Chapter 3 of 629% of exam

Areas of Clinical Focus

This is one of the two largest domains, and it lists the concerns clients bring: grief, development across the lifespan, career, culture and discrimination, trauma, violence, anxiety, depression, substance use and many more. Most items name a theory or model that explains the concern, or the approach a primary source recommends for it.

Development across the lifespan

Developmental theories give the vocabulary for many scenarios, from a toddler's attachment to an older adult's life review. Match the age and the task described to the theorist's stage.

Erikson

Eight psychosocial stages from trust versus mistrust to integrity versus despair; middle adulthood is generativity versus stagnation.

Erikson, Childhood and Society (1950)

Piaget

Preoperational children fail conservation tasks; concrete operational children reason logically about tangible things; abstract reasoning comes with formal operations.

Piaget & Inhelder, The Psychology of the Child (1969)

Marcia

Identity status depends on exploration and commitment: diffusion, foreclosure, moratorium, achievement.

Marcia, J Pers Soc Psychol 1966

Attachment

Ainsworth described secure, anxious-avoidant and anxious-resistant patterns; Bowlby described protest, despair and detachment after separation.

Ainsworth et al. (1978); Bowlby (1973)

Grief, stress, trauma and violence

Loss and trauma items test whether you know the models and the order of care. Trauma-informed work starts with safety; grief models differ on whether mourning is a series of stages or a set of tasks.

Grief models

Kubler-Ross described stages in dying patients; Worden framed mourning as tasks; Doka named grief that is not socially recognized as disenfranchised.

Kubler-Ross (1969); Worden (2009); Doka (1989)

Safety first

The initial objective of trauma-informed treatment is establishing safety, including safety from overwhelming symptoms.

SAMHSA TIP 57

Trauma-informed principles

Safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; cultural, historical and gender issues.

SAMHSA trauma-informed approach (2014)

Cycle of violence

Walker described tension building, an acute battering incident, and loving contrition.

Walker, The Battered Woman (1979)

Stress

Selye's general adaptation syndrome moves from alarm to resistance to exhaustion.

Selye, The Stress of Life (1956)

Career, culture and identity

Career items draw on a handful of theories that each explain something different: fit, lifespan roles, narrowing of options, or chance. Cultural items test models of identity development, acculturation and everyday discrimination.

Holland

Six RIASEC types are matched to work environments; the Social type prefers helping and teaching people.

Holland, Making Vocational Choices (1997)

Super

Growth, exploration, establishment, maintenance and disengagement across the life span.

Super (1990)

Gottfredson and Krumboltz

Children circumscribe options by sex type and prestige; planned happenstance turns unplanned events into opportunities.

Gottfredson (1981); Mitchell, Levin & Krumboltz (1999)

Acculturation

Berry's strategies are integration, assimilation, separation and marginalization.

Berry, Applied Psychology 1997

Microaggressions

Sue and colleagues distinguish microassaults, microinsults and microinvalidations such as color blindness.

Sue et al., Am Psychol 2007

Mood, anxiety, eating, sleep and addiction concerns

For symptom-based concerns, the NCE tests the approach rather than the diagnostic criteria. Know which technique targets which pattern, and how readiness to change shapes substance use work.

Compulsions

Exposure and response prevention, a form of CBT, exposes the client to triggers while preventing the compulsive response.

NIMH, OCD publication

Panic

Interoceptive exposure targets fear of the bodily sensations of panic.

NIMH, Panic Disorder publication

Insomnia

Stimulus control re-links bed with sleep: bed only when sleepy, leave the bed if awake, fixed wake time, no naps.

Bootzin (1972); AASM guideline (2021)

Stages of change

Precontemplation, contemplation, preparation, action and maintenance; people cycle through them rather than moving in a straight line.

SAMHSA TIP 35

Binge eating

Binge-eating disorder involves loss-of-control eating without the purging that marks bulimia nervosa.

NIMH, Eating Disorders publication

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