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7. Psychotherapy > Bryan Chow Psychotherapies PowerPoint > Flashcards

Bryan Chow Psychotherapies PowerPoint Flashcards

1
Q

what type of therapy is supportive therapy

A

non directive

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2
Q

what are the goals of supportive therapy

A

symptom relief + adaptation

–> ameliorate symptoms
–> foster STABILITY and improve FUNCTION
–> improve SELF ESTEEM
–> support adaptive efforts to decrease relapse risk

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3
Q

describe the therapeutic stance in supportive therapy

A

conversational

transparent

collaborative

psychoeducation

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4
Q

describe a conversational therapeutic stance

A

active listening, not interrogating

RESPONSIVE–> diminish anxiety and fear

empathic, direct, supportive

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5
Q

what does it mean to have a transparent and collaborative therapeutic stance

A

explain reasons for questions

agree on topics for discussion

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6
Q

list 6 techniques used in supportive therapy

A
  1. focus on present
    –> express interest, acceptance, respect, empathy, understanding
  2. get to know your patients
    –> including supportive people int heir lives
  3. build self esteem and reduce anxiety
    –> praise accomplishments
    –> provide honest reassurance and encouragement
  4. advice, teaching, guidance
  5. clarify, summarize and paraphrase
  6. discuss maladaptive behaviours if present
    –> use MI techniques to motivate change
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7
Q

what should you NOT do in supportive therapy

A

interrupt feelings prematurely

problems solve for the patient

structure the session

be too active

assign homework

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8
Q

what SHOULD you do in supportive therapy

A

make an emotional connection

follow affect

build alliance

encourage catharsis

emphasize strengths

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9
Q

where do the techniques of supportive therapy fall on the “expressive-supportive” continuum

A
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10
Q

who coined the term alexithymia

A

peter sifneos

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11
Q

list 4 therapists associated with various forms of short term psychodynamic psychotherapy

A

Sifneos

Mann

Malan

Davanloo

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12
Q

which therapists is associated with the form of short term psychodynamic psychotherapy known as “short term anxiety provoking psychotherapy”

A

Peter Sifneos

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13
Q

what is the focus of short term anxiety provoking psychotherapy

A

anxiety-provoking confrontations–> direct attack on patients defenses

understand mechanisms used in dealing with oedipal conflicts

focus on OEDIPAL CONFLICT with goal of resolution

development of INSIGHT

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14
Q

what techniques are used in short term anxiety provoking psychotherapy

A

use of positive transferrence

maintain focus

anxiety provoking confrontations

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15
Q

what are the tasks of the therapist in short term anxiety provoking psychotherapy

A

build alliance

contract about focus

work through–> CORRECTIVE EXPERIENCE

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16
Q

what are indications for short term anxiety provoking psychotherapy

A

depressive disorders

some anxiety disorders

adjustment disorder

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17
Q

how often and for how long does short term anxiety provoking psychotherapy happen

A

10-20 sessions–no set number tho!!

once weekly

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18
Q

who developed the “triangle of conflict” and “triangle of person”

A

Malan

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19
Q

what is Malan’s triangle of person

A

current (others) <–> past (parents) <–> transference (therapist)

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20
Q

what is Malan’s triangle of conflict

A

defense <–> anxiety <–> impulse

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21
Q

what is a key element of short term psychodynamic psychotherapy in Malan’s conceptualization

A

linking the triangle of person and triangle of conflict

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22
Q

what did Malan call his conceptualization of short term psychodynamic psychotherapy

A

brief focal psychotherapy

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23
Q

what is the focus of Malan’s brief focal psychotherapy

A

internal conflict present since childhood–> development of insight is imperative

identify transference early–> link transference to relationship with PARENTS

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24
Q

how long does Malan’s brief focal psychotherapy last

A

average 20 sessions–> termination date set in advance!

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25
Q

who developed “time limited psychotherapy” as a form of short term psychodynamic psychotherapy

A

Mann

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26
Q

how long is time limited psychotherapy

A

only 12 sessions

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27
Q

what is a major focus of time limited psychotherapy

A

termination

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28
Q

what are the overall therapeutic foci of time limited psychotherapy

A

present and chronically endured pain

particular image of the self

conflicts likely to be encountered:
–independence vs dependence
–activity vs passivity
–unresolved vs delayed grief
–adequate vs inadequate self esteem

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29
Q

who developed short term dynamic therapy (as a form of short term psychodynamic psychotherapy)

A

Habib Davanloo

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30
Q

how long is short term dynamic therapy

A

no set number of sessions

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31
Q

indications for short term dynamic therapy

A

depressive d/o

some anxiety d/o

adjustment

SOMATOFORM

HYPOCHONDRIASIS

CLUSTER C TRAITS

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32
Q

what are the therapists tasks in short term dynamic therapy

A

build therapeutic alliance

rapidly reduce resistance

ACCESS UNCONSCIOUS via rage, guilt, other patient feelings

increase patient awareness

work to change way patient related to others

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33
Q

what techniques are associated with short term dynamic therapy

A

CENTRAL DYNAMIC SEQUENCE

problem inquiry, pressure, challenge, access unconscious

analyze transference, explore conflict, consolidate

terminate

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34
Q

what is psychodynamic psychotherapy

A

“involves attention to the therapist-patient interaction, with carefully timed interpretation of transference and resistance, embedded in a sophisticated understanding of the patient and an appreciation of the therapist’s contribution to the two-person field”

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35
Q

is psychodynamic psychotherapy indicated for the worried well

A

no

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36
Q

where does psychodynamic psychotherapy rank in the CANMAT depression guidelines

A

third line for acute MDD

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37
Q

what type of therapy is associated with Mann

A

time limited psychotherapy

12 sessions

focus on present and chronically endured pain, particular image of the self

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38
Q

what type of therapy is associated with Malan

A

brief focal psychotherapy

uses the triangles of self and triangles of conflict–> link the triangles in therapy

focus on internal conflict present since childhood, emphasis on developing insight

identify transference early and link to relationships with parents

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39
Q

what type of therapy is associated with Sifneos

A

anxiety provoking psychotherapy

direct attack on patients defenses, focus on oedipal conflict

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40
Q

what type of therapy is associated with Davanloo

A

short term dynamic therapy

access unconscious

central dynamic sequence

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41
Q

what are indications for psychodynamic psychotherapy

A

non psychotic, complex, long standing, treatment resistant:

GAD
chronic depression
unresolved trauma
personality disorders
multiple comorbidities

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42
Q

list signs and symptoms of unresolved trauma

A

narrative incoherence

alexithymia

mentalizing deficits

fearful/disorganized attachment

emotional dysregulation

relational problems

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43
Q

how and why do you aim to access the “zone of optimal arousal” in psychodynamic psychotherapy

A

address unresolved trauma

do this by validating distress

allows patient to think, feel, reflect and mentalize

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44
Q

list key concepts in psychodynamic psychotherapy

A
  • Some of mental life is unconscious
  • The past influences the present–> Trauma & neglect are sources of pathology
  • Transference & countertransference–> Data for understanding patients
  • Defense & resistance–> Mind may keep unpleasant thoughts out of awareness, but can emerge to cause symptoms or difficulties
  • Subjectivity–> Reflecting, mentalizing, inner subjective experiences–> improve agency, authenticity
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45
Q

what is transference

A

REACTIONS based on perceptions of, and responses to a person in the HERE AND NOW that REFLECTS PAST FEELINGS about, or responses to, important people earlier in one’s life–> especially parents and siblings

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46
Q

what is resistance

A

the patients attempt to PROTECT THE SELF by AVOIDING the anticipated emotional discomfort that accompanies the emergence of conflictual, dangerous or painful experiences, feelings, thoughts, memories, needs and desires

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47
Q

how do the ideas of counter transference differ between Freud and Winnicott+contemporaries

A

Freud–> counter transference is the therapists transference

Winnicott–> idea of “objective countertransference”–> idea that strong feelings of the therapist towards the patient may reflect WHAT THE PATIENT EVOKES IN OTHERS rather than it being a sole product of the therapists own unconscious conflict–> can be useful in therapy

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48
Q

list the “primitive” defense mechanisms

A

splitting

projective identification

denial

dissociation

idealization

acting out

somatization

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49
Q

list the neurotic defense mechanisms

A

introjection

identification

displacement

intellectualization

isolation of affect

rationalization

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50
Q

list the mature defence mechanisms

A

humour

anticipation

altruism

suppresion

sublimation

asceticism

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51
Q

what is the focus of “insight oriented psychodynamic psychotherapy”

A

focus on individual and INTERPERSONAL RELATIONS

focus on AFFECT and expression of EMOTION

*explore attempts to avoid aspects of experience, identify recurrent themes and patterns

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52
Q

what techniques are emphasized in insight oriented psychodynamic psychotherapy

A

mentalizing techniques

i.e communication of mental states, reflection of mental states, wondering about intentions

collaborate in creating a coherent narrative –> use a “not knowing” stance

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53
Q

who developed interpersonal therapy

A

Gerald Klerman and Myrna Weissman

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54
Q

list indications for interpersonal therapy

A

depression

post partum depression

bipolar disorder

binge eating disorder

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55
Q

how many phases are there in IPT

A

3

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56
Q

how many sessions are in interpersonal therapy

A

8-16

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57
Q

is interpersonal therapy empirically supported

A

yes

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58
Q

what are the goals of interpersonal therapy

A

alleviate suffering

remit symptoms, improve functioning

resolve CURRENT interpersonal problems

improve communication and relationships

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59
Q

what theoretical idea underlies interpersonal therapy

A

“depressogenic cycle”

–> unwittingly evoke distance from others, can be disempowering and perpetuate isolation and despair

60
Q

what are the functions of the initial phase of interpersonal therapy

A

form alliance, assess, psychoeducation

ASSIGN SICK ROLE

do INTERPERSONAL INVENTORY

choose FOCUS of therapy

61
Q

what is the function of the middle phase of interpersonal therapy

A

focus specific

COMMUNICATION ANALYSIS

62
Q

what is the structure of the ending phase of interpersonal therapy

A

review changes and gains

CONTINGENCY planning

good goodbye

63
Q

what are the four possible foci of interpersonal therapy

A

grief –> bereavement

role transitions –> adapting to lifes changes

role disputes –> improve understanding and communication

interpersonal sensitivity –> decrease social isolation

64
Q

CBT is based on what theoretical underpinning

A

learning theory (i.e classical, operant and social learning theory)

65
Q

who is associated with classical conditioning

A

pavlov

watson

wolpe

66
Q

who is associated with operant conditioning

A

skinner

67
Q

who is associated with social learning theory

A

bandura

68
Q

ideas of positive and negative reinforcement are associated with what type of learning

A

operant conditioning

69
Q

what is classical conditioning

A

NEUTRAL stimulus associated with a NATURAL response (pavlovs dogs)

70
Q

what is operant conditioning

A

specific CONSEQUENCES are associated with a VOLUNTARY behaviour

71
Q

explain the differences between positive reinforcement, negative reinforcement, positive punishment, and negative punishment

A

are ideas in operant conditioning

BOTH positive and negative REINFORCEMENT work to INCREASE the likelihood of a behaviour being repeated, just in different ways–> positive reinforcement involves GIVING something to increase likelihood of a behaviour, and NEGATIVE reinforcement involves taking something AWAY to increase likelihood of a behaviour

positive and negative punishment are the same ideas but involve trying to DECREASE the likelihood of a behaviour being repeated

72
Q

what is the focus of therapy in CBT

A

on MAINTENANCE factors rather than historical factors (i.e what is perpetuating the problem rather than what caused it in the first place)–> causes or motives are NOT NECESSARY

behavioural assessment and self monitoring

setting specific and measurable goals

measuring outcomes

73
Q

list behavioural interventions that are based on CLASSICAL conditioning

A

systematic desensitization

flooding

interoceptive exposure

therapeutic exposures

exposure and response prevention

74
Q

list behavioural interventions based on operant conditioning

A

behavioural modification

contingency management

aversion-based approaches

75
Q

what do you use systematic desensitization for

A

phobias

76
Q

how does systematic desensitization work

A

by RECIPROCAL INHIBITION

imagined anxiety situations are paired with RELAXATION (counter conditioning)

77
Q

what is flooding used for

A

phobias

78
Q

how does flooding work

A

engage with MOST feared situation, in a controlled setting, with relaxation PRN

EXTINCTION–> decreasing fear and maladaptive anxiety

79
Q

what is interoceptive exposure used for

A

panic disorder

80
Q

how does interoceptive exposure work

A

exposure to bodily sensations

extinction–> reduce fear response with repeated, prolonged contact with feared stimulus in the absence of a panic attack

habituation–> intensity of fear response decreases with repeated presentation of physiological sensations

81
Q

what are therapeutic exposures used for

A

anxiety disorders

82
Q

how do therapeutic exposures work/how are they structured

A

planned, prolonged and repeated

construct FEAR HIERARCHIES with SUDS–> graduated exposures

can do imagined or in vivo

operate on principles of extinction and habituation

83
Q

what do you use exposure and response prevention for

A

OCD

84
Q

how does behavioural modification work

A

reinforcement and punishment to acquire new behaviours

continuous or intermittent schedules of reinforcement

shaping + chaining

85
Q

what is “shaping” in behavioural modification

A

reinforcing successive approximations to goal

86
Q

what is “chaining” in behavioural modification

A

teaching sequence of behaviours until goal

87
Q

how do contingency management programs work

A

token economy programs

rewards or punishes according to contracted rules

spells out series of behaviours to be expected in contingencies

88
Q

how to aversion based approaches work

A

PUNISHMENT paired with response to be extinguished

for efficacy–> high intensity, immediate, continuous (initially)

LAST RESORT

89
Q

list some other interventions classified as “behavioural”

A

behavioural activation

problem solving therapy

social skills training

relaxation training

habit reversal (trichotillomania)

90
Q

name the 3 propositions upon which CBT is based

A

access hypothesis

mediation hypothesis

change hypothesis

91
Q

what does CBT’s access hypothesis posit

A

with appropriate training + motivation + attention, one can become AWARE of the content and process of one’s thinking

92
Q

what does CBT’s mediation hypothesis posit

A

MANNER in which one thinks about, interprets and construes events INFLUENCES emotional and behavioural responses

93
Q

what does CBT’s change hypothesis posit

A

by INTENTIONALLY modifying cognitive and behavioural responses to situations one can become MORE FUNCTIONAL and adaptive

94
Q

who is associated with cognitive theory (CBT)

A

Aaron Beck

–> cognitive theory
–> beck depression inventory

95
Q

what is Beck’s cognitive triad

A

negative view of self <–> negative view of future <–> negative view of world <–> (is a triangle)

–> certain characteristic cognitive biases are associated with specific psychiatric conditions

96
Q

based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:

depressive

A

negative view of self, experience, future

97
Q

based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:

hypomania

A

inflated view of self, future

98
Q

based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:

suicidality

A

hopelessness

deficiencies in problem solving

99
Q

based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:

anxiety

A

sense of physical or psychological danger

100
Q

based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:

phobias

A

fear of danger in specific, avoidable situations

101
Q

based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:

panic disorder

A

catastrophic interpretation of bodily/mental experiences

102
Q

based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:

paranoia

A

attribution of bias towards others

103
Q

based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:

conversion

A

concept of motor or sensory abnormality

104
Q

based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:

OCD

A

repeated warning about doubt and safety—> acts to ward off

105
Q

based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:

anorexia

A

fear of being fat

106
Q

based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:

IAS/SSD

A

attribution of serious medical disorder

107
Q

what are the 10 principles of CBT according to Beck

A
108
Q

how might you approach a CBT cognitive formulation

A
109
Q

what are schemas in CBT

A

core beliefs

“schemas are deep cognitive structures that enable an individual to interpret his or her experiences in a meaningful way”-beck

central ideas about self, other, world

characteristic, recurrent themes in thought

upon activation–> INFLUENCE PERCEPTIONS of experiences

develop early in life

global, rigid, overgeneralized, absolute

LEAST AMENABLE TO CHANGE

110
Q

what are automatic thoughts

A

automatic negative and dysfuncitonal thoughts–> cognitive distortions

typically INITIAL TARGET in cognitive therapy

111
Q

list some of the cognitive distortions (burns)

A
112
Q

list some of the cognitive distortions (gabbard)

A
113
Q

what are the goals of CBT’s cognitive techniques

A

COGNITIVE RESTRUCTURING
–> use the socratic questioning and behavioural experiements
–> develop alternative, more productive thoughts and perspectives

114
Q

when might group CBT be preferred over individual

A

social anxiety

chronic pain

115
Q

what is the first wave cognitive/behavioural therapy

A

behavioural therapy

116
Q

what is the second wave cognitive/behavioural therapy

A

CBT

117
Q

what is the third wave cognitive/behavioural therapy

A

DBT

MBSR

MBCT

ACT

118
Q

what are the therapeutic factors of group therapy (list)

A

universality

altruism

instillation of hope

imparting information

corrective recapitulation of primary family group

developing socializing techniques

imitative behaviour

interpersonal learning

existential factors

catharsis

group cohesiveness

119
Q

what is the primary dialectic of DBT

A

ACCEPTANCE of clients as they are
+
CHANGE in order to reach their goals

120
Q

what does “dialectical” mean

A

integration of opposites

121
Q

what are the 4 components of a DBT program

A

skills training group

individual DBT therapy

phone coaching

therapist consultation team

122
Q

what are the four areas of focus in DBT as a therapy

A

mindfulness

distress tolerance

interpersonal effectiveness

emotional regulation

123
Q

what are the components of DBT that are focused on the “acceptance” part of the dialectic

A

mindfulness

distress tolerance

124
Q

what are the component of DBT that focus on the change part of the dialectic

A

interpersonal effectiveness

emotional regulation

125
Q

how do you prioritize treatment targets in DBT?

A
  1. life threatening behaviours are FIRST–> suicidal, non suicidal, self injury, SI, suicidal communication
  2. therapy interfering behaviours are SECOND–> coming late, cancelling, being non collaborative
  3. quality of life interfering behaviours are THIRD–> mental disorders, relationship problems, financial/housing crisis
  4. skill acquisition is FOURTH–> replace ineffective behaviours to achieve goals
126
Q

what are the four stages of treatment in DBT

A

stage 1–> achieving BEHAVIOURAL control

stage 2–> full EMOTIONAL experiencing

stage 3–> life of ordinary HAPPINESS

stage 4–> ongoing CAPACITY for experiences of joy and freedom

127
Q

what is “defusion”

A

skill learned in mindfulness

distancing oneself from, letting go of unhelpful thoughts, beliefs, memories

128
Q

how do MBCT and CBT differ?

A
129
Q

who came up with structural family therapy

A

salvador minuchin

130
Q

what are the goals of structural family therapy (5)

A
  1. creating an EFFECTIVE HIERARCHICAL STRUCTURE in the family
  2. helping parents become effective PARENT SUBSYSTEM
  3. aiding children to become SUBSYSTEM OF PEERS
  4. increasing FREQUENCY of interactions and NURTURANCE (if disengaged)
  5. DIFFERENTIATION of family members (if enmeshed)
131
Q

what are the two assumptions made in structural family therapy

A
  1. families possess the skills to solve their own problems
  2. families generally act with good intentions
    –> have problems with carrying out good intentions
132
Q

name 5 techniques used in structural family therapy

A

joining

enactment

boundary making

reframing

restructuring

133
Q

define the following technique used in structural family therapy:

joining

A

empathic relationship with the family in order to modify current functioning

134
Q

define the following technique used in structural family therapy:

enactment

A

therapist constructs interpersonal scenario in session where dysfunctional transactions among family members are played out

135
Q

define the following technique used in structural family therapy:

boundary making

A

maintaining clear boundaries around subsystems (healthy)

136
Q

define the following technique used in structural family therapy:

reframing

A

examining a situation in a new perspective so that the meaning is changed

137
Q

define the following technique used in structural family therapy:

restructuring

A

changing the structure of the family

138
Q

what is the main goal of Bowen family therapy

A

facilitating AWARENESS of how the emotional system functions

INCREASE LEVELS OF DIFFERENTIATION–> focus making changes for self

–> diffuse anxiety by focusing on patterns that develop in families–> perception of either TOO MUCH CLOSENESS or TOO MUCH DISTANCE
–> determined by levels of external stress, sensitivities to themes
–> transmitted down generations

139
Q

the genogram is associated with what type of family therapy

A

Bowen family therapy

140
Q

describe the concept of triangles as seen in Bowen family therapy

A

when inevitable anxiety arises in a dyad, this is relieved by involving a vulnerable third party who either takes sides or acts as a detour for the anxiety

avoidance of the original anxiety

triangles tend to repeat across generations

141
Q

what is the understanding of the nuclear family emotional system in Bowen family therapy

A

couples conflict/symptoms in a spouse–> projection on to children

142
Q

what is the understanding of the family projection system in Bowen family therapy

A

children with the least emotional separation from parents are the MOST vulnerable

143
Q

what is motivational interviewing?

A

directive, client centered counseling style for eliciting behaviour change by helping clients EXPORE and RESOLVE ambivalence

144
Q

what is a mnemonic for motivational interviewing principles

A

DEARS

Discrepancy
Empathy
Ambivalence
Roll with resistance
Self efficacy

145
Q

what is a mnemonic for motivational interviewing spirit

A

PACE

Partnership
Acceptance
Compassion
Evocation

146
Q

what is a mnemonic for the motivational interviewing process

A

EFEP

Engagement
Focusing
Evoking
Planning

147
Q

what is a mnemonic for motivational interviewing communication

A

OARS

Open ended questions
Affirmations
Reflections
Summarizing

7. Psychotherapy (3 decks)

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