assessment

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The Sociocultural Model: Family- Social and Multicultural Perspectives

PHILIP BERMAN IS ALSO a social and cultural being. He is surrounded by people and by institutions, he is a member of a family and a cultural group, he participates in social relationships, and he holds cultural values. Such forces are always operating upon Philip, setting rules and expectations that guide or pressure him, and helping to shape his behaviors, thoughts, and emotions.

According to the sociocultural model, abnormal behavior is best understood in light of the broad forces that influence an individual. What are the norms of the individual’s society and culture? What roles does the person play in the social environment? What kind of family structure or cultural background is the person a part of? And how do other people view and react to the individual? In fact, the sociocultural model is composed of two major perspectives — the family-social perspective and the multicultural perspective.

of NOTE … Changing Families

23% Percentage of U.S. children currently living with a single parent, compared to 9% a half-century ago

(Information from: Pew Research Center, 2019a, 2015a, 2013)

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How Do Family-Social Theorists Explain Abnormal Functioning? Proponents of the family-social perspective argue that clinical theorists should concentrate on those broad forces that operate directly on individuals as they move through life — that is, family relationships, social interactions, and community events. The proponents believe that such forces help account for both normal and abnormal behavior, and they pay particular attention to three

kinds of factors: social labels and roles, social networks, and family structure and communication.

Social Labels and Roles

Abnormal functioning can be influenced greatly by the labels and roles assigned to troubled people (Marcussen, Gallagher, & Ritter, 2019). When people stray from the norms of their society, the society calls them deviant and, in many cases, “mentally ill.” Such labels tend to stick. Moreover, when people are viewed

in particular ways, reacted to as “crazy,” and perhaps even encouraged to act sick, they gradually learn to accept and play the assigned social role. Ultimately the label seems appropriate.

For years, one of psychology’s most famous studies — “On Being Sane in Insane

Places” by clinical investigator David Rosenhan (1973) — seemed to support this position. Eight normal people, actually colleagues of Rosenhan, presented themselves at various mental hospitals, falsely complaining that they had been hearing voices say the words “empty,” “hollow,” and “thud.” According to the study, on the basis of this complaint alone, each was diagnosed as having schizophrenia and admitted. Once hospitalized, the pseudopatients had a hard time convincing others that they were well, even though they behaved normally and stopped reporting symptoms as soon as they were admitted. The label

“schizophrenia” kept influencing the way the staff viewed and dealt with them; for example, one pseudopatient who paced the corridor out of boredom was, in clinical notes, described as “nervous.” And overall, the pseudopatients came to

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feel powerless, invisible, and bored. As you will see in Chapter 13, some key details and assertions of this study have been challenged in recent years, but most sociocultural theorists continue to embrace the study’s emphasis on the power of negative labels.

Social Connections and Supports

Family-social theorists are also concerned with the social environments in which people operate, including their social and professional relationships. How well do they communicate with others? What kind of signals do they send to or receive from others? Researchers have often found ties between deficient social connections and psychological dysfunction (Zhong, Wang, & Nicholas, 2020; Teo et al., 2019). They have observed, for example, that people who are isolated and

lack social support or intimacy in their lives are more likely to become depressed when under stress and to remain depressed longer than are people with supportive spouses or warm friendships.

of NOTE … Social Enhancement

57% Percentage of teenagers who have made one or more new friends online

29% Percentage of teenagers who have made five or more new friends online

33% Percentage of marriages in the United States that began online

27% Percentage of young adults who use online dating websites or apps

(Information from: Lieberman & Schroeder, 2020)

Some clinical theorists believe that people who are unwilling or unable to communicate and develop relationships in their everyday lives will, alternatively, find adequate social contacts online, using social networking platforms like Facebook or Instagram. Although this may be true for some such individuals,

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research suggests that people’s online relationships tend to parallel their offline relationships. Several studies of college students, for example, have found that students who are self-disclosing and have many friends on social media also are particularly social offline, while those who reveal less about themselves and

initiate fewer relationships on social media are less willing to communicate with other people offline (Lieberman & Schroeder, 2020; Dunbar, 2016).

Isolation A man in Paris, France, looks out of his balcony in 2020 a�er the French government ordered him and all citizens to stay home for an extended period due to

the COVID-19 pandemic. Given the relationship between social isolation and mental disorders such as depression, clinical theorists have been concerned about the

psychological effects — immediate, ongoing, and long-term — brought about by the strategies of social distancing, isolation, and confinement needed to help contain the virus.

Family Structure and Communication

Of course, one of the important social networks for an individual is the family. According to family systems theory, the family is a system of interacting parts — the family members — who interact with one another in consistent ways and

follow unwritten rules unique to each family (Goldenberg & Stanton, 2019). Family systems theorists believe that the structure and communication patterns

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of some families actually force individual members to behave in a way that otherwise seems abnormal. If the members were to behave normally, they would severely strain the family’s usual manner of operation and would actually increase their own and their family’s turmoil.

Family systems theory holds that certain family systems are particularly likely to produce abnormal functioning in individual members (Martin, 2019). Some families, for example, have an enmeshed structure in which the members are grossly overinvolved in one another’s activities, thoughts, and feelings. Children from this kind of family may have great difficulty becoming independent in life.

Some families display disengagement, which is marked by very rigid boundaries between the members. Children from these families may find it hard to function in a group or to give or request support.

Philip Berman’s angry and impulsive personal style might be seen as the product

of a disturbed family structure. According to family systems theorists, the whole family — Philip’s mother, father, and brother, and Philip himself — relate in such a way as to maintain Philip’s behavior. Family theorists might be particularly interested in the conflict between Philip’s mother and father and the imbalance between their parental roles. They might see Philip’s behavior as both a reaction to and stimulus for his parents’ behaviors. With Philip acting out the role of the misbehaving child, or scapegoat, his parents may have little need or time to question their own relationship.

Family systems theorists would also seek to clarify the precise nature of Philip’s relationship with each parent. Is he enmeshed with his mother and/or disengaged from his father? They would look too at the rules governing the sibling relationship in the family, the relationship between Philip’s parents and

brother, and the nature of parent–child relationships in previous generations of the family.

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Family-Social Treatments The family-social perspective has helped spur the growth of several treatment

approaches, including group, family, and couple therapy, and community treatment. Therapists of any orientation may work with clients in these various formats, applying the techniques and principles of their preferred models (see MindTech). However, more and more of the clinicians who use these formats believe that psychological problems emerge in family and social settings and are best treated in such settings, and they include special sociocultural strategies in their work.

MINDTECH Therapy, Now Ready-to-Wear?

The availability of highly sophisticated mobile computing devices has changed how we engage

with our worlds, consume information and goods, go about our work, and interact and socialize with

others. And so it is not surprising that modern mobile computing has also opened new doors in

mental health care. Text message–based interventions are on the rise, and mental health apps

offering digital self-help have flooded the marketplace (Hong, Sanchez, & Comer, 2020; Lattie et al.,

2020).

With the ever-growing production of small and low-profile computer devices that can be worn, such

as “smart” watches/wristbands and “smart” glasses, forward-thinking clinicians have increasingly

used these wearable devices to help manage the emotional and behavioral problems of their clients

(Comer, Conroy, & Timmons, 2019). Wearable devices are able to continuously monitor key

physiological and behavioral processes — including heart rate, respiration, sleep quality, physical

activity, and tone of voice — in clients’ everyday lives and to instantly identify problematic areas of

functioning.

One form of wearable therapy — known as the “Just-in-Time Adaptive Intervention” (or JITAI) —

aims to deliver just the right types and doses of support to clients (known as “micro-interventions”),

at the most appropriate times and in the most relevant settings, in direct response to the shi�ing

states of clients (Comer et al., 2019). For example, a JITAI seeking to increase a client’s level of

physical activity might use a smartwatch to continuously detect instances when the individual is too

sedentary. When such an instance is identified, the JITAI would provide an in-the-moment micro-

intervention — perhaps a smartwatch text instructing the person to get up and do 10 jumping jacks,

or simply a tone to remind them to do so (Nahum-Shani et al., 2018).

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Critics of mental health JITAIs argue that although wearable technologies may accurately detect

activities and psychophysiological states, they cannot reliably detect the more subjective emotional

states that typically bring clients into treatment, such as anger, sadness, and stress. Critics further

worry that relying exclusively on computer algorithms to determine interventions will eliminate

critical human elements from mental health care, such as a therapist’s clinical instincts and

judgments or the therapeutic bond between the client and therapist.

Proponents of mental health JITAIs, on the other hand, are very optimistic about the usefulness of

wearable technologies to help guide clinical interventions and believe that the technology’s

potential benefits far outweigh its drawbacks. They argue that delivering automated micro-

interventions to clients in specific moments of great need can add up and eventually result in greater

behavioral change (for example, increased physical activity) than typically results from traditional

therapist-led care that focuses on broader and longer-term goals (such as going to the gym more

o�en). To these proponents, the “around-the-clock” availability of wearable technologies offers

unprecedented client access and intervention opportunities, and they are confident that such

computer devices will one day be sophisticated enough to identify the subjective psychological

states that are most relevant to mental health care.

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Group Therapy

Thousands of therapists specialize in group therapy, a format in which a therapist meets with a group of clients who have similar problems. Typically, members of a therapy group meet together with a therapist and discuss the problems of one or more of the people in the group. Together they develop important insights, build social skills, strengthen feelings of self-worth, and share useful information or advice (Brabender, 2020). Many groups are created

with particular client populations in mind; for example, there are groups for people with alcoholism, for those who are physically disabled, and for people who are divorced, abused, or bereaved.

Why might group therapy actually be more helpful to some people with psychological problems than individual therapy?

Research suggests that group therapy is of help to many clients, often as helpful as individual therapy (Brabender, 2020; Mayor, 2019). The group format also has

been used for purposes that are educational rather than therapeutic, such as “consciousness raising” and spiritual inspiration.

A format similar to group therapy is the support group (also called self-help group, peer group, or mutual-help group). Here people who have similar problems (for example, bereavement, substance abuse, illness, unemployment,

or divorce) come together to help and support one another without the direct leadership of a professional clinician (Lauritzen et al., 2019; Risher, 2019). In such groups, members may join together in person, or they may connect online (Yang, 2020; Sanger, Bath, & Bates, 2019). It is estimated that there are millions of support groups across the world.

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Support from those who know In this group, parents of children who have died by

suicide meet to share their stories, empathize, and offer each other support, information, and advice. A leading kind of group intervention across the world is the

support group, in which people with similar problems or experiences come together to help one another, typically without direct professional leadership.

Family Therapy

Family therapy was first introduced in the 1950s. A therapist meets with all members of a family, points out problem behaviors and interactions, and helps the whole family to change its ways (Kaslow, Mirsalimi, & Celano, 2020). Here, the entire family is viewed as the unit under treatment, even if only one of the members receives a clinical diagnosis. In the following case, for example, Jake, a

17-year-old, has recently been arrested on drug charges; however, the therapist works with the boy’s whole family, helping them identify and correct problems in family functioning — problems that may be contributing to Jake’s behavioral difficulties:

Sarah, 8 years old: (Cuddles into her mom. Mom puts her arm around Sarah, kissing her on the

head.)

Therapist: (to Dad) What’s it like to see Sarah like this?

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Dad: I hate it. I hate how she (Mom) babies her.

Therapist: It seems like Mom does the comforting in the family and you draw the hard line. It must be

tough sometimes, playing the bad guy.

Dad: Somebody’s got to do it….

Therapist: (To Sarah) It looks like you might be feeling afraid.

Sarah: (Shakes her head)

Therapist: Dad, what do you think Sarah might need right now, while she’s cuddled into Mom, holding

up her shield?

Dad: She wants her mom.

Therapist: I’m thinking you might be able to do something for her too. Why don’t you move over to this

couch and sit next to Sarah. Sarah, would that be okay?

Sarah: (Nods her head)

Dad: (Moves next to Sarah, puts his arm around her)

Therapist: So Jake, what would you add … ?

Jake, 17 years old: No one here used to give a shit about me. I was never taken care of like Sarah is now.

Therapist: … Talk to your mom about this. Tell her about your anger and your hurt.

Jake: Mom, you weren’t there for me. I took care of these kids most of the time. I’m sick of cleaning up

your messes.

Mom: (Tears up, looks down)

Therapist: Mom, let’s let Dad sit with Sarah, so you can focus on Jake. Move over here so you can face

him.

Mom: (Moves over, avoids looking at Jake)

Therapist: It’s even hard to look at him. You’re feeling a lot of guilt. Tell Jake about your tears.

Mom: I’m just really sorry.

Jake: You being sorry don’t take it away. It doesn’t fix everything.

Sarah: (Moves toward Mom, climbs into her lap….)

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Today’s TV families Unlike television viewers during

the twentieth century, when problem-free families ruled the airwaves, today’s viewers prefer more

complex and occasionally dysfunctional families, like the Kardashians, whose trials and tribulations and

relationship issues are on display in their hugely popular reality series Keeping Up With The Kardashians.

Therapist: Sarah, I wonder if you could be brave and try something new for me. Let’s let Mom feel what

she needs to feel and talk to Jake. This is going to be a little scary, being so new. Who would you like to

sit with while Mom and Jake tell each other about their hurt and sorrow?

Anna, 14 years old: (Opens her arms for Sarah. Sarah walks over and is held next to her. An authentic

conversation between Mom and Jake continues….)

(Sommers-Flanagan & Sommers-Flanagan, 2018, pp. 332–333)

Family therapists may follow any of

the major theoretical models, but many of them adopt the principles of family systems theory. Today 2 percent of all clinical psychologists, 4 percent of counseling psychologists, and 14 percent of social workers identify themselves mainly as family systems therapists (Prochaska &

Norcross, 2018).

As you read earlier, family systems theory holds that each family has its own implicit rules, structure, and

communication patterns that shape the individual members’ behavior. Thus, family systems therapists often try to change the family power structure, the roles each person plays, and the relationships between members. They may also try to help members recognize and change

harmful patterns of communication (Kaslow et al., 2020).

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Family therapy is often helpful to individuals, although research has not yet clarified how helpful. Some studies have found that as many as 65 percent of individuals treated with family approaches improve, while other studies suggest much lower success rates. Nor has any one type of family therapy emerged as

consistently more helpful than the others (Kaslow et al., 2020; Jiménez et al., 2019).

Couple Therapy

In couple therapy, or marital therapy, the therapist works with two individuals who are in a long-term relationship. Often, they are husband and wife, but the couple need not be married or even living together. Like family therapy, couple therapy often focuses on the structure and communication patterns in the

relationship (Lebow & Kelly, 2020). A couple approach may also be used when a child’s psychological problems are traced to problems in the parents’ relationship.

Although some degree of conflict exists in any long-term relationship, many couples in our society have serious marital discord. The divorce rate in Canada,

the United States, and Europe is now close to 50 percent of the marriage rate. Many couples who live together without marrying apparently have similar levels of difficulty.

Couple therapy, like family and group therapy, may follow the principles of any

of the major therapy orientations. Cognitive-behavioral couple therapy, for example, uses many techniques from the cognitive and behavioral perspectives. Therapists help partners recognize and change problem behaviors largely by teaching specific problem-solving and communication skills. A broader, more sociocultural version, called integrative behavioral couple therapy, further helps partners accept behaviors that they cannot change and embrace the whole relationship nevertheless. Partners are asked to see such behaviors as an understandable result of basic differences between them (Christensen, Doss, &

Jacobson, 2020).

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Couples treated by couple therapy seem to show greater improvement in their relationships than couples with similar problems who do not receive treatment, but no one form of couple therapy stands out as superior to others (Lebow & Kelly, 2020). Although marital functioning improved in two-thirds of treated

couples by the end of therapy, fewer than half of those who are treated achieve “distress-free” or “happy” relationships. One-fourth of all treated couples eventually separate or divorce.

Community Treatment

Community mental health treatment programs allow clients, particularly those with severe psychological difficulties, to receive treatment in familiar social surroundings as they try to recover. Such community-based treatments, including community day programs and residential services, seem to be of special value to people with severe mental disorders (Perera, 2020). A number of countries have launched such programs over the past several decades.

As you read in Chapter 1, a key principle of community treatment is prevention. This involves clinicians actively reaching out to at-risk individuals rather than waiting for them to seek treatment. Research suggests that such efforts are often very successful (Stallman, 2019; Thomas, 2019). Community workers recognize three types of prevention, which they call primary, secondary, and tertiary.

of NOTE … Their Words

“Intellectuals solve problems, geniuses prevent them.”

Albert Einstein

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Primary prevention consists of efforts to improve community attitudes and policies. Its goal is to prevent psychological disorders altogether, and so it is often called “universal prevention.” Community workers may, for example, consult with a local school board, offer public workshops on stress reduction, or

construct websites on how to cope effectively.

Secondary prevention consists of identifying and treating psychological problems in the early stages, before they become serious. Community workers may work with teachers, ministers, or police to help them recognize the early signs of psychological dysfunction and teach them how to help people find treatment.

Similarly, hundreds of mental health websites provide this same kind of information to family members, teachers, and the like.

The goal of tertiary prevention is to provide effective treatment to specific persons who have already developed moderate or severe disorders so that

these disorders do not become long-term problems. Community agencies across the United States successfully offer tertiary care for millions of people with moderate psychological problems but, as you read in Chapter 1, they often fail to provide the services needed by hundreds of thousands with severe disturbances. One of the reasons for this failure is lack of funding, an issue that you will read about in later chapters.

How Do Multicultural Theorists Explain Abnormal Functioning? Culture refers to the set of values, attitudes, beliefs, history, and behaviors shared by a group of people and communicated from one generation to the next (Mio et al., 2019). We are, without question, a society of multiple cultures. Indeed, it is projected that members of racial and ethnic minority groups in the United States will collectively outnumber non-Hispanic white Americans by the middle of this century (WPR, 2019b).

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An unacceptable difference Dressed in traditional

American Indian clothing, a high school student from the Mescalero Apache Reservation in New Mexico

testifies before Congress on “The Preventable

Partly in response to this growing diversity, the multicultural, or culturally diverse, perspective has emerged (Comas-Díaz, 2019). Multicultural psychologists seek to understand how culture, race, ethnicity, gender, and similar factors affect behavior and thought and how people of different cultures,

races, ethnicities, and genders differ psychologically (Mio et al., 2019; Alegría et al., 2018). Today’s multicultural view is different from past — less enlightened — cultural perspectives: it does not imply that members of cultural minority groups are in some way inferior or deprived in comparison with a majority population. Rather, the model holds that an individual’s behavior, whether normal or abnormal, is best understood when examined in the light of that individual’s unique cultural context, from the values of that culture to the special external pressures faced by members of the culture.

The groups in the United States that have received the most attention from multicultural researchers are ethnic and racial minority groups (African American, Hispanic

American, American Indian, and Asian American groups) and groups such as economically disadvantaged persons, LGBTQ individuals, and women (although women are not a minority group numbers-wise). Each of these groups is subjected to special, often profound, pressures in

American society that may contribute to feelings of stress and, in some cases, to abnormal functioning. Researchers have learned, for example, that psychological abnormality, especially severe psychological abnormality, is

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Epidemic: Youth Suicides and the Urgent Need for Mental Health Care Resources in Indian Country.”

indeed more common among poorer people than among wealthier people (APA, 2020b; Grohol, 2019a).

Perhaps the pressures of poverty explain this relationship.

Of course, membership in these various groups overlaps. Many members of minority groups, for example, also live in poverty. The higher rates of crime, unemployment, overcrowding, and homelessness; the inferior medical care; and the limited educational opportunities typically available to poor people often place great stress on many members of such minority groups (Edwards, 2019).

Thus multicultural theorists are increasingly interested in understanding persons through the lens of intersectionality, a framework that examines how each individual’s memberships across multiple cultural groups and social identities — including race, ethnicity, socioeconomic class, gender, and sexual orientation — combine to shape their particular experiences, opportunities, outlook, and functioning.

of NOTE … Experiencing Discrimination

76% Percentage of African Americans who report being regularly or occasionally treated unfairly because of their race

58% Percentage of Hispanic Americans who report being regularly or occasionally treated unfairly because of their ethnicity

(Information from: Pew Research Center, 2019b)

Multicultural researchers have noted that the prejudice and discrimination faced by many minority groups may contribute to various forms of abnormal functioning (Puckett et al., 2020). Women in Western society receive diagnoses of anxiety disorders and of depression at least twice as often as men (MHA, 2018). Similarly, African Americans, Hispanic Americans, and American Indians are more likely than non-Hispanic white Americans to experience serious

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psychological distress (APA, 2018a; HHS, 2009). American Indians also have exceptionally high alcoholism and suicide rates (AFSP, 2018; NSDUH, 2016). Although many factors may combine to produce these differences, prejudice based on race and sexual orientation, and the problems such prejudice poses,

may contribute to abnormal patterns of tension, unhappiness, and low self- esteem.

Multicultural Treatments Studies conducted throughout the world have found that members of ethnic and racial minority groups tend to show less improvement in clinical treatment, make less use of mental health services, and stop therapy sooner than members of majority groups (APA, 2020c; Tilhou et al., 2020; Alegría, 2019).

A number of studies suggest that two features of treatment can increase a therapist’s effectiveness with minority clients: (1) greater sensitivity to cultural issues and (2) inclusion of cultural morals and models in treatment, especially in therapies for children and adolescents (Comas-Díaz, 2019; Sue et al., 2019). Given such findings, some clinicians have developed culture-sensitive therapies, approaches that are designed to help address the unique issues faced by members of various cultural minority groups. Therapies geared to the

pressures of being a female or gender minority, sometimes called gender- sensitive therapies, follow similar principles (Chandra et al., 2019).

Culture-sensitive approaches typically include the following elements:

1. Special cultural instruction for therapists in their graduate training program 2. The therapist’s awareness of a client’s cultural values 3. The therapist’s awareness of the stress, prejudices, and stereotypes to

which minority clients are exposed 4. The therapist’s awareness of the hardships faced by the children of

immigrants 5. Helping clients recognize the impact of both their own culture and the

dominant culture on their self-views and behaviors

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6. Helping clients identify and express suppressed anger and pain 7. Helping clients achieve a bicultural balance that feels right for them 8. Helping clients raise their self-esteem — a sense of self-worth that has

often been damaged by generations of negative messages

Community mental health: Brazilian style Different countries and cultures each

have their own way of reaching out to people with psychological disorders. Here patients and members of the community come together and dance during the

annual Carnival parade and street party in front of the Psychiatric Institute in Rio de Janeiro, Brazil. The goal of the event is to promote community awareness,

acceptance, and outreach by blurring the lines between normal and abnormal functioning.

Assessing the Sociocultural Model The family-social and multicultural perspectives have added greatly to the

understanding and treatment of abnormal functioning. Today most clinicians take family, cultural, social, and societal issues into account, factors that were overlooked just 35 years ago. In addition, clinicians have become more aware of the impact of clinical and social roles. Finally, the treatment formats offered by the sociocultural model sometimes succeed where traditional approaches have failed.

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At the same time, the sociocultural model has certain problems. To begin with, sociocultural research findings are often difficult to interpret. Indeed, research may reveal a relationship between certain family or cultural factors and a particular disorder, yet fail to establish that they are its cause. Studies show a

link between family conflict and schizophrenia, for example, but that finding does not necessarily mean that family dysfunction causes schizophrenia. It is equally possible that family functioning is disrupted by the tension and conflict created by the psychotic behavior of a family member.

Another limitation of the sociocultural model is its inability to predict

abnormality in specific individuals. If, for example, social conditions such as prejudice and discrimination are key causes of anxiety and depression, why do only some of the people subjected to such forces experience psychological disorders? Are still other factors necessary for the development of the disorders?

Given these limitations, most clinicians view the family-social and multicultural explanations as operating in conjunction with the biological or psychological explanations. They agree that family, social, and cultural factors may create a climate favorable to the development of certain disorders. They believe, however, that biological or psychological conditions — or both — must also be present for the disorders to evolve.

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Integrating the Models: The Developmental Psychopathology Perspective

TODAY’S LEADING MODELS vary widely (see Table 3-2), and none of the models has proved consistently superior. Each helps us appreciate a key aspect of human functioning, and each has important strengths as well as serious limitations.

TABLE: 3-2

Comparing the Models

Biological Psychodynamic Cognitive- Behavioral

Humanistic Existential Family- Social

Multicultural

Cause of dysfunction

Biological malfunction

Underlying conflicts

Maladaptive thinking and learning

Self-deceit Avoidance of responsibility

Family or social stress

External pressures or cultural conflicts

Research support

Strong Modest Strong Weak Weak Moderate Moderate

Consumer designation

Patient Patient Client Patient or client

Patient or client

Client Client

Therapist role

Doctor Interpreter Collaborator/ teacher

Observer Collaborator Family/social facilitator

Cultural advocate/teacher

Key therapy

technique

Biological intervention

Free association and interpretation

Reasoning and conditioning

Reflection Varied Family/social intervention

Culture-sensitive intervention

Therapy goal

Biological repair

Broad psychological change

Functional thoughts and behaviors

Self- actualization

Authentic life Effective family or social system

Cultural awareness and comfort

Despite all their differences, the conclusions and techniques of the various models are

often compatible. Indeed, many clinicians now favor explanations of abnormal behavior that consider more than one kind of cause at a time. Such integrative explanations, sometimes referred to as biopsychosocial theories, state that abnormality results from the interaction of genetic, biological, emotional, behavioral, cognitive, social, cultural, and

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societal influences (Tripathi, Das, & Kar, 2019). In a similar quest for integration, many therapists now combine treatment techniques from several models (Gold & Stricker, 2020; Norcross & Beutler, 2019). In fact, 22 percent of today’s clinical psychologists, 31 percent of counseling psychologists, and 26 percent of social workers describe their approach as

“eclectic” or “integrative” (Prochaska & Norcross, 2018). Studies confirm that clinical problems often respond better to combined approaches than to any one therapy alone.

One of today’s most influential integrative views is the developmental psychopathology perspective. As its name implies, this perspective uses a developmental framework to understand how variables and principles from the various models may collectively account

for human functioning — both adaptive and maladaptive functioning (Cicchetti & Handley, 2019; Cicchetti, 2018, 2016). As such, the perspective pays particular attention to the timing of influential variables. The emergence of particular events, experiences, or biological factors — from neurons to neighborhoods — can continue to have enormous impact on later functioning if they occur at vulnerable points in a person’s life. Moreover, the critical question for developmental psychopathologists is not which single factor is the cause of an individual’s current psychological problems, but rather when, how, in what context, and to what degree the multiple factors in their life interact with one another. In Philip Berman’s

case, for example, when did his brother’s birth occur, what was going on in Philip’s life at that point in time, how did his mother’s depression affect her parenting skills, did his childhood experiences teach him how to cope effectively with stress, and were his social systems during childhood, college, and adulthood supportive or did they intensify his difficulties?

What are the factors that developmental psychopathologists look at collectively when seeking to understand a person’s abnormal functioning? As noted above, they draw from each of the clinical field’s major models (Salazar de Pablo et al., 2019). They draw from the biological model, for example, by determining how certain genetic and brain factors have set the stage for the individual’s important environmental experiences. They extract from the psychodynamic model by considering how earlier events in a person’s life — including parent–child relationships — have stifled subsequent development. They employ principles

from the cognitive-behavioral model by determining how the individual’s maladaptive behaviors have been reinforced over the years and how the person has interpreted and processed life experiences. In addition, developmental psychopathologists draw from the humanistic-existential model by considering the person’s competencies, uniqueness, and resilience, even in the face of overwhelming life stress. And finally, they embrace the

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sociocultural model’s emphasis on the influence of social context and culture — both present and past — on the individual’s functioning.

The developmental psychopathology perspective contends that various developmental routes can lead to dysfunction. In fact, two key principles — equifinality and multifinality — are at the center of the perspective. According to the principle of equifinality, a number of different developmental routes can lead to the same psychological disorder. Consider, for example, two teenage boys with conduct disorder, a disorder that you’ll be reading about in Chapter 16. Both boys may come to display the same characteristic symptoms of this disorder, such as stealing, skipping school, lying, and breaking into cars. However, as

illustrated in Figure 3-5, for one of the boys, factors such as unfavorable genes, a difficult temperament, and poor parenting may have interacted to foster the development of conduct disorder. In contrast, the other boy with the disorder may have had favorable genes, been born with a positive temperament, and been raised by highly attentive parents. His serious conduct problems may have resulted instead from an interaction of low self- esteem, strong needs for peer approval, and affiliations with peers who typically engage in delinquent activities.

FIGURE 3-5

Equifinality in Action

Equifinality, one of the key principles of the developmental psychopathology perspective, is on display in this illustration. Two boys who experience different negative variables throughout their development each wind up manifesting the same problem — conduct

disorder — as teenagers.

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According to the other principle of developmental psychopathology, the principle of multifinality, persons who have experienced a number of similar developmental variables (for example, comparable biological predispositions, family structures, schools, and neighborhoods) may nevertheless have different clinical outcomes. Consider two boys who

are each challenged by unfavorable genes and a difficult temperament as they are growing up, along with other negative variables like poverty, traumatic events, and community violence. As illustrated in Figure 3-6, despite their very similar backgrounds, one boy may develop conduct disorder as a teenager, while the other may be well-adjusted. Why this enormous difference in outcome? Perhaps other aspects of their developmental histories differ in key ways. The former boy may, for example, have experienced poor parenting throughout his childhood, while the latter may have been raised by effective parents who helped him develop a strong sense of resilience. When a positive developmental variable

such as effective parenting helps to offset the impact of negative variables such as unfavorable genes or a difficult temperament, it is often referred to as a “protective” factor.

FIGURE 3-6

Multifinality in Action

Multifinality is displayed in this drawing. Two boys who are challenged by several similar negative variables in their childhoods,

such as unfavorable genes and a difficult temperament, wind up with very different teenage outcomes (conduct disorder for one, good adjustment for the other). This is largely because one boy had the additional disadvantage of ineffective parents while the

other boy had the good fortune of effective parents.

Given the developmental psychopathology perspective’s emphasis on timing and development to help explain psychological disorders, it is not surprising that its practitioners focus more on the timing of treatment than on specific treatment techniques. For example, they tend to prioritize prevention, the introduction of protective factors, and

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early intervention for vulnerable persons over treatment for individuals who have already developed severe disorders (Cicchetti & Handley, 2019; Forbes, Rapee, & Krueger, 2019). Furthermore, consistent with the perspective’s special emphasis on context and sociocultural influences, developmental psychopathologists echo the call of community

mental health advocates for community-wide interventions, commonly targeting entire schools or neighborhoods, as opposed to individual treatment formats. Indeed, developmental psychopathologists often play prominent roles in social policy, seeking changes in societal factors that negatively influence development, such as poverty, community violence, and social inequalities.

Given the rise of integrative perspectives and combination treatments, our examinations of abnormal behavior throughout this book will take two directions. As various disorders are presented, we will look at how today’s models explain and treat each disorder, and how well those explanations and treatments are supported by research. Just as important, however, we will also be observing how the explanations and treatments may build upon one another, and we will examine current efforts toward integration of the models, including the efforts of developmental psychopathologists.