by D Sue · 2006 · Cited by 562 — Chapter 18 (Legal and Ethical Issues in Abnormal Psychology): Clearly, a key issue in the case of. Steven V. is the dilemma faced by his therapist.

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HOUGHTON MIFFLIN COMPANY BOSTON NEW YORK Instructor™s Resource Manual Understanding Abnormal Behavior EIGHTH EDITION David Sue / Derald Sue / Stanley Sue Revised by Fred W. Whitford Montana State University David Sue Western Washington University Derald Wing Sue Teachers College, Columbia University Stanley Sue University of California, Davis

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Vice President and Publisher: Charles Hartford Sponsoring Editor: Jane Potter Development Editor: Laura Hildebrand Editorial Associate: Liz Hogan Project Editor: Aileen Mason Editorial Assistant: Susan Miscio Marketing Manager: Laura McGinn Marketing Assistant: Erin Lane Copyright © 2006 by Houghton Mifflin Company. All rights reserved. Houghton Mifflin Company hereby grants you perm ission to reproduce the Houghton Mifflin material contained in this work in classroom quantities, sole ly for use with the accompanying Houghton Mifflin textbook. All reproductions must include the Houghton Mifflin copyright notice, and no fee may be collected except to cover the cost of duplication. If you wish to make any other use of this material, including reproducing or transmitting the material or portions thereof in any form or by any electronic or mechanical means including any information storage or retrieval system, you must obtain prior written permission from Houghton Mifflin Company, unl ess such use is expressly permitted by federal copyright law. If you wish to reproduce material acknowledging a rights holder other than Houghton Mifflin Company, you must obtain permission from the rights holder. Address inquiries to College Permissions, Houghton Mifflin Company, 222 Berkeley Street, Boston, MA 02116-3764. Printed in the U.S.A. ISBN: 0-618-52830-X

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Copyright © Houghton Mifflin Company. All rights reserved. Contents PREFACE.V THE CASE OF STEVEN V VIII CHAPTER 1 – A BNORMAL BEHAVIOR.1 CHAPTER 2 – M ODELS OF ABNORMAL BEHAVIOR.17 CHAPTER 3 – A SSESSMENT AND CLASSIFICATION OF ABNORMAL BEHAVIOR35 CHAPTER 4 – T HE SCIENTIFIC METHOD IN ABNORMAL PSYCHOLOGY..52 CHAPTER 5 – ANXIETY DISORDERS70 CHAPTER 6 – D ISSOCIATIVE DISORDERS AND SOMATOFORM DISORDERS 87 CHAPTER 7 – P SYCHOLOGICAL FACTORS AFFECTING MEDICAL CONDITIONS .102 CHAPTER 8 – P ERSONALITY DISORDERS AND IMPULSE CONTROL DISORDERS 119 CHAPTER 9 – S UBSTANCE-RELATED DISORDERS134 CHAPTER 10 – S EXUAL AND GENDER IDENTITY DISORDERS152 CHAPTER 11 – M OOD DISORDERS170 CHAPTER 12 – S UICIDE..190 CHAPTER 13 – S CHIZOPHRENIA: DIAGNOSIS AND ETIOLOGY207 CHAPTER 14 – C OGNITIVE DISORDERS.237 CHAPTER 15 – D ISORDERS OF CHILDHOOD AND ADOLESCENCE 258 CHAPTER 16 – E ATING DISORDERS AND SLEEP DISORDERS..270 CHAPTER 17 – T HERAPEUTIC INTERVENTIONS .280 CHAPTER 18 – L EGAL AND ETHICAL ISSUES IN ABNORMAL PSYCHOLOGY ..297

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Copyright © Houghton Mifflin Company. All rights reserved. Preface This Instructor™s Manual is designed for instructor s to use in conjunction with the Eighth Edition of Understanding Abnormal Behavior by Sue/Sue/Sue. It is meant to be both a guide to using the text and a handy reference, filled with numerous teaching ai ds and ideas for enlivening classroom presentations. Whether novice or expert, each instructor should be able to select material from these resources to suit his or her needs. ORGANIZATION OF THIS MANUAL The Chapters. This manual contains eighteen chapters th at correspond to the textbook chapters. Each chapter in the manual is filled with teaching suggestions and resources designed to enhance teaching and learning. CHAPTER-BY-CHAPTER ORGANIZATION Chapter Outlines Chapter outlines are one of the most important features in any Instructor™s Manual. The outlines in this manual are very detailed and hi ghlight critical information for student mastery. Instructors can follow the outlines a nd be assured that they will cover all the key material in each chapter, or instructors can edit the outlines to accommodate their own teaching objectives. Learning Objectives Learning objectives, intended to aid students™ mastery of essential facts and concepts, appear in both the Instructor™s Resource Manual and the student Study Guide; text pages corresponding to the objectives are also identified. In addition, multiple-choice questions in the Test Bank are keyed to the learning objectives. This interac tive approach to learning is unique and designed to maximize students™ understanding of text material. Classroom Topics for Lecture and Discussion At least three topics for classroom lectures and discussions are given in each chapter. We have chosen topics that are current, complex, and interesting to studentsŠones we hope will encourage them to conn ect abstract principles and theories to their daily lives. Also, throughout the chapters we have added topics that allow students to think clinically and make differential diagnoses. Internet annotations ar e included to support key topics in this section. These Internet annotations will allow you to have the most current information on a specific topic, thus enhancing your lectures. Classroom Demonstrations Every chapter contains at least three classroom demonstrations, selected for their ability to draw students into many of the issues and challenges confronting abnormal psychology. Many of the demonstrations come w ith handouts that can easily be removed from the perforated manual and copied for classroom use. Inte rnet annotations for the classroom demonstrations are also included in this section. These Internet annotations will allow you to have the most current information on the specific demonstration, thus enhancing your effectiveness. Selected Readings A list of selected readings is supplied in each chapter to support text material and classroom discussions. The lists comprise many ar ticles and books dealing with important issues in abnormal psychology.

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vi Preface Copyright © Houghton Mifflin Company. All rights reserved. Video Resources An annotated list of films and tapes, dealing with high-interest topics in abnormal psychology, completes each chapte r of the Instructor™s Manual. Instructors can use these resources to support classroom presentations or as discussion starters. On the Internet Information is provided about web addresse s for Internet sites related to abnormal psychology. Internet addresses are listed, with annot ations about sites to visit for general topics presented in the chapter. ADDITIONAL ANCILLARIES AVAILABLE Supplements for Instructors New! Abnormal Psych in Film ® DVD/VHS is a hybrid product that contains clips from popular films such as The Deer Hunter , and Apollo Thirteen that illustrate key concepts in abnormal psychology, as well as thought-provoking footage from documentaries and client interviews. Each clip is accompanied by overviews and discussion questions to help bring the study of abnormal psychology alive for students. This DVD works in tandem with the Abnormal Psychology, Eighth Edition Student CD-ROM as a unique learning system. On the Student CD-ROM are select, corresponding video clips with overviews, multiple-choice and essay questions, d esigned to stimulate critical thinking about the diagnosis and treatment of various disorders. Punctuate your lecture with engaging videos from the DVD; then have your students use the Student CD-ROM to further study the concepts presented in those videos. HM ClassPrep CD-ROM with HM Testing This CD-ROM provides one convenient location for testing and presentation materials. It contains PowerPoint slides, the Instructor™s Resource Manual, and the Computerized Test Bank. Our HMTesting program offers delivery of test questions in an easy-to- use interface, compatible with both Mac and Windows platforms. Test Bank The Test Bank features 100 multiple-choice and three essay questions (with sample answers) per chapter. Each question is labeled w ith the corresponding text page reference as well as the type of question being asked for easier test creation. The Test Bank is available on our HM ClassPrep CD-ROM with HM Testing. PowerPoint Slides A completely revamped set of PowerPoint slides is available with the Eighth Edition. Each chapter™s show contains dozens of slides that include tables and illustrations that help highlight the major topics in abnormal psychology. The PowerPoint slides are available on the instructor web site and the HM ClassPrep CD-ROM with HM Testing. Instructor Website For maximum flexibility, much of the material from the HM ClassPrep CD-ROM is also available on our website, which may be accessed at http://psychology.college.hmco.com/instructors . Easy to navigate, this site offers a range of instructional strategies and tools. Course Cartridges for WebCT and Blackboard Course cartridges for WebCT and Blackboard are available for the Eighth Edition, allowing instructors to use text-specific material to create an online course on their own campus course management system. Supplements for Students Study Guide The Study Guide provides a complete review of the chapter with chapter outlines, learning objectives, fill-in-the-blank review of ke y terms, and multiple-choice questions. Answers to test questions include an explanation for both the correct answer and incorrect answers. Student CD-ROM The CD that accompanies every copy of the student is designed to reinforce concepts presented in the textbook as well as provi de engaging, interactive activities that sharpen

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Copyright © Houghton Mifflin Company. All rights reserved. The Case of Steven V. A NOTE ABOUT STEVEN V. Readers familiar with previous editions of Understanding Abnormal Behavior will notice that the extended case of Steven V. now appears only in Chapte r 2. Recognizing that instructors may want to use all of the Steven V. material, the full text of the case from the Fifth Edition has been included here, as well as this guide to using the case in chapters throughout the current edition of the text. GUIDE TO USING THE CASE OF STEVEN V. Chapter 2 (Models of Abnormal Behavior): This condensed chapter describing six approaches to abnormal behavior is an excellent place to use the Steven V. case. Students can be assigned to use one or more of the approaches to explain Steven™s behavior, thoughts, and f eelings. Written assignments, panel discussions, and debates are activities that can engage students in the important process of analyzing this single case from different angles. Chapter 3 (Assessment and Classification of Abnormal Behavior): Because this chapter surveys the many forms that assessment can take , it suggests that Steven V.™s st rengths and weaknesses might have been assessed in many different ways. Each theoretical orientation emphasizes certain forms of data and using particular methods to collect them. Again, an assignment requiring students to describe, compare, and contrast assessment approaches taken by clinicians of different theoretical stripes reinforces the importance of flexible thinking. An integra tive approach to assessment, using neurological, psychological, and observational techniques, could be emphasized here since most clinicians are eclectic rather than purist. Chapter 10 (Sexual and Gender Identity Disorders) : Some of Steven V.™s symptoms entail violent sexual fantasies. Sexual performance concerns and em barrassment with his genitalia are both relevant to the material in this chapter. His use of sexually violent videos in adolescence illustrates some of the points made in the text about a behavioral explan ation for sexual disorders. His Oedipal relationship with his mother relates to th e psychoanalytic explanation. Chapter 11 (Mood Disorders): Bipolar disorder is on e of the diagnoses Steven V. received. Here you can compare the diagnostic criteria for bipolar and major depressive disorder with the symptoms that Steven displays. Ask students which signs are missing, which are present, and which ones we must speculate about. Chapter 12 (Suicide): Steven V. seems like a young man with a high potential for violent behavior directed either at himself or at others. Have students do a lethality assessment of Steven based on what they are told. Give them a reasonable amount of di scretion in speculating on the circumstances in which he would become more and more suicidal. What kind s of suicide prevention efforts might have been put in place on his university campus? How might hi s parents have responded if they knew he was suicidal? Chapter 15 (Disorders of Childhood and Adolescence): Stev en V. is a late adolescent when he arrives at the university counseling service. Students are likel y to see him as having adult disorders. But what disorders would have been diagnosed when he was eight or twelve or fifteen? Students can review the information on childhood depression, separation anxiet y disorder, and conduct disorder to see if the

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The Case of Steven V. ix Copyright © Houghton Mifflin Company. All rights reserved. symptoms and events in Steven V.™s traumatic ch ildhood match. Ask students what interventions with his parents might have changed the trajectory of his personality development. Chapter 17 (Therapeutic Interventions): Here, as in Ch apters 2 and 3, students have an opportunity to describe, differentiate, and critique the use of different theoretical approaches with one case. Written assignments, panel discussions, debates, or ro le-played fitherapy sessionsfl can impress upon students how different therapies would highlight different asp ects of Steven™s behavior, thoughts, and feelings. Once again, you could ask students to design an integr ative approach that would take the best of the many approaches described to effectively treat him and, perhaps, his family. Family therapy is a particularly intriguing option for Steven. The c onflict between and among him, his father, and his mother may trigger some strong reactions from students who often face similar, if less intense, circumstances. An entertaining an d thought-provoking activity is to have students role-play a family therapy session with the V. family. Chapter 18 (Legal and Ethical Issues in Abnormal Psychology): Clearly, a key issue in the case of Steven V. is the dilemma faced by hi s therapist. Should the therapist ta ke seriously Steven™s threats and break confidentiality or keep these secrets? Students should see the links between the Tarasoff ruling and the case of Steven V. They can also think about the means by which a therapist attempts to predict dangerousness. Ask students what evidence from the p ast would indicate that Steven was prepared to harm his former girlfriend; have them assess the ri sks of overpredicting dangerousness versus the risks of underpredicting it. Finally, compare the list of exemptions from privileged communications given in the text and the situation the counseling center th erapist found himself in when Steven discussed his plans to harm his girlfriend.

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x The Case of Steven V. Copyright © Houghton Mifflin Company. All rights reserved. THE CASE OF STEVEN V. Steven V. had been suffering from a severe bout of depression. Eighteen months earlier, Steve™s woman friend, Linda, had broken off her relationship with Steve. Steve had fallen into a crippling depression. During the past few weeks, however, with the encour agement of his therapist, Steve had begun to open up and express his innermost feelings. His depression had lifted, but it was replaced by a deep anger and hostility toward Linda. In today™s session, Stev e had become increasingly loud and agitated as he recounted his complaints against Linda. Minutes ago, with his hands clenched into fists, his knuckles white, he had abruptly lowered his voice and looked hi s therapist in the eye. fiShe doesn™t deserve to live,fl Steve had said. fiI swear, I™m going to kill her.fl The therapist could feel himself becoming tense, a pprehensive, and uncertain: How should he interpret the threat? How should he act on it? One wheel of his swivel chair squealed sharply, breaking the silence, as he backed away from his client. Until this session, the therapist had not believed St eve was dangerous. Now he wondered whether Steve could be the one client in ten thousand to act out such a threat. Should Linda or the police be told of what Steve had said? Steve V. had a long psychiatric history, beginning we ll before he first sought help from the therapist at the university™s psychological services center. (In fact , his parents wanted their son to continue seeing a private therapist, but Steven stopped therapy during his junior year at the university.) Steve had actually been in and out of psychotherapy since kindergarte n; while in high school, he was hospitalized twice for depression. His case records, nearly two inches thick, containe d a number of diagnoses, including labels such as schizoid personality, paranoid schizophrenia, and manic-depressive psychosis (now referred to as bipolar mood disorder). Although his present therapist did not find these labels particularly helpful, Steve™s clinical history did provide some clues to the causes of his problems. Steven V. was born in a suburb of San Francisco, Ca lifornia, the only child of an extremely wealthy couple. His father was a prominent businessman w ho worked long hours and traveled frequently. On those rare occasions when he was at home, Mr. V. was often preoccupied with business matters and held himself quite aloof from his son. The few intera ctions they had were characterized by his constant ridicule and criticism of Steve. Mr. V. was greatly disappointed that his son seemed so timid, weak, and withdrawn. Steven was extremely bright and did we ll in school, but Mr. V. felt that he lacked the fitoughnessfl needed to survive and prosper in today™s wo rld. Once, when Steve was about ten years old, he came home from school with a bloody nose and bruised face, crying and complaining of being picked on by his schoolmates. His father showed no sympathy but instead berated Steve for losing the fight. In his father™s presence, Steve usually felt wo rthless, humiliated, and fearful of doing or saying the wrong thing. Mrs. V. was very active in civic and social affairs, and she too spent relatively little time with her son. Although she treated Steve more warmly and lovingly than his father did, she seldom came to Steve™s defense when Mr. V. bullied him. She generally a llowed her husband to make family decisions. When Steve was a child, his mother at times had been quite affectionate. She had often allowed Steve to sleep with her in her bed when her husband was away on business tr ips. She usually dressed minimally on these occasions and was very demonstrativeŠholding, stroking, and kissing Steve. This behavior had continued until Steve w as twelve, when his mother abruptly refused to let Steve into her bed. The sudden withdrawal of this privilege ha d confused and angered Steve, who was not certain what he had done wrong. He knew, though, that hi s mother had been quite upset when she awoke one night to find him masturbating next to her.

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The Case of Steven V. xi Copyright © Houghton Mifflin Company. All rights reserved. Most of the time, however, Steve™s parents seemed to live separately from one another and from their son. Steve was raised, in effect, by a full-time maid. He rarely had playmates of his own age. His birthdays were celebrated with a cake and candles, bu t the only celebrants were Steve and his mother. By age ten, Steven had learned to keep himsel f occupied by playing fimind games,fl letting his imagination carry him off on flights of fantasy. He frequently imagined himself as a powerful figureŠ Superman or Batman. His fantasies were often ex tremely violent, and his foes were vanquished only after much blood had been spilled. As Steve grew older, his fantasies and heroes b ecame increasingly menacing and evil. When he was fifteen, he obtained a pornographic videotape that he viewed repeatedly on a video player in his room. Often, Steve would masturbate as he watched scen es of women being sexually violated. The more violent the acts against women, the more arou sed he became. He was addicted to the Nightmare on Elm Street films, in which the villain, Freddie Kruger, disem boweled or slashed his victims to death with his razor-sharp glove. Steve now recalls that he spent much of his spare time between the ages of fifteen and seventeen watching X-rated videotapes or violent movies, his favorite being The Texas Chainsaw Massacre, in which a madman saws and hacks women to pieces. Steve always identified with the character perpetrating the outrage; at times, he imagined his parents as the victims. At about age sixteen, Steven became convinced that external forces were controlling his mind and behavior and were drawing him into his fantasies. He was often filled with guilt and anxiety after one of his mind games. Although he was strongly attracted to his fantasy world, he also felt that something was wrong with it and with him. After seeing the movie The Exorcist, he became convinced that he was possessed by the devil. Until this time, Steve had been quiet and withdrawn. In kindergarten the school psychologist had described his condition as autisticlike because Steve seldom s poke, seemed unresponsive to the environment, and was socially isolated. His pa rents had immediately hired a prominent child psychiatrist to work with Steve. The psychiatrist had assured them that Steve was not autistic but would need intensive treatment for several years. And th roughout these years of treatment, Steve never acted out any of his fantasies. With the development of his interest in the occult and in demonic possession, however, he became outgoing, flamboyant, and even exhibitionistic. He read extensively about Satanism, joined a fiChurch of Satanfl in San Fran cisco, and took to wearing a black cape on weekend journeys into that city. Against his will, he was hospitalized twice by his parents with diagnoses of, respectively, bipolar affective diso rder and schizophrenia in remission. Steve was twenty-one years old when he met Linda at an orientation session for first-year university students. Linda struck him as different from other women students: unpretentious, open, and friendly. He quickly became obsessed with their relationship. But although Linda dated Steve frequently over the next few months, she did not seem to reciprocate his intense feelings. She took part in several extracurricular activities, including the student news paper and student govern ment, and her willingness to be apart from him confused a nd frustrated Steve. When her friends were around, Linda seemed almost oblivious to Steve™s existence. In private, however, she was warm, affectionate, and intimate. She would not allow sexual intercourse, but sh e and Steve did engage in heavy petting. Even while he and Linda were dating, Steve grew in creasingly insecure about their relationship. He felt slighted by Linda™s friends and bega n to believe that she disliked hi m. Several times he accused her of plotting against him and deliberately making him fe el inadequate. Linda continually denied these allegations. Finally (on one occasion) , feeling frightened and intimidated by Steve, she acquiesced to having sex with him. Unfortunately, Steve could not maintain an erection. When he blamed her for this fifailurefl and became verbally and physically abusive, Linda put an end to their relationship and refused to see him again.

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