Research@Fielding.edu

Coach, Know Thyself: The Developmental Consciousness of Professional Coaches

Kimberly Ann Perry, Fielding's School of Human and Organizational Development

This dissertation explores the developmental consciousness (DC) of a sample of certified professional coaches using Kegan's (1982) constructive developmental theory as its foundation. Kegan (1994) proposes five progressively complex stages of human consciousness and his empirical work has found most in the general population to be at the third stage. Kegan (1994) argues that, given the complex demands of work and life, adults need to be at the fourth order of consciousness in order to be successful. In order to facilitate the transformation of clients, professional coaches arguably will need to be at least the fourth order of consciousness. However there is little existing research exploring the DC of coaches. Thirty-six certified professional coaches participated in a Subject-Object interview (SOI), a validated measure of developmental consciousness (Lahey, Souvaine, Kegan, Goodman, & Felix, 1988). Results indicated that over a quarter of coaches (28%) had not achieved fully the fourth order consciousness. A majority of coaches (66%) had achieved at least the fourth order or was in transition to the fifth. Only six percent of the participants had achieved the full fifth order of consciousness.

The research also explored whether the extent of coaching experience and/or the level of professional certification was positively related to greater developmental consciousness and surprisingly, found no clear relationships. Finally, the study examined how coaches at the different levels of consciousness make meaning of their engagements with clients. A broad typology of coaches based on their stage of DC is presented. The study found distinct differences in how coaches at the different levels of DC construct their engagements via analysis of six themes (anger, conflicted, changed, success, unsuccessful, and unconditional positive regard). The results of this study point to the importance of attention to developmental consciousness in coaching education programs—including providing coaches with a developmental understanding of where they are on the consciousness spectrum and ways of increasing coaches' complexity of mind. This research suggests there are plenty of growth opportunities for coaches to achieve a greater level of developmental consciousness that will facilitate transformation in the clients they serve.

Suicidal Ideation: Racial Differences in Risk and Protective Factors among Men in Late-Life

Tracey L. Phillips, Fielding's School of Psychology

Late-life suicide in the United States is a growing concern, yet little attention has been given to the considerable differences in suicide rates between elderly Caucasian and Black American men. This study examined the influence of race, age, and marital status on suicidal ideation as mediated by reasons for living, loneliness, perceived burdensomeness, and thwarted belongingness. In a sample of 120 community-dwelling men aged 65 and older, results indicated that age was not a significant predictor of suicidal ideation; race and marital status were predictors of suicidal ideation through intervening variables reasons for living and perceived burdensomeness, respectively. Black men had more reasons for living related to responsibility to family, moral obligations, and child-related concerns in comparison to Caucasian men. Loneliness and thwarted belongingness were related to marital status, but had no direct or indirect relationship with suicidal ideation. These findings have implications for understanding the risk and protective factors that may benefit suicide prevention efforts and treatment of men in late-life.

An Exploration of Racial Identity, Self-Esteem, and School-Level Diversity for African and African American Adolescents in Seattle, Washington

Dolores Irene Blueford, Fielding's School of Human and Organizational Development

This two-phase, sequential mixed methods research study explored racial identity, self-esteem, and school-level diversity for African and African American adolescents in Seattle, Washington. The study addressed three research questions: 1. What are African American and African adolescents’ perceptions of the salience and meaning attached to their racial identity? 2. What is the significance of the relationship between perceptions of racial identity, interracial contact, and self-acceptance for African American and African adolescents within racially/ethnically diverse schools? 3. What are the lived experiences of African American and African adolescents related to racial identity, self-acceptance, and interracial contact within racially and ethnically diverse high schools?

Four assessment instruments were administered to 68 high school students who self-identified as African or African American, age 15-19 years, in grades 10-12, attending four high schools within the Seattle Public School District. The Multidimensional Inventory of Black Identity-Teen (MIBI-T; Scottham, Sellers, & Nyugen, 2008), Rosenberg Self-Esteem Scale (RSES; 1965), a researcher-modified version of the Interracial Contact Scale (Wegner & Shelton, 1995), and Demographic Data were administered. Nine survey respondents participated in three separate 2-hour small group sessions. One direct student interview was conducted. The representative reliability of the assessment instruments with the research population was a = .84 for the MIBI-T, a = .87 for the RSES, and a = .81 for the IRCS.

Hypotheses that scores on MIBI-T subscales were correlated with self-esteem and with having more and frequent interracial contact were partially supported. Four relevant themes were identified by a thematic analysis of extracted text from the group sessions and participant interview. The integration of the quantitative results and interpretations of the relevant themes resulted in three overarching findings: Participants reported (a) a high level of self-acceptance; (b) identities defined by factors other than race, and primarily by ethnicity, culture, and global concerns; (c) school-level diversity significantly influenced the frequency and quality of intergroup contact. These findings suggest that the growing influence of black immigrants has expanded perceptions and understanding of individual and black racial group identity, and qualitative meaning to being African American. The current study also challenged a prevailing idea of low self-esteem in black adolescents, and affirmed the positive influence of school-level diversity to black adolescents’ self-acceptance and positive intergroup interactions. Finally, the findings questioned the prevailing construct of race as a social and biological imperative, and research factor to exploring identity for adolescent participants.

Key words: adolescents, African, African American, intergroup contact, school-level diversity, self-esteem, race, racial identity

Expatriate Managers’ Conceptions of Their Experience as Managers: A Phenomenographical Study

Jeannie Duncan, Fielding's School of Human and Organizational Development

Expatriate literature provides valuable information about the experience of living overseas, focused primarily on cross-cultural adjustment and improving engagement and retention. This study contributes to the literature by revealing how expatriate managers understand their experiences as managers. Fifteen senior-level expatriate managers working in the mining industry in Indonesia participated in this phenomenographic study of the perceptions they have of their experiences as managers. Findings revealed that expatriate managers view their managerial work as understanding and solving problems. Their perspective on the problems they are to solve and the discretion they have to do it impacts the ways they manage self, people, and the business. Three distinct, increasingly complex role perceptions emerged that define their problem-solving framework: (a) compliance with past practice and maintaining status quo, (b) completing projects and improving project-related processes, and (c) advancing the organization. While there are common approaches to managing across the three role perceptions, some important differentiating behaviors emerged. Suggestions for expatriates and organizations to maximize the experience of managing overseas are discussed, along with limitations of this study and recommendations for future research.

Keywords: expatriation, expatriate manager, cross-cultural leadership, phenomenography

Inspired Self-Directed Learning: How Motivated Children Pilot Their Own Learning Paths

Kristen Miney, Fielding's School for Human and Organizational Development

How motivation drives learning through a self-directed process, especially in childhood, has become a much theorized, researched, and developed topic. Human learning, once recognized as self-driven, was explored with motivation inquiries, defined with self-determined effort studies, and found depth through perseverance findings. Questions that emerged from a review of literature defined my examination into this dynamic: the first recognized experience with inspiration, the self-directed method, and the collaborative engagement.

This research investigated the inspiration that sparks initiative, the self-directedness for developing a plan, and the collaborative mind-set to enlist others in achieving a learning goal. Six fifth- and sixth-grade teachers recommended eight motivated students, of which four student-parent interviews chronicled first recognized experiences with inspiration. Qualitative analysis examined the multiple perspectives around the synergistic themes of ambitious and collaborative learning, analytical intellect and introspective awareness, and supportive circumstances.

Keywords: andragogy, ambition, curiosity, qualitative research, grit and perseverance, initiative, heutagogy, self-directed learning, social learning.

Supports Frontline Workers Identify as Helpful in Their Work with Troubled Youths

Karlene C. Ferron, Fielding's School of Educational Leadership for Change

Troubled youths are vulnerable individuals who rely on the support of human services frontline workers. This study examined the following question: "What supports do frontline workers identify as helpful in their work with troubled youths?" Autoethnography was one of two methodologies that framed the current research and connected the study to my personal journey. I conducted affirmative interviews with 12 frontline workers using the appreciative inquiry method. The major findings were that frontline workers identified the following significant supports: clinical supervision, paid time off, tuition reimbursement, continuing education, reduced paperwork, and collaboration with employers and team members. The findings are consistent with the philosophy of positive psychology, which values authenticity and the opportunity for individuals seeking to continue to grow personally and professionally (Duckworth, Steen, Martin & Seligman, 2005). The therapeutic position requires helping to "build the pleasant life, the engaged life, and the meaningful life" (Duckworth et al., 2005, pp.. 631-641).These results have implications for employers seeking to sustain frontline workers. Team effort might be more effective since schools, communities, and worksites are considered complex ecological systems (Hawe, Shiell & Riley, 2009). Additionally, frontline workers have a responsibility to uphold best practices by gaining the most out of supportive activities. They must perceive it as support not just for them but also to help them help youths and families (Halpern, 1997).

Keywords: Appreciative inquiry, frontline workers support, clinical supervision, employer-employee collaboration, autoethnography

Negative Capability: A Phenomenological Study of Lived Experience at the Edge of Certitude and Incertitude

Anil Behal, Fielding's School of Human and Organizational Development

The study examined what it was like for leaders to be in a state of negative capability during
periods of uncertainty and conflict in the workplace. “Negative Capability” is an expression that
was coined by the English romantic poet John Keats and suggests a peculiar disposition to stay in
mysteries, doubts, and uncertainty without the irritable reaching after fact and reason. Interviews
were conducted using the interpretative phenomenological analysis (IPA) methodology. The
analysis indicated that the context in which a leader is embedded does not have a significant
bearing on how that individual experiences and makes sense of negative capability. The majority
of leaders interviewed appeared to have a diminished capacity to contain uncertainty when faced
with paradoxical dilemmas. In these situations, they resorted to behaviors such as problem solving,
consulting others, shutting down, and dispersing as a means of defending against the uncertainty.
Exercising servant leadership and the intermingling of the leaders personal and professional
lives were strongly emerging themes.

Keywords: John Keats, negative capability, OCD, paradox, levels of abstraction, certitude,
dialectics, Buddhism, dispersal, social defenses, reframing

Executive Coaching and Self-Efficacy: A Study of Goal-Setting and Leadership Capacity

Carol-Anne Minski, PhD, Fielding’s School of Human and Organizational Development

Executive coaching has been proposed as an intervention that helps executives improve their performance, and achieve the goals of the organization. It is generally accepted that goal-setting is a necessary condition for successful coaching (Grant, 2004). However, what actually happens in coaching engagements remains a mystery. The purpose of this research was to investigate coaching strategies, and reveal the roles those strategies played in positive goal accomplishment. This dissertation research examined the strategies used by executive coaches to enhance leader’s self-efficacy in goal accomplishment. This was a qualitative descriptive study that utilized a semi-structured interview method with 20 executive coaches. The main focus of the interview was to ask coach participants to describe the specific coaching strategy that takes place during goal-setting with executive clients. Thematic analysis was the method used for identifying, analyzing, and reporting patterns (themes) within data.

A description of what actually happens in the executive coaching engagement to increase self-efficacy was unknown prior to this research. This research has taken the first step to fill that gap in the research literature. As a result of this research, a new a coaching model that coaches can utilize in order to enhance positive goal accomplishment has been discovered. The strategies used by the coaches in this research are based on the following five theories: adaptive leadership, appreciative inquiry, social cognitive theory, adult learning theory, and change theory. Coaches now can have a firmer understanding of how the combination of these evidence-based strategies can influence self-efficacy to accelerate positive goal accomplishment. It is suggested that this model be added to coach training and certificate programs.

Key Words: Executive coach, goal-setting, self-efficacy, social cognitive theory

Secondary Traumatic Stress in Mental Health Providers

Kevin Petersen, Fielding's School of Psychology

A cross-sectional sample of 228 mental health providers completed an online survey to explain the factors relating to the development of secondary trauma in mental health workers. Risk factors were measured by the Life Event Checklist and the Secondary Exposure Scale. The Self-Care Checklist, Shared Power Scale, and the Post Traumatic Growth Inventory Short-Form were used to measure protective factors. A structural equation modeling approach was used to determine the general compatibility of the model with the data, and examine the strength and direction of relationships that predict elevated symptoms of secondary trauma. The results support the compensatory resilience model and suggest that protective factors such as self-care and workplace empowerment are very important in lessening the risk of developing trauma symptoms in mental health professionals.

KEY WORDS: SECONDARY TRAUMA, PROTECTIVE FACTORS, RISK FACTORS

A Narrative Study of the Relationships Between Women Diagnosed with Borderline Personality Disorder and Their Therapists

Shari E. Goldstein, Fielding's School of Psychology

The goal of improving therapy experiences for individuals diagnosed with borderline personality disorder (BPD) requires that the relationships between this patient population and the clinicians who treat them be better understood (Clearly, Siegfried, & Walter, 2002; Commons-Treloar, 2009; Westen, 1990). Though studies suggest that the therapy relationships of BPD-diagnosed patients are unusually fraught with miscommunications and mutual feelings of frustration and dissatisfaction (Clearly, Siegfried, & Walter, 2002; Fallon, 2003; Muller & Poggenpoel, 1996; Nehls, 1999), little is known about how these tensions develop, particularly from the viewpoint of the patients. The purpose of this qualitative study was to explore the interpersonal therapy experiences of seven female participants previously diagnosed with BPD using participants’ narratives as the primary data source. An additional purpose was to consider the impact of participants’ object relations patterns on their therapy relationship experiences. Prominent interpersonal patterns were identified from three sources--participants’ narratives, results from the Core Conflictual Relationship Theme-Relationship Anecdotes Paradigm (CCRT-RAP) interview (Luborsky, 1990), and my interpersonal reactions to each participant. The results were analyzed by participant and by group. Identified object relations patterns contributed significantly to each participant’s interpersonal therapy experiences, including experiences of alliance ruptures and outcomes. Sustainability of therapy relationships was closely linked to participant reports of how their therapists responded to interpersonal tensions. As a group, the seven participants desired therapists who demonstrated caring and kindness and who joined them in their experiences through a deep form of listening and validation. These conditions were necessary but not adequate for the development of a healing alliance. Participants also desired clinicians who were confident, skilled, knowledgeable about BPD, and who maintained a collaborative approach, balancing strength with flexibility. Therapist neutrality, withholding, and inactivity were experienced as aversive and participants expressed a desire for explicit evidence of clinician humanity. Though participants were aware of the stigma associated with BPD, especially within the mental health community, they experienced relief and hope in receiving a diagnosis. The results support further investigation into how identified object relations patterns can assist clinicians in developing more intricate conceptualizations of client interpersonal experiences and how these may serve to moderate counter-therapeutic experiences. The significance of therapist contributions to what develops in the interpersonal context is also highlighted.

Key words: borderline personality disorder, therapy relationships, narrative research, object relations, intersubjectivity, reflexivity

Self-Care Effects On Anxiety In Doctoral Students

Ashlee Brooke Orozco, Fielding's School of Psychology

This study investigated the effects of self-care practices on anxiety in doctoral students. The Burns Anxiety Inventory (Burns, 1999) was used to measure feelings, thoughts, and physical symptoms associated with anxiety. The Self-Care Assessment Worksheet (Saakvitne & Pearlman, 1996) was used to examine the self-care activities frequently practiced by doctoral students, including physical, psychological, emotional, spiritual, and professional activities. Lower self-care scores were expected to be associated with higher anxiety scores. In addition, physical self-care subscale scores were expected to explain significantly more of the variance in anxiety scores than the other self-care subscales. Participants (N= 161) were recruited through Fielding Graduate University’s communication system and asked to complete a survey on their self-care practices and their anxiety levels. A simple linear regression was conducted and the findings suggest that the self-care scores contributed to the variance in anxiety scores. A multiple linear regression was conducted to examine the relationship of the five SCAW subscales and the total score on the Burns Anxiety Inventory. As expected, physical self-care subscale scores explained significantly more of the variance on the total scores of the Burns Anxiety Inventory than the other self-care subscales. However, psychological, emotional, and workplace or professional self-care subscales also contributed significantly to the variance and therefore, may also be useful predictors.

Keywords: self-care, anxiety

Leadership Dynamic Analyzed and Assessed through an Autoethnographic Lens

Michael Patterson, Fielding's School of ELC

Leadership is one of the most widely written about topics and has increasingly gained mainstream popularity. Countless leadership practitioners and academics often produce works that give advice on how to be an effective leader. Much of this information attempts to examine and typologize existing leadership theories as well as seeking to provide new insights on this complex and diverse area of inquiry (Northouse, 2012). In this dissertation, I explore the vast conceptual and theoretical landscape of leadership within mostly corporate settings through the lens of autoethnography. The overall aim is to present the frames of reference and variations of three distinct leadership models: autocratic, servant, and situational. These are articulated through three vignettes seeking to demonstrate how the culture of each organization played an integral role in the shaping of the leadership philosophies examined (Bergquist & Pawlak, 2008).

Implications of the results for future research and practice as well as the current study’s limitations are discussed. This dissertation seeks to make a contribution to leadership learning by exploring actual situations that occurred during my 30-year leadership tenure, which continues to evolve. This study reveals elements of the nature of leadership while sharing the actual development of an individual learned leadership practice. Names of people and organizations in the vignettes have been changed to protect the confidentiality of all parties.

Keywords: Autoethnography, Autocratic Leadership, Servant Leadership, Situational Leadership, Management, Leadership.

Mechanisms of Behavior Change within Peer-Implemented Alcohol Interventions

Erica M. Eaton, Fielding's School of Psychology

College campuses have experienced a large increase in referred students due to alcohol violations. Offenses vary in severity and therefore all mandated students do not necessarily need extensive treatment. Further, in the effort to reduce the demand on university alcohol programs, there has been a trend to use peer-implemented interventions. Fifteen-minute peer-based minimal interventions (PMIs) are a promising approach to reduce alcohol use and problems among mandated students. However, little is known about how these minimal interventions facilitate behavior change in at-risk college students. By examining the mechanisms of behavior change (MOBC) within these sessions, defined as the process leading to therapeutic improvement (Kazdin & Nock, 2003), the field will gain a better understanding of how minimal interventions influence post-session behaviors. Participants (N = 146; M age = 18.7, SD = 0.90; 67% male gender; 94% Caucasian) were college students who violated campus alcohol policy at a small northeastern liberal arts college. The current project conducted secondary data analyses with audio-recorded session tapes from a clinical trial delivering PMIs with mandated students. Peer therapist behaviors consistent (MICO; e.g., affirming) and inconsistent with motivational interviewing (MIIN; e.g., warning), along with therapist global scores, client change talk (CT), counter-change talk (CCT), and client self-exploration were coded using the Motivational Interviewing Skill Code (MISC). In addition, past-month alcohol consumption and alcohol-related negative consequences were assessed at baseline and 6-week follow-up. Regression analyses revealed a significant positive relationship between MICO peer therapist behaviors and CT (p < .01) and client self-exploration (p < .05). Peer therapist global scores (acceptance, empathy, and MI spirit) were also positively related to CT (p < .05) and client self-exploration (p < .05). No associations were found between MIIN peer therapist behaviors and CT or client self-exploration, but a positive association was found between MIIN peer therapist behaviors and CCT (p<.05). Furthermore, a significant negative relationship was supported between CT and alcohol-related problems (p =.04), average drinks per occasion (p = .02), peak drinks per occasion (p = .02), typical BAC (p = .002), and peak BAC (p = .003) at the 6-week follow-up. Specifically, increase in CT was related to lower levels of alcohol-related problems, average drinks per occasion, peak drinks per occasion, typical BAC, and peak BAC. No significant relationship between CCT and drinking outcomes was found. This study suggests that peer-implemented behaviors influence client behaviors, and subsequently alcohol-related consumption. Results will be discussed further as they relate to training of peer therapists. Future research directions and limitations will also be noted.



Keywords: alcohol, mandated college students, peer therapists, motivational interviewing, therapy process

Canadian Aboriginal Professionals’ Accounts of Success: Stories of Strength and Resilience

Chez-Roy Birchwood, Fielding's School of Psychology

A growing number Aboriginal Canadians obtain successful professional careers, despite multilevel psychological, economic, social, and political challenges. This study utilizes a qualitative narrative approach to examine how Aboriginal professionals understand their professional development in the context of socioeconomic obstacles and related psychological difficulties. Twelve Aboriginal Professionals between the ages of 32 and 55 were interviewed. The results indicated that the sample of participants had similar socioeconomic challenges to other Aboriginal Canadians and revealed 11 other themes associated with overcoming obstacles to professional accomplishment. These themes are as follows: Responding to Racism; Resolving Aboriginal Identity Struggles; Family Support; Spiritual Life; Specialized Educational Access and Support Programs; Psychological Insight and Therapy; Adjustment to Transiency and Relocations; Recesses, Retreats, and Timeouts; Finding a Voice; Perseverance and Determination; and Professional Pursuits in the Contexts of Personal Development and Community Engagement. Each theme had discrete utility in accounting for professional successes, however there were points of overlap between themes. The themes were then organized around four transformative elements and presented on an Aboriginal Medicine Wheel.

Improving Post-Incident Trauma-Informed Care for Drive-By Shooting Victims/Survivors by Building Collaborative Leadership Systems among Agencies and Their Clients

Secret Charles-Ford, Fielding's School of Educational Leadership for Change

Drive-by shooting incidents are a part of the broader discussion and policy deliberations that regard community gun violence. Non-gang-related drive-by shootings are not well researched, but news and media accounts and law enforcement reports suggest that non-gang related drive-by shootings constitute a major proportion of the drive-by shootings to which law enforcement respond. Children and adolescents in the United States and worldwide are among those commonly exposed to traumatic events, yet practitioners treating these young people to reduce subsequent psychological harm may not be aware of or use interventions based on the best available evidence (Wethingten et al., 2008). Given the magnitude and urgency of this issue, communities always are admonished, and admonish themselves, to mobilize and collaborate to address the issue of gun violence.

Although numerous studies exist that articulate the effect of traumatic events on children and adolescents, very few studies concentrate on the families, including the adults, of the victims/survivors of drive-by shootings to help them process through grief and successful recovery.

This qualitative study addresses the research question, “How are multiple-agency collaborations used to improve post-incident trauma-informed care for survivors, individuals, families, and communities victimized by gun violence, especially drive-by shootings, in a metropolitan area?” Semi-structured interviews were conducted with one or more representatives from three separate agencies that work with trauma associated with both fatal and non-fatal gun violence. In addition, semi-structured interviews were conducted with three adult family members of drive-by shooting victims/survivors. A fictional story based on real events offers insight into the nature of post-incident trauma-informed care among victims and their family members.

After careful analysis the data revealed that more work needs to be done to serve low-income and minority populations. Law enforcement, currently the primary community resource in addressing drive-by shooting incidents, and other community service groups only marginally help with both prevention and postvention services for victims/survivors of violence. Bringing attention to the personal trauma suffered as the result of drive-by shootings may inspire improved future changes in trauma-informed services. Such social change is a slow process, but creating hope for our children and communities is seen as important by all interviewees. Hopefully this work will have inspired increased collaboration to better serve drive-by shooting victims/survivors and their families with post-incident trauma-informed care.

Key Words: post-incident trauma-informed care, recovery and healing, agency collaborations, drive-by shootings, gun violence, mental health and trauma, fear of law enforcement, fictional therapeutic writing

Delusions and Cognitive Functioning in Alzheimer's Disease

Claire Milgrom, Fielding's School of Psychology

Alzheimer’s disease (AD) is a neurodegenerative disease of unknown etiology that affects cognitive functioning and functioning of daily living, and is frequently accompanied by behavioural and psychological symptoms (BPSD) including delusions, hallucinations, apathy, agitation, aggression, and depression. The presence of delusions in dementia patients is generally thought to be indicative of more advanced cognitive decline. Delusional thinking in people with dementia has also been found to be associated with aggressive behaviour, increased caregiver burden, high rates of institutionalization, and significant morbidity. Using data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI), this study focused on the relationship between delusions in individuals with AD, their impairment in global and specific neuropsychological functioning (e.g., memory, executive functioning), and their functioning in daily living. It compared the neuropsychological functioning and daily functioning of AD patients with and without delusions. It also examined if the presence of delusions was associated with greater decline over time in global functioning, in specific cognitive domains, and in activities of daily living for patients with AD.

The results showed that delusions in AD patients may be more associated with the stage and progression of the illness rather than overall cognitive functioning or any specific neurocognitive indices. The results also indicated greater decline in daily functioning over time for AD patients who experienced delusions when compared to those who did not. This is an important finding in terms of its clinical application to assessment and intervention with AD patients.

Central to this study was the theoretical explanation of delusions using deficit or defect models. These models view delusions as “disorders of belief,” that is, “disruptions or alterations in the normal functioning of belief mechanisms such that individuals come to hold erroneous beliefs with remarkable tenacity” (McKay, Langdon & Coltheart, 2007, p. 933). A deficit model explains delusions as the result of fundamental cognitive or perceptual abnormalities stemming from disturbances in neurobiologically based cognitive-perceptual apparatus, distorted cognitive processes, or both.