Assessment Flashcards
What is Assessment
Includes assessing the acute problems and ongoing patters, constructing an initial forumula and making a recommendation for treatment.
Holding Environment
establishing a connection that helps patients feel secure, safe and trusting
What does history include
history of present illness (when was the last time the person was at their baseline), history of symptoms, development/personal history
ego functions
patient’s characteristic ways of thinking, feeling, and behaving
ethical judgement/super-ego function
patient’s capacity to distinguish right from wrong
reflective capacity
ability to step outside their immediate thoughts to look at them critically. Two aspects include Psychological Mindness and reality testing
psychological mindedness
the way in which patients think about their mind, is there a unconscious? Can childhood events effect the present?
id
wishes, desires
super-ego
conscience and personal ideals
ego
person’s inner mental life and relationship to the world
self-perception
how we see ourselves relates to both our identity and our self appraisal
identity
sense of who we are. Likes, dislikes, talents, limitation, often consolidated in teen years
self-appraisal
how well our subjective sense of our self matches up with what we are actually able to do. Relates to both setting yourself up for failure and low self esteem
ideals/ego-ideal
inner images, fantasies, who we wish to be.
self-esteem regulation
ability to bounce back fro self esteem blows
empathize
ability to appreciate the way others see the world
mentalization
ability to think about others as having thoughts and feelings distinct from ones own
internal/external stress
internal stress thoughts and fantasies, feelings and anxiety, pain and other physical sensations. External stress includes relationships, economic/work pressures, trauma etc
defenses
unconscious and automatic ways he mind responds to internal and external stress/emotional conflict. Some are adaptive and some are less adaptive
object constancy
knowing that bad and good can exist in the same person
object permanence
knowing something out of sight is still there.
splitting
experiencing feelings as if they are coming from outside the self. Normal in children, but problematic when they need to protect their good image of an abusive parent or care giver
types of less adaptive defenses (tend to be based on splitting)
- Splitting
- Projection
- Projective identification
- Pathological idealization & devaluing
- Denial
- Dissociation
- Acting Out
- Regression
adaptive defenses (based on repression)
- Isolation of Effect
- Intellectualization
- rationalization
- Displacement
- Somatization
- Undoing
- Reaction Formation
- Identification
- Excessive Emotionality
- Externalization
- Sexualization
- Repression
- Turning against the self
Isolation of Affect
the mind represses the affect but the thoughts remain concicous. Person seems devoid of feeling
Intellectualization
uses substitution of excessive thinking to take the place of painful or uncomfortable feelings
Rationalization
Deals with unacceptable feelings by coming up with good reasons for the problematic situation/feeling
Displacement
exchanges the object of a wish or feeling for one that feels more acceptable
EX Nate is afraid of his father, but instead feels afraid of the school principal.
Somatization
causes thoughts or feelings to be experienced as bodily sensations (headache, diarrhea, chest pain etc)
Undoing
Minds do-over, reverses something that feels unacceptable or uncomfortable
EX: She cheated people all day long at work then gave a dollar to a bigger on the street
Reaction formation
turns unacceptable feelings into their opposite EX Ms Q is overprotective of her infant son in an effort to protect herself from rage at not being able to sleep at night
Identification
If you can’t bet them, join them. Feelings of jealousy are dealt with by pulling in characteristics of the other person
Excessive Emotionality
Represses thoughts while affect remains conscious. Not feeling emotional that a divorce is final but exploding that grocery order is delayed
Externalization
leads people to perceive internal conflicts as if they were external conflicts. Note that this is not a splitting-based defense mechanism, because the feelings are still perceived as coming from within the self
EX Ms U consulted a therapist to talk about whether she should stay with her fiancé or begin to date an old boyfriend who had contacted her. Months into therapy, she realized that she was ambivalent about getting married at all.
Sexualization
Takes issues that are not sexual and makes them so in order to avoid deeper feelings
Repression
hiding thoughts, feelings and fantasies leading to forgetting, denial and inhibited sexuality
Turning Against the Self
Substitutes the self for the object
EX Mr X was angry with his father for buying a new house rather than paying for a year of his college education; however, he experienced this rage as self-criticism for not doing as well as he could have during his first semester.
Most Adaptive Defenses (can be problematic if used persistently and inflexibly)
- Humor
- Alturism
- Sublimation
- Supression
Sublimation
when an uncomfortable thought goes straight from the unconscious to the conscious in a useful form. Like discharging anger by writing poetry or going to the gym
Supression
Differs from repression as it is conscious. Scarlet O’hara “I won’t think of that now”
Projective Identification
On person projects a thought/feeling onto another person and behaves in a way that makes the second person feel that way
EXMr C is passed over for a promotion by his boss. Although he says that this is fine with him, his unconscious rage is so overwhelming that he comes in two hours late for a week until his boss is so enraged that he fires him.
Pathological Idealization/devaluation
the person who is idealized today may easily be devalued tomorrow:
General Cognitive Function
persons built in cognitive apparatus (intelligence, memory, speech, language, linear thinking). Gross impairments make it difficult to benefit from psychotherapy
Reality Testing
can differentiate reality from fantasy
Judgment/Impulse Control
aware of appropriateness and consequences of intended behavior and acts in a way that reflects this awareness
Sensory Stimulus Regulation
ability to tune out insignificant stimuli (like traffic noise)
Five Domains of Function
Self, relationships, adapting, cognition, work/play
supportive stance
Supporting the patient’s thoughts and feelings instead of uncovering the problem or challenging
uncovering stance
challenging the patient to uncover what is below the surface problem,
