Chapter 17_Psychotherapies Flashcards
What are the 3 components of Freud’s topographic theory?
Unconscious - repressed thoughts, out of one’s awareness (primary process thinking - primitive/pleasure seeking, childlike)
preconscious - memories that can easily be brought into conscious
conscious - current thoughts and secondary process thinking (logical, organized, delayed gratification)
What are the 3 components of Freud’s structural theory?
Id - unconscious; instincts, sexual urges
superego - moral conscious, inner ideal to strive towards
ego - mediator between first two + environment, seeks to develop satisfying personal relationships; uses defense mechanisms; distinguishes fact and reality with reality testing
What are 4 mature defense mechanisms?
altruism, humor, sublimation, suppression
Patient’s child recently died from ovarian cancer. As part of the grieving process, the patient donates money to help raisse community awareness about symptoms of ovarian cancer
altruism (mature)
performing acts that benefit others in order to vicariously experience pleasure
Person with unconscious urges to physically control others becomes a prison guard
Former gang member becomes social worker to help reform kids in gangs
sublimation (mature)
satisfying socially objectionable impulses in an acceptable manner (channeling them rather than preventing them)
Nurse who feels nauseated by an infected wound puts aside feelings of disgust to clean wound and provide necessary patient care
suppression (mature)
conscious process that involves paying attention to a particular emotion
Patients with which disorders tend to show neurotic defense mechanisms?
OCD, anxiety, stress disorders
What are some examples of neurotic defenses?
controlling, displacement, intellectualization, isolation of affect, rationalization, reaction fromation, repression
Student who is angry with his mother talks back to his teacher the next day and refuses to obey her instructions
displacement (neurotic)
shifting emotions from an undesirable to one that is personally tolerable
Physician who is dying describes the pathophysiology of his disease in detail to his 12-year old son
intellectualization (neurotic)
avoiding negative feelings by excessive use of intellectual functions and by focusing on irrelevant details
Woman describes the recent death of her husband without any emotion
isolation of affect (neurotic)
unconsciously limiting the experience of feelings/emotions associated with a stressful life event to avoid anxiety
My boss fired me today not because she wasn’t meeting her quotas, not because i’m a bad employee
I bought this fancy new watch because the old wasn’t reliable enough and I needed to make my appointments
rationalization (neurotic)
explains an event to justify outcomes or make them acceptable
Man who is in love with his married coworker insults her
reaction formation (neurotic)
doing the opposite of an unacceptable impulse
Conscious version of suppression
Repression (preventing a thought or feeling from entering consciousness)
neurotic
In what kinds of patients would you see immature defense mechanisms?
children, adolescents, psychotic patients, patients with severe personality disorders
What are some examples of immature defense mechanisms?
acting out, denial, regression, projection
Man who has been told his therpist is going on vacation “forgets” his last appointment and skips it
child throws temper tantrum, hit head on wall
acting out (immature)
giving into an impulse, even if socially inapprpriate in order to avoid anxiety of suppressing that impulse
Husband who is attracted to other women believes his wife is having an affair
Wife who doesn’t listen to her husband accuses husband of not listening to her enough
projection (immature)
attributing objectionable thoughts/emotions to others
Woman who has been scheduled for a breast mass appointment cancels because she believes that she is healthy
denial (immature)
not accepting reality that is too painful
Woman brings her childhood teddy bear to the hospital when she needs to spend the night
regression (immature)
performing behaviors from an earlier stage of development to avoid tension associated with current stage of development
A patient is awesome and great with med student but refuses to even talk to attending
Splitting
labeling people as all good or all bad (often seen in BORDERLINE personality)
Man who has had a brief fantasy of killing his wife by sabotaging her car takes the car in for a complete check up
undoing
attempting to reverse a situation by adopting a new behavior
What is the goal of psychoanalysis?
resolve unconscious conflicts by bringing repressed experiences and feelings into awareness and integrating the into the patient’s conscious
T/F: Psychoanalysis is insight oriented
True. Patients should be intelligent and in stable relationships/daily living (cannot be psychotic) HIGH FUNCTIONING
How intensive is psychoanalysis?
Very! 3-5 days per week fo many years (couch with therapist)
What is psychoanalysis useful in treating?
- Cluster B and C personality disorders
- Anxiety disorders
- Problems coping with life events
- Sexual disorders
- PDD
Goal of interpersonal therapy
focuses on development of social skills in order to improve interpersonal relations.
short once weekly sessions for a few months
Goal of supportive psychotherapy
help patient feel safe during a difficult time and to help build up a patient’s healthy defenses; focuses on empathy, understanding, and education. Often used as adjunctive treatment
Shorter version of psychoanalysis?
Psychoanalytically oriented psychotherapy and brief dynamic psychotherapy (less intense, briefer, no couch)
What theory does behavioral therapy use?
Learning theory (conditioning and deconditioning)
classical conditioning (stimulus can evoke a conditioned response)
operant conditioning (behaviors can be learned when followed by positive/negative reinforcement
Patient performs relaxation techniques while being exposed to increasing doses of anxiety provoking stimulus. Used to treat phobia disorders
systematic desensitization
Patient who has a fear of flying is made to fly in an airplane or imagine flying (technique)
flooding and implosion (mor eintense form of systematic desensitizaiton), patient cannot escape until relaxed
An aalcoholic patient is prescribed Antabuse, which makes him ill every time he drinks alcohol (technique)
Aversion therapy
negative stimulus (i.e. electric shock) is repeatedly paierd with a specific behavior to create an unpleasant response
Therapy in which patient identifies maladaptive thoughts and replace them with positive ones. Useful in treating depressive and anxiety disorders used in combo with CBT
cognitive therapy
Patient learns how their feelings and behaviors are influenced by their thoughts. Treatment brief from few weeks to few months
CBT
What is CBT effective for?
Many
depression, anxiety, schizophrenia, and substance use disorders
Which therapy is once weely individual and group treatment that diminishes self destructive behaviors and minimizing hospitalizations?
DBT
What is DBT most useful for?
Treating borderline patients
What is group therapy useful for?
substance use (AA), adjustment disorders, and personality disorders. Uses peers for immediate feedback and support
How does family and couples therapy work?
Family - reduce conflict and help family members understand needs of whoever has psyhiatric condition (corrects boundaries and “triangles”)
couples - therapist sees couple together (conjoint) and may also be seen separately (concurrent) or separate therapist (collaborative)
