essay by cheryl yow
Question:
Psychoanalytic model of psychopathology views phobia as a
symbolic outward expression of internal anxiety.
Using the concept of defence mechanisms, one of their
important contributions, discuss the possible defences
being used by Rhea. Explain what these defence mechanisms
are and what behaviours in Rhea express their use.
Scenario:
Rhea, 26 years old has a phobia of the dark. She was
transferred to Singapore one month back. She hesitated
coming here as she had never lived on her own but the
lure of her dream job was strong. Today, after a month,
she resigned. When questioned by the office counsellor,
she replied it involved travelling back from office at
9pm: 'I could not concentrate on the job after 6pm in
fear that I have to go home alone in the dark’. She did
not want to tell anyone why she was leaving as she
‘knows’ people do not understand that she is only being
sensible in not putting herself in dangerous situations.
When she informed her parents, her mother
sympathized with her and understood her fears
as she has been fearful of being alone especially
at night since childhood. She remembers never
allowing her to go on school camps or night out
with friends as Rhea was unable to sleep without
the lights turned on and somebody looking out for
her. The mother always had to reassure her that
that her door was open to hear if Rhea ever
needed her. The mother remembers her own
childhood when she would be afraid of
the buggy man.
Rhea’s father, on the other hand, tried to
reason with her saying how safe Singapore is and
how there is enough traffic at night for her to be
not alone and not fearful. This infuriates Rhea
as, ‘he always suggests something but then does
not really do anything about it, at least my mother
will offer help like she can come and stay with me.’
When asked to elaborate she explained how her
mother and father do not have a very warm
relationship. He is a workaholic and her mother
takes all decisions in the running of the home. She
calls him a ‘weak man’ who does not have a
‘backbone’.
Her memory of her childhood is of a protective
mother ‘I am my mother’s doll. With her in my life,
I don’t have to worry about anything. She takes
care of my every need.’When questioned if she
missed not having any siblings, she replied, ‘Well,
I had one brother who, I don’t know how, died
when I was 4. But nobody talks of him so I
really don’t know what it means to have a sibling.’
Psychoanalytic perspective, Sigmund Freud’s
influential model in psychopathology, focuses on
the unconscious mind and its significant impact
on psychological disorders. Psychoanalytic model
establishes the structure of the mind: Id, ego and superego.
The conflicts between these three theoretical constructs
are referred as intra-psychic conflicts, they are
constantly in conflict. These complex unconscious mental
conflicts give rise to neurotic symptoms that hamper
mental functioning. Although it is difficult to study the
premises of psychoanalytic theory scientifically, many
insights from psychoanalysis help us to understand our
unconscious urges. Defence mechaniisms, an important
contribution of psychoanalysis- are the psyche way to
help us deal with our anxiety. We will look into the
nature of phobia and the causes of Rhea’s
nyctophobia; then we will examine the dynamics of
Id, ego and superego including Rhea’s use of specific
defence mechanisms to deal with her fears and insecurity.
Anxiety helps an individual escape an anticipated
threatening situation that has no immediate threat to
his well-being. Everyone experiences a variety of normal
anxieties. Having some anxieties is helpful,; it can
prepare people in handling unsetting and challenging
situations. Only when an anxiety persists that it becomes
a phobia- an extreme, severe, persistent fear of an object
or a situation that severely limited one’s life. Anxiety is
a fear of ‘nothing’ (no immediate threat) and phobia is a
fear of something (symbolic). Phobia is a symbolic outward
expression of internal anxiety. Nyctophobia is a frenzied
fear of darkness, usually started from childhood. It is
triggered by the mind’s flawed perceptivity of what could
happen in the dark or what darkness symbolizes . The
Darkness phobia is usually associated with security: the
fear of the loss of a personal connection and separation
from loved ones or fear of being left alone and unable to
find a person when needed or fear of abandonment.
In Rhea’s case, her phobia is probably caused by four
factors. Firstly, her mother’s fear of the buggy man
(an imaginary being) and also the her own fear of being
alone at night might have influenced Rhea. Secondly, her
mother considers Rhea’s father a ‘weak man with no backbone’
and this leads to the unconscious internalization of her
mother’s values. As a result, Rhea describes her father
as a passive, undemonstrative man who ‘always suggest
something and does not really do anything about it’ when
she informed him of her fears. This further highlights the
fact that the father is unable to protect her from her
phobia. Thirdly, Rhea’s parents did not have a warm
relationship. Her father is a workaholic and he might not
be too involved with the home and certainly lacked deep
bonding with Rhea during her childhood. This could
contribute to Rhea’s insecurity – loss of a personal
connection with her father (father represents the
protector of the family) and the unconscious fear of
‘mental’ abandonment (by her father). Lastly, and the
most significant factor is the death of her brother when
she was four; this triggers her fear of separation from
loved ones. Rhea family’s avoidance from the painful
reality of her brother’s death is obvious as no one talk
about his death even when Rhea is already an adult. Without
an outlet for the proper grief of the death of her brother,
that pain is forever trapped within her mind. Her mother
has unknowingly contributed and extended Rhea’s phobia
by not seeking treatment for her phobia.
Sigmund Freud’s Psychoanalytic theory categorizes human
personality into three essential parts: Id, Ego and
Superego. Personality, according to Freud is the conflict
between biological impulses and social restraints that are
internalized. Id is the dark, negative part of our
personality which leads to the construction of neurotic
symptoms. It begins at birth and it is the repository mass
of inherited instinctive impulses (food, water) and drives
(primitive, sexual, aggressive). Id, the animalistic nature
operates within the pleasure principle demands instant
self-gratification. Id is often egocentric, illogical,
irrational and amoral. Ego operates differently, it is the
conscious mind that develops when the child understands
reality and acts realistically. Ego is logical, rational
and realistic. Ego is the defensive operator, composed of
forces that opposes oppose id’s drives. Superego, the
ethical element, emerges once the child learns about moral
values instilled by one’s parents and culture (society's
norms, taboos). Superego’s idealism is the conscience based
on values, guilt and shame. It abides by moral principles
and strives to act in a socially appropriate manner.
Intra-psychic conflicts arise when the emotional Id ruled by
the pleasure principle demands instant self-gratification
while Ego driven by the reality principle is logical and
rational whereas Superego abide by the moral principle is
concerned with conscience. Due to their conflicting
objectives, they tend to stand in opposition to each
other’s values and desires. Ego controls Id impulses by
being realistic and Superego seek to inhibit Id’s desires
and convince ego of more moral goals rather than realistic
ones. An interesting example would be: Mr Davies
walks into a café and sees an attractive lady who
smiles at him and his Id thinks ‘I like to walk up to
her and kiss her in the middle of the café’. The ego
would say ‘You can’t just goa nd kiss any attractive
woman that you don’t know publicly. You should
get to know her first’. Superego moralises and
snaps ‘You can’t do that, you are married!’ Id
represents instinctual biological impulses (sexuality,
aggression). The Id’s impulse to kiss an unknown
woman publicly conflicts with Ego’s rationality as well
as the ideals of Superego. These conflicts invoke
anxiety and Ego, the mediator, would then try to pacify
and compromise both Id and Superego. To reduce
anxiety Ego would use defense mechanisms. Defence
mechanisms are used unconsciously to reduce tension
by covering up our threatening impulses.
In Freudian psychoanalytic theory, defense mechanisms are
psychological strategies to cope with reality and to
maintain self-image. Defence mechanisms provide a refuge
and protect us (our ego) from social sanctions and
anxieties. Everyone uses defence mechanisms. Defence
mechanisms only become pathological when its persistent
use leads to maladaptive behavior that adversely impair an
individual’s mental and physical functioning. Ego employs
defence mechanisms when anxiety (feelings of guilt, shame,
embarrassment) becomes overwhelming to protect the
individual; taking defensive action towards the perceived
danger. All defence mechanisms unconsciously block impulses
by distorting, transforming or falsify reality. In
distorting reality, there is a change in perception which
reduces tension and lessens anxiety. Through defense
mechanisms, the ego tries to eliminate anxiety.
In Rhea’s case, she is using some defence mechanisms known
as denial, regression, projection as well as introjection.
Denial is the refusal to accept external reality by not
acknowledging its existence or occurrence because it is too t
hreatening or too painful.. Rhea is unconsciously denying pain
from the death of her brother because she and her family
could not accept the reality of it; that is why nobody talks
about it and she does not even know how her brother died
(implicitly denying its occurrence). Repression blocks
disturbing thoughts or experiences from conscious
awareness. An unacceptable fear is repressed into the
subconscious mind which then search for a substitute- for
something symbolic to which the original feelings of
anxiety and fear can be transferred into. Rhea must have
repressed the unacceptable fear of her brother’s death and
the lack of her father’s presence and protection. Thus the
subject of her phobia- darkness actually masks her real
fear of insecurity and abandonment by loved ones.
Projection: falsely attributes own unacceptable feelings,
impulses or thoughts to another individual or object. Rhea
has projected her fear and perhaps guilt into something
symbolic – darkness. Introjection – the process of
unconscious appropriation of an external happening or
assimilation of the characteristics of a person into
one's psyche. Rhea has certainly assimilated her mother’s
fear of being alone at night, her mother’ s belief – of her
weak and not protective father and her parents’ attitude
of her brother’s death.
The purpose of psychoanalysis was to bring repressed
memories, fears and thoughts back to conscious
awareness. Relaxation techniques are helpful:
visualization (of floating on a cloud) and deep breathing.
With proper child therapy, usually involving play therapy
in the dark (for darkness phobia), Rhea could have
recovered. The key to resolving phobias is to overcome
them. Therapeutic experiences of realization are used
to show how these mechanisms are no longer appropriate.
When a patient fully understands the repressed feelings,
the fear will become manageable or will disappear.
Carl Jung, the Swiss psychiatrist, wrote about the shadow
aspect of our psychology : every person has a shadow, which
is made up of anything unconscious, repressed, denied or
undeveloped. (Carl Junghttp://en.wikipedia.org /wiki
/Carl_Jung) However, he also claims that this shadow also
contains light - our undeveloped potential and tremendous
creativity. The shadow is therefore an aspect of ourselves
that we should get to know instead of avoiding it. With
proper therapy the phobic individual like Rhea will be
able to resolve her fears in her shadow of darkness that
had impaired her life and activities for too long and
instead unleash her hidden creative potential.
(1503 words)
Reference
Barlow, D.H., & Durand, V.M. (2009, 2005). Abnormal psychology: An integrative approach (5th ed.). Belmont, CA: Wadsworth.
McQuade, J (2007). Sigmund’s Freud’s Psychoanalytic Theory. Retrieved 28 February 2009
HTTP://WWW.ASSOCIATEDCONTENT.COM/ARTICLE/424863/SIGMUND_FREUDS_PSYCHOANALYTIC_THEORY_PG2.HTML?CAT=47
Berryhill, K. Three Major Concepts of Psychoanalytic Theory - A Brief Summarization. Retrieved 28 February 2009 http://ezinearticles.com/?Three-Major-Concepts-of-Psychoanalytic-Theory---A-Brief-Summarization&id=1394331
Psychoanalysis: psychopathology ( Mental Disturbances). Retrieved 28 February 2009 http://www.psychotherapy.ro/resources/psychotherapies/psychoanalysis-psychopathology-mental-disturbances/
Cadena, C. (2007). Underlying Cause & Origin of Darkness Phobia in Children. Retrieved 28 February 2009
http://www.associatedcontent.com/article/446913/underlying_cause_origin_of_darkness_pg2.html?cat=25
Carl Jung. Retrieved 28 february 2009
http://en.wikipedia.org/wiki/Carl_Jung
Sunday, February 7, 2010
Abnormal psychology: Cognitive theories of depression
essay by cheryl yow
Scenario:
26 year old Mary has been depressed for months.
Her boyfriend of two weeks left her. Rita, her
childhood friend suggests that Mary sees a
therapist. Mary replies, ‘What is the point?’
I think I am meant to be alone, I can never find
one who can love me, and I have nothing
special to offer.’
Rita assures her that she has many positive
qualities, e.g.; ‘You look great, you have a good
job, you are educated and not to forget what a
sincere friend you are’. Mary is hardly
impressed and says, ‘What good looks?
Remember in university, I only got referred to as
‘pretty’, not beautiful.I am no more special than
anyone else, my job is average, I am not the CEO,
I am never going to be really successful, and I am
only a graduate, not even with honours. I just
cannot excel at anything, if I was meant to be
happy like you, why should I have inherited my
mother’s illness; she suffered just like I am’.
Question:
Describe how a cognitive therapist would explain
why Mary is experiencing depression.
Cognitive theories of depression emphasize the role
of irrational thought processes. American psychiatrist
Aaron Beck proposed that individuals learn to view things
negatively during early childhood. Depressed people tends
to view themselves, their environment and the future
negatively because of errors in thinking. Depressed people
commonly acquired negative views through abusive rearing
style of parents, critical parents, loss of loved one or
social rejection of friends . This could give rise to
‘depressive’ personality traits – self-criticism,
excessive scepticism, gloominess, pessimism, and people
with these traits appear at greater risk for depression.
We will look into the cognitive explanation for Mary’s
depression by looking into the cognitive revolution and
the three major features of cognition- depressive
cognitive triad, cognitive errors (arbitrary inference,
over-generalisation), negative schemas as well as learned
helplessness and hopelessness theory.
The ''cognitive revolution'' emerges as a reaction against
behavioral interpretations of depression. Behavioural
approaches to depression were popular until the early 1980’s
after which they were overtaken by cognitive perspectives.
Behavioural theorists ignore the impact or meaning of the
emotions in depression, instead they saw emotions merely
as drive mechanisms implicated in the processes of positive
and negative conditioning. Modern cognitive theories emerged
when psychologists, rejecting exclusively consequence-based
explanations of behavior, began to elaborate their own
interpretations of learning. Cognitive perspective, in
understanding depression, focuses not on observable
responses but on the inferred mental processes. Cognitive
processes and activities such as information processing,
mental representations, and expectations are central
to the cognitive interpretation of depressions.
Regarding Mary’s case, her boyfriend of two weeks has left
her and she has been depressed for months. Any breaking off
of a relationship is upsetting, it can cause anxiety which
later leads to depression. The quality and quantity of time
they spent together during those 2 weeks is an important
consideration- from having one or two short dates a week
to living together everyday for two weeks -the longer one
spends with the other the more time for bonding thus it
gets harder to part. A relationship that short may not have
impacted most people, however it all depend depends on the
context and the meaning an individual attaches to a
relationship. It depends how intense the relationship was,
have they already reached a point where they were
already intimate physically or were they just merely
holding hands. The more intimate a couple is the harder
it is to lose the other. Again, whether a person in this
situation would have depression also depends on the
individual’s personality. Mary’s boyfriend whom she had
only known for 2 weeks had left her and she was depressed
for months, yet another person in the same situation might
just cry for a night or two and then choose to start
partying to meet other potential suitors. Thus depending,
how intense andhow intimate the relationship has developed
in those two weeks and also the individual’s personality,
depression may or may not occur.
Beck suggests that depression is due to dysfunctional
cognition. There are three major features of cognition.
Firstly, the ‘depressive cognitive triad’: this consists
of negative cognitions concerning oneself (e.g. “I am
undesirable, worthless and inadequate”), the world
(e.g. the world is defeating and overly demanding), and
the future (e.g. “I am always bound to fail and to suffer”).
Mary comments that she was only referred as ‘pretty’ not
beautiful, that she is not more special than anyone else,
she is only a graduate and her job is average shows her
extreme self negativity. ‘I think I am meant to be alone,
I can never find one who can love me,..’, ‘I am never going
to be really successful.’ tells us that Mary is certainly
very negative about her immediate world and her future.
Secondly, faulty thinking or cognitive errors in the
cognitive triad of which a number of errors have been
identified, e.g. arbitrary inference and
overgeneralization. Arbitrary inference refers to a
depressed person who focuses on the negative rather
than the positive aspects of a situation – even the
smallest setback becomes a major tragedy. In Mary’s
case leaving a boyfriend of only 2 weeks seems to her
more like she is leaving a boyfriend of 2 years. When
Rita, her best friend, suggests that Mary should see a
therapist, she replies, ‘What is the point?’ I think I
am meant to be alone, I can never find one who can love
me, and I have nothing special to offer.’ This reflects
Mary’s negative attitude even when the break-off was
months ago.
Overgeneralisation, another form of cognitive errors,
is when one tends to overgeneralise one’s negative
situation as we can see from Mary’s response that she was
meant to be alone and that she will not be able to find
someone who could love her and that she ‘just cannot excel
at anything’. Mary overgeneralizes the negativity of her
one break-up and believes that her future holds impending
gloom for her. In time these practiced thinking errors
becomes ‘automatic negative thoughts’. People are usually
only partially aware of their automatic thoughts; however
they exert a great influence over how they view the world
and accordingly behave.
Thirdly, schemas; these are hypothetical cognitive
structures that influence the screening, coding and
organization of environmental information. Negative schemas
are learned from early unfortunate interactions with the
environment, especially with significant others. Beck
theorized that individuals may develop a deep-seated
negative schema after some negative events during childhood.
Early experience can shape maladaptive attitudes and beliefs
in the child. Dysfunctional schemas (e.g. “I must do
everything perfectly or else I’m a failure”) can predispose
people to distort events in a way that leads to depression.
It is thought that dysfunctional schemas and beliefs can lie
‘dormant’ for a number of years until a series of events
‘re-awaken’ the schematic beliefs which then activate the
cognitive triad.Mary could not believe that she could be
happy - ‘why should I have inherited my mother’s illness;
she suffered just like I am’. Though inheriting her
mother’s depression, Mary will be more vulnerable to
stress and depression, but also growing up with a
depressed mother (the environment) could even
further intensifies her vulnerability to it. Becks
suggests these cognitive errors and schemas are automatic,
unconscious, individual individuals might not even know
they are thinking negatively or illogically. Thus
depressive cognition seems to emerge from automatic
processing of information and distorted views.
Learned helplessness theory, a related but differing
cognitive perspective is proposed by Seligman (1975,
cited by Barlow & Durand, 2009). Learned helplessness
is a learned belief that one cannot control the outcome of
events. In this view depression is seen as faulty learning
regarding personal locus of control that is -when one is
subjected to negative events seen as outside of one’s
control - hopelessness, passivity and depression result.
Rats that received occasional shocks, can cope with them
by doing something to avoid them ( pressing a lever).
However, if they are not able to do something to avoid
these shocks, they will become anxious, helpless and
depressed as they had no control over difficult
life events. Seligman suggests that learned helplessness
(also referred to as conditioned helplessness) occurs in
individuals as a form of depression.Long-time exposure to
uncontrollable and inescapable events leads to apathy and
pessimism . When all attempts to escape or avoid negative
situations have failed, people give up and an attitude
of learned helplessness develops. In Mary’s case, if she
feels that she is not in control of this negative
situation she might lapse into learned helplessness.
Another cognitive perspective suggests that depression
results not only from ‘learned helplessness’ but also
from hopelessness. The hopelessness theory attributes
depression to a pattern of negative thinking in which
people blame themselves for negative life events and view
the causes of those events as permanent. Thus people with
depression often experience feelings of guilt, self-blame
and worthlessness. They may interpret a minor failing on
their part as a sign of incompetence or interpret minor
criticism as condemnation. In some cases, people with
depression may experience psychotic symptoms, such as
delusions (false beliefs) and hallucinations (false
sensory perceptions). People with major depression may
experience such extreme emotional pain that they consider
or attempt suicide.
Mary’s depression, according to cognitive perspective is
due to faulty cognition during childhood (much influenced
by her mother who also has depression): depressive
cognitive triad, cognitive errors (arbitrary inference,
over-generalisation), negative schemas that leads to learned
helplessness and hopelessness theory. Once we understand and
spot these cognitive errors and distorted schemas we can
correct it to prevent potential depression.
(1416 words)
Reference:
Barlow, D.H., & Durand, V.M. (2009, 2005). Abnormal psychology:
An integrative approach (5th ed.). Belmont, CA: Wadsworth.
Scenario:
26 year old Mary has been depressed for months.
Her boyfriend of two weeks left her. Rita, her
childhood friend suggests that Mary sees a
therapist. Mary replies, ‘What is the point?’
I think I am meant to be alone, I can never find
one who can love me, and I have nothing
special to offer.’
Rita assures her that she has many positive
qualities, e.g.; ‘You look great, you have a good
job, you are educated and not to forget what a
sincere friend you are’. Mary is hardly
impressed and says, ‘What good looks?
Remember in university, I only got referred to as
‘pretty’, not beautiful.I am no more special than
anyone else, my job is average, I am not the CEO,
I am never going to be really successful, and I am
only a graduate, not even with honours. I just
cannot excel at anything, if I was meant to be
happy like you, why should I have inherited my
mother’s illness; she suffered just like I am’.
Question:
Describe how a cognitive therapist would explain
why Mary is experiencing depression.
Cognitive theories of depression emphasize the role
of irrational thought processes. American psychiatrist
Aaron Beck proposed that individuals learn to view things
negatively during early childhood. Depressed people tends
to view themselves, their environment and the future
negatively because of errors in thinking. Depressed people
commonly acquired negative views through abusive rearing
style of parents, critical parents, loss of loved one or
social rejection of friends . This could give rise to
‘depressive’ personality traits – self-criticism,
excessive scepticism, gloominess, pessimism, and people
with these traits appear at greater risk for depression.
We will look into the cognitive explanation for Mary’s
depression by looking into the cognitive revolution and
the three major features of cognition- depressive
cognitive triad, cognitive errors (arbitrary inference,
over-generalisation), negative schemas as well as learned
helplessness and hopelessness theory.
The ''cognitive revolution'' emerges as a reaction against
behavioral interpretations of depression. Behavioural
approaches to depression were popular until the early 1980’s
after which they were overtaken by cognitive perspectives.
Behavioural theorists ignore the impact or meaning of the
emotions in depression, instead they saw emotions merely
as drive mechanisms implicated in the processes of positive
and negative conditioning. Modern cognitive theories emerged
when psychologists, rejecting exclusively consequence-based
explanations of behavior, began to elaborate their own
interpretations of learning. Cognitive perspective, in
understanding depression, focuses not on observable
responses but on the inferred mental processes. Cognitive
processes and activities such as information processing,
mental representations, and expectations are central
to the cognitive interpretation of depressions.
Regarding Mary’s case, her boyfriend of two weeks has left
her and she has been depressed for months. Any breaking off
of a relationship is upsetting, it can cause anxiety which
later leads to depression. The quality and quantity of time
they spent together during those 2 weeks is an important
consideration- from having one or two short dates a week
to living together everyday for two weeks -the longer one
spends with the other the more time for bonding thus it
gets harder to part. A relationship that short may not have
impacted most people, however it all depend depends on the
context and the meaning an individual attaches to a
relationship. It depends how intense the relationship was,
have they already reached a point where they were
already intimate physically or were they just merely
holding hands. The more intimate a couple is the harder
it is to lose the other. Again, whether a person in this
situation would have depression also depends on the
individual’s personality. Mary’s boyfriend whom she had
only known for 2 weeks had left her and she was depressed
for months, yet another person in the same situation might
just cry for a night or two and then choose to start
partying to meet other potential suitors. Thus depending,
how intense andhow intimate the relationship has developed
in those two weeks and also the individual’s personality,
depression may or may not occur.
Beck suggests that depression is due to dysfunctional
cognition. There are three major features of cognition.
Firstly, the ‘depressive cognitive triad’: this consists
of negative cognitions concerning oneself (e.g. “I am
undesirable, worthless and inadequate”), the world
(e.g. the world is defeating and overly demanding), and
the future (e.g. “I am always bound to fail and to suffer”).
Mary comments that she was only referred as ‘pretty’ not
beautiful, that she is not more special than anyone else,
she is only a graduate and her job is average shows her
extreme self negativity. ‘I think I am meant to be alone,
I can never find one who can love me,..’, ‘I am never going
to be really successful.’ tells us that Mary is certainly
very negative about her immediate world and her future.
Secondly, faulty thinking or cognitive errors in the
cognitive triad of which a number of errors have been
identified, e.g. arbitrary inference and
overgeneralization. Arbitrary inference refers to a
depressed person who focuses on the negative rather
than the positive aspects of a situation – even the
smallest setback becomes a major tragedy. In Mary’s
case leaving a boyfriend of only 2 weeks seems to her
more like she is leaving a boyfriend of 2 years. When
Rita, her best friend, suggests that Mary should see a
therapist, she replies, ‘What is the point?’ I think I
am meant to be alone, I can never find one who can love
me, and I have nothing special to offer.’ This reflects
Mary’s negative attitude even when the break-off was
months ago.
Overgeneralisation, another form of cognitive errors,
is when one tends to overgeneralise one’s negative
situation as we can see from Mary’s response that she was
meant to be alone and that she will not be able to find
someone who could love her and that she ‘just cannot excel
at anything’. Mary overgeneralizes the negativity of her
one break-up and believes that her future holds impending
gloom for her. In time these practiced thinking errors
becomes ‘automatic negative thoughts’. People are usually
only partially aware of their automatic thoughts; however
they exert a great influence over how they view the world
and accordingly behave.
Thirdly, schemas; these are hypothetical cognitive
structures that influence the screening, coding and
organization of environmental information. Negative schemas
are learned from early unfortunate interactions with the
environment, especially with significant others. Beck
theorized that individuals may develop a deep-seated
negative schema after some negative events during childhood.
Early experience can shape maladaptive attitudes and beliefs
in the child. Dysfunctional schemas (e.g. “I must do
everything perfectly or else I’m a failure”) can predispose
people to distort events in a way that leads to depression.
It is thought that dysfunctional schemas and beliefs can lie
‘dormant’ for a number of years until a series of events
‘re-awaken’ the schematic beliefs which then activate the
cognitive triad.Mary could not believe that she could be
happy - ‘why should I have inherited my mother’s illness;
she suffered just like I am’. Though inheriting her
mother’s depression, Mary will be more vulnerable to
stress and depression, but also growing up with a
depressed mother (the environment) could even
further intensifies her vulnerability to it. Becks
suggests these cognitive errors and schemas are automatic,
unconscious, individual individuals might not even know
they are thinking negatively or illogically. Thus
depressive cognition seems to emerge from automatic
processing of information and distorted views.
Learned helplessness theory, a related but differing
cognitive perspective is proposed by Seligman (1975,
cited by Barlow & Durand, 2009). Learned helplessness
is a learned belief that one cannot control the outcome of
events. In this view depression is seen as faulty learning
regarding personal locus of control that is -when one is
subjected to negative events seen as outside of one’s
control - hopelessness, passivity and depression result.
Rats that received occasional shocks, can cope with them
by doing something to avoid them ( pressing a lever).
However, if they are not able to do something to avoid
these shocks, they will become anxious, helpless and
depressed as they had no control over difficult
life events. Seligman suggests that learned helplessness
(also referred to as conditioned helplessness) occurs in
individuals as a form of depression.Long-time exposure to
uncontrollable and inescapable events leads to apathy and
pessimism . When all attempts to escape or avoid negative
situations have failed, people give up and an attitude
of learned helplessness develops. In Mary’s case, if she
feels that she is not in control of this negative
situation she might lapse into learned helplessness.
Another cognitive perspective suggests that depression
results not only from ‘learned helplessness’ but also
from hopelessness. The hopelessness theory attributes
depression to a pattern of negative thinking in which
people blame themselves for negative life events and view
the causes of those events as permanent. Thus people with
depression often experience feelings of guilt, self-blame
and worthlessness. They may interpret a minor failing on
their part as a sign of incompetence or interpret minor
criticism as condemnation. In some cases, people with
depression may experience psychotic symptoms, such as
delusions (false beliefs) and hallucinations (false
sensory perceptions). People with major depression may
experience such extreme emotional pain that they consider
or attempt suicide.
Mary’s depression, according to cognitive perspective is
due to faulty cognition during childhood (much influenced
by her mother who also has depression): depressive
cognitive triad, cognitive errors (arbitrary inference,
over-generalisation), negative schemas that leads to learned
helplessness and hopelessness theory. Once we understand and
spot these cognitive errors and distorted schemas we can
correct it to prevent potential depression.
(1416 words)
Reference:
Barlow, D.H., & Durand, V.M. (2009, 2005). Abnormal psychology:
An integrative approach (5th ed.). Belmont, CA: Wadsworth.
Abnormal psychology: Confidentiality vs Duty to Warn
essay by cheryl yow
Scenario:
Amanda is suffering from acute post traumatic
stress disorder for the last six months. Three years
back she was a victim of date rape. She did not
report the incident, believed it was an accident,
and moved on. Six months back she had a panic
attack while watching a movie and had to be
helped by friends to return home. She did not
leave her apartment for a week. Her friend
cajoled her to take help.
The social worker, Jane has been working with
her since and it took her months to develop a good
working alliance and earn Amanda’s trust and
confidence. But yesterday Jane found out that
behind Amanda’s anxiety is rage. She is
expressing her plan to kill her rapist whom she
finds is enjoying life, succeeding in his career and
now planning to get married when he should have
been in prison. In Jane’s assessment, Amanda’s
plan is well thought out. Jane finds herself caught
in her promise of confidentiality
and her duty to warn.
Question:
Discuss the ethical code provided by American psychological
Association (APA) on this subject.
Psychological treatment, by necessity, entails the
disclosure of extremely sensitive, private information.
The significance of confidentiality is reflected in the ethical
and legal obligations to protect the patient’s privacy. A breach
of confidentiality will harm the patient and expose the
psychologist to a malpractice lawsuit. Although psychologists
have to preserve the confidentiality of their patients, there
are circumstances under which this confidentiality may be
breached such as danger to self and others – committing
suicide, homicide or child/wife abuse. How to ethically set
patient confidentiality boundaries – the balance of the
rights of the patient with the responsibilities of protecting
the society is controversial. This essay addresses the issue
of confidentiality in the above situation of Amanda, who is
suffering from acute post traumatic stress disorder, and by
revealing her plan to kill her rapist, placed Jane, her
social worker, in a dilemma. We will look at the American
Psychological Association’s (APA’s) Ethical code in
maintaining confidentiality and in disclosure; and evaluate
the conflicting values of Jane’s duty to protect and her
duty to warn.
The American Psychological Association’s (APA’s) Ethical
Principles of Psychologist and Code of Conduct serve to guide
psychologists toward the highest ideals of their profession.
These ethical principles in the Ethics Code set forth
psychology’s core values and they play a fundamental role in
setting its ethical parameters. In APA’s 4.01 - Maintaining Confidentiality: it states that the ethical responsibility
of psychologists is to safeguard information they receive
in the course of their practice.
The patient, Amanda, has the right to expect all
communications and records pertaining to her case to be
confidential. The real meaning of trust is that one may tell
all from the depth of one’s soul to another confidentially
and believe without doubt, that the information given is safe
unto death. As it had taken Jane months to be able to gain
Amanda’s trust and confidence in a special therapeutic
relationship, breaking that trust would further worsen
Amanda’s condition and expose her to more harm. A patient
must be able to trust the therapist without a second thought
to information being disclosed to his/her personal detriment.
If this assurance of absolute confidentiality is not honoured
and results in broken trust; it will deter future patients
from seeking psychological treatments or therapies.
An ethically exigent issue in the psychology profession is
the principle of confidentiality and the dilemma it causes
in society. This ethical dilemma arises when two of the
values found in the ethical principles conflict. The duty
to warn in APA’s ethical code has created a principled
dilemma for psychological professionals. Jane faces a moral
problem; she has to choose between –the duty to protect
Amanda, her patient or the duty to warn the rapist or
appropriate authorities of the potential danger. This
creates a potential problem for psychologists, who must
adhere to APA ethical standards, which advocate that under
most circumstances psychologists do not disclose
confidential information without the prior consent of the
patient. Thus ‘to maintain patient’s confidentiality’
conflicts with ‘duty to warn’.
In another similar dilemma, John, a psychologist is the
principal investigator for the ‘Assist’ Project, which is to
identify behavioural trends among HIV+ adults in New York
city. Participants were recruited from HIV/AIDS support
groups. One participant tells John that she is having
unprotected sex with her boyfriend and that her boyfriend
does not know about her HIV status. She has no plans to
reveal her condition. Here, the duty to preserve patient
confidentiality clearly conflict with the need to inform
past and present contacts of an HIV-infected patient of
possible exposure to the virus. Under Principle E: Respect
for People's Rights and Dignity, the APA’s Ethics Code
states that psychologists should respect people's rights
and dignity, including their rights to privacy,
confidentiality and autonomy.
(http://www.onlineethics.org/CMS/research/rescases
/gradres/gradresv3/ hivaffect.aspx).
Thus, Jane needs to seriously consider Amanda’s rights,
autonomy and dignity.
Additionally, there are no clear boundaries that
psychologists can determine whether a patient is dangerous
or not. One may say ‘ I am so angry I could kill him now!’.
Is this said in a fit of anger that does not carry any
threat or to what extent will the patient really executes
this perilous action? Since Jane had found out that behind
Amanda’s anxiety is rage she needs to determine to what
extent will Amanda really set out to harm her rapist. It
could depend chiefly on the intensity of Amanda’s rage
and anxiety. We can never be sure how accurate are
therapists are at predicting who will or will not be
dangerous. In a recent shocking local case, where a
70 year-old taxi driver, Mr Ong Kah Chua set MP Seng
Han Thong on fire by pouring a bottle of thinner! Mr Ong
was angry just because he did not received any hongbao.
A neighbour described Mr Ong as a quiet, reserved and
caring man. He only started acting strangely
(ran up and down the corridorfor no apparent reason)
after his wife moved out to live with their son to
babysit their grandchildren. It is inconceivable and
unpredictable how a quiet, reserved man, even if he has
been acting a little strange lately ( don’t most of us act
a little strange at times, even when we are ‘normal’?)
to resort to such a violent action for a ridiculous
reason. Although he has been in and out the Institute of
Mental Health, no warning was given by his therapist.
This issue of confidentiality and disclosure were the
subject of a tragic case known as Tarasoff v. Regents of
the university of California. In 1969, Prosenjit Poddar,
a graduate student, killed a female student, Tatiana
Tarasoff,after she rejected his romantic advances. He was
diagnosed as having paranoid schizophrenia and had confided
in his therapist that he wais going to kill Tarasoff. The
therapist did inform the campus police and Poddar did
assure the police that he would not commit the crime.
However, Tarasoff’s family sued the university and the
therapists, insisting that they should have warned Tarasoff
of the danger. The Tarasoff case has since been used as a
standard for therapists to warn a client’s potential victims.
Consequently, the Supreme Court of California stated ‘The
protective privilege ends where the public peril begins’
in other words, whenever conflicts arise, safety should
receive priority. California law now advocates that a
psychotherapist has a duty to warn a third party only if:
the therapist actually believed that the patient posed a
serious risk of inflicting serious bodily injury upon an
identifiable victim. The California Supreme Court has
also ruled that threats must be specific: Therapist does
not have to warn if the client makes non-specific threats
against non-specific people.
(http://education.ucsb.edu/csbyd/ED165/docs
/ED165-ethics-Oct-2008.pdf).
This limit to confidentiality has since been highlighted
in the APA Ethical Principles of Psychologists and Code
of Conduct – Disclosure 4.05 states (b)
Psychologist may disclose confidential information-
(3) to protect the client/patient, psychologist,
or others from harm (http://www.apa.org/ethics
/code2002. html). This duty to warn refers to the
responsibility of a therapist to breach confidentiality
if a patient or other identifiable person is evidentially
in clear, imminent danger. The therapist must determine the
degree of gravity of the threat and notify the person in
danger and others who are in a position to protect that
person from harm. Psychologists must maintain
confidentiality and discuss limits of confidentiality
at outset. In John’s case (HIV ‘Assist Project) he could
change his informed consent in future research to include
the notification that confidentiality will not be
maintained if participants indicate that they have placed
an identified person at risk of harm.
Jane’s dilemma could now be eased based on the ethical
code of conduct in Disclosure 4.05. She should tell Amanda
the limits of confidentiality before beginning the
counselling sessions. In assessing Amanda, she should
determine the gravity of Amanda’s threat. Jane believed
Amanda’s plan is well thought out and this indicates that
the threat is serious and is not merely said in a fit of
anger. Moreover, the threat of ‘to kill’ is specific: not
to harm or to injure but ‘to kill’. Furthermore, the person
Amanda wants to kill is a specific person - the rapist. The
rapist is now clearly in imminent danger of losing his life.
Endorsed by Disclosure 4.05 Jane would not be accused of
breaching confidentiality, instead she has the
responsibility to warn the potential victim. In doing so
Jane could prevent an imminent tragedy from happening, she
would have saved a life (though the rapist deserved to be
punished but certainly not by death) and prevented
Amanda from being committed to a mental institute or a jail
term or a death sentence!
The debate whether patients with disorder need protection
from society or society needs protection from these patients
is endless. Resolving an ethical dilemma entails identifying
the pertinent values and evaluating those competing values.
There is no single, definite way of thinking about what it
means to be an ethical psychologist. Mental health
professionals must consider both individual and societal
rights and responsibilities. Confidentiality is required to
protect patient’s identity but more importantly is; in order
to protect the patient from committing an imminent
regrettable crime and to protect the potential victim from
a fatal situation; it is inevitable that in honouring the
duty to protect, the discerning psychologist must
serve his or her duty to warn.
(1552 words)
Reference
Barlow David. H. et Durand V. Mark., (2009). Abnormal Psychology, an integrative approach, USA: Wadsworth Cengage Learning
Reethompson .Psychological Therapy and Confidentiality. Retrieved 5 February 2009 http://www.allfreeessays.com/essays/Confidentiality-Mental-Health/6458.html
APA Assembly. Confidentiality, Disclosure, and Protection of Others. Retrieved 5 February 2009
http://www.psych.org/Resources/OfficeofHIVPsychiatry/HIVPolicy/PolicyStatements.aspx
2002 American Psychological Association. Ethical Principles of psychologist. Retrieved 5 February 2009 http://www.apa.org/ethics/code2002.html
Scenario:
Amanda is suffering from acute post traumatic
stress disorder for the last six months. Three years
back she was a victim of date rape. She did not
report the incident, believed it was an accident,
and moved on. Six months back she had a panic
attack while watching a movie and had to be
helped by friends to return home. She did not
leave her apartment for a week. Her friend
cajoled her to take help.
The social worker, Jane has been working with
her since and it took her months to develop a good
working alliance and earn Amanda’s trust and
confidence. But yesterday Jane found out that
behind Amanda’s anxiety is rage. She is
expressing her plan to kill her rapist whom she
finds is enjoying life, succeeding in his career and
now planning to get married when he should have
been in prison. In Jane’s assessment, Amanda’s
plan is well thought out. Jane finds herself caught
in her promise of confidentiality
and her duty to warn.
Question:
Discuss the ethical code provided by American psychological
Association (APA) on this subject.
Psychological treatment, by necessity, entails the
disclosure of extremely sensitive, private information.
The significance of confidentiality is reflected in the ethical
and legal obligations to protect the patient’s privacy. A breach
of confidentiality will harm the patient and expose the
psychologist to a malpractice lawsuit. Although psychologists
have to preserve the confidentiality of their patients, there
are circumstances under which this confidentiality may be
breached such as danger to self and others – committing
suicide, homicide or child/wife abuse. How to ethically set
patient confidentiality boundaries – the balance of the
rights of the patient with the responsibilities of protecting
the society is controversial. This essay addresses the issue
of confidentiality in the above situation of Amanda, who is
suffering from acute post traumatic stress disorder, and by
revealing her plan to kill her rapist, placed Jane, her
social worker, in a dilemma. We will look at the American
Psychological Association’s (APA’s) Ethical code in
maintaining confidentiality and in disclosure; and evaluate
the conflicting values of Jane’s duty to protect and her
duty to warn.
The American Psychological Association’s (APA’s) Ethical
Principles of Psychologist and Code of Conduct serve to guide
psychologists toward the highest ideals of their profession.
These ethical principles in the Ethics Code set forth
psychology’s core values and they play a fundamental role in
setting its ethical parameters. In APA’s 4.01 - Maintaining Confidentiality: it states that the ethical responsibility
of psychologists is to safeguard information they receive
in the course of their practice.
The patient, Amanda, has the right to expect all
communications and records pertaining to her case to be
confidential. The real meaning of trust is that one may tell
all from the depth of one’s soul to another confidentially
and believe without doubt, that the information given is safe
unto death. As it had taken Jane months to be able to gain
Amanda’s trust and confidence in a special therapeutic
relationship, breaking that trust would further worsen
Amanda’s condition and expose her to more harm. A patient
must be able to trust the therapist without a second thought
to information being disclosed to his/her personal detriment.
If this assurance of absolute confidentiality is not honoured
and results in broken trust; it will deter future patients
from seeking psychological treatments or therapies.
An ethically exigent issue in the psychology profession is
the principle of confidentiality and the dilemma it causes
in society. This ethical dilemma arises when two of the
values found in the ethical principles conflict. The duty
to warn in APA’s ethical code has created a principled
dilemma for psychological professionals. Jane faces a moral
problem; she has to choose between –the duty to protect
Amanda, her patient or the duty to warn the rapist or
appropriate authorities of the potential danger. This
creates a potential problem for psychologists, who must
adhere to APA ethical standards, which advocate that under
most circumstances psychologists do not disclose
confidential information without the prior consent of the
patient. Thus ‘to maintain patient’s confidentiality’
conflicts with ‘duty to warn’.
In another similar dilemma, John, a psychologist is the
principal investigator for the ‘Assist’ Project, which is to
identify behavioural trends among HIV+ adults in New York
city. Participants were recruited from HIV/AIDS support
groups. One participant tells John that she is having
unprotected sex with her boyfriend and that her boyfriend
does not know about her HIV status. She has no plans to
reveal her condition. Here, the duty to preserve patient
confidentiality clearly conflict with the need to inform
past and present contacts of an HIV-infected patient of
possible exposure to the virus. Under Principle E: Respect
for People's Rights and Dignity, the APA’s Ethics Code
states that psychologists should respect people's rights
and dignity, including their rights to privacy,
confidentiality and autonomy.
(http://www.onlineethics.org/CMS/research/rescases
/gradres/gradresv3/ hivaffect.aspx).
Thus, Jane needs to seriously consider Amanda’s rights,
autonomy and dignity.
Additionally, there are no clear boundaries that
psychologists can determine whether a patient is dangerous
or not. One may say ‘ I am so angry I could kill him now!’.
Is this said in a fit of anger that does not carry any
threat or to what extent will the patient really executes
this perilous action? Since Jane had found out that behind
Amanda’s anxiety is rage she needs to determine to what
extent will Amanda really set out to harm her rapist. It
could depend chiefly on the intensity of Amanda’s rage
and anxiety. We can never be sure how accurate are
therapists are at predicting who will or will not be
dangerous. In a recent shocking local case, where a
70 year-old taxi driver, Mr Ong Kah Chua set MP Seng
Han Thong on fire by pouring a bottle of thinner! Mr Ong
was angry just because he did not received any hongbao.
A neighbour described Mr Ong as a quiet, reserved and
caring man. He only started acting strangely
(ran up and down the corridorfor no apparent reason)
after his wife moved out to live with their son to
babysit their grandchildren. It is inconceivable and
unpredictable how a quiet, reserved man, even if he has
been acting a little strange lately ( don’t most of us act
a little strange at times, even when we are ‘normal’?)
to resort to such a violent action for a ridiculous
reason. Although he has been in and out the Institute of
Mental Health, no warning was given by his therapist.
This issue of confidentiality and disclosure were the
subject of a tragic case known as Tarasoff v. Regents of
the university of California. In 1969, Prosenjit Poddar,
a graduate student, killed a female student, Tatiana
Tarasoff,after she rejected his romantic advances. He was
diagnosed as having paranoid schizophrenia and had confided
in his therapist that he wais going to kill Tarasoff. The
therapist did inform the campus police and Poddar did
assure the police that he would not commit the crime.
However, Tarasoff’s family sued the university and the
therapists, insisting that they should have warned Tarasoff
of the danger. The Tarasoff case has since been used as a
standard for therapists to warn a client’s potential victims.
Consequently, the Supreme Court of California stated ‘The
protective privilege ends where the public peril begins’
in other words, whenever conflicts arise, safety should
receive priority. California law now advocates that a
psychotherapist has a duty to warn a third party only if:
the therapist actually believed that the patient posed a
serious risk of inflicting serious bodily injury upon an
identifiable victim. The California Supreme Court has
also ruled that threats must be specific: Therapist does
not have to warn if the client makes non-specific threats
against non-specific people.
(http://education.ucsb.edu/csbyd/ED165/docs
/ED165-ethics-Oct-2008.pdf).
This limit to confidentiality has since been highlighted
in the APA Ethical Principles of Psychologists and Code
of Conduct – Disclosure 4.05 states (b)
Psychologist may disclose confidential information-
(3) to protect the client/patient, psychologist,
or others from harm (http://www.apa.org/ethics
/code2002. html). This duty to warn refers to the
responsibility of a therapist to breach confidentiality
if a patient or other identifiable person is evidentially
in clear, imminent danger. The therapist must determine the
degree of gravity of the threat and notify the person in
danger and others who are in a position to protect that
person from harm. Psychologists must maintain
confidentiality and discuss limits of confidentiality
at outset. In John’s case (HIV ‘Assist Project) he could
change his informed consent in future research to include
the notification that confidentiality will not be
maintained if participants indicate that they have placed
an identified person at risk of harm.
Jane’s dilemma could now be eased based on the ethical
code of conduct in Disclosure 4.05. She should tell Amanda
the limits of confidentiality before beginning the
counselling sessions. In assessing Amanda, she should
determine the gravity of Amanda’s threat. Jane believed
Amanda’s plan is well thought out and this indicates that
the threat is serious and is not merely said in a fit of
anger. Moreover, the threat of ‘to kill’ is specific: not
to harm or to injure but ‘to kill’. Furthermore, the person
Amanda wants to kill is a specific person - the rapist. The
rapist is now clearly in imminent danger of losing his life.
Endorsed by Disclosure 4.05 Jane would not be accused of
breaching confidentiality, instead she has the
responsibility to warn the potential victim. In doing so
Jane could prevent an imminent tragedy from happening, she
would have saved a life (though the rapist deserved to be
punished but certainly not by death) and prevented
Amanda from being committed to a mental institute or a jail
term or a death sentence!
The debate whether patients with disorder need protection
from society or society needs protection from these patients
is endless. Resolving an ethical dilemma entails identifying
the pertinent values and evaluating those competing values.
There is no single, definite way of thinking about what it
means to be an ethical psychologist. Mental health
professionals must consider both individual and societal
rights and responsibilities. Confidentiality is required to
protect patient’s identity but more importantly is; in order
to protect the patient from committing an imminent
regrettable crime and to protect the potential victim from
a fatal situation; it is inevitable that in honouring the
duty to protect, the discerning psychologist must
serve his or her duty to warn.
(1552 words)
Reference
Barlow David. H. et Durand V. Mark., (2009). Abnormal Psychology, an integrative approach, USA: Wadsworth Cengage Learning
Reethompson .Psychological Therapy and Confidentiality. Retrieved 5 February 2009 http://www.allfreeessays.com/essays/Confidentiality-Mental-Health/6458.html
APA Assembly. Confidentiality, Disclosure, and Protection of Others. Retrieved 5 February 2009
http://www.psych.org/Resources/OfficeofHIVPsychiatry/HIVPolicy/PolicyStatements.aspx
2002 American Psychological Association. Ethical Principles of psychologist. Retrieved 5 February 2009 http://www.apa.org/ethics/code2002.html
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