8-21 Phenomenon that Arise

Question 1

Sigmund Freud

Answer 1

Created Psychosexual theory of development speculating that personality was mostly developed by age 5

Question 2

What are Freud’s 3 Models of the Psyche

Answer 2

1. ID=biological urges/instincts. Maximizes pleasure and acts according to PLEASURE PRINCIPLE
2. Ego=realistic thinking, postpones pleasure and acts according to REALITY Principle

3.SUPEREgo=How the ego should behave-no correspondence w/actual somatic brain structures and conscience ego-ideal

Question 3

Definition of “Defense Mechanism”

Answer 3

Unconscious ways in which the ego wards off anxiety and controls unacceptable urges/unpleasant emotions by distorting reality

Question 4

What are 7 Types of Defense Mechanisms

Answer 4

1. DENIAL: REFUSES->external reality as a primitive defense to avoid pain/anxiety/disappointment
2. PROJECTION:Falsely projecting ur own unacceptable feelings/thoughts onto someone else! [Married man attracted to other women accuses his wife of lusting after other men]
3. REGRESSION: returns to earlier/more comfortable stage of development (childlike) in order to escape anxiety
4. IDENTIFICATION:you adopt others’ ways/traits to you and began identifying w/ur aggressor [Attending treats resident bad so resident treats med students bad]
5. REPRESSION: Level 3-Represses memories/feelings associated w/painful/unacceptable impulses
6. RXN FORMATION:Level 3-start to develop thoughts/behavior OPPOSITE of what u truly believe in
7. AFFECT ISOLATION: u isolate the affect/emotional component of an event while leaving cognitive part still intact[giving embarrassing testimony in court w/out crying]

Question 5

Transference?

2)How does Transference affect MD/Pt relationship?

Answer 5

Transference=Pt “transfers” feelings toward others in their past life onto the relationship w/the MD
2)If a pt has grown up perceiving others as unhelpful or harmful, they will likely think same for MD

Question 6

CounterTransference?

2)How does CounterTransference affect MD/Pt relationships?

Answer 6

CTrnsfrnce=MD “transfers” experiences from others in their life onto the pt!
2)MD who dislikes a pt may start to be dismissive or aggressive. OR MD with strong father relationship responds deferentially to older male pt

Question 7

Ambivalence

2)What are 3 ways to treat this as a MD?

Answer 7

People often weigh the *discomforts of changing their behavior(short term) with their **hope for good outcomes (long-term)[2 ways of behavioral change being weighed]
2) A.show empathy by listening, NOT TELLING
B. Don’t challenge Resistance head-on! roll with it ;-)
C. Identify discrepancies between where pt is now and where they eventually WANT to be

“I want to but I don’t want to” :-(

Question 8

What is Shame?

B. What are some common signs of pt shame? [5]

Answer 8

Shame=the decrease in one’s self-respect and pride;feeling like you haven’t measured up to ur set standards
Signs:Anxious laughter/avoiding the MD/ Witholding information/ Suing/ withdrawal

Question 9

As the MD, how do you treat Pt Shame? [5]

Answer 9

• Refer to pt by proper titles/names
• Be mindful of privacy!
• Establish the PT goals/concerns;don’t force ur own agenda
• Praise pt for seeking help/managing dz
• Keep convo focused on the BEHAVIOR and not the person! & avoid malperceived intentional shame infliction

Question 10

What are the 2 most cited shaming topics?

Answer 10

WEIGHT and SEXUAL BEHAVIOR=most shameful topics

Question 11

A. What is Validation?
B. Why is this important in clinical setting?
C. Validation ___[is / IS NOT] a type of agreement

Answer 11

A. Informing someone that you understand his/her emotional reasoning
B. Pt will have a difficult time being upset with someone who understands the reasoning for why they’re upset
C. VALIDATION IS NOT AN AGREEMENT

Question 12

What are some great ways as an MD to show “Validation” to a pt?

Answer 12

• Reflecting, acknowledge the pt’s points of views
• Extending, match pt problems w/your own vulnerability to certain situations
• Normalize responses when they are normative

Question 13

What are NO-GO’s! for “Validation”

Answer 13

it is BAD to:

• DEMAND behavior change
• using a lot of “Shoulds and Ought Tos”
• Interrogration or counter-arguments
• Making things “ok” by validating the invalid

Question 14

Intellectualization

2)Example?

Answer 14

level 3 Defense mechanisms in which Shift of emphasis from immediate interpersonal conflict shifts to some high-level intellectual ideas to avoid conflict
ex.Resident tells pt he has cancer and to avoid conflict upset pt may bring about Resident goes into over-intellectual, lengthy technical explanation of prognosis

Question 15

Displacement

Answer 15

Level 3-Displacing Anger from its original location [your Job] to a more acceptable substitute somewhere else –>[yelling @ your wife/ kicking the dog]

Question 16

Undoing

2)Example?

Answer 16

Saying or doing something only to make up for an unacceptable thought/feeling you had previously
“Wife fantasizes about death of unfaithful husband but then feels bad about it so tells him to take his cholesterol med to make up for her bad thoughts”

Question 17

Sublimation

2)Example?

Answer 17

Level 4! Channeling/Subliming unacceptable thoughts/drives into more socially acceptable practices.
ex. Sadistic impulses to inflict pain are sublimed into the socially acceptable practice of surgery [which will def inflict pain on people]

Question 18

Suppression

–Example?

Answer 18

Level 4! Defense mechanism involving the CONSCIOUS decision to postpone attention to an unpleasant subject
ex.Med student CONSCIOUSLY suppresses attention to & postpone paying bills until after exams are over

Question 19

Altruism

Answer 19

Level 4! Adaptive defense mechanism involving someone doing “extra” stuff (volunteer work, charity donations, random kindness) just to compensate for inferiority complex or lack of significance

Question 20

Humor

Answer 20

Level 4! unconscious or forbidden feelings are expressed via a socially acceptable outlet like making a joke to lighten a sad situation “Facetious = Humor” “Depressed Comedian”

Question 21

What are the 4 Levels/Classification of defense mechanisms?

Answer 21

Valliant Defense Mechanisms classifications

• Level 1. Pathological defenses(delusional projection, psychotic denial)
• *Level 2. immature {fantasy, projection, acting out, passive/agression}

***Level 3. Neurotic(intellectualization, rxn formation, displacement, repression, dissociation)

**Level 4. MATURE(humor, sublimation, suppression, altruism, anticipation)