearly state that the treatment is experi­mental; Explain whether the control group gets a treatment or not; Describe how partic­ipants are assigned to groups; Provide altern­ative treatment options if partic­ipants withdraw; and Clarify any costs or compen­sation, including insurance coverage
The goal of these requir­ements is to protect partic­ipants and ensure ethical research practices

Confid­ent­iality Compli­cations in Group Therapy

 When psycho­logists provide services to several persons in a group setting, they describe at the outset the roles and respon­sib­ilities of all parties and the limits of confid­ent­iality

Confid­ent­iality Compli­cations in Family Therapy

Code 10.02 Therapy Involving Couples or Families
Includes spouses, signif­icant others, or parents and children
First Step:
When psycho­logists take reasonable steps to clarify at the outset: (1) Which of the indivi­duals are client­s/p­ati­ents, and; (2) The relati­onship the psycho­logist will have with each person (e.g., services provided, info obtained, limits of confid­ent­iality)
Multiple Relati­ons­hips:
If it becomes apparent that psycho­logists may be called on to perform potent­ially confli­cting roles (such as family therapist and then witness for one party in divorce procee­dings), psycho­logists take reasonable steps to clarify and modify, or withdraw from, roles approp­riately

Protocol for Release of Records

Family Therapy:
All members of the family must sign the release of records.
Divorce Cases:
Whoever has legal custody has to sign, ask to see the custody agreement form to verify. Also consider medical custody
Treatment of Minors:
Legal guardian consents, 12+ mature and paying own fees, don’t have to disclose to the family if disclosing harms the minor. Docume­nt/­history of why 12+ client could consent and reason why not disclosing to family due to potential harm (e.g., pregnant, transg­ender, etc.)

Mandated Reporting for Psycho­logists

Danger to Others:
"­Tar­aso­ff" Duty to Protect: Applies when a client commun­icates a serious threat of physical violence against a reasonably identi­fiable victim to their therapist
Danger to Self:
Client is in imminent risk of harming themselves (e.g., has a plan, means, and intent)
Child Abuse:
Includes suspicion of physical, sexual, emotional abuse, and neglect
Child/­Elder Abuse:
Includes suspicion of physical, emotional, financial, sexual, or neglect
Tarasoff Law
Can be collateral inform­ation from a family member

Proper Response to Subpoenas

Who usually issues a subpoena?
Subpoenas are usually issued by attorneys and may be a subpoena alone (requiring the therapist to appear for questi­oning) or a subpoena duces tecum (requiring the therapist to appear with the client records).
Can subpoenas be ignored?
 Subpoenas cannot be ignored.
What are the first actions when receiving a subpoena?
A psycho­logist should first contact the client, inform the client of the subpoena, and seek the client's permission to release inform­ation. If the client grants permis­sion, the psycho­logist may release the records.
What happens if the client grants permission to release the records?
The psycho­logist may release the records.
What happens if the client does not grant permis­sion?
The psycho­logist may first contact the attorney who issued the subpoena, requesting that the subpoena be quashed (nullified or voided).
What happens if the subpoena is not quashed?
The psycho­logist must appear at the designated location (court­house or attorney's office) and bring any requested records.
What should the psycho­logist do in court?
The psycho­logist should then assert patien­t-t­her­apist privilege, and neither testify nor turn over the records, unless ordered to do so by the court. 

Court Ordered Eval vs. Court Ordered Treatment

Court-­App­ointed Eval:
The psycho­logist is retained by the court
Who is the client?
The court is the client
Privilege:
An exception to privilege; in a court-­app­ointed evals, privilege does not exist
Informed Consent:
There is no requir­ement that the psycho­logist get the defend­ant's consent to partic­ipate. 
Confid­ent­iality:
The defendant has no confid­ent­iality rights however, the psycho­logist must explain the nature of the evaluation and the limits of confid­ent­iality to the defendant prior to beginning the evalua­tion. 
ROI:
The results of the eval are to be shared with the court, no signed RIO is needed
Court-­Ordered Therapy:
The client hires the psycho­logist
Who is the client?
The client is the client
Privilege:
The client may invoke or assert privilege (or have the psycho­logist do so on the client's behalf) 
Informed Consent:
The psycho­logist who agrees to treat this client must make sure to clarify the nature of the treatment that has been ordered by the court, as well as the inform­ation that the court needs. They must then discuss this inform­ation with the client and obtain informed consent.
Confid­ent­iality:
The client has confid­ent­iality rights and there is a need for a release
ROI:
The psycho­logist must generallyobtain a signed ROI from the client in order to be able to commun­icate with the court.  At the end of treatment, or period­ically throughout treatment, the court requests inform­ation from the treating therapist
Privilege is the client's right to keep confid­ential commun­ica­tions from being disclosed in a legal proceeding

Internet Searches of Clients by Therapist

It’s unethical and you shouldn’t do it. - Dr. Forman 

Sex with Clients

Code 10.05- Sexual Intimacies with Current Therapy Patients
Current Clients:
Never engage in sex
Code 10.08 Sexual Intimacies with Former Therapy Clients/ Patients
Former Clients:
May never have sex with a former client unless at least two years have passed since treatment ended
After Two Years:
Still, should not enter into sexual relati­onships with former clients unless the "most unusual circum­sta­nce­s" exist
Things to Consider:
The burden remains on the psycho­logists to prove that there has been no exploi­tation, especially in light of seven factors: time passed since termin­ation; the nature, intensity, and duration of treatment; circum­stances of termin­ation; personal history of the client; the client's current mental status; the likelihood of adverse impact; and sexual statements made during treatment

Treating Former Sexual Partners

Code 10.07 Therapy with Former Sexual Partners
Psycho­logists may never treat previous sexual partners

Finances

Waiving co-pays:
We can waive co pay if it's okay with insurance company or if we reach out to them and ask to waive the co pay (means we are willing to work for less money)
Using collection agencies:
Must be indicated in the initial consent forms/­pra­ctice parame­ter­s. ­Psy­cho­logists first inform the person that such measures will be taken and provide that person an opport­unity to make prompt payment.
Changing diagnosis:
We can’t change diagnosis for insurance benefit

Client Abando­nment

Client Abandonment:
Should never abandon a client
Code 3.12 Interr­uption of Psycho­logical Services
Includes:
Make plans for contin­uation of care in the event of their reloca­tion, illness, death, reloca­tion, or financial limita­tions
"A Profes­sional Will"
Refers to the plans made. The Ethics Code qualifies this requir­ement with the statement "­unless otherwise covered by contra­ct" 
Code 10.09 Interr­uption of Therapy
Includes:
Psycho­logists should make sure to provide approp­riate resolution to their clients continue to receive proper care. The client's well-being should always come first, and efforts should be made for a smooth transition
Termin­ating a Client:
Consider safety of client and psycho­logist
Code 10.10 Termin­ating Therapy
When to Terminate:
When it is reasonably clear that the client no longer needs, is not benefiting from, or is being harmed by treatment; if the client, or someone in a relati­onship with the client, is threat­ening or endang­ering the psycho­logist
Includes:
Should usually be preceded by preter­min­ation counseling (e.g., suggesting altern­ative treatment providers)
Exceptions for Preter­min­ation Counse­ling:
Actions of clients make it impossible (e.g., sudden refusal to attend therapy sessions) or when it is prohibited by third-­party payors (e.g., managed care companies)

Goals of Superv­ision

-Growth and develo­pment through teaching
-Gatek­eeping
-Promoting supervisee growth and develo­pment through teaching.
-Prote­cting the welfare of the client.
-Monit­oring supervisee perfor­mance and gateke­eping for the profes­sion.
-Empow­ering the supervisee to self-s­upe­rvise and carry out the above goals as an indepe­ndent profes­sional.

Treating Minors (Record Release/ Informed Consent)

 

Culturally Encaps­ulated vs. Culturally Humble

Cultural Encaps­ula­tion:
Cultural Humility:
Cultural Compet­ence: