Friday, December 9, 2011

Starting my Master's degree at Walden University

After a long and often arduous journey through the psychology program at the University of Phoenix, I decided to embark upon the next part of my academic pursuits at Walden University.  I chose Walden because it is one of the few universities offering an online CACREP-accredited program.  This is, as you probably know, an important choice to make if your goals include gaining licensure for mental health counseling.   This was my first week at Walden.

I would love to tell you that I approach this next phase of my education without trepidation, although my honest feeling is that the University of Phoenix did not adequately prepare me for making my way comfortably amidst authentically intelligent, serious graduate students.  The formulaic approach, lack of challenge, lackluster discussions, and the impractical and unrealistic venture into collaborative practice called team assignments were some of the components to that particular online education that made the journey arduous. 

In my new educational venue, I feel spastic and somewhat nervous that I won't find my way around the new website, library, and classroom discussions.  I will say the University of Phoenix library is spectacular and at this time, seems more easily navigable than my new university library.  I am, however, well aware of the constraints of new places, so stay tuned for the rest of the story!

I am interested in your plans after graduation.  Please email me and let me know.

Thanks for reading.

Monday, October 17, 2011

Pay It Forward

This author had the honor and pleasure of providing a traditional turkey dinner for a large group of homeless people at a local religious facility. Although done primarily to accomplish the assignment herein, she found pleasure and a sense of goodness from this act of volunteerism. Because she did not do the action altruistically (she had reason and expectation), perhaps the deed can be called student responsibility. In other circumstances, her behavior may be called social responsibility. Regardless of its name, the deed provided the doer with good feelings and instilled in her the desire to give again in some way.

Altruism, Personal and Professional Social Responsibility, and Codependency

Pure altruism is giving without expectation of compensation or return of any kind (Trivers, 1971). Unlike altruism, which is an authentic and selfless concern for others, personal and professional social responsibility is acting in a way that benefits society at large. Codependency is an emotional and behavioral condition wherein individuals with low self-esteem try to find meaning and happiness in things outside of themselves. Altruistic deeds are rare, if they exist at all (Trivers, 1971), and social responsibility is common, although not always done with authentic care. Codependent actions take place only because the giver needs the reciprocal relationship with the receiver, and usually vice versa. This author's actions for this assignment were done out of personal (and student-related) social responsibility.

Applying Altruism to Psychology or Psychological Principles
In psychology, practicing professionals are not necessarily altruistic, although must aim to support the best interest of their clients. Psychological principles were created to encourage and support a better quality of life and to help individuals thrive. Designed specifically to assist and allay human difficulty and alleviate suffering, not for profit, personal agenda, or political purpose. Altruistic behavior is in alignment with the essence of psychological principles.

Altruism as it Improves the Human Condition

This author experienced a sense of goodness in feeding individuals at the homeless shelter as well as providing a meal for more than 50 people. The nature of altruistic behavior is that it provides benefit for both sides of the transfer, and may promote a pay-it-forward syndrome whereby those who have been helped will be inspired to help others (Berkowitz & Daniels, 1964). Those taught will inspire others to learn, those who benefit may later support a philanthropic cause. The excessive need of humankind could be partially filled with the products of altruistic behavior or social responsibility.

Personal and Professional Responsibilities Related to Altruism

This author believes it is the responsibility of capable persons to emulate altruistic behavior when necessary and appropriate and to the best of one's ability, although she does not believe most individuals are capable of altruistic behavior. Psychological professionals' primary regard must be for their patient or client, and their needs must be placed above self needs. To fill somewhat of an altruistic role, many professionals provide pro-bono services to the underprivileged, underserved, and underrepresented populations as well as maintaining exceedingly high standards of practice (Plante, 2011).

The Future of Psychology in Contemporary Society
The future of psychology depends on its professionals to act according to altruistic ideas and to aim to serve others authentically before attending to personal agendas. The human race is in dire need of strong, responsible, directive individuals whose goal is to change the course of human life. Although not everyone is capable of altruistic behavior, personal and professional responsibility will eventually alter the human condition. The future relies on the altruistic behavior and social responsibility of capable individuals, including psychological professionals.


According to American legend, one rainy day, Abraham Lincoln left his carriage to save a pig who had gotten itself stuck in the mud. When praised for his selfless action, he simply replied that it was not selfless; had he not saved the pig, he would have felt terrible and it would have ruined his day. Social responsibility, in most cases, provides as good an outcome as altruism, and perhaps may eventually inspire altruism.


Berkowitz, L., & Daniels, L. R. (1964). Affecting the salience of the social responsibility norm: effects of past help on the response to dependency relationships. The Journal of Abnormal and Social Psychology, 68(3), 275-281. doi: 10.1037/h0040164

Plante, T. G. (2011). Contemporary clinical psychology. Hoboken, NJ: John Wiley & Sons.

Trivers, R. L. (1971). The evolution of reciprocal altruism. The Quarterly Review of Biology, 46(1), 35. doi: 10.1086/406755

Ethics Awareness Inventory

Although every individual views ethics from a different perspective, most people agree there is right and wrong, although they may vary on how to make moral and ethical decisions. This author's ethical perspective is based on character, and she believes being ethical is more important than simply performing ethical deeds. To determine the ethical nature of people, she looks into their character rather than judging them by the quality of their actions. Herein, the author describes her perspective as suggested by the Ethics Awareness Inventory (The Williams Institute of Ethics and Management, 2011).

Personal Ethics, Principles, and the Code of Conduct

Personal ethics must be deliberately developed over the lifespan. In a psychological profession and when working with people, professionals must continually implement ethical judgment and moral decision-making and persist in developing and evolving one's understanding of morality. This development does not cease once a goal is attained, it is an ongoing process that becomes more deeply engrained as the individual evolves. Personal ethics are an essential part of any professional discipline, and to conduct oneself ethically, one must be ethical.

Although designed with good intentions, developing a list of appropriate behavior, such as the code of conduct designed by the American Psychological Association, cannot aid in the development of personal moral and ethical judgment, only rule-following. The American Psychological Association handles thousands of ethical infractions committed by psychologists each year (Plante, 2011). However, most of the offending individuals understand ethical behavior by its rules, not by its essence. Without personal ethics, an individual has only rule-following to guide them in professional and ethical conduct. For truly ethical individuals, the written rules are of a lesser quality than their understanding of ethics. For an individual possessing integrity, no contention would exist in deciding between conflicting rules, or judging right from wrong.

Effects of Ethical Applications

This author's belief is that personal ethics permeates one's spiritual, social, and organizational endeavors. For authenticity in spiritual practice, one must have ethical, rather than self-righteous goals otherwise spiritual understanding cannot deepen. This author values honesty, wisdom, and integrity, and she places more emphasis on behaving according to these qualities more than she values rule-following. Regarding social applications, whether associating with one individual or many, this author believes people act according to intrinsic values and beliefs, and behavior changes along with evolving ethical understanding. It is far more beneficial to assist others in strengthening their ability to grasp the true nature of wisdom and integrity rather than passing judgment on their ignorance.

In organizational applications, I believe wisdom and ethical character applied to human diversity creates interactions based on integrity, honesty, benevolence, and justice. Personal interaction with others encourages me to search for goodness of character within all people (The Williams Institute, 2011). I must be careful not to judge the character and growth of others and recall not everyone has the opportunity to develop the ethics, values, and virtues that I value. Social inequalities exist and tolerance, compassion, and an appreciation for diversity are necessary virtues when working with people (The Williams Institute, 2011). Furthermore, I have a keen awareness of the neglect in character growth in contemporary society and quick fixes are neither realistic, nor are they a plausible solution for positive change.

Ethics' Effect on Personal Growth, Health, and Development

It is my understanding that ethical behavior is evident in the quality of an individual's character, which is more important than his or her actions. Personal growth does not involve learning to follow rules, but how to adhere to one's own experience of morality. Because of the intrusive quality of human nature upon behavior, one must continually strive to be morally correct and of ethical character. Maintaining health is continually balancing what one knows is right with what is easy as well as fostering growth in oneself in areas of weakness. Natural development takes place when an individual grasps what is morally good. Ethical value begins with individual thought and as people learn to master their thoughts, personal growth, health, and development are a natural human process.

Advantages of a Psychology Degree

In my estimation, there are many reasons to pursue an advanced degree in psychology. Some learners, including this author, find human nature compelling, although often disappointing. My choice in a psychology degree had little to do with ethics and more to do with her previously established belief in her spiritual need to help others understand human nature and the human journey. Possessing a perspective of the understanding of the relationship between human nature and ethics, I understand becoming ethical is superior to learning appropriate and ethical behavior.

If I had been more keenly aware of psychological science, I would have chosen an undergraduate degree in a different science, although gaining a clearer understanding of ethics, diversity, tolerance, and compassion has been beneficial, although not a direct result of my undergraduate program. However, I maintain a belief that as individual perceptions vary widely, along with the individual capacity to understand what is wholly ethical, it is essential for any science, including psychology, to present a code of conduct to its members as a replacement parameter until ethical behavior becomes an intrinsic mechanism. Neither all people nor all psychologists understand the essence of being ethical. It is the responsibility of those who do understand to help those who do not.


Personal ethics, principles, and moral judgment supports the ability to function optimally in any professional capacity, especially within psychological disciplines. The degree to which individuals become ethical dictates the level by which they function within their discipline in personal, spiritual, social, and organizational issues. Ethics function as a parameter that supports psychological knowledge as well as personal growth, health, and development. For many individuals, choosing psychology as an educational pursuit may impel them toward a deeper understanding of ethics and its pivotal role in their becoming an individual with the capacity to function morally and ethically. Regardless of career or educational direction, it is the responsibility of each person to act and make judgments according to his or her evolving understanding of morality (Pappajohn, n.d.).


Pappajohn, J. (n.d.). Ethics and social responsibility. John Pappajohn Entrepreneurial Center. Retrieved September 30, 2011, from

Plante, T. G. (2011). Contemporary clinical psychology (3rd ed.). Hoboken, NJ: John Wiley & Sons.

The Williams Institute for Ethics and Management. (2011). Ethics awareness inventory. The Williams Institute - Promoting Ethics in Community. Retrieved September 29, 2011, from

Sunday, October 16, 2011

The Diverse Nature of Psychology

The diverse nature of psychology is evident in its 54 divisions of the American Psychological Association, each addressing a different perspective of psychology and a unique aspect of human interaction (Plante, 2011). Psychology permeates and has broad implications for human interaction as well as for the sciences and other disciplines. The psychological science, through its diverse distinctions supports and studies a variety of perceptions and perspectives, serving and honoring the individuality of the human experience (Shiraev & Levy, 2010). Psychological diversity influences the major concepts and contributes to a unique perspective of human behavior. In sum, the whole of psychology has a far greater ability to encompass humanity's entirety because of its diverse and diffuse nature.

The Influence of Diversity on Major Concepts in Psychology
Diversity exerts a dynamic influence on the major concepts in psychology. The psychodynamic, cognitive-behavioral, and humanistic perspectives, represent varied perceptions of human behavior, each offering a unique solution to a psychological challenge, or an exclusive theory on human nature. Each of the major concepts emphasizes different aspects of human behavior, such as the cognitive, social, spiritual, and unconscious factors, which contribute to such behavior. The variety of perspectives and the confluence of these variations reflects the diverse nature of thinking among the human population. As no two individuals perceive an event in the same way, no two psychologists view every aspect of psychology the same. The major concepts define and explain human behavior according to theories unified under one specific aspect or perspective of psychology.

Alternatively, diverse thinking may engage a wide range of thought, but may limit the ability to focus on one particular idea or consolidated theory. Although psychology benefits from its diverse nature, it lacks such unification. Older sciences with unifying theories such as chemistry and physics appear more directed. Psychology is often criticized for its "soft" nature and may continue to struggle with its reputation as long as there are disputes between researchers, practitioners, and other branches of the science. Psychology may never have one unifying theory, but it is important for the science as with any other science to gain credibility in regard to therapeutic efficiency and in its use and application of the scientific method to determine the most effective therapeutic strategy. Perhaps the cohesion found in psychological disciplines is the unifying goal of and dedication to improving the quality of life for people and solving human problems as they change and evolve over time.

Subdivisions and Subtopics in Psychology and Their Effect on Other Disciplines

Abnormal Psychology

Abnormal psychology studies abnormal behavior and psychopathology and emphasizes the research and treatment of mental disorders (Hansell & Damour, 2008). This branch of psychology has implications in psychotherapy and clinical psychology as well as neuroscience. Subdivisions in this area include the biological basis of mental illness and the study of effective treatment options (Plante, 2011). Neuroscientific exploration studies the biological basis of mental illness as well as other physiological illness and seeks to understand the implicit relationship between the body and the mind by which science gains a more holistic perspective of multiple causality (Deckers, 2010).

Theories in abnormal psychology focus on the development of cognitive abilities, morality, social functioning, identity, and other life areas (Hansell & Damour, 2008). Understanding abnormal psychology and the ravaging effects of mental illness helps individuals suffering from the range of these disorders. Applying the behaviors in psychological disease in neuroscientific exploration assists in determining and addressing the biological components of the disease or disorder (Deckers, 2010). Furthermore, the relationship between neuroscience and the biological basis of psychology supports more accurate diagnosis and therapeutic chemical interventions (Plante, 2011, Wickens, 2009).

Lifespan Development

Developmental psychology focuses on human growth and development over the lifespan. The subtopic that discusses the effects of nature and nurture plays important roles in understanding human development and how experiences in early childhood have far-reaching implications in ongoing human social development (Berger, 2008). Developmental psychology plays a significant role in education whereby educational facilities embrace various theories of early childhood development to offer a more appropriate educational experience that aligns with developmental theory (Blume, 2006). In later childhood and adolescence, education and programs in the judicial system have developmental theories central in their aim to affect problematic behaviors in teens.

Comparison and Contrast of Two Theoretical Perspectives

Two major theoretical perspectives in psychology are psychoanalytical and the cognitive-behavioral perspectives. Each of these two major psychological perspectives maintain unique and diverse perceptions of mental conflict and illness (Feist & Feist, 2009). Psychoanalytic theory claims underlying unconscious directives bear responsibility for disordered human thought and behavior, whereas in the cognitive-behavioral paradigm, thoughts influence behavior and vice versa (Plante, 2011). The former emphasizes the need to bring unconscious internalized conflicts into consciousness for resolution and reconciliation although the latter claims by altering one's thoughts, behavior will follow and consequently change and similarly, changing one's behavior will assist in changing one's thoughts. Psychoanalytic therapy is often long and tedious whereas cognitive-behavioral therapy is often shorter in duration and enables the client to implement practical solutions immediately (Plante, 2011). The benefit of cognitive-behavioral therapy has been empirically proven for a number of disorders, although much of psychoanalysis has neither lent itself to verifiability nor falsifiability. The common goal of both perspectives is to reconcile inappropriate thoughts and behavior that interfere with the quality of life and to relieve personal conflict and disordered thinking (Feist & Feist, 2009).


Although viewpoints and perspectives in the science of psychology sometimes appear abysmal, each attempts to address disease and disorder from its distinct scientific point of reference. Each perspective addresses human behavior from a distinct viewpoint, although none is an all-encompassing composite (Kowalski & Westen, 2009). Diversity permeates the major perspectives in psychology as well as their divisions and subtopics, which affects other disciplines as well as secular and popular thought. Abnormal psychology and lifespan development affect thought in education and neuroscience as well as other disciplines and fields of psychology (Hansell & Damour, 2008). The diverse character of the psychodynamic and cognitive-behavioral perspectives exemplifies the distinct nature of psychological perspectives, although both support the unifying goal of psychology to improve the quality of life for people and resolve human conflict.


Berger, K. S. (2008). The developing person through the life span (7th ed.). New York: Worth Publishers.

Blume, L.B. (2006)., Inc. Retrieved from

Deckers, L. (2010). Motivation: Biological, Psychological, and Environmental (3rd ed.). Boston: Pearson/Allyn & Bacon.

Feist, J., & Feist, G. (2009). Theories of personality (7th ed.). New York: McGraw Hill.

Hansell, J., & Damour, L. (2008). Abnormal psychology. Hoboken, NJ: Wiley.

Kowalski, R. M., & Westen, D. (2009). Psychology. Hoboken, NJ: John Wiley & Sons.

Plante, T. G. (2011). Contemporary clinical psychology. Hoboken, NJ: John Wiley & Sons.

Shiraev, E. B. & Levy, D. A. (2010). Cross-cultural psychology: critical thinking and contemporary applications (4th ed.). Boston: Pearson/Allyn Bacon.

Wickens , A.P. (2009). Foundations of Biopsychology (2nd ed.). New York: Pearson/Prentice Hall.

Friday, September 23, 2011

Practice of Clinical Psychology

What are at least two legal issues associated with clinical psychology? Provide an example of a situation that could be legal but unethical.

Confidentially is an issue that involves the codes of both ethics and legality. Maintaining confidentiality is a significant issue in clinical psychology, and one by which the psychologist is bound by law as well as the ethical codes. These laws require the psychologist to refrain from referring to a patient's treatment or results of assessment outside of the appropriate context (Hogan, 2007). Furthermore, regarding confidentiality in record keeping, psychologists must maintain records efficiently, securely, and effectively so results are not prone to dissemination by other inappropriate parties. The psychologist does; however, have the responsibility to waive confidentiality when he or she suspects harm to self (Hogan, 2007).

Another legal issue is obtaining written informed consent before counseling, consulting, or providing any type of treatment. If the patient is incapable of giving such consent, a parent, legal guardian, or other individual functioning in an official capacity must do so. Patients can revoke informed consent at any time during treatment, in most cases. Furthermore, issues involved in obtaining such consent must be provided to the client is understandable terms.

Participating in a sexual relationship with a client is one example of behavior, not considered illegal (in most states) although definitely unethical. According to Plante (2011), dual relationships are common ethical violations. Even if it were legal, it is neither fair to a client/patient nor is it conducive to maintaining healthy, appropriate, and uncompromising boundaries for both the client and the psychologist. Plante (2011) claims "clinical psychologists...are entrusted with the emotional and often physical vulnerabilities, confidences, and wellbeing of the people who seek their guidance" (p. 371). Dual relationships, such as participating in a sexual relationship with the client, compromises the therapeutic relationship.

What are at least two ethical issues associated with clinical psychology? 

Competence is an ethical principle that requires psychologists have appropriate training, education, and experience in their use and practice of therapeutic applications. According to Plante (2011), maintaining competence by ongoing efforts that include continuing education and understanding personal limitations is essential. The idea of competence is not absolute, and psychologists must rely on the general standard of care as recommended by the psychological community. Plante (2011) also emphasizes the importance of maintaining a progressive understanding of available treatments as well as personal mental and physical health when treating clients.

Another ethical concern is the fundamental respect for people's rights and dignity. Psychologists must respect and protect individuals' right for privacy and the protection of their welfare with no bias toward their "age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status" (Plante, 2011, p. 491). Although psychologists are aware of vast differences between people, they must continually work toward treating and counseling without bias or prejudice.

Both issues are of significant consequence to clinical psychology. Individuals depend upon educated and professional assistance, ethical judgment, treatment, and applications formed without bias and toward their betterment. Protecting these fundamental rights supports the attempt of every individual toward achieving and a more positive quality of life.

One issue that continues to involve the jurisdiction of ethical and legal considerations is assisted suicide. Many people believe it is an individual's right to commit suicide under certain conditions, and providing assistance for its accomplishment is both humane and appropriate. This action crosses legal boundaries in most states. Although a psychologist may have a personal belief that assisting the suicide of a client is ethical and in the patient's best interest, in most states, it is clearly illegal.

Define professional boundaries, boundary crossings, and boundary violations. What effects do boundaries have on the therapeutic relationship?
"What is a boundary? Is it too amorphous, protean, and abstract to define at all? Should we take refuge by saying, as St. Augustine was supposed to have said about time, 'Time? I know what time is, provided you do not ask me'?" (Gutheil & Gabbard, 1993, para. 8). Professional boundaries are psychological borders or margins drawn between acceptable and not acceptable behavior. Incorporating boundaries allows professionals to claim personal space, set limits for interactions with others, decide which behaviors are acceptable, and create a personal sense of individualism. In clinical psychology these boundaries define the limits of a professional, therapeutic relationship and responsibilities of the therapist and his or her behavior with the client as well as designating the borders between a professional therapeutic relationship and a personal relationship (Learning Nurse Resource Network, 2011). Boundary crossings are brief deviations from or across professional boundaries that may be accidental, inconsiderate, or done on purpose for therapeutic reasons. A boundary violation takes place when professionals confuse their personal needs with the needs of their clients (Learning Nurse Resource Network, 2011). Boundary violations can degrade a therapeutic relationship and confuse clients (Plante, 2011). One difficulty is that professional boundaries are not always fixed and clearly defined, although ethical standards ordered by the American Psychological Association provide definitive guidance on the subject of ethics in psychology (Plante, 2011).

What are at least two cultural limitations associated with assessment and treatment? In your response, discuss the use or misuse of assessment instruments, therapy techniques, research results, or any other facet of clinical practice that could have potentially harmful, culture-specific implications.
Any action undertaken by psychologists, whether it is treatment, counseling, or simple advice, if the offering does not take into account the client's culture, is inappropriate. Furthermore, any judgment or treatment for individuals of a specific culture must consider the underlying values of the cultural context of the individual (Solomon, Greenberg, & Pyszczynski, 1991). When treating or assessing individuals from a foreign culture, it is difficult to understand their values and norms without first understanding their intrinsic or indigenous ideologies (Shiraev & Levy, 2010). The accommodation of the patient's cultural rules, norms, and ideologies must play a significant role in the therapeutic design of the treatment as well as any judgment placed upon the patient. Without such accommodation neither the judgment nor the therapy will have a basis in the reality embraced by the individual or his or her culture. Without cultural consideration, a therapy would have no positive consequence for the individual in treatment.

Cultural limitations are especially true of psychometric testing. Although assessment has an important role in clinical psychology, it is essential to assess clients with constructs that fairly and appropriately assess them within their cultural context. Some types of testing overrates skills and underestimates or simply does not assess individuals adequately according to the traditions, beliefs, and values of their culture. It is also important that individuals understand the language of the assessment as well as its results. Understanding the detrimental nature of generalizing assessments to minority clients is critical to their treatment. When an assessment was originally based on norms of White American males, it is not appropriate to measure an individual who does not fit into such a narrow category.

Equally essential is the treatment plan for individuals of minority status or culturally different affiliations. Americans tend to believe their ideas, beliefs, standards, and norms, are superior to those of culturally different ethnicities. Plante (2011) emphasizes the importance in treatment to "develop appropriate culturally informed intervention strategies and techniques" (Plante, 2011, p. 254). If psychologists treat according to their own set of cultural norms, the results may not be of consequence or help to the culturally different individual.


Gutheil, T., & Gabbard, G. (1993). The Concept of Boundaries in Clinical Practice: Theoretical and Risk- Management Dimensions. Boundaries in Psychotherapy. Retrieved August 31, 2011, from

Hogan, T. P. (2007). Psychological testing: a practical introduction (2nd ed.). Hoboken, NJ: John Wiley & Sons.

Learning Nurse Resource Network. (2011). Professional Boundaries Quiz. Retrieved August 31, 2011, from

Plante, T. G. (2011). Contemporary clinical psychology. Hoboken, NJ: John Wiley & Sons.

Shiraev, E. B. & Levy, D. A. (2010). Cross-cultural psychology: critical thinking and contemporary applications (4th ed.). Boston: Pearson/Allyn Bacon.

Solomon, S., Greenberg, J., & Pyszczynski, T. (1991). Advances in experimental social psychology. San Diego: Academic Press.

Friday, September 9, 2011

Interview and Response

Professional careers in psychological disciplines vary widely and this is certainly evident in the settings of the two professionals chosen for the required interviews. Perhaps the two defining characteristics of both professionals was their desire to be flexible and helpful during the difficult current economic climate and the reward and fulfillment they enjoy in their work.

Professional Identities

The two professionals used for this interview are Kelly Bass and Alton Shimodoi. Bass has a PhD in clinical psychology, and is a practicing clinical psychologist. She maintains a private practice in Wailuku, Hawaii. Alton Shimodoi has spent the last 12 years as a behavioral health specialist working at Maui High School in both office and classroom settings. Both professionals use a variety of approaches and modalities, although both claim making a difference in individuals' lives is the most rewarding and fulfilling part of their work.

Clinical Focus, Modalities, and Techniques

Central issues in Shimodoi's work relate to the developmental period between ages 14 and 18. His students highly contrast Bass' older clientele on whom the focus is couple's and marriage counseling, and individual therapy. Although the working environment of each is vastly different, both tend many cases of ADHD, depression, anxiety, and substance abuse. Shimodoi is far more restricted in his ability to help his students because the school setting does not allow sufficient time for therapeutic sessions. Furthermore, he provides service to his students for a limited four years, whereas Bass has counseled many of her patients through life challenges during her 27-year practice. Shimodoi uses cognitive-behavioral, reality therapy, and casual dialog with students, whereas Bass uses a holistic and family systems therapy and traditional psychotherapy.

Training and Psychology's Future

Shimodoi has a master's degree, is a Licensed Mental Health Counselor, and was trained on-the-job at the high school. Bass received her post-doctorate in pharmacology, and has certification in eye movement desensitization and reprocessing, and hypnosis. Although Shimodoi had no perspective on the future direction of psychology, Bass has counseled successfully using Skype, and believes phone counseling, tele-health, and cyber-health are future psychological directions. Furthermore, she believes these issues will require different forms of licensure to allow clinicians to practice across state borders when counseling individuals using the Internet or telephone venue. Perhaps because of her level of education, Bass appears to have far more flexibility in the range of services she performs, and the options of expertise she can offer. She has provided forensic psychological services in several high profile cases in Hawaii.

Ethical and Legal Considerations

Shimodoi's greatest concern is the mental health of practicing counselors. He believes an essential part of helping others must include maintaining one's own mental health because when professionals engage in engineering treatment and change for another individual, it must come by way of mental clarity. Bass believes some of the most challenging legal concerns she encounters are those in which families argue over custody rights. It not only requires legal management, but she sees the greatest difficulty as watching the child cope with the dissolution of the family during these battles.

Advice for the Aspiring Psychologist

Shimodoi advises aspiring psychologists to keep themselves healthy and relieve stress through exercise, eating a healthy diet, and engaging in enjoyable activities. Furthermore, he recommends supervision throughout the educational process by an objective individual. Bass has similar beliefs regarding psychologists and the maintenance of personal health and emphasizes the importance of engaging in a variety of work environments to circumvent exhaustion in one area of psychological service. She advised broadening psychological interests to engage in continued learning. To have the most flexibility and control to accomplish established goals, she recommends attaining doctoral level education.


Fortunately, the two individuals interviewed were passionate service providers in a profession that manages anger, anxiety, misery, and challenges that often seem insurmountable. The positive hopes and perspectives of Alton Shimodoi and Kelly Bass were a reminder of the potentially significant contribution such professionals can offer in support of the human journey. Although a worthy challenge, there is considerable responsibility in managing mental health, yet it seems to provide abundant reward and fulfillment in making a difference.

Saturday, August 27, 2011

Major Approaches to Clinical Psychology: Obsessive-Compulsive Disorder

Slide 2:  A variety of approaches exist for the treatment of obsessive-compulsive disorder (OCD). Four major approaches include psychodynamic, cognitive-behavioral, humanistic, and family systems. Each approach perceives obsessive compulsive disorder as an intrusive condition characterized by unwanted repetitive and anxiety-producing thoughts accompanied by the compulsive act of rituals the individual believes will protect them from the anxiety (Hansell & Damour, 2008). The obsessions are thoughts or impulses over which the individual has no control except to apply the ritual for relief, and the compulsions make the individual feel driven to do something - usually the ritualistic practice for the purpose of relieving the anxiety (Hansell & Damour, 2008).

OCD has a well-established biological component similar to other anxiety disorders. According to the National Institutes of Health (2010) anxiety produces affective physical reactions in people, and the biological perspective views the activation or stimulation of the nervous system and its excesses or deficiencies. There may also be associated genetic predispositions, neuro-chemical, and hormonal malfunctions (Schimelpfening, 2009). Emotion components include underlying concerns or experiences that have not been openly addressed. From a psychodynamic perspective, there may be pain and sadness resulting from early childhood parental relations. Most psychologists consider underlying conditions as a prelude to OCD (Hansell & Damour, 2008).

The cognitive-behavioral components of OCD include cognitive distortions of oneself and one's environment. Anxiety is often the result of maladaptive thought processes and dysfunctional thought patterns. Misinterpreted situations, and the underestimation of emotional ability may contribute to the disorder. As mentioned previously, behavioral components include the obsessive thoughts or impulses which precedes the application of ritualistic practice (Hansell & Damour, 2008). Each approach has distinct perceptions of OCD and equally distinct methods of management.

Freud believed obsessive-compulsive symptoms are based on defense mechanisms that he called isolation of affect and undoing. These mechanisms help the affected individual manage anxiety-provoking impulses and thoughts. Using the isolation of affect, individuals treat unwanted thoughts as unconnected to their feelings and experience and more as intruding annoyances. Isolating relates to how individuals treat their obsessive thoughts. Undoing is the use of ritual as a magical treatment to rid oneself of the disturbing thought. The undoing relates to the compulsion side of OCD.

Freud also theorized the symptoms of OCD were caused by misunderstood punishment and rigid toilet training that led to internalized conflicts. Other psychodynamic theorists considered OCD the result of the cultural demand for cleanliness and neatness, as well as parental style and punishment tactics during childhood. According to Fraum (2011), "the fundamental issues that drive these symptoms include fear of rejection or abandonment, as well as interpersonal issues regarding intimacy, sex, control, power or other problems in their relationship" (para. 11). Freud published a case study on a patient he called Rat-man. He claimed he successfully treated the man for obsessive thoughts and compulsive behaviors which Freud thought began from sexual and punitive issues in his childhood (Wertz, 2003).

The goal of the psychodynamic interventions is to help clients understand the roots of their symptoms, gain greater self-acceptance, develop better solutions to emotional conflicts, and decrease needs for problematic defense mechanisms (Hansell & Damour, 2008). In the case of OCD by relieving individuals’ stress, they will cease to need to use the defense mechanism.
According to Abend (1996), psychodynamic therapy focuses on pathological anxiety that arises from unconscious emotional conflicts, so therapists in this discipline tend to use basic psychodynamic techniques to address most anxiety disorders (Abend, 1996). Through an established bond between the patient and the therapist, the patient is encouraged to speak freely to uncover the roots of the anxiety, and to recall dreams. Guided imagery and movement is also used in the psychodynamic approach. The therapist helps the client identify and understand problems as a reaction to present and past issues.

Since the psychodynamic approach seeks to uncover unconscious directives, the therapist must be capable of interpreting the patient's thoughts, feelings, and dreams and assisting the patient to identify the unconscious motives to help the patient resolve the conflicting emotions. A significant part of psychodynamic therapy is the ongoing bond built between the patient and the therapist and the trust within the relationship will allow the patient to thoroughly investigate the issues.

Uncovering the roots of anxiety is effective in any anxiety disorder and psychodynamic therapy has been successfully used in the development of treatment goals, as well as, especially in group treatment (Wells, Glickauf-Hughes, & Buzzell, 1990). The patients modify their character by “evolving autonomous functions and partly through evolving relationships with other individuals” (Wells, Glickauf-Hughes, & Buzzell, 1990, p. 375). According to Bram and Björgvinsson ( 2004), in severe cases of OCD cognitive behavioral therapy was more successful than psychodynamic therapy alone and relieved more symptoms of the OCD. Bram and Björgvinsson ( 2004) claim that training psychodynamic clinicians to accommodate cognitive-behavioral techniques will help successfully treat patients with OCD.

According to cognitive behavioral theory, in obsessive compulsive disorder, an association is made between a compulsive ritual that seems to reduce anxiety caused by a disturbing thought or impulse (Hansell & Damour, 2009). In effect, the reduction in anxiety negatively reinforces the ritual. Traditionally, cognitive-behavioral theory claims behavior is a product of one's environment and is either positively or negatively reinforced, or positively or negatively punished. Individuals learn to adjust behavior according to the response received from the environment.

In a cognitive behavioral intervention, the goal would be to change the way the individual responds to the stimulus in effect, changing the ritualistic response to the disturbing thoughts. For example, a client may be asked to allow themselves to think about the disturbing thoughts without engaging in the usual ritualistic behavior. According to Hansell and Damour (2009), the goal of cognitive-behavioral therapy would be to interrupt the ritualistic behavior to allow the client to experience the dissipation of the anxiety even without the application of the ritual. When the process of obsessive thoughts followed by ritualistic behavior is interrupted, the behavior ceases to negatively reinforce the anxiety, so the pattern is broken.

Cognitive therapists teach strategies and perspectives for responding to the challenges that life has to offer so that individuals can gain a greater sense of self-efficacy (i.e. developing faith in their abilities to achieve specified goals). Equally as important as knowledge, training, experience, and credentials on the part of the cognitive therapist are warmth, understanding, and compassion (Phillipson, n.d., para. 3).
Cognitive interventions for anxiety disorders are generally goal-oriented and highly structured; cognitive therapists take an active, directive stance toward the client and his or her problems (Beck, Emery, & Greenberg, 2005). The therapist will help the client identify the automatic responses to the disturbing thoughts, and the negativity associated with the thoughts. They might discuss the logic (or lack thereof) of the disturbing thoughts and identify the distortions involved in such thinking. Ultimately, the client will be taught how to challenge his or her typical thought processes.

Because the cognitive- behavioral perspective is based on the idea that people learn from reinforcement from the environment, the strategies in therapeutic application emphasize altering the pattern of reinforcement. If a response causes disordered patterns, a change in response is necessary (Phillipson, n.d.). The behaviorist approach claims all learning takes place by the organisms adaptability to change according to its environment, and changing that response alters the established pattern.

Research (Clark et al., 2003) finds cognitive-behavioral therapy effective in treating anxiety disorders. According to Phillipson (n.d.), cognitive behavioral treatment for obsessive-compulsive disorder provides the client with effective tools with which to continually manage anxiety and challenge internalized thinking. Rather than depending on a therapist for longer periods, the client can immediately learn to use the cognitive-behavioral tools. The behavioral tools are ultimately important in the client's ability to continue the management of the disturbing thoughts, and finally decrease the endless ritualizing. Nathan and Gorman (2002) found the interventions were as effective used alone as in combination with other behavioral techniques such as relaxation training.

The humanistic approach uses philosophy, existentialism, and the belief that humans are motivated toward fulfilling certain growth potential. Humanism is committed to a paradigm that emphasizes the human ability "to be consciously reflective and have the ability to experience self-determination and freedom" (Plante, 2011, p. 58). This perspective was strongly influenced by philosophy and an existential approach to psychotherapy, which became popular after World War I. Humanism embraced the human characteristic need to understand life's meaning. Thus, the individual is not considered a passive being who requires the intervention of an expert, but rather an active cognitively aware being. This notion reflects the fundamental underlying principle of humanism that states traditional schools of therapy see the approach as a treatment for illness, rather than seeing patients as active and responsible and participatory in creating and maintaining their mental and emotional states. The patient can chose to alter their mental state under appropriate conditions (Dombeck, 2006). Unlike Freud's psychoanalytic view, humanism views people as essentially good, rather than dysfunctional and bad by nature.

The goal of humanistic therapy for OCD is to create an appropriate environment by which the patient will be able to develop, mature, and evolve, and as a result continue the process in healthy development (Dombeck, 2006). I the humanistic view, psychological dysfunction is caused by an interruption in development because of social and emotional immaturity. By enabling natural development, the patient regains his or her natural ability to proceed in a healthier direction. By maintaining natural development, individuals continue along their personal life pathway, and meeting their psychological needs.

Because the humanistic approach sees the patient as an active participant, and an active cognitively aware party who has the inherent power to determine the course of life and mental disturbances, the patient is the center of the therapy. Several techniques include Rogerian humanistic therapy best known for its gentle engineering of the patients own determination of how they feel about certain topics. Alternatively, Gestalt therapists might use a more direct approach enabling patients to allow the emotional experience within the body rather than in a more limited cerebral experience (Dombeck, 2006).

One well-known Gestalt technique is known as the empty chair technique which is a visualization technique wherein the patient is directed to imagine a person in the empty chair that sits in the therapists office. By entering into a discussion with the imagined person, conflicts are more easily resolved. The goal is to allow the patient to work with the fears and emotions surrounding the issue, ultimately rendering the situation less scary whereby the patient no longer needs to avoid the other person or situation (Dombeck, 2006).

According to Whelton (2004), depth of experience in psychotherapy is positively related to outcome. In humanistic therapy, this depth is a normal expectation and one goal of its application. This indicates feelings and emotions are being processed and new more appropriate meanings are formed as well as finding solutions to problems that create fear and avoidance, and other issues that derail the natural human proclivity to evolve. There is, however, no empirical research clarifying the effective role of humanistic therapy in relieving the intrusive symptoms of obsessive -compulsive disorder.

According to Plante (2011), "prior to the 1950s most psychological treatment focused on the identified patient defined as the person regarded within the family as manifesting problematic symptoms, behaviors, or attitudes" (p. 60). Family members did not participate directly in the identified member's therapy. Neither were they considered an integral part of the recovery nor were they considered part of the problem. Later in the 1970s the family system approach became popular in clinical applications (Plante, 2011).

Family systems approaches differ from psychodynamic, behavioral, and humanistic approaches as they use the integration of the family in recognizing and treating disordered emotions and behavior. Rather than working with the individual having the specific problem, the whole family is involved in the therapy. Psychological insight provided a new platform for therapy that supported the family as an interrelated system, not a group composed of members with random, unrelated experiences. Rather than viewing the identified individual as affected by motivations exclusive of the family, this new systems saw the identified individual as a product of the family unit and "dysfunction resided in the family as an interrelated system" (Plante, 2011, p. 60).

The goal of family systems therapy is to treat the whole family and reduce the dysfunction affecting all the members, but more severely expressed by the identified family member. The issues of the identified individual are acknowledged and addressed, although within the scope of the family. As well as developing the identified individual, the system also develops each family member as autonomous and independent while re-establishing family solidarity (Plante, 2011). The system seeks a balance between the function of the group and the independent individual performance.
In family systems the therapist guides the family in assessing their needs and defining goals. Improving communication within the group is accomplished by several techniques including reframing or changing perceptions within the group, and paradoxical intention, which defines symptoms, especially those of OCD to alleviate resistance to the therapy. Joining or developing a rapport with the family allows the therapist to become more familiar with the mechanisms by which the OCD became symptomatic. Through establishing rapport with the family unit, the therapist can identify any anxiety producing relationships or psychological enmeshment between members (Plante, 2011). Furthermore, the therapist assists in the recognition of disengagement of one or more members whereby the individuals remove themselves from the family unit as a coping mechanism, in this case the symptoms of disturbed thoughts and ritualistic coping behavior. Alleviating the symptoms of OCD in one family member includes understanding the anxiety and psychological pressure the individual experiences. Identifying such issues will help to establishing new ways of relating within the family, disabling the individual's need for obsessive-compulsive behaviors.

The communication approach seeks to re-establish healthy communication within the family thereby eliminating unreasonable expectations, inappropriate rules, and inaccurate assumptions between the individuals, which may be causing the OCD symptoms. The structural approach aims to disengage dysfunctional family patterns and balance relationships, while the Milan approach establishes the therapist as an integral member of the family, providing a neutral position and garnering respect for the unit. The guidelines of all the specific techniques and strategies embrace the general assumption that the family unit contains the dysfunction causing the OCD, and issues are not exclusive to the identified individual (Plante, 2011).

Unlike the other three approaches addressed herein, family systems therapy addresses inadequacies in the family unit. Although addressing these relational issues, there is little evidence that family systems therapy is efficient as an exclusive therapy for treating OCD. Carr (2000) believes family therapy is an effective treatment "either alone or as part of a multimodal or multisystemic treatment program for child abuse and neglect, conduct problems, emotional problems, and psychosomatic problems" (p. 48) although severe symptoms of OCD requires adjunct therapy.
The major theoretical approaches are philosophies about human behavior that provide psychologists with a thematic conceptual understanding of mental health, illness, and disorder. The approaches also provide a consistent parameter by which to assess and treat the patient and a dependable plan of action in a variety of situations and patient needs. Whereas the psychodynamic perspective emphasizes the unconscious directives that influence the individual's ability to maintain normal functioning, the foundation of the cognitive-behavioral approach focuses on contemporary, measurable and observable behavior. It uses classical and operant conditioning as explanations for many types of behavior.

The humanistic approach emphasizes the natural human ability to evolve and develop and perceives people as "active, thinking, creative, and growth oriented" (Plante, 2011, p. 133) and crave self-actualization. The family systems approach views the unhealth of the individual as a consequence of dysfunction in the family, and only by creating health and solidarity within the family can the individual be freed from symptoms of mental illness.

Psychologist have become more integrating with their perspective preference and less rigid to one particular theoretical approach. Each approach has advantages for specific challenges, and some perspectives lend themselves to particular research whereas others do not. The integration of various theoretical perspectives in clinical psychology allows the therapist to afford the broadest potential for successful change within the individual. "Furthermore, as more research and clinical experience help to uncover the mysteries of human behavior, approaches need to be adapted and shaped in order to best accommodate these new discoveries and knowledge" (Plante, 2011, p. 132). The human psyche is a rich and complex maze of diverse needs and challenges, served most appropriately by an equally elaborate and divergent palette of treatments and interventions.

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