final Flashcards
1
Q
Interpersonal Therapy (IPT) Basics
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Manualized
Short-term (12-16 sessions)
Focused on interpersonal relationship as source of emotional distress
Combo psychodynamic and cog-beh approaches
2
Q
IPT–Interpersonal Disputes
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Incongruence in expectations b/w client & other person
INTERVENTIONS
-Draw connection b/w symptom onset & symptom
-Understand role expectations
-Identify patterns of relationship attachment
-Problem-solving to change expectations/roles
3
Q
IPT–Role Transitions
A
Normal transitions–>role adjustment, experienced as loss
INTERVENTIONS
-Identify new role challenges
-Grieve loss of old, view new +, sense of mastery of new
4
Q
IPT–Grief
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Death–>impact client relational capacity
INTERVENTIONS
-Facilitate mourning
-Reconstruct relationship with lost person
-Become willing/able to invest in other relationship
5
Q
IPT–Interpersonal Deficits
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Impoverished relationships in quality & quantity
INTERVENTIONS
-Focus on reducing social isolation/formulating new relationships
-Use psychodyn idea of transference to understand patterns of attachment
6
Q
IPT: Non-directive exploration
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Encouraging client to initiate and inteify problem areas and solutions
7
Q
IPT: Encouragement of affect
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Allows & encourages expression of emotions
8
Q
IPT: Clarification of beliefs & perceptions
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Therapist draws attention to inconsistencies in order to correct cognitive distortions
9
Q
IPT: Communication analysis
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Assist client in improving communication skills and verbalizing needs and desires
10
Q
IPT: Therapeutic relationship
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Used as a model for healthy interpersonal relationships
11
Q
IPT: Behavioral change strategies
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Focuses on assisting client in seeing range of behavioral options and actively choosing and developing new skills
12
Q
IPT: Stages
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Assessment
Intermediate sessions focused on problem area
Termination
13
Q
IPT: Criticisms
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Medical model of mental illness (not person in environment)
Requires specialized training
Lacks own theoretical underpinnings
14
Q
Motivational Interviewing (MI) Basic Concepts
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- Some reason for maladaptive behavior
- Focuses on motivation for change
- Desire for change must be internal
- Reflect back pros & cons
- Ambivalence normal–help progress through stages of change
15
Q
MI: Therapeutic Relationship
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Empathy
Non-judgmental
Active listening
Client is capable of change when ready
16
Q
MI: Interventions
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- Rolling w/ resistance–understand that client has reasons for behavior and lack of motivation to change
- Highlight discrepancies between client’s values & behaviors
- Elicit change talk
17
Q
MI: Skills
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OARS Open-ended questions Affirming statements Reflective listening Summarizing throughout the therapeutic process
18
Q
Phases of MI
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FIRST Resolve ambivalence Increase intrinsic motivation THEN Develop and implement plan for change
19
Q
MI: Criticism
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Focuses only on motivation
Lacks broad theoretic basis
Worker selectively choosing what elements of change talk to bring out
20
Q
Evidence-Based Practice: Benefits
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- proven results
- easier to bill for
- provides measure of success
- clear quantitative objectives
- shared language/lingo of profession
21
Q
EBP: Drawbacks
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- some research biased
- can put us in a box-insurance dictates treatment
- need to base on individual client, not just want research says will work
22
Q
Psychological Assessment: Functions
A
- Assist in problem solving and prioritizing interventions to target symptoms
- Provide communication between and within care team
- Make recommendations re: tx setting, intensity, goals, mode, strategies and techniques, methodological framework
23
Q
Psychological Assessment: Components
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- Specifics of the problem
- Client resources
- Client’s personal characteristics
- Environmental circumstances
- Treatment recommendation
24
Q
Specifics of the Problem
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Severity
Duration (length, remission/relapse)
Onset (when, what brought it on)
Specific symptoms (times when worse)
25
Client Resources
Social supports
History of treatment & experience of it
Psychological/emotional/spiritual strenths
26
Client's Personal Characteristics
Level of motivation--why here?
Willingness to engage in treatment
Stage of change
27
Treatment Recommendations
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Based on:
Level of functioning
Social supports
Problem complexity/chronicity
Coping styles
Resistance
Subjective distress
Problem-solving (related to stage of change)
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28
Level of Functioning
- Level of restrictiveness needed (inpatient, outpatient, partial hospitalization)
- Intensity needed (frequency, duration)
- Biological/medical concerns (inc. medication)
- Prognosis
- Urgency of achieving goals
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Problem complexity/chronicity
Underlying patterns or themes present in multiple domains of client's life
30
Subjective distress
Client's perception of symptomatic distress
| Can be stimulant for change
31
Psychological assessment report
- Demographics
- Reason for referral
- How evaluated
- Behavioral observation
- Background info (onset, symptom, hx of tx, meds)
- Test results
- Impressions and interpretations
- Summary and recommendations
32
Spiritual assessment--why?
- Understand client perspective
- Obtain knowledge a/b how healthy perspective is & influence on counseling
- Determine possible resource of beliefs & support groups
- Determine possible interventions that can be used in counseling
- To clarify the level of need to address spiritual or religious views in counseling
33
Psychodynamic Basics
Deterministic
All behavior has meaning
Behavior is determined by unconscious drives, motivation, and instincts
34
Psychodynamics: 5 Major Constructs
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Topographic hypothesis
Dynamic hypothesis
Economic hypothesis
Structural hypothesis
Adaptive hypothesis
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35
Topographic Hypothesis
Much of our behavior/feelings unconscious
| Bringing unconscious motivations to surface/conscious leads to change
36
Dynamic Hypothesis
Mind=energy system w/ cause and effect
React b/c of instinctual drives
Every behavior can be boiled down to cause & effect
Defense mechanisms--need to suppress releases tensions b/w ego, superego, id
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Economic Hypothesis
Instinct always to seek pleasure and avoid pain
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Structural Hypothesis
Id-instincts, survival, protection, discharge tension
Super Ego-moral compass, values & beliefs
Ego-mediator b/w id and super ego
39
Ego
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Basis of our conception of who we are
Awareness of external world
Judgement
Sense of identity
Impulse control
Thought process regulation
Interpersonal object relations
Defense mechanisms
Stimulus regulation
Autonomous functions
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40
Adaptive Hypothesis
Individuals attempt to cope with societal demands by using defense mechanisms
41
Psychosexual Stages
Oral (birth to 18 months)
Anal (18 months to 3 years)
Phallic (3 years to 6 years)
42
Oral Stage
Pleasure and relief of tension related to feeding
Trust
Stuck in this phase--> difficulty trusting people, dependency, continually seeking nurturing
43
Anal Stage
Learn to assign self worth, autonomy, manage anger a/b lack of autonomy-FLEXIBILITY
Stuck in this phase-->rigidity, can't think outside box
44
Phallic Stage
Pleasure associated with genitalia/erogenous zones
Gender identification
Stuck in this phase-->high/low self-esteem, vain, narcissistic
45
Defense Mechanisms
Intrapsychic processes that operate unconsciously to protect the person from threatening, anxiety producing thoughts, feelings, and impulses
46
Types of Defense Mechanisms
Defense mechanisms (ego defenses):
1. Repression involves keeping unwanted thoughts and feelings out of awareness, or unconscious. Repression may involve loss of memory for specific incidents, especially traumatic ones or those associated with painful emotions.
2. Reaction formation involves keeping certain impulses out of awareness by replacing the unwanted impulse with its opposite.
3. Projection attributes to others unacceptable thoughts and feelings of his or her own that are not conscious.
4. Isolation is referred to as “isolation of affect”, for there is a repression of feelings associated with particular items, or of ideas connected with certain affects.
5. Undoing involves symbolically nullifying or voiding an unacceptable or guilt-provoking act, thought, or feeling.
6. Regression involves the return to an earlier developmental phase, level of functioning, or type of behavior in order to avoid the anxieties of the present.
7. Introjection involves taking another person into the self, psychologically speaking, in order to avoid the direct expression of powerful emotions such as love or hate.
8. Reversal is a general mechanism for the process of turning a feeling or attitude into its opposite.
9. Sublimation involves converting an impulse from a socially objectionable aim to a socially acceptable one while still retaining the original goal of the impulse. It is considered the most “mature” defense.
10. Intellectualization is warding off of unacceptable affects and impulses by thinking about them rather than experiencing them directly.
11. Rationalization involves the use of convincing reasons to justify certain ideas, feelings, or actions so as to avoid recognizing their true underlying motive, which is unacceptable.
12. Displacement is shifting feelings or conflicts about one person or situation onto another.
13. Denial involves the negation or non-acceptance of important aspects of reality or of one’s own experience, even though they may actually be perceived.
14. Somatization is when intolerable impulses or conflicts are converted into physical symptoms.
15. Idealization is the overvaluing of, for example, person, place, family, or activity beyond what is realistic to protect the individual from anxiety associated with aggressive or competitive feelings toward a loved or feared one.
16. Compensation tries to make up for what he or she perceives as deficits or deficiencies.
17. Asceticism involves the moral renunciation of certain pleasures in order to avoid the anxiety and conflict associated with impulse gratification.
18. Altruism involves obtaining satisfaction through self-sacrificing service to others or through participation in causes as a way of dealing with unacceptable feelings and conflicts.
19. Splitting is characteristic of borderline conditions and involves the keeping apart of two contradictory ego states such as love and hate.
47
Neurotic Anxiety
Unconscious worry that we will lose control of the id's urges, resulting in punishment for inappropriate behavior
48
Reality anxiety
fear of real-world events
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Moral anxiety
fear of violating our own moral principles
50
Psychoanalysis Strategies
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Blank slate
Analysis of transference
Counter transference
Free association
Interpretation
Dream analysis
Analysis of resistance
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51
Transference
Projections of early attachments
52
Counter transference
Therapists thoughts/feelings toward the client--evoked by client's behavior
53
Psychoanalysis: Limitations
Time consuming (4x/week for 1-2 years)
Training (including own analysis)
Expensive
Anonymous role of therapist (no therapeutic alliance)
54
Jung
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Focus on midlife: break away from many values from first half of life and confront unconscious
Shaped not just by past but where want to go
Goal to be individual
Made up of dichotomies
-conscious vs. unconscious
-masculine vs. feminine
-public face we wear
-shadow-distance from darkness inside
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55
Erickson
Psychosocial stages throughout life
Dichotomies at every stage
Motivation of ego to move toward mastery and competence--EGO PSYCHOLOGY
56
Ego Psychology
- inherent ability to adapt to environment
- psychosocial functioning influenced by environment
- behavior motivated by innate drive toward mastery and competence
- problems in functioning can occur throughout lifespan due to internal or person-environment conflicts
57
Ego Psychology: Interventions
Therapeutic Relationship--empathy & authenticity FIRST intervention
Ego-sustaining: insight into motivations & behaviors
Ego-modification: exploration of past experiences, maladaptive patterns of functioning, unconscious processes
58
Ego Psychology: Limitations
Somewhat vague concepts
Interventions can be hard to operationalize
Mostly deficits oriented
Doesn't respect human diversity
Interventions are open-ended
Outcomes difficult to evaluate
Not incorporating idea that environment needs to change
59
Object relations
interpersonal relationships
| internalized attitude toward others and self and how these attitudes impact new relationships
60
Object relations: goals
Gain insight into repetitive negative interpersonal patterns
| Client as whole person reacting to whole people
61
Object relations: basic concepts
Inherent biological need to form attachments to support health development and emotional needs.
As seen by research on neural plasticity
Introjections
Psychological “taking in” of characteristic of other people
Representation
A cognitive representation of others ex. Father figure
Object relations
Internalized attitudes toward others and self
Object
Can be an actual person or a representation of the person
Part object
One or more characteristics of the person but not the whole person
Splitting
Seeing the person as all good or all bad
Whole object
Internalization of the whole person (object) good with the bad
Object constancy- maintaining a whole object representation of significant people in our lives
Self object
Internal representation of one’s own self
True self
Self-object representation reflecting a whole object perspective (conflicting characteristics encompassed in one)
False self
When one ignores part of the self in order to give higher priority to others needs
62
Object Relations: Interventions
- similar to ego psychology
- explore client's interpersonal history and developmental milestones
- create holding environment (model healthy relationships, encourage internalization of true self & whole objects)
- interpret pos and neg patterns of interactions in various life contexts
- interpret maladaptive defenses
63
Object Relations: Limitations
problems not seen within context of society
historically oriented toward nuclear family/rigid gender roles
focus on early development challenging b/c of reporting
64
Individual Psychology
ADLER
- individual can self-determine behavior and decisions
- behavior should be understood in social context
- avoid diagnosing disorders; symptoms from feelings of inferiority
- therapy as cooperative educational experience
65
Individual Psychology: Basic Concepts
Social connectedness
Discouragement-->lack movement toward social connectedness and life goals
Superiority-->move toward idealized self, better than current
Inferiority-disconnect between ourselves and ideal self
66
Individual Psychology: Goals of Therapy
Increased social interest
Recognition of one's resources to overcome discouragement and inferiority feelings
Changing client's perceptions and life goals
Identifying and correcting client's motivation
Assisting client in becoming contributors to society
67
Behavioral Analysis
Behavior directly related to consequences
| Pos/neg reinforcement/punishment
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Classic Conditioning
Pavlov's dogs
| Direct relationship between stimulus and response
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Social Learning Theory
Behavior is learned
| Interacting forces: environment, personal factors, individual behavior
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Social-Cognitive Theory
Behavior based on:
external stimulation
external reinforcement
cognitive meditational processes
71
Behavioral Therapy: Basic Assumptions
Abnormal behavior not illness
All behavior learned and can be treated through behavioral process
Current determinants of behavior rather than hx
Treatment tailored to individual
Treatment adheres to scientific methods
72
Behavioral Therapeutic Techniques
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Operant conditioning
relaxation training
systematic desensitization (imagined)
in vivo exposure (actual stimulus)
Social skills training--communication/anger mgmt
Mindfulness/acceptance
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73
Behavioral interventions
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Modeling behavior
Behavioral rehearsal
Reinforcement control
Stimulus control (rearranging stimuli)
Systematic desensitization
Shaping
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74
CBT
Individual's behavior often result of internal schema & core beliefs
Cognitive mediation b/w stimulus & response
75
CBT Principles
Thoughts and assumptions subjective/based on past experiences
Emotions directly related to assumptions assigned to situation
If change way think, emotions will change
76
CBT Interventions
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Cognitive restructuring
Cognitive coping
Problem-solving
Identifying cognitive distortion
Behavioral activation
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Cognitive Distortions
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All or nothing thinking
Should statements
Over-personalization
Selective attention or mental filter
Denial or blaming
Over-generalizing or labeling
Catastrophizing
Magical thinking
Emotional reasoning
Mind-reading
Double standard
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78
Culturally Alert Counseling-Accessibility
Be approachable
Adapt language
Show trustworthiness
79
Culturally Alert Counseling-Assessment
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What is the story?
What are the cultural dimensions of the story?
Listening for culture
General impact of client’s culture
External and internalized oppression
Cultural genogram
Culturally sensitive diagnosis
Culturally aware use of tests
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80
Culturally Alert Counseling-Intervention
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Address internalized oppression
Adapt common interventions to culture
Utilize narrative approach
Engage in advocacy
Recognize indigenous healing
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81
Solution Focused Brief Therapy (SFBT)-Basic Theoretical Assumption
Social Constructivism
There is no one objective reality rather our perceptions are based on interactions with society and social learning theory
-Focuses on the solution
-Equifinality
-Problems are not indicative of pathology
-Problems are outside of the individual
If the client is not successful in solving problems they may feel stuck and thus limit their ability to generate solutions—when set goals and achieve, motivated to set and achieve more
-Change is inevitable
82
SFBT-Key Elements
The client is the expert
Focuses on what is going right
Exceptions to the problem
Encourage client to understand what he/she did differently when not experiencing the problem
What has happened since called to make appointment? Sometimes change just after taking the step to try to feel better
83
SFBT: Goals
To change perspective on what is occurring
Help the client see him- her- self as a competent person capable of change
To change what the client is doing
84
SFBT: Techniques
Solution-oriented talk (why problem not worse)
Miracle question
Exception oriented question (when problem not there)
Scaling question
85
SFBT: Criticisms
Superficial
| Solution focus may deny or minimize problem
