Tuesday, September 1, 2015



Association in bivariate data means a systematic connection between changes in one variable and changes in the other.

When an increase in one variable tends to be accompanied by an increase in the other, the variables are positively associated.

When an increase in one variable tends to be accompanied by a decrease in the other, the variables are negatively associated.

The correlation coefficient, r, makes sense as a measure of association; it is positive when the association is positive, and negative when the association is negative.

The correlation coefficient, r, always has a value between -1 and +1.

The extreme values of r= -1 and r=+1 indicate perfect straight line association. In particular, r=-1 means that all of the data points fall exactly on a straight line having negative slope. And r=+1 means that all of the data points fall exactly on a straight line with positive slope.

The correlation coefficient, r, measures how tightly the points on a scatter plot cluster about a straight line. That is, r does not measure association in general but only straight line association. Correlations near either +1 or -1 indicate that the points fall close to a straight line, When r>0, the scatter plot shows a trend from lower left to upper right, and the line about which the points cluster has positive slope. For r<0, the trend is from upper left to lower right and the slope is negative.


Tuesday, August 25, 2015



Interpersonal Theory of Psychiatry

Personality is the product of interaction with other individuals. The need to relate is as basic as biological needs.

Individuals go through seven stages of personality development during their lifetime to try to maintain a balanced psychological outlook as their lives change. He believed that the individual was influenced by expectations of others.

The concept of PERSONIFICATIONS is related to the individual’s perception of THEMSELVES and perceptions of OTHERS. When there is a conflict between these two, the individual must strive to resolve the conflict and bring his/her self-concept into balance.

Sullivan’s Concepts of Interpersonal Relationships

PERSONALITY, according to Sullivan, consists of the characteristic ways in which a person deals with other people in his interpersonal relationships.

Personality is basically the result of interaction with significant other individuals. Sullivan believed that the need to relate to others is as important and necessary as our other biological needs.

Sullivan builds his approach to psychiatry on the study of personality characteristics which can be directly observed in the context of interpersonal relationships.

Personality is formed by the interpersonal relationships an individual has, especially with close persons, during his entire lifetime.

Patterns of behavior are modified during aging process, but the basic core remains.

Anxiety is one of the central concepts of interpersonal psychiatry. Sullivan employs this term in a special way. He has a very broad concept of anxiety. By anxiety he means basically all basic types of emotional suffering; thus, anxiety includes anxiousness, guilt, shame, dread, feelings of personal worthlessness, etc. Anxiety can be viewed as a warning signal. All causes of anxiety have one thing in common. They threaten the individual’s feelings of personal worth and competence; they erode his concepts of himself as a capable, esteemed person. Hence, anxiety has a tendency to bind a person in whatever unhealthy interpersonal patterns he has.

Anxiety is always interpersonal in origin. It always arises from long-term or short-term unhealthy relationships between people.

The major task of psychiatric treatment is to decrease the various kinds of emotional discomforts grouped under the term “anxiety,” and thus, to facilitate better interpersonal adjustments.

Eventually, the individual develops a concept of himself called (SELF-DYNAMISM) . This is accomplished by developing and stressing characteristics which meet with approval from significant others and de-stressing aspects which meet with disapproval.


Security is the opposite of anxiety. It is a state of relaxed comfort in which an individual feels no apprhensiveness, self-doubt, guilt, inadequacy, or any other kind of emotional distress. People seek security as a result of the prolonged period of helpless experienced in infancy.

A security operation is a kind of interpersonal action or attitude (which we are often unaware of) a person seeks to abolish anxiety and to become emotionally at ease.

Healthy security operation achieves its goal of diminishing anxiety and increasing security without interfering with the individual’s interpersonal competence.

An unhealthy security operation, on the other hand, reduces anxiety and increases security at a certain cost to the individual. The kinds of costs are extremely varied. They may be limitations in the person’s interpersonal capacities, or they may consist of some kind of emotional discomfort.

It is important to remember that each security operation whether healthy or unhealthy, is interpersonal in nature; it occurs in the context of an individual’s relationship with another person or with a group of persons. It is not an unobservable process going on in something called the “mind.”

One of the most common, and easily defined, healthy security operations is sublimation. In sublimation, a person discharges and gives expression to uncomfortable feelings in interpersonally acceptable ways.

Another security operation, which often works in a healthy way, is selective inattention. In selective inattention, an individual (in ways of which he is not aware) fails to observe a stressful or emotionally repulsive thing that is occurring in an interpersonal relationship in which he is involved. He simply blots it out from his perception.

Another security operation, which may operate in healthy or unhealthy ways, is called by Sullivan the “as if” process. In an “as if” security operation, an individual behaves “as if” he were someone other than himself in an interpersonal situation. He adopts and acts out a role; the role is false, but it nevertheless makes practical and comfortable an otherwise painful interpersonal situation.

Unhealthy security operations cause a large number of the states which are labeled psychiatric illnesses.


The word self-system is more accurately conveyed by the term self-protecting system. The self-system is composed of all the security operations by which a person defends himself against anxiety and seeks emotional security. Restated in different words, the self-system is composed of all a person’s characteristic, customary interpersonal devices for protecting himself against emotional distress and for seeking more emotional comfort. Sullivan acknowledged this is not observable however the security operations are. (the black hole )

Most people get along fairly well with most other people much of the time. Thus, Sullivan says, there is a basic tendency toward emotional health and sound interpersonal functioning. If other things do not interfere, personalities tend to grow in healthy ways, and interpersonal relationships tend to proceed in a sound manner.


Awareness and unawareness are fundamental concepts in Sullivan’s system of psychiatry, and they differ much from the concepts of “consciousness” and ‘unconsciousness” of Freud, Jung, and others. Sullivan feels that the “un-conscious mind” is a metaphorical concept which Freud invented and that its existence can no more be demonstrated than the existence of other metaphorical concepts. However, a person’ s awareness or unawareness of something can be objectively demonstrated by talking. Moreover, a matter of common observation is that every person is unaware at each moment of many aspects of their behavior. If a person has a high degree of awareness of his personality structure and how it was influenced by the experiences of his early life, he may, in essence, be able to say, “I am aware that the way I was brought up leads me to be very tense and often irritable when things go wrong in ways that undermine my self-confidence and self-esteem.

A person who is unaware of the nature of his interpersonal experiences learns nothing from them; he says that a person who is unaware of something in his interpersonal life simply does not experience it.

The cause of unawareness is anxiety. Abrupt confrontation with the things he excludes from his awareness usually makes a person feel anxiousness, guilt, shame, loathing of himself, or some other form of emotional discomfort.

A psychiatrist’s role is to participate, as an expert in interpersonal relationships and emotional functioning, in observing and helping a person who has problems in these areas; the therapist is not watching from the audience but up on the stage with the client.


A parataxic distortion occurs when an individual treats another person as if he were someone else, usually a significant, close person from the individual’s past life.


The process by which unhealthy interpersonal patterns are corrected. In consensual validation, a person arrives at a healthy consensus with one or more people about some aspect of his feelings, through individual interpersonal relationships, and this consensus is validated by repeated experiences which emphasize its soundness.


Tuesday, August 18, 2015

Anticipatory Trauma

◆ Reactions to anticipatory trauma:
        o Emotional
                ■ Fear
                ■ Anger
                ■ Confusion
                ■ Hopelessness
                ■ Loss of control
                ■ Numbness
                ■ Moodiness
                ■ Irritability
                ■ Guilt
        o Behavioral
                ■ Social withdrawal
                ■ Disruption of daily activities
                ■ Easily startled or jumpy
                ■ Easily cry
        o Cognitive
                ■ Thoughts preoccupied with anticipation of trauma
                ■ Difficulty concentrating
                ■ Low self esteem
                ■ Indecisiveness
                ■ Poor memory recall
        o Somatic
                ■ Muscle tension
                ■ Headaches
                ■ Gastric problems
                ■ Irregular sleep and appetite
                ■ Fatigue

◆ Treatment Techniques
        o Social support:
        o Physical self-care
                ■ Exercise
                ■ Eating healthy
                ■ Regular sleep
        o Spirituality
        o Meditation or Guided Relaxation
        o Positive self talk
        o Humor

Tuesday, August 11, 2015

Risk factors for and patterns of abuse

Recognizing sings of abuse
In the child: o Sudden changes in behavior or school performance
o Not medical attention for problems brought to parents attention.
o Learning problems, difficulty concentrating, that cannot be attributed to specific disabilities.
o Tends to be watchful, expecting something to happen.
o Lacks adult supervision.
o Overly compliant, passive, or withdrawn.
o Comes to school or other activities early, stays late, does not want to go home.

The Parent: o Shows little concern.
o Denise existence of, or blames the child, for problems at school or home.
o Asks teachers to use physical discipline.
o Describes child as bad or burdensome.
o Demanding high levels of academic and physical performance.
o Relies on child for care, attention, emotional needs.

Parent and Child: o Do not look or touch each other.
o View of relationship is only negative.
o State they do not like each other.

Pattern of Abuse
Tension building o Anger builds.
o Poor communication.
o Victim feels the need to keep the abuser calm.
o Tension mounts.
o Victim constantly feels weary of abuser.
o Abuse (physical, emotional, or sexual) takes place.
Making up:
o Apology may be made.
o Promise of the last time.
o Victim blaming.
o Denial of abuse.
o Calm
o Abuser acts as if nothing has happened.
o Some promises may be met, during this time.
o Victim may believe the abuse is truly over.
o Abuser may give gifts to victim.

Tuesday, August 4, 2015

Statutes, case law and regulations

Professional disclosure statement tells clients about:o the education and qualifications of the therapist
o the nature of the therapeutic process
o Informed Consent
o Document that the client reads about the specifics of therapy treatment
o Client consents to treatment by signing the form
o Procedures and goals of therapy
o Potential harms or risks to client
o Reasonable benefits of therapy
o Qualifications and policies of therapist
o Theoretical orientation of therapist
o Ability to terminate treatment at any time
o Reassurance of referral sources for treatment (3 is standard)
o Fee disclosure

o Ethical obligation of therapist to keep communications between themselves and client private.
o May be charged in contempt of court if therapist refuses to testify about a client.

Exceptions:o Child abuse reporting laws: mandated to report the suspicion of child abuse or neglect. (in some states this is required of all citizens not just counselors)
o Duty to warn: if therapist establishes there is a likelihood that client will cause harm to him/herself or to someone else and the therapist knows who that victim may be.

Privilege- Legal right, owned by the client, which is an exception to the general rule that the public has a right to relevant knowledge in court proceedings. This means information revealed in session is not permitted in court.

Appropriate standard of care- how most therapists would treat a case under similar circumstances. Those who do not follow this are at risk for malpractice.

Dual relationship- occur when therapist does not keep appropriate boundaries and thereby blends personal or business relationships with the therapeutic relationship.

Secret policies- written statements about how information shared privately will be handled by the therapist. Must be signed by both parties.