Class notes for test 1 Flashcards
1
Q
What is a Psychological/Psychiatric Evaluation/Assessment?
A
This is the process of determining which disorder/diagnosis best explains a person’s symptoms as both observed and as reported by the patient and/or by close family members.
2
Q
This is the process of determining which disorder/diagnosis best explains a person’s symptoms as both observed and as reported by the patient and/or by close family members.
A
What is a Psychological/Psychiatric Evaluation/Assessment?
3
Q
The evaluation/assessment uses a combination of:
arrive at
A
techniques or components to help arrive at a hypothesis about a person and their behavior, personality, and capabilities.
4
Q
techniques or components to help arrive at a hypothesis about a person and their behavior, personality, and capabilities.
A
The evaluation/assessment uses a combination of:
5
Q
4 main points about a Clinical Interview/Intake:
7 points in part 3
A
- The interview is always used.
- Typically lasts from one to two sessions.
- It tends to be a semi-structured
conversation about the client’s presenting problem, significant family history for mental illness, drugs, education,developmental milestones,family constellation and employment history. - From this information, the therapist develops a case history and begins to hypothesize which diagnosis best fits the client.
6
Q
Explain Psychological Testing:
6 points
Formal
A
- Formal testing is sometimes done.
- It may include IQ tests,
- neurological screening,
- behavioral assessments,
- depression inventories,
- and suicide inventories.
7
Q
Formal diagnosis is made using the….
A
DSM5
8
Q
Define DSM-5:
3 points
A
1.The Diagnostic and Statistical Manual of Mental Disorders, published by American Psychiatric Association (2013):
2.Provides a common language to describe observed abnormal behavior.
3.It’s used by Psychiatrists, Psychologists, & LCSW’s, LMHC’s and Psychiatric Nurse Practitioners in the United States to form a diagnosis.
9
Q
Three main reasons for conducting an evaluation:
A
- Treatment Plan
- Prognosis
- Payment:
10
Q
Define Treatment Plan:
3 points
A
- The information gathered during the assessment defines the problem/diagnosis.
- The treatment plan specifies how each problem area will be treated.
- Treatment plans may include psychotherapy, medication, life-style change, or any combination of these elements.
11
Q
The information gathered during the assessment defines the problem/diagnosis.
A
Treatment Plan
12
Q
Define Prognosis:
3 points
A
- A prognosis is an estimate or prediction of the typical outcome of the disorder.
- The assessment and diagnosis help us determine the prognosis;
- both the short and long-term outcomes of treating, or not treating the disorder.
13
Q
The assessment and diagnosis help us determine the _______
A
Prognosis.
14
Q
Explain how Payment works:
A
For the therapist to get paid by the insurance company, a diagnosis must be made/submitted.
15
Q
Counseling for the Counselor. Why is it helpful?
5 points
A
- Explore your motivation for being a counselor.
- If you’re not committed to exploring your own life, how can you encourage clients to do the same?
- Discover your own unresolved issues, prejudices, biases, & cultural norms.
- Some of what you discover about yourself, you may discover in conducting therapy.
- Unconscious Bias
16
Q
Why do you need to explore your motivation for being a counselor ?
A
- Do you think you have the power to change others?
- Do you feel the need to save others?
- Who’s this about, you or the client?
17
Q
If you’re not committed to exploring your own life…
A
how can you encourage clients to do the same?
18
Q
Discover your own unresolved issues include..
A
- Prejudices
- Biases
- Cultural norms.
19
Q
- Some of what you discover about yourself, you may discover in __________ Hopefully, you’ll continue to discover __________ you have by working with others. Themes such as loneliness, power, death, intimacy are _________for the counselor since these are issues, we all deal with. You may also discover your own __________.
A
- Conducting therapy
- Unresolved issues
- Common triggers
- Unconscious bias
20
Q
Unconscious Bias are …
A
Judgements and behaviors towards others that we’re not consciously aware of.
21
Q
How the counselor’s values can impact the therapeutic relationship:
3 Points
A
- Recognize that no one is “value neutral.” We were raised with certain family and societal values, sometimes we just haven’t examined them, but they’re there.
- Avoid imposing your own values on the client. They’ll feel judged by you and less likely to open up.
- Help the client to create therapeutic goals that are congruent with their own values, not yours.
22
Q
Becoming an effective multicultural competent counselor:
3 Points
A
- Gain a knowledge of the dynamics of oppression, racism, discrimination, and stereotyping.
- Learn about your client’s traditions, background, and values.It’s OK to just ask them.
- Don’t assume you share values and traditions with the client just because you’re the same age, gender, race, or ethnic background.
23
Q
Common issues faced by beginning counselors. Most of these issues are initially dealt with in supervision during internship experiences:
7 Points
A
- Dealing with your own anxiety:
- Being yourself and becoming aware of when to self-disclose.
- Perfectionism
- Know your limitations
- Understand and embrace silence
- Dealing with the demands of the client
- Decline to give advice
24
Q
Explain “Dealing with your own anxiety”:
A
Am I competent enough?
25
Being yourself and becoming aware of when to self-disclose.
Disclose when it serves the client, not you.
26
Perfectionism:
What happens if I make a mistake?
27
Know your limitations:
Learn when and how to refer a client when your limitations prevent you from helping them.
28
Understand and embrace silence:
Try to let the client be the one to break an awkward silence, you’ll learn more from what they eventually say than if you break it.
29
Dealing with the demands of the client:
1.Boundaries are necessary, set them at the beginning of the relationship.
2.Let them know when you’re available, when you’re not, when you’ll get back to them if they leave a message, when their session begins and ends.
3.You’re their counselor, not their friend.
30
Decline to give advice:
Work towards getting the client to make better decisions based upon their own values.
31
Understand and embrace silence:
Try to let the client be the one to break an awkward silence, you’ll learn more from what they eventually say than if you break it.
32
What is the Code of Ethics?
State and/or professional organizations’ guidelines that outline professional behavior and practice.
33
What are other things that the code of ethics does ?
| 2 points
1. Educates therapists about responsibility to never harm the client.
2. Ethics always exceeds the law.
34
When Making Ethical Decisions:
| 2 points
1. Review relevant codes and laws set by the state board of ethics
2. Seek consultation with supervisor, peer, or the state board of ethics if necessary
35
Define Informed Consent:
An ethical term used to describe the permission/consent granted by the client to the therapist as to what the treatment will consist of.
36
2 facts about informed consent:
1.It’s often a written agreement.
2.It educates clients about their rights in therapy.
37
Informed consent should include:
1. An overview of the therapeutic procedures and goals
2. The right to voice concerns, ask questions
3. The out-of-pocket cost
4. The right to withdraw from treatment
5. The limits of confidentiality
38
Define Limits of Confidentiality:
Conditions under which a therapist can break the confidential agreement between therapist and client.
39
Examples of Limits of Confidentiality:
| 5 points
1. Client poses danger to self or others (suicidal or homicidal)
2. Suspected child or elder abuse or neglect
3. Client needs to be hospitalized
4. Information is made an issue in a court action
5. Client requests a release of records
40
Facts about clients under the age of 18:
| 2 Points
1. They do not have a right to confidentiality in therapy.
2. However, most therapists ask parents and minor clients to agree to the therapist’s confidentiality rules before they treat the client.
41
Multiple or Dual Relationships Between Therapist and Client:
| 3 points
1. These relationships are exploitive and harmful to the client and should be avoided.
2. Socializing or starting a business relationship with a client or former client.
3. Having a sexual or personal relationship with the client or former client.
42
Facts about Sigmund Freud (1856-1939)
| 6 points
1. Freud was born in Vienna and considered the father of psychoanalytic theory.
2. He was a neurologist, not a psychiatrist or psychologist.
3. His interest in psychiatric problems came later on; during a time when he was experiencing severe emotional problems of his own. That’s when he became the most creative and developed his psychoanalytic theory.
4. Had a troubled relationship with his dominating father.
5. Intensely attached to his mother who was very loving.
6. Subsequent related theoretical orientations such as those therapists who consider themselves Psycho-Dynamically Oriented, are based upon his basic concepts/tenets.
43
Freud’s Structure of the Personality include:
1. Id
2. Ego
3. Super Ego
44
Explain the Id:
| 5 points
1. There at birth
2. Driven by instinctual needs (hunger, thirst, sexual drives)
3. Demanding, can’t tolerate the tension in delaying gratification
4. Immoral, illogical
5. Ruled by the pleasure principle. I want it, and I want it now!
45
Explain the Ego:
| 5 Points
1. Develops by age 1 as a consequence of dealing with reality; can’t always get what it wants
2. Realistic, logical
3. Becomes the mediator between the Id and the Superego
4. Keeps the Id in check by satisfying it in socially acceptable ways (uses defense mechanisms)
5. Ruled by the reality principle.
46
Explain the Super Ego in 5 Points:
1. Develops by age five
2. Begins developing in toddlerhood
3. Our parents’ and society’s moral code.
4. Guilt
5. Ruled by right and wrong. Don’t do that, it’s not nice!
47
What are Freuds beliefs about Anxiety ?
| 3 points
1. Freud believed anxiety derives from a conflict between the Id and the Superego.
2. The Id wants what it wants immediately, and the Superego fears the Id instincts will get out of control,
3. so…. we unconsciously use our defense mechanisms (from the Ego) to get control of the conflict and satisfy our Id in more socially acceptable ways.
48
Define Defense mechanisms
Strategies that we unconsciously use to ward off anxiety and not act upon our unacceptable thoughts, urges, and feelings.
49
Examples defense mechanisms
| 6 points
1.Repression
2.Denial
3.Rationalization
4.Displacement
5.Sublimation
6.Projection
50
All defense mechanisms have two characteristics in common, what are they ?:
1. They either deny or distort reality.
2. They operate on the unconscious level.
51
Explain the conscious mind:
| 2 Points
1. What’s on our mind at the time and easily accessed.
2. Freud believed this was the just tip of the iceberg.
52
Explain the Unconscious:
| 4 points
1. Stores all our repressed memories and experiences.
2. Unconscious processes are at the root of all symptoms and behaviors,
3. Out of our awareness or conscious control.
4. Memories that we can’t readily access but often spill into our dreams.
53
What are Freud’s Theory of the Conscious and the Unconscious?
1. Conscious: what’s on our mind at the time and easily accessed. Freud believed this was the just tip of the iceberg.
2. Unconscious: stores all our repressed memories and experiences. Unconscious processes are at the root of all symptoms and behaviors, and out of our awareness or conscious control.
Memories that we can’t readily access but often spill into our dreams.
54
What are the 6 therapeutic goals of psychoanalysis ?
| 6 points
1. Strengthen the ego so it becomes more reality based, and less reliant on defense mechanisms.
2. Gradually brings unresolved conflicts from the unconscious into the consciousness so they can be worked through in therapy.
3. The ego must be made stronger before the person can deal with what’s being brought into their consciousness.
4. Childhood experiences discussed and analyzed as to how they relate to current problems.
5. Achieve emotional insight, not just intellectual insight
6. Eventually free up emotional energy so the client can work, love and play.
55
What are the 6 techniques used in psychoanalysis ?
1. The Blank Screen
2. Resistance
3. Dreams
4. Free Association
5. Freudian Slips (slip of the tongue)
6. Analyst Maintaining a Distant Role in the Therapeutic Relationship
56
Analyst Maintaining a __________ in the Therapeutic Relationship
Analyst Maintaining a Distant Role in the Therapeutic Relationship
57
Explain the Blank screen:
| 2 points
1. The analyst offers little to no facial expression or nonverbal cues, displays nothing of their personal life in the office, in hopes that the client will project their unconscious (unresolved) conflicts from their early childhood, onto the analyst.
2. The blank screen helps to encourage transference.
58
Explain Tranference:
| 3 points
1. Client unconsciously transfers unresolved feelings, originally experienced in an early relationship with significant others, such as parents or siblings, onto the analyst.
2. Transference helps client make projections onto therapist.
3. Client begins to react to the analyst as their significant other (parent, sibling) and works through unresolved conflict by doing so.
Psychoanalysts want transference to happen.
59
Explain resistance:
| 3 Points
1. The client’s reluctance to bring what’s in their unconscious, into their consciousness.
2. The client unconsciously uses resistance to avoid anxiety and due to their fear of change.
3. It’s important for the analyst to stay attuned to the client’s resistance.
60
Why did Freud believe resistance happened ?
Freud felt resistance exists in therapy because there’s always a struggle between the client wanting to change, but also wanting to remain embedded in their old neurotic world.
61
Examples of resistance:
| 3 Points
1. Client forgetting what they were talking about
2. Arriving late
3. Forgetting appointments.
62
Explain how Freud views Dreams:
| 2 Points
## Footnote
related
1. Freud saw dreams as the Royal Road to the Unconscious.
2. What we dream is related to repressed memories or unresolved conflicts.
63
What we dream is related to ______ memories or ____________ conflict.
What we dream is related to repressed memories or unresolved conflicts.
64
Explain Free association:
| 2 Points
1. Free association is when a client is asked to lie down or not directly face the analyst
2. Share thoughts, random words, and anything else that comes to mind, regardless of how incoherent or inappropriate the thoughts are.
65
Explain Freudian Slips (slip of the tongue):
| 2 Points
1.Freud believed it’s a mistake we make when we speak
2.Revealing the thoughts and desires of the unconscious mind slipping through.
66
Freudian slips are revealing the _________ and __________of the unconscious mind slipping through.
Revealing the thoughts and desires of the unconscious mind slipping through.
67
Given an example of the slip of tongue:
Calling the new boyfriend your old boyfriend’s name
68
Explain Analyst Maintaining a Distant Role in the Therapeutic Relationship :
| 2 Points
1. Patient refers to analyst by “Dr.”, never by first name
2. Avoids eye contact
69
What is the Clients Role in Psychoanalysis?
## Footnote
6 points
1. Must be willing to commit to long term, intense therapy, often meeting 3– 5 times per week
2. Commit to remembering and discussing dreams
3. Take part in free association, divulging early childhood experiences, associations, memories, fantasies
4. Lie down on couch or sit in a way that avoids analyst and client making direct eye contact
5. Client needs to be vulnerable
6. Client commits to not making any major life changes while in analysis; divorce, changing jobs, moving, etc.
70
Must be willing to commit to _________ intense therapy, often meeting _________times per week
Must be willing to commit to long term, intense therapy, often meeting 3– 5 times per week
71
Take part in free association, ________early childhood experiences, ________, __________ and __________.
Divulging , associations, memories, fantasies
72
In psychodynamic therapy the client must _________on couch or sit in a way that _______ analyst and client making ________.
Lie down
avoids
direct eye contact
73
Explain Psycho-Dynamically Oriented Psychotherapy:
This is a more modern approach to analysis, still using Freud’s basic theory
74
What's different about the psycho-dynamically oriented psychotherapy ?
| 5 Points
1. Sees client less often (usually weekly)
2. More likely to sit facing each other, avoids using the couch
3. Therapist less distant and more engaged in process
4. More emphasis on the here and now, not just the past
5. Can be time-limited
75
Strengths of Psychoanalytic Approach from a Multicultural Perspective:
| 2 Points
1. Stresses the value of intensive psychotherapy as part of therapist’s training.
2. This helps the therapist become aware of their own biases, prejudices, and stereotypes.
76
The Psychoanalytic Approach helps the therapist become aware of their own ________, _________, and ______.
This helps the therapist become aware of their own biases, prejudices, and stereotypes.
77
6 Shortcomings (limitations) of Psychoanalytic approach to therapy:
1. Costly, purposely so.
2. Based on upper-middle class values
3. Too ambiguous since it rarely helps patients to define specific problems they came to therapy to solve
4. More concerned with long-term possible character change than short-term solutions to the client’s presenting problems
5. Too threatening for highly intellectualized individuals (people out of touch with their feelings, and resistant to delve into their feelings or their past)
6. Severely emotionally disturbed or intellectually limited individuals lack the ego strength or ability to think abstractly needed for this type of treatment.
