EA Psychotherapy Final Exam - Intro

Question 1

Give a definition of “counselling.”

Answer 1

Counselling can be described as communication (= transfer or mutual development) of information, experience, and knowledge on a topic (problem area) together with corresponding guidance for independent practice and behaviour.

Question 2

What is counselling about?

Answer 2

It is solution/resources-oriented work. It is on a task or a topic at the action level. It requires cognitive grasping of what is there and what is missing.

Question 3

What does counselling require from the client?

Answer 3

1) Ability to recognize that outside help is useful and the motivation to seek assistance.
2) Ability to achieve immediate and relatively independent implementation under one’s own steam. (relatively good state of health and ego-strength)

Question 4

What does giving appropriate advice require from the counsellor?

Answer 4

Good counselling involves strengthening human autonomy. Advice touches on the decision-making level of another person and bears the risk of being patronizing, incapacitating, and/or constriction. Therefore, be careful and don’t give too much advice! Present course of action as recommendation. Don’t make decisions (or give instruction).
- Don’t offer advice that has not been asked for
- Give as much information as possible
- Show options for action
- Don’t give advice unless they are in a risky or dangerous situation. Emergencies may require advice even if not asked for.

Question 5

What are the main means/levels used by the counselling process?

Answer 5

Level of knowledge and cognition: Change of perspective and attitude/stance
Level of behaviour: Step-by-step methods can be used (e.g., MCM, WSM, PP, PI, dereflection, PEA) as structural aid.
Work level: Focus on client’s capabilities, defining objectives and steps together.

Question 6

Dangers of counselling?

Answer 6

“The trap of counselling is the potential assumption of decisions.” → Therapist takes over
Robbing them of their humanity
Potentially assuming the person has the resources that they do not have if psychopathology is missed.

Question 7

What is the central role of the therapist in psychotherapy?

Answer 7

The function of the therapist is accompaniment and guidance through the process. This requires a close relationship, which is much closer than in counselling and where EA becomes personal (not private, though!).

Question 8

What do you see as the goal of psychotherapy in EA?

Answer 8

The goal of psychotherapy is healing by strengthening the ego and connecting with the person as well as working through the disorders. = specific treatment of diagnosis
Many Objectives:
Change of attitudes
Change of the manner of experiencing
Strengthening of personal abilities
Change of behaviour can grow on this basis = “experienced-founded change”
Healing is, in part, also “post-maturing”

Question 9

What is existential analytical support?

Answer 9

Relationship is the basis of support, it is taken into account and needs to be established (by feeling understood).
Client feels understood as a person (= to sense what is important for the person) → needs to be close to the person (= to sense why they feel this way)
Dialogical
→ Relationship is closer in psychotherapy than in counselling

Question 10

Give four typical situations where ‘accompaniment’ is indicated.

Answer 10

Palliative care; psychotic defective states; severe (bedridden) illnesses, accompaniment through difficult times (mourning, unemployment, retirement home …); personality development (adolescent, adults, professional development).

Question 11

What is the relationship between accompaniment and counselling and psychotherapy?

Answer 11

Development helps a person expand their abilities. Counselling heps them realize their possibilities (1-20 hours, 5-10 typically). Accompaniment helps a person bear their situation (may take years).
→ Middle position between counselling and psychotherapy - still task-based but higher level of relationship than counselling.

Question 12

Can advice also be given to friends? – Explain your position.

Answer 12

Advice can be given to friends. Again, we run the risk of robbing them of their autonomy in this. Due to the established relationship, we may be less objective, less able to set aside our biases about them. It depends on the nature of the friendship. Some friends may regularly appreciate or request advice. Others may prefer supportive listening. We are less narrowly duty bound in friendship, compared to counselling.

Question 13

Why is relationship building so important in therapy?

Answer 13

Relationship has a pivotal function in dealing with this deepness.
- Ability to trust, experiencing support, immediate understanding and respect, etc. are central for the patient.
- Patient should be able to sense the therapist’s attitude towards them. This is the only way for the therapist to take on the essential function of → supporting the patient’s ego.
- Allows Reference to form: We observe the patient’s immediate experience in therapy
- Allows Reference to the subject: offering your own feelings, offering closeness to your ego; ego support
- Empathy and sense = reasons behind patient’s emotions, why they suffer this way, and how they feel about it. Empathy with patients and their motives for their actions. Awareness of your own bodily feelings. Also: Show empathy by saying how you feel.
- Participatory presence

Question 14

How should the relationship between personal and private be treated in psychotherapy?

Answer 14

Participatory presence (Lazarte) = phenomenological openness: personal closeness - but private restraint (protection of my own and the patient’s privacy). For the process and corresponding inductions, it is essential to establish closeness.
Attitude: “I’m by your side and I feel you, I won’t abandon you and I’ll even go through hell with you if necessary!” “I’m ready to feel what you feel myself, your suffering. - But I am only concerned with you in this regard - not with me.” = phenomenological openness means that I allow myself to get touched by what is being said = personal presence and closeness. About you, not about me.”

Re-designation of the personal therapist relationship into a private relationship, which is to be seen as an abuse of therapeutic relationship; = protection against too much intimacy and from the great risk for abuse associated with it.

Question 15

What needs to be considered when transferring from counselling to psychotherapy? Name some important elements.

Answer 15

A) Criteria with respect to content
The process requires accompaniment; mere guidance would be perceived as overwhelming
Personality change and work on emotional blocks
Intrusion of issues related to biography

B) Formal criteria:
State of client is worsening → Patient probably needs more support and guidance → therapeutic relationship.
No progress as to issue or problem area.
Overstraining of client or counsellor
Supervision or referral to another counselling or psychotherapist
Mental disorder (with the exception of 1-2 treatments of personality disorders to make client capable of psychotherapy and to relieve them situationally; accompaniment of chronic psychoses such as schizophrenia and endogenous depression).
The degree of psychological strain is not necessarily a reason for referral. In grief, crisis (or in the case of personality disorders), the pressure of suffering can be enormous. However, it isn’t a reason for psychotherapy in terms of content.

Question 16

What is abuse of a counselling or therapy relationship?

Answer 16

Re-designation of the personal therapist relationship into a private relationship,
which is to be seen as an abuse of the therapeutic relationship; = protection against too much intimacy and from the great risk for abuse associated with it.

The therapist bears the sole responsibility for the relationship in psychotherapy! The patient may behave as they wish. They may try to seduce as much as they would like to, they are entitled to do so! Therapists are the experts in shaping the relationship, and we need to have the necessary skills to do this. Moreover, we must always behave in such a way that we could explain in supervision what we do, or imagine that someone else could be present during therapy (conscience).
Absolute principle: my needs never belong in therapy with patients

Question 17

What is meant by “setting” and what does it relate to?

Answer 17

Setting relates to the form/structure of dialogue in EA:
- The fundamental personal attitude of EA
- We stand on the same level as persons; always work on the basis of consent with the patient, and ask them for their permission → Respect + activation of the free autonomous person within the patient.
- Setting boundaries
- Abstinence of self-interest and private matters
- Working together
- Ask for their their expectations and ideas; address irritating issues
- Defining the therapy goal
- What are the patient’s goals, what would they consider “success” in therapy?
- Be careful not to be instrumentalized by patients who adopt a questioning attitude.
- When outlining the therapy goal, it is advantageous to differentiate between working on the current problem and working with longer lasting personality development/maturing issues.
- Session structure
- Attunement and opening phase; Working phase; Closing phase

Question 18

What types of relationships do you know? Use one or two keywords to describe the characteristics of each type of relationship.

Answer 18

i) Contact – the immediate moment of touch
FM 1
ii) Relationship – A fundamental, continuous form of interaction, into which one is inescapably placed by the very presence of conception of the other, as soon as one becomes aware of them
FM 1
iii) Encounter – Intentional seeking out and meeting of a you (equals the essence of human being or their person) by way of dialogue
FM 3
iv) Rapport – being understood and receiving appropriate responses, the message has reached the other, and we hear confirmation of this
FM 3
v) Verhaltnis – a functional/personal relationship (love affair, teacher, clouded)
FM 4 – see person in context
vi) Attachment – the experience of a relationship that is solid, committed
FM 2
vii) Love – the intense emotionally experienced form of relationship. A view of the essence of the other

Question 19

What do we mean by “contact”?

Answer 19

The immediate moment of touch
Other forms???????????

Question 20

What do we mean by encounter?

Answer 20

“Intentional seeking out and meeting of a you by way of dialogue”
- Intentional - requires freely chosen openness
- Seek out - requires trying to understand, examine
- Encounter - trying to grasp the “you”
- Dialogue - the medium of encounter, the carrier, not just spoken

Question 21

What are the criteria of a good relationship?

Answer 21

i) To be able to be there with and for the other (giving and receiving support); we both have space and give protection to each other.
ii) To feel that it is good to be with the other and liking to feel how the other is doing ( I am part of the other), and vice versa; to feel attracted by the other, wanting to do good to the other.
iii) To see the other and let them respectfully be as they are - enabling me to be the way I am in their presence
iv) To share a common context, to have something which matters to both (common interests) and therefore connects
v) Includes: PEA (1 addressing, 2 understanding, 3 responding)

Question 22

How can the therapeutic attitude be briefly described in light of EA?

Answer 22

1) Phenomenological attitude: “openness to the other, leaving the other as is”
- double openness (towards the other/world, and towards self).
2) Relational attitude:
- Accepting
- Turning towards
- Attentive
- Sharing something in common (a goal and context)
3) Biographical model:
- Patience
- Empathy
- Support

Question 23

What makes a relationship “therapeutic”?

Answer 23

Being responsible for the relationship
Being present and open
Creating change, expanding a person’s capacities, reducing problems

Question 24

What is the therapist’s attention focused on during the exploration phase?

Answer 24

Exploration is the third category of therapy (gaining knowledge).
- The focus is trying to understand the problem more
- What do they understand is needed?
- Are there hidden values?
- Redirect attention from solving the problem

Question 25

What do you consider to be the minimum anamnesis required to be able to focus on a topic professionally?

Answer 25

In order to work on your problem, you need to know what relates to it, so in order to do the work you need sufficient medical history to inform your theory of the patient’s psychopathogenesis.

Question 26

Which forms of diagnosis play a role in a therapeutic process?

Answer 26

“Non-pathologizing that uses diagnostic categories from a descriptive perspective”
- How do symptoms show what is underlying the suffering?
- Looking for amount of choice vs. reactions

Question 27

What is meant by “resistance” in therapy?

Answer 27

“Behaviour that impedes change for the better”
Understood as psychodynamic, not decided/chosen behaviour, is a protection/defense
The therapist is also responsible for resistance - what is my role in the client’s resistance?

Question 28

What is meant by “defense” in therapy?

Answer 28

i. Coping reactions which function as protection against aggression from the outside, to hep master a difficulty, or as prophylaxis
ii. Are not chosen, but are reactive (not coming from freedom)
iii. “Automatic self-protective reaction”

Question 29

What is “displacement”?

Answer 29

i. Shifting the issue, changing the value to withdraw from the problem: content transformation: (e.g., Frankl and Langle - respect vs. closeness)
ii. Is a type of paradoxical movement, under the idea of construction of contexts of significant to maintain one’s ability to function

Question 30

Give some points on how we treat resistance phenomena in EA.

Answer 30

Treating requires (PEA steps):
a) Notice/recognize it
b) Understand it - what is being protected? What am I contributing to this? (going to fast etc.)
c) Take a position on it
d) Talk about it/express it
Note: The problem is that it is undecided (the resistance is a reaction not purposeful)

Question 31

What do we understand by transference in EA? Give five important descriptions.

Answer 31

1) Occurs as an attempt to understand situations and new objects, to gain access to something as an expression of psychodynamics and learning processes.

2) The more neutral or abstinent our counterpart, the more we construct an image of them and the more transference takes place (we need this image for orientation and to adjust to the person we’re dealing with).

3) In EA, we don’t share the view that the model neurosis is only a symptom of transference pressure (repetition compulsion). It contains real parts due to the impersonal behaviour of the analyst: the patient is in a dialogical situation (with another person), but without the capacity to reach them as a dialogue partner. This is a deliberately conscious frustration.

4) Transference is not just early childhood libido dynamics, but rather an ability inherent to animals and humans that allows them to learn by generalizing and offloading energy.

5) Transference is not encounter

6) T = projection, an activism of the 2nd and 3rd FM.

7) T = repetition of prior experience

8) T = partial misinterpretation of a situation/person: to a limited extend, the transference is caused by the recipient, because they may trigger it

9) T is not a phenomenon of consciousness, but of being affected emotionally (primary emotion).

10) T = special form of the human ability to link impressions and their dynamics with immediate substitutes

11) Differentiation between transference and the patient’s phenomenological perception: phenomenological perceptions are not transference or countertransference in EA understanding. Sensing the patient and their emotions, desires, and anger by putting oneself in their frame of reference is not transference

12) Definition of Transference: Transference is a primary emotion that originates in a relationship and connects arising content (wishes, impulses, previous experience in relationships, needs, fantasies, and emotions) with the individual opposite, as far as experience is concerned.

13) Difference in significance of transference in EA and psychoanalysis:
a) EA: we recognize healing in real relationships, in encounter → opening one’s mind, engaging in dialogue, breaking free from conceptions to see who you are. We don’t attempt to find, mobilize, or search for transference; the less transference, the better our work.
b) Psychoanalysis: recognizes healing in the transference relationship → patient can grasp their psychodynamics in projection, without being “distracted by the you”.

14) Transference must be distinguished from:
a) Associations: interconnection of thoughts or affects with a new object due to similarity in content or form.
b) Suggestion: attempt to convey a view/opinion to someone else unconsciously/secretly, if possible, in a way that bypasses their consciousness/opinion.

Question 32

How does the EA view differ from that of psychoanalysis regarding the importance of transference?

Answer 32

Psychoanalysis- transference is traditionally seen as an unconscious process.

EA: Transference happens “automatically”, it is not based on a decision. It may or may not be a conscious process, or it may be only partly conscious and unconscious.

Psychoanalysis: T (Generalization of previous experience) is the patient’s emotional attitude toward the psychotherapist in analogy to the patient’s emotional attitude toward their former (especially family) caregivers.
Transference is a form of projection.
Negative transference: The therapist is the object of hostile emotions (hatred, fear, humiliation) without the therapist having given any concrete cause for this.
Positive transference: Transference of friendly or tender emotions (love, affection, respect).

Difference in significance of transference in EA and psychoanalysis:
a) EA: we recognize healing in real relationships, in encounter → opening one’s mind, engaging in dialogue, breaking free from conceptions to see who you are. We don’t attempt to find, mobilize, or search for transference; the less transference, the better our work.
b) Psychoanalysis: recognizes healing in the transference relationship → patient can grasp their psychodynamics in projection, without being “distracted by the you”.

Question 33

Give three points by which a transference can be recognized.

Answer 33

Recognizing transference:
1) You feel pushed into a role, but at the same time you can see that it’s not about you.
2) You don’t understand why the patient wants you to convey something particular → Perception of unfreedom, what’s going on doesn’t have anything to do with what’s been said before. You feel misled and under pressure.
3) Patient’s behaviour and feelings are inadequate to the situation, they don’t fully match
4) Incomprehensible resistance on the part of the patient

Question 34

How can we differentiate between transference and countertransference in practice?

Answer 34

Sensing (transference) = What do I sense from the other person, what do they need, what do they want from me, can I see what they are doing to push me into a certain role? Perception of transferences and their phenomenal content.

Feeling (Countertransference)= How am I doing in the presence of the patient? Focus on countertransference.

Question 35

How do we fundamentally deal with countertransference phenomena in EA?

Answer 35

a) using phenomenology in supervision, phenomenological analysis-rather than with free association by creating a transference neurosis.
b) through the therapist applying PEA to themselves during therapy and/or after therapy and/or in supervision.
We understand countertransference as those feelings, impulses and thoughts that come from one’s own historicity and previous experience.

Question 36

How do we deal with transference in EA?

Answer 36

Essential (professional attitude): Don’t enact the role of countertransference, because that would encourage the patient in terms of transference feelings.
1) Meet the patient’s transference with personal understanding and encounter, which will stop a personal transference.
2) Return the transference to its original addressee: (person from the past)
Acceptance as an attitude
Addressing the perception of transference and returning to structure:
Formally
Content
Focus on emotional level
Motivational
Address level of encounter

Question 37

What is considered malpractice when dealing with countertransference?

Answer 37

Discussing countertransference with the patient without clarifying your own contributions= I must not make my problem, the patient’s problem.

Rule: Countertransference isn’t part of the therapeutic relationship.

Question 38

What does the term “normal” refer to and what is a patient concerned about when they ask about what is normal?

Answer 38

A client is referring to others. Do I still fit in or do I deviate so much that I no longer have typical behavior? What is an average amount of self-doubt, self-criticism.

Phenomenologically they are concerned about no longer fitting into the crowd. There is something: is that weird that others are going to judge them, and they won’t be seen in a typical way.

Question 39

What is a mental disorder/illness according to EA?

Answer 39

When someone is repeatedly and internally hindering themselves, to fail to act on what is important and meaningful. They do without inner consent, they use coping reactions, there is a lack of freedom.
Pathology- I cannot not do it. Impulsive, so I lash out. I get angry, aggressive. This is not the right way to do it but have Fixated coping reactions. A person is psychologically ill when they work systematically against other people. Happens repeatedly and is against one’s will.

Question 40

What does “mental health” consist of from an existential analytical perspective?

Answer 40

Mental health seen in a holistic way = living in resonance with values and feeling the power to cope with situations with inner coherence.
= ability to face up to life and to engage in dialog. Well-being is a pleasant concomitant that, fortunately, is usually right with us. When well-being is missing for a longer time, then we perceive it as a lack of something or that something is dysfunctional. Feeling upset for just a few days ≠ mental illness. – Feeling unwell due to physical conditions ≠ mental illness. – The fact that well-being by itself is not a criterion for mental health is also a result of the phenomenon of dissociation: relative well-being is created by dissociation!
E.g., by avoiding conflict and secluding oneself as the result of an inability to bear guilt = beginning of fixation, illness
Summary: @ 4 FMs: to be able to, like, may (allowed to), ability to live = personhood, which is able to be coherent with itself in the outer dialog, and which has a good vibe on the inside. Consent as a central criterion.
Therefore, health is more than the absence of dysfunction and even more than the power that allows us to live with it. It means, for example, despite an abuse, despite a loss or the like, that we are able to engage with the world and to be in tune with it.

Question 41

What is a diagnosis and what is its purpose?

Answer 41

Diagnostics. Definition and conceptualization of disorders, recognizes some type of disorder or disease. To see something through (the symptoms).
Diagnosis - What the problem is. What is the source of the problem? Pooling together of knowledge on an issue. Provide a theory as to how it developed, what keeps it in place, theorize on how to solve or get rid of. Pooling together this knowledge about how something manifest in a certain way. Accumulation of experience. Anthropology, structure and its function.
Purpose -
Diagnoses are definitions, “conceptualizations” of disorders. (We need concepts, because we can only think this way. Otherwise, chaos would arise inside of us).
Diagnosis = recognizing a disease or disorder. Comes from the Greek: “dià-” (through the symptoms) to recognize (“-gnosis”) the essence of the disorder. It basically means “to see through” it.
= Understanding the symptoms present through one’s overall knowledge of and experience with manifestations of a certain nature (“with this disease”).
What is the purpose of diagnosis?
→ Recognition of the regularities of the picture through accumulation of experience and its assignment to anthropology (to structures of the ego and its functions), so that
· We know something about the course of disease, e.g., likelihood of suicidality, relapse etc. … → prevention! → We know what to expect, inabilities, further development…
· We can make a prognosis (expected duration of illness, forecast) and adapt ourselves to it. E.g., After a phase of endogenous depression, the patient’s health is fully restored; schizophrenic episodes are usually followed by further deterioration.
· We can decide to select an appropriate approach (diagnoses follow knowledge that we can use: e.g., addiction: first abstinence, then withdrawal…) Þ arriving at an indication to know what to do, who can do it, what sort of means we can use, what can patients do themselves, what should we not do, etc.
· We can see that a certain theory is connected to pathogenesis and to the upkeep of a disease (= causation).
· We can use a term to better communicate about the illness
Diagnosis Þ Summaries of individual symptoms that are thought to have a common cause or are observed to occur together in clusters
Diagnosis only makes sense when it results in an improved way of dealing with the disorder (in terms of research, methodological-technical aspects), or when the patient can be helped more effectively.
Disease is when there is a causal coherence of symptoms (strictly speaking). E.g.: schizophrenia: thought disorders, reality disorders, depersonalization disorders…
Today, the correlation of symptoms is less certain than previously thought. New examination methods, which today are mostly done by computer (and hardly any more on the basis of individual case studies) - statistical descriptions of diseases. Statistics, however, never describe causes, but only accumulations. - The term “disease” is used less and less; today we usually speak of “disorders”.

Question 42

What is a syndrome?

Answer 42

“Syndrome is the regular, clustered, common occurrence of individual symptoms without their common cause or association to a clinical picture already being theoretically ascertainable or empirically demonstrable.”
“concurrence” = “syn-drome” (unclear causal relationship, statistical accumulation only)
Individual symptoms tend to have commonalities.
E.g.: PMS – premenstrual syndrome; Rett syndrome; shoulder-neck syndrome

Question 43

What are the dangers associated with diagnosis?

Answer 43

Danger of diagnostics: stigmatization (“labeling”); denigration; hasty judgment that leads to a lack of scrutiny/questioning. Diagnosing can also stem from a human need for causality that is too strong. It keeps us from having a phenomenological look at what is individual in a human ® patient isn’t seen as who they are but what they have ® failure to see the person.
On the other hand, with a personalistic approach, there is little danger of this happening - what we risk is rather that, through individualization, we overlook or know too little about the general and the regular. [® that’s why we (EA) are not so attractive for research, because research mostly focuses on what follows a set pattern].
Diagnosis in EA:
To make sure that we correspond to the purpose of diagnostics ® it is important to use method-specific diagnostics in addition to the generally applicable one (ICD, DSM) ® because this, by grasping the structure of the disorder, makes it possible that

· We obtain a specific understanding of it that is linked to anthropology
· And also gain access to the tools and methods.
In EA, we diagnose three structural elements: cf. Luss K, Freitag P, Längle A, Tutsch L, Längle S, Görtz A (1999) Diagnostik in Existenzanalyse und Logotherapie. Existenzanalyse 16, 2, 4-9

1. Anthropology: in which dimension do we see the disorder (mainly)?
   In the somatic case ® consult or refer to medical doctor.
   Is it mental or spiritual-personal or systemic-interactional?
   = substrate diagnosis
   2nd FM: structural level: which existential structure is affected? E.g., disorder is on the third FM
   = etiological diagnosis
2. PEA: process level: which level of processing is affected?
   = process diagnosis
3. Degree of disorder: episode, neurosis, personality disorder, psychosis?
   = nosological diagnosis

Question 44

Which structural elements do we use to diagnose in EA?

Answer 44

3 Structural elements
Anthropology- to what dimension does burden penetrate (ie: somatic, psychological, noetic)
Which FM is being obstructed? – is patient primarily dealing with 2, 3 motivation?
Process (PEA)- Does the obstruction like within access to feelings. Is it about expression, or taking a position?

Question 45

What do the terms “nosology”, “etiology”, “psychopathology” mean?

Answer 45

Nosology- Theory of illness
Etiology- Theory of the causes of illness
Psychopathology – Theory of suffering, criteria of a psychopathological report.

Question 46

What is a psychological reaction or episode?

Answer 46

An “event” is the central area of dysfunction.
It is a severe, persistent psychological reaction lasting for some time, arising in stressful or traumatic situations.
Characteristically they are reversible – most times disappearing by itself.
Reinforced and long-lasting use of coping-reactions
Range: “normal reactions” to “temporary mental disorders”
Client understands their reaction and does not feel a loss of freedom

Question 47

How can we define “neurosis” from an existential analytical perspective?

Answer 47

“Behaviour/Interaction with the world” is the central area of dysfunction
Definition: behavioural pattern in response to a specific trigger to regulate emotions. A fixation of coping reactions (unfree). Manipulation of the environment to cope with life difficulty

Question 48

From an existential point of view, what is the impossibility of leading a fulfilling life in neurosis?

Answer 48

When neurosis is present, personhood and existentiality can only be accomplished in a reduced way.
One is not really related to the world because of:
- Insufficient coping strategies
- Having to struggle with the impossible
- Neuroses are self-sustaining

Question 49

What are the main forms of neuroses with their typical reaction patterns?

Answer 49

Anxiety avoidance/attack (suffering from loss of support)

   Depression withdrawal  	        		(suffering from loss of value)
 
   Histrionic overlooking/skipping 		(suffering from loss of self)

Question 50

What is meant by “personality disorders” (description or definition)?

Answer 50

Heredity, psychodynamic processing structures are the central area of dysfunction
It is caused by both heredity and is acquired = a disturbed disposition to experience and reaction.

= a structure of psychodynamics, in the psychological dimension, leading to a circumscribed, persistent tendency toward:
- Rigid emotionality
- Rigid affectivity (impulsivity, basic mood)
- Rigid reactivity
= this disturbs relationship to self and to the world

Do not primarily suffer because of themselves, but because of the circumstances or because of others
Often don’t feel understood because of them, the way they are is “normal”
Experience is related to concrete, real impressions. The reference to reality is there.

PD is a disorder of the personality (the psychological structure of the human being) not of the person.
Disorder of the disposition to experience and behaviour = hereditary and throughout life experiences; shaping, molding, over-shaping

Question 51

Characteristics of personality disorders (according to ICD 10 or 11 or DSM V - your choice)?

Answer 51

From Notes ICD 10:
Very long lasting, deeply rooted behavioural patterns and tendencies with marked imbalance in several functional areas such as affectivity, drive, impulse control, perception, thinking, relationships
To most different situations equal, rigid, typical behaviour and reactions
Reactions differ from the majority of the population and affect multiple domains
Always have their beginnings in childhood or adolescence, usually lead to limitations in life and may lead to subjective suffering

From DSM V:
Significant impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning.
One or more pathological personality trait domains or trait facets.
The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.
The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individua’s developmental stage or socio-cultural environment.
The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance or a general medical condition.

Question 52

How do personality disorders arise?

Answer 52

Origin of Personality Disorders:
Inherited disposition
Learning processes during the course of life
Trauma

Question 53

Give seven examples of personality disorders.

Answer 53

Anxious PD
Obsessive-compulsive PD
Depressive PD
Histrionic PD
Borderline PD
Narcissistic PD
Paraexistential PD
Antisocial PD
Paranoid PD
Schiziod PD
Schizotypal PD
Dependent PD
Avoidant PD
Immature PD

Question 54

Can personality disorders be treated in counselling – if so, how?

Answer 54

Yes: Accompaniment and problem reduction in daily life. Preparing the ground for psychotherapy – realizing what share of the problem is their contribution.
Best treated through long-term psychotherapies.

Question 55

What are psychoses?

Answer 55

Capability and skill are the central areas of dysfunction
They are disorders marked by significant impairment that result from a loosened or displaced grip on reality.
The insight and ability to meet the usual requirements of life are compromised.
Most theories assume a causal dysfunction of the cerebral metabolism (hence medication treatment).

Question 56

What are the main types of psychosis you know? What is the central inner psychological disturbance and the theme of suffering in psychosis?

Answer 56

Main types: dysfunction/disturbance: suffering:
Schizophrenias → perceptual ability and thinking → cohesion, coherence
Bipolar disorder → vitality → attitude toward life
Paranoia → feeling of evidence → preservation of one’s own

Question 57

What are Jaspers’ criteria for delusion?

Answer 57

Certainty
Incorrigibility
Impossibility or falsity of content

Question 58

What is the focus of counselling work in delusions?

Answer 58

Make sure that the patient lives what is important in life, despite their delusions.
In the elderly, it is often helpful to give low doses of Haldol.
Talk to the family, because delusional patients are often persuasive, and they often suffer a lot as well.
BUT, be careful not to lose the patient’s trust!

Question 59

What are the main types of active elements?

Answer 59

a.k.a Effective Elements:
Receiving attention and sympathy
Opportunity to talk to someone
Expectation of the healing effect of therapy
Client’s belief that they can be helpful
Structure

Question 60

What do we consider to be the main effective factor of EA/LT?

Answer 60

The restoration or strengthening of the dialogical ability – namely the dialogical exchange with the world (towards the outside) and with oneself (towards the inside)

Question 61

What are the classic effective factors of psychotherapy that Jerome Frank described?

Answer 61

An emotional, trusting relationship with someone “helping”
Necessary, (at times) sufficient condition for change
The therapeutic setting
Therapist = healer; and safe space for the client to open up
Scientifically founded explanations
Understanding
A therapeutic ritual
Active participation by both client and therapist