Class notes for test 1 COPY Flashcards
1
Q
This is the process of determining which disorder/diagnosis best explains a person’s symptoms as both observed and as reported by the patient and/or by close family members
A
What is a Psychological/Psychiatric Evaluation/Assessment?
2
Q
Clinical term for feelings or emotions. Can be normal, blunted, or flat.
A
Affect
3
Q
________ uses techniques or components to help arrive at a hypothesis about a person and their behavior, personality, and capabilities.
A
The evaluation/assessment
uses a combination of:
4
Q
- The interview is always used.
- Typically lasts from one to two sessions.
- It tends to be a semi-structured
conversation about the client’s presenting problem, significant family history for mental illness, drugs, education,developmental milestones,family constellation and employment history. - From this information, the therapist develops a case history and begins to hypothesize which diagnosis best fits the client.
A
4 main points about a Clinical Interview/Intake:
5
Q
- Formal testing is sometimes done.
- It may include IQ tests,
- neurological screening,
- behavioral assessments,
- depression inventories,
- and suicide inventories.
Formal
A
Explain Psychological Testing:
6
Q
Provides a common language to describe observed abnormal behavior.
It’s used by Psychiatrists, Psychologists, & LCSW’s, LMHC’s and Psychiatric Nurse Practitioners in the United States to form a formal diagnosis.
A
Define DSM-5:
7
Q
A term that refers to the practice of referring to individuals by their disorder, rather than who they are.
A
Labeling
8
Q
- Treatment Plan
- Prognosis
- Payment:
A
Three main reasons for conducting an evaluation:
9
Q
The information gathered during the assessment defines the problem/diagnosis.
A
Treatment Plan
10
Q
The presence of two or more disorders diagnosed at the same time.
A
Define Comorbidity:
11
Q
An estimate or prediction of the typical outcome of the disorder.
- The assessment and diagnosis help us determine this
- both the short and long-term outcomes of treating, or not treating the disorder.
A
Define Prognosis:
12
Q
The notion that all disorders have multiple causes or etiologies.
A
Define Multi-determined:
13
Q
The practice of prescribing medications for a different disorder than the one for which the medication was designed, or for a population (age group) for which it was not initially intended. It’s done all the time. It’s acceptable practice.
A
Off-Label
14
Q
The assessment and diagnosis help us determine the :
A
Prognosis.
15
Q
For the therapist to get paid by the insurance company, a diagnosis must be made/submitted.
A
Payment
16
Q
- Explore your motivation for being a counselor.
- If you’re not committed to exploring your own life, how can you encourage clients to do the same?
- Discover your own unresolved issues, prejudices, biases, & cultural norms.
- Some of what you discover about yourself, you may discover in conducting therapy.
- Unconscious Bias
A
Counseling for the Counselor.
17
Q
Any medication that treats mood, cognition (thoughts), and/or behavior.
A
Psychotropic Medications:
18
Q
Clinical term for the causes of disorders.
A
Define Etiology:
19
Q
Why do you need to explore your motivation for being a counselor ?
A
- Do you think you have the power to change others?
- Do you feel the need to save others?
- Who’s this about, you or the client?
20
Q
If you’re not committed to exploring your own life…
A
how can you encourage clients to do the same?
21
Q
Discover your own unresolved issues include..
A
- Prejudices
- Biases
- Cultural norms.
22
Q
An estimate of how a person will function in the future.
A
Prognosis
23
Q
- Some of what you discover about yourself, you may discover in __________ Hopefully, you’ll continue to discover __________ you have by working with others. Themes such as loneliness, power, death, intimacy are _________for the counselor since these are issues, we all deal with. You may also discover your own __________.
A
- Conducting therapy
- Unresolved issues
- Common triggers
- Unconscious bias
24
Q
Judgements and behaviors towards others that we’re not consciously aware of.
A
Unconscious Bias
25
Chemicals in the brain that transmit signals across the synapse of the neurons, from the presynaptic neuron to the postsynaptic neuron.
Neurotransmitters
26
1. Recognize that no one is “value neutral.” We were raised with certain family and societal values, sometimes we just haven’t examined them, but they’re there.
2. Avoid imposing your own values on the client. They’ll feel judged by you and less likely to open up.
3. Help the client to create therapeutic goals that are congruent with their own values, not yours.
How the counselor’s values can impact the therapeutic relationship:
27
1. Gain a knowledge of the dynamics of oppression, racism, discrimination, and stereotyping.
2. Learn about your client’s traditions, background, and values.It’s OK to just ask them.
3. Don’t assume you share values and traditions with the client just because you’re the same age, gender, race, or ethnic background.
Becoming an effective multicultural competent counselor:
28
A generic term referring to any type of talk therapy. For our purposes this term, we will use the terms interchangeably.
Psychotherapy/Counseling
29
1. Dealing with your own anxiety:
2. Being yourself and becoming aware of when to self-disclose.
3. Perfectionism
4. Know your limitations
5. Understand and embrace silence
6. Dealing with the demands of the client
7. Decline to give advice
| 7 Points
Common issues faced by beginning counselors. Most of these issues are initially dealt with in supervision during internship experiences:
30
Explain "Dealing with your own anxiety":
Am I competent enough?
31
Disclose when it serves the client, not you.
Being yourself and becoming aware of when to self-disclose.
32
What happens if I make a mistake?
Perfectionism:
33
Learn when and how to refer a client when your limitations prevent you from helping them.
Know your limitations:
34
Try to let the client be the one to break an awkward silence, you’ll learn more from what they eventually say than if you break it.
Understand and embrace silence:
35
1.Boundaries are necessary, set them at the beginning of the relationship.
2.Let them know when you’re available, when you’re not, when you’ll get back to them if they leave a message, when their session begins and ends.
3.You’re their counselor, not their friend.
.Dealing with the demands of the client:
36
Work towards getting the client to make better decisions based upon their own values.
Decline to give advice:
37
Try to let the client be the one to break an awkward silence, you’ll learn more from what they eventually say than if you break it.
Understand and embrace silence:
38
State and/or professional organizations’ guidelines that outline professional behavior and practice.
What is the Code of Ethics?
39
1. Educates therapists about responsibility to never harm the client.
2. Ethics always exceeds the law.
What are other things that the code of ethics does ?
40
1. Review relevant codes and laws set by the state board of ethics
2. Seek consultation with supervisor, peer, or the state board of ethics if necessary
| 2 points
When Making Ethical Decisions:
41
A term referring to the person who conducts the counseling or therapy session. For our purposes this term, we will use the terms interchangeably.
Define Therapist/Counselor:
42
A very specific type of psychotherapy using classical Freudian techniques.
Define Psychoanalysis:
43
The therapist who conducts psychoanalysis
Define Psychoanalyst:
44
An ethical term used to describe the permission/consent granted by the client to the therapist as to what the treatment will consist of.
Define Informed Consent:
45
1.It’s often a written agreement.
2.It educates clients about their rights in therapy.
2 facts about informed consent:
46
1. An overview of the therapeutic procedures and goals
2. The right to voice concerns, ask questions
3. The out-of-pocket cost
4. The right to withdraw from treatment
5. The limits of confidentiality
Informed consent should include:
47
Conditions under which a therapist can break the confidential agreement between therapist and client.
Define Limits of Confidentiality:
48
A medical doctor who sees patients that have common medical problems. The ____ often involved in patient care over a long period of time. This is generally the first person you might see when not feeling well. They can prescribe all types of medication.
Define Primary Care Physicians:
49
A licensed physician (medical doctor) who typically diagnoses and prescribes medication for individuals with psychiatric disorders. They are certified to practice psychotherapy, but typically don’t. They tend to refer the patient to a psychologist or LCSW, with whom they work collaboratively. They’re experts at diagnosing and prescribing psychotropic medications.
Define Psychiatrist:
50
An individual who has a BS in nursing, is a RN (Registered Nurse) and then completes a graduate program in Psychiatric Mental Health Nurse Practitioner. There are two options, MNP (master’s level) and DNP (doctoral level). They can work independently, diagnose and prescribe medications. Typically they concentrate on diagnosing and prescribing medications.
Define Psychiatric Nurse Practitioner:
51
An individual who has earned their Doctoral degree (Ph.D., Psy.D.) in psychology. They can legally practice independently if they become licensed. Not all psychologists are licensed, some who are academics or researchers may decide not to be licensed. The license is what allows them to practice psychotherapy, & diagnose patients, but in most states, including NY, they can’t prescribe medication.
Define Psychologist:
52
An individual who’s successfully completed a 60-credit graduate program in social work. Social workers can legally practice independently & diagnose patients after they’ve completed their post-graduate training (3,000 hours) and then pass a licensing exam. They often work in hospitals, clinics or private practice. They are experts at coordinating outreach services for patients/clients. They can’t prescribe medication.
Define Licensed Clinical Social Worker
53
1. Client poses danger to self or others (suicidal or homicidal)
2. Suspected child or elder abuse or neglect
3. Client needs to be hospitalized
4. Information is made an issue in a court action
5. Client requests a release of records
| 5 points
Examples of Limits of Confidentiality:
54
1. They do not have a right to confidentiality in therapy.
2. However, most therapists ask parents and minor clients to agree to the therapist’s confidentiality rules before they treat the client.
| 2 Points
Facts about clients under the age of 18:
55
1. These relationships are exploitive and harmful to the client and should be avoided.
2. Socializing or starting a business relationship with a client or former client.
3. Having a sexual or personal relationship with the client or former client.
| 3 points
Multiple or Dual Relationships Between Therapist and Client:
56
Facts about Sigmund Freud (1856-1939)
| 6 points
1. Freud was born in Vienna and considered the father of psychoanalytic theory.
2. He was a neurologist, not a psychiatrist or psychologist.
3. His interest in psychiatric problems came later on; during a time when he was experiencing severe emotional problems of his own. That’s when he became the most creative and developed his psychoanalytic theory.
4. Had a troubled relationship with his dominating father.
5. Intensely attached to his mother who was very loving.
6. Subsequent related theoretical orientations such as those therapists who consider themselves Psycho-Dynamically Oriented, are based upon his basic concepts/tenets.
57
1. Id
2. Ego
3. Super Ego
Freud’s Structure of the Personality include:
58
1. There at birth
2. Driven by instinctual needs (hunger, thirst, sexual drives)
3. Demanding, can’t tolerate the tension in delaying gratification
4. Immoral, illogical
5. Ruled by the pleasure principle. I want it, and I want it now!
| 5 points
Explain the Id:
59
1. Develops by age 1 as a consequence of dealing with reality; can’t always get what it wants
2. Realistic, logical
3. Becomes the mediator between the Id and the Superego
4. Keeps the Id in check by satisfying it in socially acceptable ways (uses defense mechanisms)
5. Ruled by the reality principle.
| 5 Points
Explain the Ego:
60
1. Develops by age five
2. Begins developing in toddlerhood
3. Our parents’ and society’s moral code.
4. Guilt
5. Ruled by right and wrong. Don’t do that, it’s not nice!
Explain the Super Ego
61
An individual who’s successfully completed a 60-credit graduate program in mental health counseling. MHC can legally practice independently & diagnose patients after they’ve completed their post-graduate training (3,000 hours) and then pass a licensing exam. They most often work in clinics. This certification/license exists in New York but does not exist in every state. They can’t prescribe medication.
Define Licensed Mental Health Counselor:
62
63
1. Freud believed anxiety derives from a conflict between the Id and the Superego.
2. The Id wants what it wants immediately, and the Superego fears the Id instincts will get out of control,
3. so…. we unconsciously use our defense mechanisms (from the Ego) to get control of the conflict and satisfy our Id in more socially acceptable ways.
| 3 points
What are Freuds beliefs about Anxiety ?
64
Strategies that we unconsciously use to ward off anxiety and not act upon our unacceptable thoughts, urges, and feelings.
Define Defense mechanisms
65
1.Repression
2.Denial
3.Rationalization
4.Displacement
5.Sublimation
6.Projection
Examples defense mechanisms
66
1. They either deny or distort reality.
2. They operate on the unconscious level.
All defense mechanisms have two characteristics in common, what are they ?:
67
1. What’s on our mind at the time and easily accessed.
2. Freud believed this was the just tip of the iceberg.
| 2 Points
Explain the conscious mind:
68
1. Stores all our repressed memories and experiences.
2. Unconscious processes are at the root of all symptoms and behaviors,
3. Out of our awareness or conscious control.
4. Memories that we can’t readily access but often spill into our dreams.
| 4 points
Explain the Unconscious:
69
1. Strengthen the ego so it becomes more reality based, and less reliant on defense mechanisms.
2. Gradually brings unresolved conflicts from the unconscious into the consciousness so they can be worked through in therapy.
3. The ego must be made stronger before the person can deal with what’s being brought into their consciousness.
4. Childhood experiences discussed and analyzed as to how they relate to current problems.
5. Achieve emotional insight, not just intellectual insight
6. Eventually free up emotional energy so the client can work, love and play.
| 6 points
What are the 5 therapeutic goals of psychoanalysis ?
70
1. The Blank Screen
2. Resistance
3. Dreams
4. Free Association
5. Freudian Slips (slip of the tongue)
6. Analyst Maintaining a Distant Role in the Therapeutic Relationship
What are the 6 techniques used in psychoanalysis ?
71
The analyst offers little to no facial expression or nonverbal cues, displays nothing of their personal life in the office, in hopes that the client will project their unconscious (unresolved) conflicts from their early childhood, onto the analyst.
Define the balnk screen
72
Client unconsciously transfers unresolved feelings, originally experienced in an early relationship with significant others, such as parents or siblings, onto the analyst.
Explain Tranference:
73
The client’s reluctance to bring what’s in their unconscious, into their consciousness.
Explain resistance:
74
Why did Freud believe resistance happened ?
Freud felt resistance exists in therapy because there’s always a struggle between the client wanting to change, but also wanting to remain embedded in their old neurotic world.
75
1. Client forgetting what they were talking about
2. Arriving late
3. Forgetting appointments.
Examples of resistance:
76
The Royal Road to the Unconscious.
Is related to repressed memories or unresolved conflicts.
| 2 Points
## Footnote
related
Freud's theory on dreams
77
When a client is asked to lie down or not directly face the analyst
Share thoughts, random words, and anything else that comes to mind, regardless of how incoherent or inappropriate the thoughts are.
Explain Free association:
78
1.Freud believed it’s a mistake we make when we speak
2.Revealing the thoughts and desires of the unconscious mind slipping through.
| 2 Points
Explain Freudian Slips (slip of the tongue):
79
Calling the new boyfriend your old boyfriend’s name.
Given an example of the slip of tongue:
79
80
1. Patient refers to analyst by “Dr.”, never by first name
2. Avoids eye contact
1. Patient refers to analyst by “Dr.”, never by first name
2. Avoids eye contact
81
1. Must be willing to commit to long term, intense therapy, often meeting 3– 5 times per week
2. Commit to remembering and discussing dreams
3. Take part in free association, divulging early childhood experiences, associations, memories, fantasies
4. Lie down on couch or sit in a way that avoids analyst and client making direct eye contact
5. Client needs to be vulnerable
6. Client commits to not making any major life changes while in analysis; divorce, changing jobs, moving, etc.
## Footnote
6 points
What is the Clients Role in Psychoanalysis?
82
1. Sees client less often (usually weekly)
2. More likely to sit facing each other, avoids using the couch
3. Therapist less distant and more engaged in process
4. More emphasis on the here and now, not just the past
5. Can be time-limited
| 5 Points
What's different about the psycho-dynamically oriented psychotherapy ?
83
1. Stresses the value of intensive psychotherapy as part of therapist’s training.
2. This helps the therapist become aware of their own biases, prejudices, and stereotypes.
Strengths of Psychoanalytic Approach from a Multicultural Perspective:
84
1. Costly, purposely so.
2. Based on upper-middle class values
3. Too ambiguous since it rarely helps patients to define specific problems they came to therapy to solve
4. More concerned with long-term possible character change than short-term solutions to the client’s presenting problems
5. Too threatening for highly intellectualized individuals (people out of touch with their feelings, and resistant to delve into their feelings or their past)
6. Severely emotionally disturbed or intellectually limited individuals lack the ego strength or ability to think abstractly needed for this type of treatment.
6 Shortcomings (limitations) of Psychoanalytic approach to therapy:
