Improving Writing and Critical Thinking Competence in Psychology: A Primer and Exercise Manual

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Published on January 3, 2016

Author: jamestobin999

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1. 1 Improving Writing and Critical Thinking Competence in Psychology: A Primer and Exercise Manual James Tobin, Ph.D. Licensed Psychologist, PSY 22074 220 Newport Center Drive, Suite 1 Newport Beach, CA 92660 www.jamestobinphd.com jt@jamestobinphd.com 949-338-4388

2. 2 Table of Contents Part I: The Thesis Paragraph ……… ………….................... 4 Part II: Formulating the Thesis Statement and an Introduction of Critical Thinking Structures…...…...11 Part III: Building the Architecture of the Essay: Section Headings and Section Thesis Paragraphs ……….…23 Part IV: A Strategic Model for Execution …………............28 Part V: Topic Sentences and Transitions …………………31 Part VI: The Essay Conclusion ……………………….…….43 Part VII: Problems to Avoid ………………………..……… 48 Part VIII: Scholarship Etiquette in Writing …………….........57

3. 3 Purpose The purpose of this primer and exercise manual is to support the undergraduate and graduate student’s ability to write more effectivelyin a variety of contexts within academic and applied settings. The primer is not meant to be a comprehensive writing guide, but instead emphasizes the core components of scholarly writing, critical thinking, and the formulation and execution of original ideas. Exercises (indicated in bold red ink) are provided to help the instructor and/or student with practice experiences to help support the refinement of the ideas and skills presented. It is my hope that this manual helps all writers in psychology improve their capacity to think, critically evaluate, and compose original and coherent perspectives along the road to the development of new knowledge. James Tobin, Ph.D.

4. 4 Part I: The Thesis Paragraph

5. 5 Sample Question/Paper Topic Identify a common problem among children, one that is not formally included in the DSM-IV-TR as a psychopathological condition but a problem that still deserves clinical attention. Discuss how this common problem among children is related to formal DSM-IV-TR diagnoses. Identify and describe how the common problem you write about should be addressed clinically. Recommended Model/Ideal First Paragraph of a Response to the Question Above INTRODUCTION Academic cheating is a problem among children and adolescent that appears to correspond with numerous psychiatric conditions and problems.1 Research indicates that the incidence of cheating among American youth has increased by 18% from 2005 to 2010 (Jones, 2011), and data show that the increase of depression and anxiety among high school students is directly correlated with academic dishonesty (Bill & Rogers, 2009; Smith et al., 2008).2 Although cheating is generally viewed by experts in the literature as a byproduct or consequence of more fundamental childhood psychiatric issues including depression (Jones, 2011), early borderline characteristics (Cooper & Carp, 2010), trauma (Smith & Carolyn, 2006), and learning disorders (Seehar, 2000), there is a growing body of work which strongly suggests that cheating causes serious chronic psychiatric and psychological problems including anxiety, attachment problems, and a range of Axis II personality disorders (Keeper, 2011).3 In this essay, I will argue that academic cheating among children and adolescents is a common problem that appears to be both a cause and consequence of fundamental DSM-IV- TR psychiatric conditions.4 Given its correspondence to various forms

6. 6 of pathology, cheating is an important “gateway condition” (Johnson & Reeves, 2006) that, if present in a child, likely signals existing or imminent psychopathology.5 Due to its pervasiveness, the occurrence of cheating deserves to be included in routine academic and medical assessments of children; its early detection would serve an important preventative function.6 In this essay, I will: (1) present data showing the rise of cheating and the co-occurring rise of psychopathology among youths; (2) summarize numerous studies that demonstrate cheating’s role as both a cause and consequence of DSM-IV-TR conditions; and (3) describe the need for clinical psychologists to develop a formalized assessment of cheating that can be included in routine evaluations of children and, as such, would serve as an important preventative intervention.7 Overview The Thesis Paragraph ….  Must exist and be positioned in the first paragraph of the essay.  Must be introduced with “INTRODUCTION.”  Must contain the following elements, more or less in the order as is indicated in the sample above: Sentence #1. Provides the context of the essay, sets the frame, introduces the general subject matter, indicates a clear connection to the question. Sentence #2. Provides one or several references to literature (empirical or theoretical) to further elaborate on the context and to continue to set the frame for the essay. Sentence #3. Provides your primary observation of the empirical/theoretical literature and/or opinion and serves as a launching pad for the thesis statement, which will

7. 7 follow in the next sentence.*** (Sentences #3 and #4 are the major components of the entire essay, requires the most thought, your original voice and candid reaction to what you know, have reviewed, and think). Sentence #4. Provides the thesis statement ********* (This organizes further and refines sentence #3, clarifying your primary observation of the literature and/or opinion into a well- organized statement). You can and should write, “I will argue that ….” Sentences #5, 6. Provides further elaboration on the thesis statement and perhaps adds in additional elements of your perspective that are necessary to respond fully and completely to all elements of the question. Sentence #7. Introduces the major components of the essay, in which you are essentially introducing the essay sections to follow. The items you list (i.e., 1, 2, and 3) should be mini-thesis statements, i.e., the thesis of each section).  This 7-sentence format can be used for most pieces you write, including course papers and comp responses. For comp questions with a main question followed by additional, smaller mini- questions, you can construct your essay as above (integrating everything together into one essay) or respond to each main and additional question separately by using the 7-sentence format for each.

8. 8 Sample Response to the Question/Paper Topic Above INTRODUCTION The impact of bullying is a common problem among children that corresponds to various DSM-IV-TR psychopathological conditions and problems.1 Research has shown a correlation between unstable home environments and bullying.2 Authors indicate that children who experience neglect and abuse are at risk for conduct disorders, particularly bullying.3 Although it may be argued that bullies do not all come from unhealthy home environments, the majority of research demonstrates otherwise.4 The impact of childhood bullying is a significant problem that has lethal effects on the human psyche.5 In this essay, I will argue that bullying is a common and serious problem that causes traumatic stress, anxiety, depression, and suicide.6 Considering the pervasiveness of childhood bullying, it should be monitored and assessed by teachers, counselors, parents, and peers.7 The detection of bullying will be used to prevent further victimization and deal with the rise in young psychopathology.8 In this essay, I will 1) provide research demonstrating the psychological effects of childhood bullying, 2) illustrate how unhealthy home environments (abuse) contribute to bullying (young psychopathology), 3) show the significance that diagnostic assessments have for detecting childhood bullying and providing resources for victims and bullies.9 Comments: This attempt begins well, setting up the context. Yet the thesis statement and surrounding sentences (sentences #2 – 5) are a bit unclear and lack focus. Sentences #7 and 8 seem somewhat tangential. Sentence #9 is well done but if the 7- sentence format was followed would appear as the final 7th sentence of the thesis paragraph.

9. 9 Exercise: Write a First Paragraph in Response to this Question/Paper Topic Sample Question/Paper Topic You are hired to lead a committee in the development of the upcoming DSM-V. One criticism of the DSM-IV-TR your committee faces is the view that while relationship problems (interpersonal/relational difficulties) are addressed in the current diagnostic manual (DSM-IV-TR), there are no reliable guidelines for identifying abnormal relational processes and tying these difficulties to particular mental disorders. Provide a summary of what types of relational processes are noted in the DSM-IV-TR and indicate how they are linked to DSM-IV-TR diagnostic categories. Comment on how you would attempt to improve the way in which disturbed relational processes would be handled in the DSM- V. Write a First Paragraph in Response to this Question  Follow the 7-Sentence Format!  Don’t review your notes or any literature …. Try to do this off the top of your head in 20 minutes or less.  Create elements of the first paragraph (literature references, etc.) before you really know if what you are writing is actually factually correct … this is a test-taking strategy that we will talk about in more detail (see Section IV). That is, write from the perspective of what you imagine will be true of the literature –when you look at it and your course notes -- and your final argument.

10. 10 Sample Response to Exercise #1 INTRODUCTION Although the DSM-IV-TR recognizes that abnormal relational processes are associated with mental disorders, it lacks formal guidelines for identifying relational problems.1 Nevertheless, the DSM-V will demonstrate a more improved method for assessing and identifying abnormal relational processes.2 A growing body of research demonstrates that abnormal relational processes are indicative of mood disorders, anxiety disorders (posttraumatic stress disorder/anxiety), and personality disorders.3 Authors indicate that abnormal relational processes negatively affect interpersonal relationships and psychological functioning.4 Considering that interpersonal skills are necessary for individuals to function, this is an area of great concern.5 It is essential to understand the association between particular disorders and abnormal relational processes in order to effectively treat individuals.6 In this essay, I will address how to improve the diagnostic assessment of DSM-IV-TR by the following ways: 1) identify common features associated with mood disorders, anxiety disorders, and personality disorders, 2) establish diagnostic criteria for abnormal relational disorders, 3) utilize a measure to evaluate abnormal relational processes.7 Comments: This is a good attempt in that it follows well the 7- sentence format. However, notice that there is no clear thesis statement.

11. 11 Part II: Formulating the Thesis Statement and an Introduction of Critical Thinking Structures

12. 12 Overview  The thesis statement provides an argument or opinion that is most effective when it is written from the perspective of an appraisal or assessment, i.e., “when the literature is evaluated on depression and trauma, three primary findings are indicated; these include ….”  Thesis statements may be intimidating because they are viewed as needing to be sensational somehow; that view usually leads to poor thesis statements.  The best thesis statements have a basic organization or tone to them: 1) general context: “Many forms of trauma lead to the emergence of depressive symptoms”, 2) what is known/the appraisal of the research: “Data reveal that pre- existing conditions of vulnerability are necessary in the victim for mood symptoms to manifest as a consequence of trauma,” and 3) implications of the appraisal/major lesson the writer is trying to convey: “These findings suggest that the correlative relationship between trauma and mood symptoms has been largely oversimplified.”  Thesis statements cannot only be formulated based on an intellectual perspective one uses in approaching a topic or literature, a lens if you will. I call this lens a “critical thinking structure” and having one frames what one is to look at/attend to while pushing aside what one does not need to attend to. To write a successful thesis statement, you must understand and utilize the critical thinking structure that corresponds to that thesis statement type.

13. 13 Types of Thesis Statements/Critical Thinking Structures There are 7 major types of thesis statements, ranging from the most basic and elementary (I) to the most complex and sophisticated (VII). In responding to a question or a paper assignment, the thesis statement type (and its corresponding critical thinking structure) should be chosen that best matches the demands of the question. Students’ development through their academic program should demonstrate progressive mastery of these 7 critical thinking structures. Progression involves the student’s capacity to review and critically evaluate a body of empirical or theoretical literature or clinical issue with an ever-increasing capacity to identify, clearly present, and link (a) current knowledge, (b) faulty assumptions inherent in the field’s current knowledge, and (c) areas of confusion and complexity arising from these faulty assumptions that may stimulate the development of new knowledge. A quality essay or article successfully describes (a), (b), and (c), but also introduces (d), a component of new knowledge. What follows is a description of the 7 major types of thesis statements that serve as “critical thinking structures” to organize a student’s response to an exam or paper assignment: I. Summarize/Present a Concept/Basic Application This involves simply presenting a term and its meanings, implications, and ramifications. Ex. “The theory of object relations, when applied to this case vignette, highlights how previous traumatic events affect current functioning and restrict the flexibility of interpersonal roles Sally can play in the world.”

14. 14 II. Compare/Contrast This involves organizing an essay of comparison between two theories or perspectives around a single concept or idea. Ex. “While a behavioral approach to the cause of the couple’s issues would focus on reinforcement contingencies established in childhood, a psychodynamic perspective would focus on unresolved unconscious conflicts from childhood.” III. The “Classic”: What is the Consensus Viewpoint? This involves organizing an essay around an appraisal of the theoretical and/or empirical literature; it is largely descriptive in tone, articulating what the consensus viewpoint seems to be on a particular subject and the general components of what is known (“current knowledge”). Ex. “An evaluation of internet therapy treatments indicates three major trends in the literature: (1) internet therapy is more effective for situational stressors than for chronic psychiatric problems; (2) internet therapy typically appeals to a client of lower SES and formal education than a client who seeks out talk therapy; and (3) internet therapy interventions are largely behavioral in orientation.” IV. Categorizing/Organizing Complex Information This involves taking a phenomenon and organizing or structuring what is known about it in an orderly way that provides conceptual clarity and easy comprehension for the reader. Ex. “The cause of the person’s Narcissistic Personality Disorder as described in the case vignettes can be organized into three main categories that interact to cause symptoms: (1) situational factors, (2) characterological factors, and (3) dynamic factors.”

15. 15 V. “Marketing Water” This involves reviewing the literature on a particular subject and highlighting specific, under-emphasized points and added complexities involved with a significant well-known trend, consensus viewpoint, or truism that are frequently downplayed or not considered at all. This thesis approach begins to identify faulty assumptions inherent in the field’s current knowledge, having the effect of leaving the reader seeing that typical picture portrayed is “really not so clear after all.” This thesis approach provides a cautionary note, still noting the utility of the consensus or trend but characterizing the limitations of a naïve enthusiasm for it. Ex. Water is healthy for all persons, but it turns out that water can be most beneficial for three distinct populations: the young, the obese, and diabetics. Translated to our field: “While a multicultural perspective in psychotherapy is widely championed and has been shown to yield positive treatment outcomes, its application seems most challenging and, at times, damaging, when clinicians apply it in certain clinical circumstances, in certain ways/with certain methodologies and intervention styles, and with three distinct patient populations: 1, 2, 3.” VI. “Earth is Flat/Earth is Round”/Challenging a Truism This involves identifying a trend, consensus perspective, or “truism” in the existing empirical or theoretical literature and poking holes in the apparent validity of the truism so that reasonable skepticism emerges and news vistas of consideration are described. In this thesis statement, the goal is not to attack researchers and theorists who have been responsible for the trend or consensus, but to begin to shed light on the shortcomings or limitations of their thinking up to this point and to begin to suggest areas of necessary refinement of current concepts and ideas. Unlike Thesis Type V above which seeks to provide a cautionary

16. 16 note, this Thesis Type VI is more aggressive and argues that the truism not only may need to be abandoned and/or completely overhauled, but that the faulty logic underpinning the truism may in fact suggest the potential validity of its opposite (the paradoxical tone of this Thesis Type is highly pronounced). Ex. #1: “While the concept of countertransference (CT) has been celebrated in the contemporary literature as an invaluable therapeutic tool, recent evidence shows that most therapists misunderstand the concept (references) and misuse it clinically (references), thus suggesting that the nature of the construct needs to be overhauled and theoretically refined.” Ex. #2: “Although there is great empirical and theoretical support for the relationship between a positive therapeutic alliance and treatment outcome across a range of clinical interventions for numerous patient populations, recent findings indicate that for substance abusers a positive therapeutic alliance is highly predictive of abusers’ ongoing relapse, refractory psychiatric symptoms, and failure to maintain romantic relationships.” VII. Metaphor This involves using a quotation, image or symbol and applying it to the concept being discussed to reveal/showcase your central argument. Ex. “Therapists have been taught for a long time to offer interpretations in moments of intense affect and tension, but I will argue that the more successful course of action is usually for the therapist to ‘strike while the iron is cold.’”

17. 17 Exercise: Creating a Thesis Statement Write a thesis statement of 1-2 sentences in length in response to each of the following questions. Attempt to use a variety of the Thesis Statement Types. Then, include the thesis statement in a complete thesis paragraph. 1. Informed consent is an important element of ethical professional practice. Prepare an essay that describes the current status and role of this concept in current clinical practice. 2. Multi-cultural perspectives are widely championed in the psychotherapy literature. Summarize the major findings in the empirical literature that compare multi-culturally sensitive therapists with non- multi-culturally sensitive therapists. Discuss whether a multi-cultural perspective enhances empathy in the clinical encounter – be specific about factors that may enhance or obstruct empathic processes. 3. Assess the value and efficacy of the term “integrative treatment approach.” Does the term “integrative” differ from the term “eclectic” – if so, how? 4. Describe presenting clinical concerns for which adjunctive treatments (e.g., individualtherapy with co-occurring group therapy or family therapy) are (1) most warranted and (2) not advised/not useful. Sample Responses to Exercise #2 #1. Informed Consent Question Thesis statement only (a): An appraisal of the concept of informed consent postulates six critical factors in ensuring optimal standard of care in clinical practice including: 1) professional, legal, and ethical confounds of therapist-patient relationship; 2) privilege communication and limits therefore; 3) setting the therapeutic frame including financial agreements and frequency, duration, and location of meetings; 4)

18. 18 identification and clarification of patient goals and objectives within the therapeutic process; 5) benefits potential risks on patient functioning, and 6) grievances and remediation policies. Comment: This is a good effort Thesis statement only (b): Informed consent plays a very important role in terms of informing and ensuring the privacy, confidentiality, and respect of patients. Nevertheless, a great concern is whether informed consent is clearly communicated and understood among patients, particularly adolescents, couples, family, and diverse cultural groups. Comment: This is a good effort. Full thesis paragraph: The current status and role of informed consent is an important element of current clinical practice.1 According to the Ethical Principles of Psychologists and Code of Conduct (EPPCC) section XX, informed consent must clearly describe the risks and costs of treatment, possible alternatives, and the potential benefits of the treatment prior to its start (xx, 2003).2 Research appears to suggest that informed consent has overall served as a benefit to the client.3 An evaluation of the role of informed consent indicates three major trends in the literature on its effectiveness: (1) informed consent lowers a client’s anxiety toward treatment; (2) informed consent decreases unrealistic expectations; and (3) informed consent increases the client’s level of motivation toward treatment.4 Given its many benefits, informed consent is an important part of doing no harm (xx, 2001).5 Current clinical practitioners must do no harm (xx, 2001) and informed consent plays an important element in abiding by this law.6 In this essay I will: (1) demonstrate how current research supports the notion that informed consent lower’s a client’s anxiety toward treatment; (2) demonstrate how informed consent decreases unrealistic expectations in therapy; and (3) show how research supports the idea that informed consent increases the clients level of motivation toward treatment.7 Comment: This is an excellent thesis paragraph: the 7-sentence format is followed nicely, and the student has used Thesis Statement Type III (“The Classic”).

19. 19 #2A. Multi-Cultural Issues Question Full thesis paragraph (a): Although various governing bodies and licensure boards including the Board of Psychology and the American Psychology Association have enforced multicultural guidelines for practicing clinicians, current empirical literature strongly suggests that incorporating multi-cultural perspectives in clinical practice can optimize the empathic process. In this essay, I will present data comparing characteristics of multi-culturally sensitive therapists with non-multi-culturally sensitive therapist as it relates to diagnosis and treatment planning, risk management and ethical practice, and therapeutic outcomes. I will then argue that incorporating a multi- cultural perspectives will enhance the empathic process within the clinical encounter due to its influence on: 1) building rapport; 2) conducting accurate assessment of appropriate versus inappropriate nonverbal communication and body language within the context of cultural background; 3) making sound clinical judgment and discerning appropriate, healthy, and adaptive behavior versus psychological pathology; and 4) demonstrating effective delivery of culturally sensitive validation and acceptance strategies. Comment: Very nice effort here, although the 7-sentence format is a bit jumbled. The thesis statement could have been moved further up in the paragraph, and the sections of the essay could have been more cleanly introduced as the end of the paragraph. Full thesis paragraph (b): A variety of research has examined the relationship between multicultural sensitivity and empathy.1 While researchers have demonstrated that multicultural sensitive therapist are likely to foster empathy, non-multicultural sensitive therapists have also demonstrated success with displaying as sense of neutrality, openness, trust, and warmth.2 Nevertheless, the growing diversity in our country requires that therapists possess both multicultural sensitivity and unique therapeutic qualities to provide the most efficient care for our diverse cliental.3 Multicultural sensitivity involves being curious, open-minded (therapeutic attitude), culturally competent, and attune to our patient’s

20. 20 experiences and journeys.4 The lack of multicultural sensitivity may significantly affect patients by resulting in misattunement, alliance ruptures, and early termination.5 In this paper, I will: 1) provide empirical literature demonstrating the clinical utility of multicultural and non-multicultural sensitivity, 2) demonstrate the relationship between multicultural sensitivity empathy, 3) and identify factors that may enhance or obstruct empathy.6 Comment: I like the general structure of this thesis paragraph, which reflects the 7-sentence format. The only major issue is the omission of a clean clear thesis statement: sentences #3, 4 and 5 approach a thesis statement but do not quite arrive a singular statement that can stand alone. #3. Integrative Treatment Approaches Question Thesis statement only: While the integrative perspective relies on theory for the treatment of patients, an eclectic perspective relies less on theory and focuses more on using various forms of treatment for different patients. Comment: Excellent use of Thesis Statement Type II (Compare/Contrast). Full thesis paragraph (a): The terms “integrative” and “eclectic” have been used interchangeably when assessing the value and efficacy of “integrative treatment approach.”1 Studies suggest that the differences between the two exist, but are subtle (xx, 2009).2 It appears as though the subtle differences have not been significant enough to separate the terms “integrative” and “eclectic.”3 In this essay I will argue that while an eclectic approach can be used as a ‘tool kit’ during treatment, an integrative approach serves to combine a number of pieces creating a brand new ‘tool’ which can be utilized in treatment.4 Integrative psychotherapy represents a fusion of one or more theories that are used in treatment.5 In contrast, eclectic practitioners use techniques from a wide array of therapies which may result in patients receiving different approaches for similar treatment.6 In this essay, I will: (1) assess the value and efficacy for the term “integrative treatment approach; and (2) explain differences between the terms “integrative” and “eclectic.” 7 Comment: I like the development of the 7-sentence format structure

21. 21 here, which supports the quality thesis statement. Full thesis paragraph (b): While the term “eclectic”, “integrative”, and “multi-modal” have been used interchangeably in contemporary literature, recent empirical data demonstrates that the focal point is not in distinguishing differences between such term, rather directing clinical attention to patient populations that would benefit most from integrative treatment approaches provided within the context of evidenced-based therapies (EBT) including: 1) patients identified as “treatment resident” toward manualized therapies; 2) patients with limited financial resources and criterion-specific managed care policies; and 3) patients with underlying personality constructs presenting with high risk behaviors. Comment: Nice start to the development of a quality thesis statement here, but the paragraph suffers from “jamming” (see where this is discussed in Section VII). #4. Adjunctive Treatments Question Full thesis paragraph (a): Clinical concern for which adjunctive treatments (i.e., individual therapy with co-occurring group therapy or family therapy) are most warranted and ill-advised contingent on the following five factors: 1) patient’s level of risk to self and other; 2) therapeutic goals and treatment objectives; 3) ethical guidelines (i.e., consent and accent to services; use of translator and language barriers); 4) access to community and treatment resources based on milieu setting; and 5) guidelines of empirically validated treatment approaches for specific populations (i.e. Dialectical Behavioral Therapy for Borderline Personality Disorders). In this essay, I will provide data supporting clinical circumstances when adjunctive treatments is warranted in addition unadvised therapeutic encounters when such recommendations may present potential risks. Comment: The two sentences are difficult to understand and there are significant grammar/punctuation problems.

22. 22 Full thesis paragraph (b): Clinical concerns serve to warrant or not be advised when using adjunctive treatments.1 Studies suggest that, individual therapy for recovering drug addicts works best when patients are participating in adjunctive treatment such as group therapy (xx, 2010).2 In contrast, Johnson & Johnson suggest that adjunctive therapy such as group therapy is not recommended for patients suffering from Bipolar I disorder (Johnson, 2011).3 It appears as though the benefits of adjunctive therapies are dependent on the nature of clinical concerns.4 In this essay, I will argue that adjunctive therapy such as groups can serve as a benefit for recovering drug addicts, whereas adjunctive treatment for other certain clinical concerns such as personality disorder may not be advised.5 Group therapy can help individuals feel as if they are not alone, and serve to encourage their acceptance of themselves through interactions with others who are growing from the same experience.6 Despite its potential benefits, group therapy can increase dissonance if the members of the group have a tendency to over react and get easily distracted.7 In this essay, I will: (1) describe clinical concerns for which adjunctive treatments are most warranted; and (2) describe clinical concerns for which adjunctive treatments are not useful.8 Comment: While there are some issues here with regard to wordiness, APA formatting and grammar, the structure of the thesis paragraph is good and there is a clear thesis statement (sentence #5).

23. 23 Part III: Building the Architecture of the Essay: Section Headings and Section Thesis Paragraphs

24. 24 What follows are sample section headings of an essay response to the question introduced at the beginning of this manual, working off of the Recommended Model/Ideal Thesis Paragraph introduced on pg. 5; you will also see below a model opening paragraph (the section thesis paragraph) that begins Section I of the essay (each section heading must be introduced with a thesis paragraph that sets up that particular section): INTRODUCTION Academic cheating is a problem among children and adolescent that appears to correspond with numerous psychiatric conditions and problems.1 Research indicates that the incidence of cheating among American youth has increased by 18% from 2005 to 2010 (Jones, 2011), and data show that the increase of depression and anxiety among high school students is directly correlated with academic dishonesty (Bill & Rogers, 2009; Smith et al., 2008).2 Although cheating is generally viewed by experts in the literature as a byproduct or consequence of more fundamental childhood psychiatric issues including depression (Jones, 2011), early borderline characteristics (Cooper & Carp, 2010), trauma (Smith & Carolyn, 2006), and learning disorders (Seehar, 2000), there is a growing body of work which strongly suggests that cheating causes serious chronic psychiatric and psychological problems including anxiety, attachment problems, and a range of Axis II personality disorders (Keeper, 2011).3 In this essay, I will argue that academic cheating among children and adolescents is a common problem that appears to be both a cause and consequence of fundamental DSM-IV- TR psychiatric conditions.4 Given its correspondence to various forms of pathology, cheating is an important “gateway condition” (Johnson & Reeves, 2006) that, if present in a child, likely signals existing or imminent psychopathology.5 Due to its pervasiveness, the occurrence of cheating deserves to be included in routine academic and medical assessments of children; its early detection would serve an important preventative function.6 In this essay, I will: (1) present data showing the

25. 25 rise of cheating and the co-occurring rise of psychopathology among youths; (2) summarize numerous studies that demonstrate cheating’s role as both a cause and consequence of DSM-IV-TR conditions; and (3) describe the need for clinical psychologists to develop a formalized assessment of cheating that can be included in routine evaluations of children and, as such, would serve as an important preventative intervention.7 SECTION I: THE SIMULTANEIOUS RISE OF CHEATING AND PSYCHOPATHOLOGY AMONG CHILDREN AND ADOLESCENTS A large body of research indicates that cheating is on the rise (references) and that cheating seems to correspond with increasing rates of various DSM-IV-TR conditions including depression (reference), panic (reference), etc.1 This data strongly suggest a systematic relationship or correspondence between cheating and a variety of formal disorders.2 Children increasingly tend to cheat, and they seem to cheat because they are disturbed in a variety of ways (i.e., mood, interpersonal, cognitive, ego-developmental, intellectual/academic achievement) and across a wide range of situations (home, school, athletic, spiritual/religious) and competencies (learning, trust-building, relational, and coping).3 In this section, I will: (1) summarize the most salient data in the literature that reveal these corresponding trends; and (2) describe the work of two experts in the field (e.g., Smith, 2007 and Jones, 2008) who argue that these corresponding trends are not due to statistical error, chance, or some form of widespread increase of problematic issues in all population demographics, thus adding support to the belief that the corresponding trends are systematically related.4 Paragraph Florida ….. Paragraph Oregon ….

26. 26 SECTION II: EVIDENCE OF CHEATING AS A CAUSE AND CONSEQUENCE OF DSM-IV-TR CONDITIONS Paragraph Kentucky …. Paragraph North Dakota …. Paragraph Hawaii …. SECTION III: ASSESSING CHEATING AS A PREVENTATIVE TOOL Paragraph New Jersey ….. Paragraph Alabama …. Paragraph Vermont …. SECTION IV: THE CONCLUSION Discussion  The section headings are numbered, bold-faced, in all caps, and titled.  The section headings directly correspond to the items listed in sentence #7 of the Thesis Paragraph (INTRODUCTION).  The title of each section heading contains within it a mini-thesis statement (i.e., that is, for Section II the title “Evidence” is weaker than the stronger title above which clearly articulates the main point of the section).  You will notice that the essay begins with INTRODUCTION and ends with CONCLUSION. How to prepare the Conclusion section will be discussed in Part VI of this manual.

27. 27  The first paragraph of each section (see the model section thesis paragraph above for Section I) roughly follows the 7-Stenence Format you learned to do in preparing the Thesis Paragraph for the entire essay (in the INTRODUCTION section); however, the section thesis paragraph can be in a somewhat more compact form than the Thesis Paragraph for the entire essay.  A 4-sentence format is proposed for writing a good these paragraph for each section of the essay: Sentence #1. Provides the context for the section integrated with a few general references from the literature. Sentence #2. Provides the thesis statement (for the section) and essentially reiterates the title of the section. Sentence #3. Provides an elaboration on the thesis statement that introduces/summarizes the material that will be discussed in this section. Sentence #4. Introduces the major components of the section; the items you list (i.e., 1, 2, and 3) should be mini-thesis statements. Sentence #4 here is very much like Sentence #7 in the Thesis Paragraph Exercise: Build the Architecture of an Essay and Write a Section Thesis Paragraph for Each Section After you have written your thesis paragraph to the question presented on page 5, compose the architecture of the essay: write your section headings and create a section thesis paragraph for each section using the 4-sentence format introduced above.

28. 28 Part IV: A Strategic Model for Execution

29. 29 How the Writing of a Response to a Question/Essay Topic Can Be Approached What follows is the “Placeholder Approach” and represents a strategy that involves free-writing first, followed by a revision process based on a review of notes, literature, etc. The initial stage of free-writing sets up a structure for the essay and its components that can then be returned to for revision purposes. Without an initial structure, some students flounder in anxiety and go to the literature with little direction or purpose. Step 1: Write a draft thesis statement (1-2 sentences); select a thesis statement type and free-write without looking at any notes or readings. This should be written freely, with imaginative zeal and a “fantasy” of how you would like the essay to read and what it would say that would be unique, surprising, intriguing. Step 2: Draft sentences #1 and #2 of the 7-sentence format for the Thesis Paragraph. Make up the content. Step 3: Draft sentences #5 and 6 of the 7-sentence format. Make up the content. Step 4: Draft sentence #7 (list a manageable number of items that will be translated into essay sections) ** The above 4 steps should take no more than 15 minutes – at this point, you have your placeholders built in a draft Thesis Paragraph (INTRODUCITON). Next, in what follows, you will revise what you wrote above but the hardest part is over** Step 5: I like to then refine sentences #1 and #2 at this point by reviewing the literature, my notes and readings to collect specific factoids to use to give my essay context.

30. 30 Step 6: I now review whatever readings I have and make notes on index cards here with an eye toward whether or not what I find confirms/disconfirms my draft thesis statement. Based on what I find, I revise the thesis statement sentences (this step takes the longest). In doing this, I may have to move to a different Thesis Statement Type than the one I had originally used or combine various types of thesis statements based on the subject matter and what the readings reveal to me. Step 7: I use my index cards from above to then revise sentences #5 and 6 of the 7-sentence format. Step 8: By this point, the major sections I need for my essay are fairly obvious and I refine sentence #7. Therefore, I have a revision of my Thesis Paragraph completed before I begin writing the rest of the essay. **If I am really moving well, I can accomplish these 8 steps in 40 minutes or so … at that point, I have my Thesis Paragraph done and the architecture of the essay fully constructed. My next steps are then to write the section headings for each section of the essay and then to write the section thesis paragraphs for each section. Next, I write the succeeding paragraphs of each section (the paragraphs that come after the section thesis paragraphs for each section). Finally, I write the conclusion paragraph.

31. 31 Part V: Topic Sentences and Transitions

32. 32 In the prior sections of this manual, the sample question on page 5 was responded to with the following thesis paragraph, section headings, and draft of a first paragraph for Section I. The architecture for the essay is in place and now the writer can go through and fill in the remaining components of the essay that have yet to be written (i.e., the paragraphs named after states and the Conclusion). As these paragraphs are written and the essay is filled in, two major issues in the writing need to be attended to: topic sentences and transitions. Topic sentences and transitions provide the “connective tissue” that links all sentences of the essay together. Topic sentences and transitions are often not attended to but, after the thesis paragraph, are the most important components of good writing. INTRODUCTION Academic cheating is a problem among children and adolescent that appears to correspond with numerous psychiatric conditions and problems.1 Research indicates that the incidence of cheating among American youth has increased by 18% from 2005 to 2010 (Jones, 2011), and data show that the increase of depression and anxiety among high school students is directly correlated with academic dishonesty (Bill & Rogers, 2009; Smith et al., 2008).2 Although cheating is generally viewed by experts in the literature as a byproduct or consequence of more fundamental childhood psychiatric issues including depression (Jones, 2011), early borderline characteristics (Cooper & Carp, 2010), trauma (Smith & Carolyn, 2006), and learning disorders (Seehar, 2000), there is a growing body of work which strongly suggests that cheating causes serious chronic psychiatric and psychological problems including anxiety, attachment problems, and a range of Axis II personality disorders (Keeper, 2011).3 In this essay, I will argue that academic cheating among children and adolescents is a common problem that appears to be both a cause and consequence of fundamental DSM-IV- TR psychiatric conditions.4 Given its correspondence to various forms of pathology, cheating is an important “gateway condition” (Johnson &

33. 33 Reeves, 2006) that, if present in a child, likely signals existing or imminent psychopathology.5 Due to its pervasiveness, the occurrence of cheating deserves to be included in routine academic and medical assessments of children; its early detection would serve an important preventative function.6 In this essay, I will: (1) present data showing the rise of cheating and the co-occurring rise of psychopathology among youths; (2) summarize numerous studies that demonstrate cheating’s role as both a cause and consequence of DSM-IV-TR conditions; and (3) describe the need for clinical psychologists to develop a formalized assessment of cheating that can be included in routine evaluations of children and, as such, would serve as an important preventative intervention.7 SECTION I: THE SIMULTANEIOUS RISE OF CHEATING AND PSYCHOPATHOLOGY AMONG CHILDREN AND ADOLESCENTS A large body of research indicates that cheating is on the rise (references) and that cheating seems to correspond with increasing rates of various DSM-IV-TR conditions including depression (reference), panic (reference), etc.1 This data strongly suggest a systematic relationship or correspondence between cheating and a variety of formal disorders.2 Children increasingly tend to cheat, and they seem to cheat because they are disturbed in a variety of ways (i.e., mood, interpersonal, cognitive, ego-developmental, intellectual/academic achievement) and across a wide range of situations (home, school, athletic, spiritual/religious) and competencies (learning, trust-building, relational, and coping).3 In this section, I will: (1) summarize the most salient data in the literature that reveal these corresponding trends; and (2) describe the work of two experts in the field (e.g., Smith, 2007 and Jones, 2008) who argue that these corresponding trends are not due to statistical error, chance, or some form of widespread increase of problematic issues in all population demographics, thus adding support to the belief that the corresponding trends are systematically related.4 Paragraph Florida ….. Paragraph Oregon ….

34. 34 SECTION II: EVIDENCE OF CHEATING AS A CAUSE AND CONSEQUENCE OF DSM-IV-TR CONDITIONS Paragraph Kentucky …. Paragraph North Dakota …. Paragraph Hawaii …. SECTION III: ASSESSING CHEATING AS A PREVENTATIVE TOOL Paragraph New Jersey ….. Paragraph Alabama …. Paragraph Vermont …. CONCLUSION A. The Topic Sentence Every paragraph in an essay must begin with a topic sentence (the topic sentence is the first sentence of the paragraph). Similar to sentence #1 in the 7-sentence format of the Thesis Paragraph, a topic sentence organizes the reader to the paragraph it introduces, sets the context for the paragraph, and gives the reader a clear roadmap regarding the significance of the paragraph (how it fits into the entire essay).  Good Topic Sentence (this would serve as a good topic sentence for Paragraph Florida above): Numerous studies have indicated that the rise of cheating in the recent past corresponds to an overall increase in psychopathology among children and adolescents.

35. 35  Bad Topic Sentence #1 (as a first sentence for Paragraph Florida above): Jones and Crowly (2008) studied a sample of adolescent cheaters hospitalized for depression.  Bad Topic Sentence #2 (as a first sentence for Paragraph Florida above): Children who are depressed cheat. Often the major mistakes with topic sentences involve their being written without setting up a general context for the paragraph (and hence are two specific, as in Bad Topic Sentence #1 above) or are written too vaguely (thus not giving the reader a clear roadmap, as in Bad Sentence #2 above). Exercise: For each of the paragraphs below, write a more effective topic sentence Paragraph #1: For example, in depression a client who is suffering from interpersonal distress or unfulfilling relationships may begin to withdraw from existing sources of social support as an adaptation to these symptoms. This, however, increases a sense of isolation and reduces the effectiveness of the social support milieu. In turn, the client begins to feel more hopeless and helpless due to cognition that he or she is no longer engaged in social support. This concept is referred to in IPT as “the interpersonal fulcrum” (Ravitz, 2003). Distressing interpersonal events boost negative moods which thereby increase distressing interpersonal events, a classic vicious circle. This suggested adaptation to depression decreases or eliminates contact with social support mechanisms. The physical correlates of depression, such as lethargy, loss of interest in pleasurable activities and low self- esteem further reduce the client’s capacity for fulfilling interaction via impaired interpersonal functioning. Paragraph #2. A seminal study on the familial incidence of fibromyalgia was completed by Arnold et al. in 2004. Arnold et al

36. 36 (2004) found that in a sample comparing 533 relatives of 78 fibromyalgia index cases to 272 relatives of 40 rheumatoid arthritis patients, the families of the fibromyalgia cases were much more likely to have early signs of fibromyalgia syndrome or to have been diagnosed with fibromyalgia than comparable individuals in the rheumatoid arthritis group were (Arnold et al., 2004). Interestingly, this study found that there was a higher rate of a decreased pain-pressure threshold in the families and that the families of fibromyalgia patients were more likely to have a family member diagnosed with a major mood disorder (Arnold et al., 2004). In conclusion, Arnold et al. (2004) speculated that the grouping of mood disorders and pain sensitivity may share genetic components but that more research is needed (Arnold et al., 2004). Some of these factors are discussed below. B. Transitions Perhaps more than any other writing problem, poor transitions are the major culprit. Transitions need to be addressed at two levels: (1) transitions from sentence to sentence, and (2) transitions between paragraphs. Transitions between paragraphs involve, of course, the writing of a good topic sentence. (1) Transitions between Sentences: Often writers consciously or unconsciously “know” how, in their own minds, sentence #1 evolves into sentence #2. However, writers are typically so familiar with their own thinking process that they forget there is a reader involved who does not so easily track the writer’s thinking. See below an example of a sequence of seven sentences (within a paragraph) drawn from an actual student paper:

37. 37 Excerpt from Student Paper Cleckley (1988) discovered that psychopathy and psychosis do not co-occur.1 Evidence of psychosis is completely lacking in psychopathic individuals.2 There is no marked evidence of depression, mania, delusions or hallucinations.3 To others, a psychopathic individual appears as a normally sane person of solid mental health.4 Psychopaths are often agreeable, charming, and socially competent individuals on the exterior.5 Freedman and Verdun-Jones (2010), note that psychopaths typically have average to above average intelligence and at first glance appear to be successful individuals.6 These traits make it easier for them to manipulate society, by lying with conviction for their own personal gain.7 Comments: In the above paragraph, sentence #1 starts out the paragraph well, and seems to be a good topic sentence orienting the reader to a paragraph that is about the lack of co-occurrence of psychopathy and pyschosis. Sentence #2 begins to build on sentence #1 in a relatively cohesive way, although “Evidence” should be followed by a list of references. However, in moving to sentence #3 we see a transitional problem: sentence #3 does not follow from sentence #2, and, what’s more, a consideration of other forms of psychopathology besides psychosis was not indicated in the topic sentence (thus, the mention of depression and mania in sentence #3 seems to come out of nowhere). Then, sentence #4 unclearly moves from sentence #3: after reading sentence #3 the reader is expecting some more sentences about the lack of evidence of depression, mania, delusions or hallucinations, etc., but instead what comes in the next sentence is the somewhat oddly-stated observation about how the psychopath appears to others. Next, sentence #5 introduces a new set of ideas that in no clear logical way connects to any of the 4 sentences preceding it. Sentences #6 and #7 continue to elaborate on ideas that are far afield from the topic sentence.

38. 38 Discussion There are two ways to resolve the problematic between-sentence transitions in this paragraph and, typically, both are needed: (1) the topic sentence needs to be refined to reflect the major ideas of the paragraph and (2) the sentence-to-sentences linkages need to be made much more clear, overt, and logical. See below an example of how these transition problems are corrected: Revision of the Student’s Paragraph Above Research (references) has demonstrated that psychopathic individuals typically do not suffer from other co-occurring disorders and are highly socially appealing.1 Smith and Jones (2010), in a meta- analytic review of empirical studies, found that mood and psychotic disorders are highly negatively correlated with psychopathy, and that the only personality disorders significantly related to psychopathy is narcissistic personality disorder.2 Other researchers (references) have found that subjects’ ratings of psychopathic individuals were highly favorable; subjects generally found psychopathic individuals to be agreeable, charming and socially competenent.3 Psychopaths’ social appeal has been implicated in their capacity to lie and manipulate others (references).4 While deception has been found to cause multiple forms of psychological distress and disorder, this relationship has not been found among psychopaths.5 In the above paragraph, notice:  The construction of a new topic sentence and how every sentence in the paragraph supports it.  The smooth transitional linkages between each sentence: “Other researchers” provides an obvious, clear linkage between sentence #2 and 3; the word “social” provides an

39. 39 obvious, clear linkage between sentence #3 and 4; “While ….” is a dependent clause that begins sentence #5 and uses the gist of sentence #4 to further drive home the topic sentence. Exercise: Revise the following paragraph with an eye toward improving the topic sentence and the transitions between sentences As the treatment of fibromyalgia involves multiple health domains such as sleep, affective regulation, pain and fatigue, it becomes necessary to examine what areas of function psychotherapy can help to improve. While many studies have been conducted on the use of psychotherapeutic interventions such as cognitive behavioral therapy in fibromyalgia, few studies have attempted to address the role of perpetuating factors such as social withdrawal and occupational difficulties (Hasset & Gevirtz, 2009). The factors which aid in perpetuating social and occupational dysfunction provide a cyclical engine which disrupts long-term gains derived from psychotherapy. (2) Transitions between Paragraphs: In addition to sentence-to- sentence transitions, good transitions also need to occur from one paragraph to the next. Paragraphs of an essay should be constructed and arranged in a logical sequence with each succeeding paragraph of the essay “locking” into the one that came before it. The locking must be made through a clear logical transition which is typically facilitated by a well-crafted topic sentence: Example Research (references) has demonstrated that psychopathic individuals typically do not suffer from other co-occurring disorders and are highly socially appealing.1 Smith and Jones (2010), in a meta- analytic review of empirical studies, found that mood and psychotic

40. 40 disorders are highly negatively correlated with psychopathy, and that the only personality disorders significantly related to psychopathy is narcissistic personality disorder.2 Other researchers (references) have found that subjects’ ratings of psychopathic individuals were highly favorable; subjects generally found psychopathic individuals to be agreeable, charming and socially competenent.3 Psychopaths’ social appeal has been implicated in their capacity to lie and manipulate others (references).4 While deception has been found to cause multiple forms of psychological distress and disorder, this relationship has not been found among psychopaths.5 New Paragraph: See the possible options of a first sentence that could begin this next paragraph. New Paragraph (Version A): “Psychopaths generally have a high degree of intelligence and a successful work life.” New Paragraph (Version B): “Even though psychopaths do not typically demonstrate co-occurring disorders and tend to be socially appealing, evidence (references) has indicated a high degree of trauma and interpersonal difficulties early in the development of these individuals.” New Paragraph (Version C): “Narcissistic personality disorder is often diagnosed in psychopaths before they commit crimes (references) and has been linked to the lack of remorse so commonly noted in psychopaths’ reflections on their physical violations of others (references).” Comment. Version B is the best option here, as it refers to and summarizes the prior sentence (the last sentence of the paragraph

41. 41 before it) and uses it to launch into a new idea. Note that it is often the case that problematic transitions between paragraphs require the alteration of the last sentence of the preceding paragraph and a refinement of the topic sentence of the succeeding paragraph, so that the two paragraphs are linked around a pivot idea or notion. Exercise: Revise the following sequence of paragraphs with an eye toward improving both the transition between the paragraphs and the transitions between sentences within each paragraph: In Interpersonal Psychotherapy (IPT), long-term improvement is believed to come from changes in interpersonal behavior outside of the therapy session. IPT encourages the use of in session behavior change techniques such as role playing to enhance interpersonal skills. Role playing involves the in-session acquisition of interpersonal skills through the use of mock demonstrations and role reversals. Weissman et al. (2000) suggest that this technique has significant impact on the client by providing a social template that can be easily applied in day-to-day situations. Returning to the example of difficult interactions with medical personnel, the client may be encouraged to describe the interaction as it occurred. The therapist would then assist the client in formulating a method to change the response of one or both parties by presenting a new scenario or actively encouraging the client to use acquired social skills in a mock interaction. Encouragement of affect refers to the use of therapeutic interventions to assist the client to express, manage and gain more understanding of her or his affective states. Therapy is a unique enterprise in that affect is encouraged to be freely expressed in the majority of therapy modes. IPT suggests the encouragement of affective expression to assist the client in developing skills to reduce conflict, manage disputes and elicit change in the self and in relationships (Weissman et al., 2000). Moreover, facilitating affect is understood to help the client acknowledge and accept events that cannot or should not be changed. In turn, Weissman et al. (2000) indicate that this technique

42. 42 can assist in developing new affective experiences that are more desirable to the client and support system members.

43. 43 Part VI: The Essay Conclusion

44. 44 A successful conclusion is an essential component of an essay and has two basic functions: (1) to summarize for the reader the most significant aspects of the essay including the context, thesis statement, and supporting argument, and (2) to close the essay with a meaningful statement that demonstrates a scholarly appreciation of the necessity for continued work regarding the topic at hand (including research and/or clinical applications) and the resolution of a complex issue or controversy (i.e., what has not quite been said yet in the essay but which necessarily recasts the essay in a new light). Recommended Model/Ideal Conclusion for the Sample Essay on Cheating We Began on Page 5 CONCLUSION In this essay, I have summarized findings from the empirical research that show that academic cheating among children and adolescence is on the rise and appears to co-occur with the rise of numerous psychiatric conditions.1 Data indicate that academic cheating among children and adolescents is a common problem that appears to be both a cause and a consequence of fundamental DSM-IV-TR psychiatric conditions.2 Cheating is characterized as a “gateway condition” that may signal the imminent presence of other forms of psychiatric distress.3 Given the relationship of cheating with other disorders, I have attempted to propose a formal assessment of cheating that may serve as an important preventative tool for doctors, clinicians, and teachers who are in frequent contact with children.4 Researchers will need to continue to pursue the identification of other problematic behaviors, in addition to cheating, that have been under-emphasized due, perhaps, to their being viewed as ordinary acting out phenomena.5 Often apparent on the frontlines of classrooms, athletic fields, and living rooms, these behaviors represent potential underlying difficulties of significance; if identified early and assessed systematically, the gradual progression of more serious psychopathology may be prevented.6

45. 45  The conclusion is signaled by a section heading, “CONCLUSION.”  The conclusion is brief (typically about 6 sentences in length) and usually limited to one paragraph.  Most of the sentences in the conclusion use an active, present verb tense (avoid past tense verb forms).  The first sentence begins with “In this essay” to signal the end of the essay and uses the first person “I” to signal the voice of the writer and his or her efforts and main points of the essay. Sentence #2 is a refrain of the thesis statement from the thesis paragraph (the thesis statement should always re-appear in the conclusion).  Sentence #4 uses the first person “I” again to summarize another major feature of the essay articulated by the writer, i.e., the preventative concerns. Also, using the “I have attempted to ….” signals to the reader that the writer is humble, i.e., that the writer is aware he or she may not have been convincing in the essay but has made an effort to be so.  Sentence #5 recasts the essay slightly by moving from the “micro” focal issue (cheating) to a more “macro” issue that the writer wants to emphasize, i.e., that other problematic behaviors may exist in addition to cheating which need to be identified and assessed. THIS SHIFT FROM THE MICRO TO MACRO IS ESSENTIAL IN THE CONCLUSION AND IS OFTEN MISSING.  Sentence #6 adds onto the gist of sentence #5 and appropriately “romanticizes” the essay by bringing it from the abstract level of ideas and research data down to the real life level of classrooms and playing fields. Also, there is and should be a somewhat dramatic tone to the last sentence. In the model above, the essay

46. 46 ends by noting significant implications, e.g., “… the gradual progression of more serious psychopathology may be prevented.” Exercise: Although it is challenging since you have not read the entire essay, revise the following conclusion of a student paper. Attempt to make revisions based on the suggestions above. In conclusion, careful consideration should be given when deciding upon which treatment to use and when. As previously stated, I believe suicidal behaviors need to be considered first and foremost, as the safety of the patient is always a primary directive. The studies shown in this report demonstrate that DBT is effective in reducing suicidal behavior. With DBT, these severe symptoms appear to reduce much faster compared to the use of TFP, and are more effective and consistent over time. Once suidicality is contained, then there is the dilemma of continuing with DBT or switching to TFP, or even SFT. On the one hand, the measurements used in the studies involving TFP are inconsistent and lack homogeneity. On the other hand, studies using TFP on interpersonal relationships have proven more effective than DBT. Since BPD is a pervasive disorder specifically affecting interpersonal relationships caused by their sense of attachment (Levy et al., 2006) it is my belief that, secondary to suicidality, attachment should be try to be resolved, or at least addressed. In my opinion Fonagy and Bateman say it best in regard to choosing an intervention, and one that also addresses the patient/therapist relationship: a therapist “must take into an inquisitive stance rather than an expert role, be flexible rather than set unachievable goals about attendance and behavior, and structure treatment in collaboration with the patient” (2006, p.3). With regard to future research, it is my opinion that more studies should be conducted with TFP using populations with severe symptoms of BPD such as parasuicidality, while DBT needs more research focusing on its effectiveness with key personality features and interpersonal functioning of borderline patients. In addition, the Fonagy and Bateman (2006) study points to another focus for future research:

47. 47 the drop-out rate of treatment. I would personally like to see a cross study including many different treatments which will address the rates of these treatments as well as the cause.

48. 48 Part VII: Problems to Avoid

49. 49 What follows is a discussion of common problems in weak writing; these are problems that exist beyond basic grammar and punctuation errors. 1. No Thesis Statement In any essay, there must exist a clear thesis statement (the best test as to whether or not a thesis statement exists is whether or not a single sentence from the first paragraph can be extracted from the essay and serve as an “abstract” for the entire essay – it should be able to stand alone). The thesis statement must appear in the thesis paragraph of the INTRODUCITON section and in the CONCLUSION, and should be implied throughout all of the

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