1. Andrew Rodriguez, L.P. C. - l.
Major approaches to Clinical psychology – Attention Deficit hyperactivity disorder
Amber Williams
PSY/480
November 10, 2014
Andrew Rodriguez, L.P. C. - l.

2. Clinical Psychology Approaches
Attention Deficit Hyperactivity Disorder
Psychodynamic
Cognitive-Behavioral
Humanistic
Family Systems
The complexity of the human makeup leads to the challenge that not can only one single theoretical orientation is the best way of dealing with human behavior. Contemporary science provides four theoretical models that can be considered as world views or philosophy. The four major approaches to clinical psychology are; psychodynamic, cognitive-behavioral, humanistic, and family systems. In this presentation consideration will be given to the philosophical origin of each of the approaches. The goal of the approach will also be addressed along with the techniques and strategies. The application of each approach will also be discussed according to its treatment of attention deficit hyperactivity disorder (ADHD). Attention deficit hyperactivity disorder is a condition characterized by inattention, hyperactivity and impulsivity (National Alliance on Mental Illness, 1996 – 2014). The first of the four sciences to be discussed is the psychodynamic.

3. Psychodynamic Origin: Sigmund Freud Goal: Understand Ego & Development
Techniques & Strategies:
Free Association
Transference
Insight
Working Through
Dream Analysis
Countertransference
The origin of psychodynamic theoretical approach comes from the founder Sigmund Freud. Although the founding father of the science there has been advances down through the years. Currently the goal of the science is to understand the ego, and how early development plays a role in the process. The techniques and strategies used for treatment include free association, transference, insight, working through, and dream analyses. Free association is allowing the patient (client) to speak about whatever is on their mind. Transference is the projection of the issue and dynamics between the patient and the other party involved, converting the issue and behavior onto the therapist. Insight is expanding the awareness of one unconscious thoughts. Dream analysis is the interpretation of dreams in to actual life. Countertransference is where the therapist responds to the transference of the patient through projecting their needs. Now to determine how these techniques and strategies are use in the therapy for Attention Deficit Hyperactivity Disorder. (Plante, 2011)
(Google, 2014)

4. Psychodynamic and ADHD
Triggers
Self Regulating
Raised Awareness
Patients (clients) with ADHD potentially have both oversensitive and under sensitive reactions to stimuli possibly leading to either staying with one activity for any length of time or to endure sudden change. Psychodynamic therapy helps the person with the disorder to understand why their behavior may annoy others that potentially have a negative impact on their relationships. The therapist will help identify problems in self-regulation. The use of the patients history, and their comprehensive understanding about their unique nervous system and the interplay it has with their life will allow them to possible raise their awareness and manage their sensitive nervous system. Within understanding that effectiveness of psychodynamic therapy and ADHD there are variations of outcome. The aforementioned information provided here explains the ability to become more self regulated and potentially a raised awareness of behavior to potentially control the sensitivity or under sensitivity of behavior. Although the case according to the American Journal of Psychotherapy (2003), “The child with symptoms of ADHD who experienced profound narcissistic injury associated with difficulties in rule-bound behavior may have particular challenges in developing a sense of mastery.” This is an elaboration on just one of the multiple variable that may impact the outcome of therapy. (Plante, 2011)
(Google, 2014)

5. Cognitive-Behavioral
Origin: B. F. Skinner & John Watson
Goal: Operant Conditioning
Techniques & Strategies:
Contingency Management
Counterconditioning
Exposure
Behavioral Contract
Participant Modeling
Behavioral Rehearsal
Thought Stopping
The cognitive-behavioral theory has a combination of sub perspectives arriving at its category. There were multiple influences two name two were B. F. Skinner, and John Watson. The focus was to determine the role that social influence play on current behavior. This theory is not about how ones past determines their behavior but rather the present circumstances are what impact behavior. Contingency management is the changing behavior by altering the consequences that follow behavior. Counterconditioning is the developing of more adaptive responses to the environmental stimuli. Exposure whether a little at a time or all at once to the feared situation or stimuli. Behavioral contract is an agreement between the therapist and patient that outlines specific consequences of behavior. Participant modeling is demonstrating the desired behavior for the patient. Behavior rehearsal is practicing how a problem situation maybe handled. Thought stopping is the stopping of irrational or defeating thoughts by interrupting the negative or problematic pattern of thinking. Then there is determining the effectiveness and the outcome that cognitive-behavioral therapy has on ADHD. (Plante, 2011)
(Google, 2014)

6. Cognitive-Behavioral and ADHD
Neuropsychological
Behavioral Skills
Maintenance of Compensatory Skills
Medication
(Google, 2014)
The treatment for ADHD starts with the premise that the disorder is a neuropsychological impairment and the core of the disorder. For the purpose of this presentation the information provided here on cognitive-behavioral therapy for ADHD is pertaining to the adult community. Worthy to note that the information provided for the treatment of adult ADHD is limited because of the newness of recognizing that the disorder is not only a childhood disorder but one that can carry from childhood on into adulthood. The use of cognitive-behavioral therapy for treating ADHD can be beneficial. The challenges are with adults is the long period of time that the patient has dealt with the negative behaviors and the impact those behaviors has had on the individuals life. Typically the disorder when not caught and managed as a child when becoming an adult will be compounded by other areas of concern such as addictions, and depression. According to National Institute of Health (2011), “ Cognitive interventions may target dysfunctional patterns of thought and associated emotions that contribute to avoidance, procrastination, and attentional shifts.” The outcome for adult ADHD and the use of cognitive-behavioral therapy requires consistency of treatment along with more research. (Plante, 2011)

7. Humanistic Origin: Abraham Maslow, Carl Rogers…… Goal: Full Acceptance
Techniques & Strategies:
Active Listening
Empathy
Unconditional Positive Regard
Congruence
Self-Actualization
Peak Experience
In the development of the humanistic approach to clinical psychology there were multiple individuals that were involve. The most influential were Abraham Maslow, and Carl Rogers. Rogers focus was that of client-centered perspective. The goal of the theory was that empathy was needed to understand people with non judgment leading the person to feel completely accepted. The techniques, and strategies used are active listening, empathy, unconditional positive regard, congruence, self-actualization, and peak experience. The description of active listening is the intense listening to the patient using paraphrasing, summaries, reflection, and other techniques. Empathy is the conveying a sense of being heard and understood. Fully accepting the feelings and thoughts of the patient is unconditional positive regard, Being genuine in behavior is congruence. Self-actualization is the innate movement toward growth and fulfilling one’s potential. Finally peak experience is the moments when self-actualization is reached. ADHD and the therapy of the Humanistic approach will be highlighted next. (Plante, 2011)
(Google, 2014)

8. Humanistic and ADHD Self-Accepting Rooted Pride
One of the challenge with the diagnosis of ADHD because if the impact of the sensitive, and under sensitive nervous system is labeling. The humanistic theory focuses on acceptance of the person with the hopes of overcoming the negative perceptions, and judgments. An example if a person is always responding prior to thinking about the outcome, and then leads to a negative impact on another party (class, work, or school, etc.) then the individual may be deemed with a derogatory perspective. The humanistic approach allows for self acceptance of the behavior to understand the disorder as not being the person but rather the circumstance. According to James Levine (1997), “It is also argued that ADHD should be viewed as anchored in the reciprocal transactions between person and situation, rather than as an individual medical disorder requiring only behavior planning and medication.” This idea at the heart of humanistic therapy embodies helping the person fit in rather than isolate. One case study of the use of this form of therapy indicated that the participants gained a sense of pride. Although valuable information for the growth of the theoretical approach there is still room for advancement. The final approach to cover here is that of the Family Approach. (Plante, 2011)
(Google, 2014)

9. Family System Origin: Bateson Group
Goal: Overcome the Stigma Patient Only
Techniques & Strategies:
Reframing
Paradoxical Intention
Joining
Enmeshment
Disengagement
The family system started in the 1950 with the Bateson group in Palo Alto, California. The approach was designed to overcome the limitations the other perspectives seeking to work only with the identified individual. The primary purpose was to find treatment to overcome interpersonal communication problems stemming from research for schizophrenic patient and the relationship with their family. The techniques and strategies used for this therapy is that of reframing, paradoxical intention, joining enmeshment and disengagement. Reframing is the altering the way one understands and interprets a give behavior. Paradoxical intentions is the prescribing the problematic symptom in order to combat resistance to treatment. Joining is when the therapist attempt to connect with the family and become part of the family unit rather than act in a detached observer manner in the sessions. Enmeshment is the over and maladaptive involvement in the lives of family members. Disengagement is over detachment of one family member from others. Now to determine the impact that family systems therapy works for ADHD. (Plante, 2011)
(Google, 2014)

10. Family System and ADHD Limitations of Medication Daily Functioning
Improve Behavior
Help for Parents
Much of the treatment recommended for ADHD includes medication. The Family System approach is an alternative for the family that does not want medication for their child’s therapy and or the medication is not working. The affects of the family system therapy is designed to assist the daily functioning of the patient by improving their behavior and family and peer relationships. Interventions for parents are designed to help parents develop strategies to cope with the difficult behaviors, rather than focusing on the core symptoms (inattention, hyperactivity, and impulsivity). The role of the therapist is to challenge family functioning and difficult interpersonal relationships and thereby enable family disorganization to be resolved. According to the National Center for Biotechnology Information (2014) “The nature of the experimental psychological interventions for ADHD that have been evaluated and reported in the literature is such that it is difficult to identify which specific attributes of an intervention are key to any beneficial effects of treatment. “
(Plante, 2011)
(Google, 2014)

11. Conclusion Approaches Research Outcomes
During the research for this presentation the reality is that there are four Clinical Psychological approaches that are different. Covered here was there application to working with Attention Deficit Hyper Activity Disorder. There is research that shows how the approach was used for the treatment of ADHD. Often the conclusions were the same. Some similarities are the limited amount of research for a particular group. Another similarity was the multiple variables that could occur in limiting the benefits of the treatment. Each had a positive aspect that there are guideline in place that potentially may assist with the helping patients, and families cope with the over sensitivity, and under sensitivity that occurs from ADHD.
(Google, 2014)

12. References Google. (2014) Retrieved from
Levine, J. E. (1997). Re-visioning attention deficit hyperactivity disorder (ADHD). Clinical Social Work Journal, 25(2), Retrieved from
National Alliance on Mental Health. ( ) retrieved from
National Center for Biotechnology Information. (2014) retrieve from
National Institute of Mental Health. (2014) retrieved from
National Institutes of Health. (2011) retrieved from
Plante, T. G. (2011). Contemporary clinical psychology (3rd ed.). Hoboken, NJ:
John Wiley & Sons.
Summers, R. F. (2003). The psychodynamic formulation updated. American Journal of Psychotherapy, 57(1), Retrieved from