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69:261: Individual Counselling > Final Test > Flashcards

Final Test Flashcards

1
Q

What are the three phases of the therapeutic relationship

A

Engagement phase
Working phase
Termination Phase

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2
Q

When does the termination phase of the therapeutic relationship begin?

A

First contact

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3
Q

Describe the role of the psychiatric nurse

A

To create a climate in which clients can examine their thoughts, emotions, feelings and actions and eventually arrive at a solution that are best for them

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4
Q

Describe the job of a psychiatric nurse

A

To assist individuals in finding answers that are most congruent with their own values

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5
Q

Describe transference vs countertransference

A

Transference is the unconscious experience in which the client projects emotions or previous experiences onto the clinician

Countertransference is the unconscious experience in which the clinician projects emotions or previous experiences onto the client

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6
Q

In regards to change we need to reflect on what three things

A

The what
The so what
The now what

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7
Q

Describe the four RPN code of ethics

A

Provide safe, component and ethical practice

Respect for inherent worth and right of choice and dignity of persons

Health, mental health and wellbeing

Quality Practice

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8
Q

Describe the steps in making ethical decisions

A

Identify problem and potential issue

Look at RPN guidelines

Consider laws, regulations, policies and practice guidelines

Seek consolutation

Brainstorm possible actions

Reflection on consequences of possible actions

Decide what appears to be the best course of action

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9
Q

Clients have the rights

A

To informed consent
Refuse treatment
Advanced health directives
Provision of least restrictive type of mental health care
Confidentiality and privacy

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10
Q

Legal duty to disclose information in what cases

A

Suspected child abuse or neglect
Client requires hospitalization
Information is made an issue in court
When clients request their records to be released to a third party

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11
Q

Counsellors have the duty to protect when

A

Assess persons risk for danger towards another

Identify persons being threatened

Take appropriate action to protect

Protect suspected child
Suspect abuse of dependent adult or older adults

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12
Q

Maintaining boundaries are always the responsibility of who

A

Psychiatric nurse

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13
Q

In regards to boundaries counsellors must

A

Establish and maintain trust
Set the tone and direction
Create and maintain a safe environment
Be aware of our responsibility to others
Be cognizant of the need for feedback

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14
Q

Describe boundary crossing vs boundary violation

A

Boundary crossing is a deviation from a typical therapeutic activity that is harmless and non-exploitative

Boundary violation is a harmful or potentially harmful act that transgresses from the psychiatric nurses typical role or actions

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15
Q

Characteristics of boundary violations include

A

Frequently appear harmless and often begin as innocent situations

Not recognized or felt as a violation until something goes wrong

Often crossing the line is a process with many small steps before an actual violation occurs

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16
Q

Are dual relationships a boundary violation?

A

Yes

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17
Q

Describe the different categories of boundary violations

A

Role, Time, Place and space, financial, physical contact, social media

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18
Q

Describe prejudice

A

Judging someone without knowing them, on the basis of what they look like or what group they belong too

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19
Q

What typically leads to microaggressions

A

Unconscious biases

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20
Q

Guidelines for working effectively with diverse backgrounds include

A

Identify basic assumptions
Learn more about own background
Willing to identify and examin personal worldviews
Pay attention to common ground
Be flexible

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21
Q

What are the six levels of validation

A

Level 1: Listens and acts interested
Level 2: Accurately reflects back what client has said
Level 3: Emphasizes articulating the unverbalized back to the client
Level 4: Validated behaviour in terms of cause
Level 5: Normalizes
Level 6: Radical Genuineness

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22
Q

Describe Reciprocal communication strategies and name 5 ways to do this

A

Balance irreverence as well as the differential by making the treatment provider more vulnerable in a session
Responsiveness, Self involving self-disclosure
Personal disclosure
Warmth and genuiness

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23
Q

Who developed psychoanalysis

A

Freud

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24
Q

How does psychoanalysis determine behaviour?

A

Irrational forces, unconscious motivations, biological and instinctual drives

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25
Q

Describe libido

A

Understood as a source of motivation that encompasses sexual energy but goes beyond to include all life instincts

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26
Q

According to psychoanalytic theory, what determinants make people act as they do?

A

Aggressive and sexual drives

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27
Q

Describe the unconscious

A

Lies deep below the surface and includes drives and instincts

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28
Q

What are the 3 parts of the freuds personality theory and describe each

A

ID - Demanding Child, ruled by the pleasure principle and is unconsciousness

EGO- Traffic cop, ruled by reality principle and is conscious

Superego- judge, ruled by moral principle and aims to suppress desires of ID and try to make the ego act more rationally

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29
Q

Describe the Freuds psychosexual stages

A

First year - Oral
Ages 1-3 - Anal
Ages 3-6 - Phallic
Ages 6-12 - Latency
Ages 12-60 - Genital

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30
Q

Ego defense mechanisms often operate on what level? List them

A

Unconscious

Repression/denial
Reaction Formation
Projection
Displacement
Rationalization
Sublimation
Regression
Introjection
Identification
Compensation

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31
Q

Describe Eriksons psychoanalytic theory

A

Expanded Freuds theory into different psychosocial Crisis based on different basic virtue

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32
Q

Describe Jungs perspective on personality development

A

Multidisciplinary approach with the emphasis on being compelled to find meaning in life
Achieving individuation is an innate and primary goal of life
Individuation is the harmonious integration of the conscious and unconscious aspects of personality

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33
Q

According to Jungs perspective on personality development how are dreams seen

A

As messages from the collective unconsciousness

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34
Q

Describe the goal of the psychoanalytic therapy process

A

Goal is to make the unconscious conscious and strengthen the ego so behaviour is based on reality

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35
Q

Describe some aspects of the psychoanalytic therapy process

A

Very long approach
Blank-screen of the therapists fosters transference

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36
Q

Describe the psychoanalytic therapy steps

A

Maintaining the analytic framework
Analysis of resistance
Analysis of transference
Free association
Interpretation
Dream analysis

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37
Q

Describe catharsis

A

The release of tension and anxiety that results from bringing repressed feelings and memories into the conscious

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38
Q

Describe the main concept of behaviour therapy

A

Focuses on the ABC model. Antecedents, behaviour and consequences. All behaviour is communication and that behaviour is influenced by antecedents and consequents.

Client participation is required and the client must be motivated by change

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39
Q

Describe behaviour therapy characteristics

A

Always begins with an assessment which is ongoing
Treatment plan is systematically formulated
Goals are determined collaboratively
Objective evaluation
Focus of treatment is on changing actions

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40
Q

Describe classical conditioning

A

Pavlov dog experiment

What happens prior to learning creates a response through pairing

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41
Q

Describe Operant conditioning

A

Developed by Skinner

Involves a type of learning in which behaviours change based on positive and negative reinforcement, punishment and extinction

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42
Q

Describe positive, negative reinforcement, extinction and punishment

A

Positive reinforcement is the most powerful change agent and involves addition of something of value after a behaviour

Negative reinforcement involves doing a behaviour to escape a negative stimulus

Extinction is withholding reinforcement from a previously reinforced event

Positive punishment is adding a negative stimulus after a behaviour

Negative punishment is removing a reinforcing stimuli after a behaviour

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43
Q

Describe the three steps involved in systematic desensitization

A

Progressive muscle relaxation
DEvelop a gradual anxiety hierarchy
Client repeatedly imagines confronting situations until it fails to produce feelings of anxiety

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44
Q

Describe in Vivo exposure

A

Exposing the client to anxiety provoking event rather than imagining it

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45
Q

Describe the two types of flooding

A

In Vivo flooding: Intense prolonged exposure to the actual anxiety provoking stimuli

Imaginal flooding: Intense prolonged exposure to an imagined life event

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46
Q

Describe EMDR

A

Used for PTSD
Comprised of bilateral eye movement paired with cognitive techniques

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47
Q

Describe social skills training

A

Key elements include
Assessment, direct instruction, coaching, modeling, role playing and homework assignments

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48
Q

Describe self-management programs and self-directed behaviour

A

Helping clients to select realistic goals, translate goals into target behaviours, create an action plan and self-monitor and eveulate their actions

49
Q

Describe Rogers Person-Centered Therapy

A

Foundational theory which serves as a basis for psychiatric nursing practice.

Used client rather than patient

Described the importance of therapeutic relationship

50
Q

Describe the view of human nature by person-centered therapy

A

Humans at their core are trustworthy and positive

Humans are capable of making changes and living productive, effective lives

Humans innately gravitate toward self-actualization

Given the right conditions, individuals strive to move forward and fulfill their creative nature

51
Q

Person-Centered Therapy challenges the traditional beliefs of

A

Assumption counselor knows best

Validity of advice giving or teaching

Belief that clients cannot resolve their own problems without help

52
Q

Person-Centered therapy emphasizes what

A

Personal characteristics of the therapist

Quality of the therapeutic relationship

Counselors creation of a growth-promoting climate

53
Q

Describe the three attributes that create a growth-promoting climate

A

Congruence
Unconditional positive regard
Accurate empathic understanding

54
Q

What are six conditions that are necessary for personality changes to occur

A

Two persons are in psychological contact

The first, the client, is experiencing incongruence

The second, the therapist is congruent or integrated in the relationship

The therapist experiences unconditional positive regard or real caring for the client

The therapist experiences empathy for the clients internal frame of reference and endeavors to communicate this to the client

The communication to the client is of the therapists understanding and unconditional positive regard is minimal

55
Q

The person-centered therapist must

A

Focuses on the quality of the therapeutic relationship

Engage in co-assessment with the client and does not value traditional assessment and diagnosis

Provides a supportive therapeutic environment

Client is the agent of change and healing

Serves as a model of a human being struggling toward greater realness

Therapists must be presence

Use of immediacies

56
Q

Describe Person-Centered Expressive Arts Therapy

A

Founded by Rogers daughter
Creative art forms are used to promote healing, self discovery, self awareness and insight and to connect us to our feelings

57
Q

Describe Emotion-Focused therapy

A

Emphasizes awareness, acceptance, and understanding of emotion and the visceral experiences of emotion

Emotional change can be the primary pathway to cognitive and behaviour change

Ex; Tapping

58
Q

Describe mindfulness

A

Mindfulness involves paying attention to your thoughts, feelings, physical sensations and actions in the here and now and comes from a place of curiosity

59
Q

Explain the difference between formal and informal mindfulness practice

A

Formal practice include mindfulness related to or incorporating mindfulness

Informal practice involves bringing focus and awareness to daily activities

60
Q

Describe Mindfulness based stress reduction

A

Developed by Zinn

Involves mindfulness mediation, body awareness, yoga and exploration of patterns of behaviours

61
Q

Describe mindfulness and acceptance based therapies

A

Centers on
An expanded view of psychological health
Broad view of acceptable outcomes in therapy
Acceptance and mindfulness
Creating a meaningful life

62
Q

Describe mindfulness-based cognitive therapy

A

Mindfulness that also incorporates principles and practices of Cognitive behavioral therapy

63
Q

Describe motivational Interviewing

A

Developed by miller and rollnick.

Deliberately directive and aimed at reducing client ambivalence about change and increasing intrinsic motivation

64
Q

When should MI be used and not used

A

Used when the individual has any ambivalence about change

65
Q

Describe the principles of MI

A

Express empathy
Non-judgmental approach
Reflective listening
Explore discrepancies and ambivalence
Reluctance to change is expected
Support clients self-efficacy
Strengthen clients commitments to change
Is not a type of therapy but a way to engage in conversation

66
Q

When using MI the clinician must not ask what type of questions

A

Questions that will signal resistance

67
Q

What must the clinician do when change talk occurs

A

Reflect, affirm, and ask for elaboration or examples

68
Q

Describe change talk

A

Statements that signal a desire, ability, reasons, need or commitment to change

69
Q

Describe rolling with resistance

A

When the therapist encounters resistance the clinicians can

Highlight clients right to autonomy , join in resistance, reflection is helpful and do not give advice

70
Q

Motivation to change focuses on

A

Importance of change (willingness)

Confidence in change (ability)

Priority (Readiness)

71
Q

Describe the steps of the change process

A

Precontemplation
Contemplation
Preparation
Action
Maintenance

72
Q

Describe the different stages of MI

A

Spirit of MI
OARS
Elicit and strength change talk
Recognize/responding to change talk
Rolling with resistance
Develop and negotiate change plans
Consolidate client commitment
Switch between Mi and other counselling styles

73
Q

Describe OARS

A

Open-ended questions
Affirmations
reflective listening
Summaries

74
Q

Describe the different types of reflection

A

Simple reflection - repetition and rephrase

Complex Reflection - Paraphrasing and reflection of what is not verbalized

Amplified reflection - reflecting back what the client said in an amplified (positive) manner

Double-sided reflection- Used to determine ambivalence. Recognize the sustained behaviour talk and the change talk

75
Q

Describe the premise of CBT

A

Psychological distress is largely a function of disturbances in cognitive processes

76
Q

CBT focuses on

A

Changing cognitions to produce desired changes in affect and behaviour

77
Q

Describe the CBT thought triangle

A

Thoughts and attitudes bring feelings, behaviours and physical sensations

INcludes thoughts, behaviours and emotions

78
Q

CBT interventions include

A

Eliciting automatic thoughts/cognitive distortions
Testing cognitive distortions
Behavioural experiments
Activity scheduling
Graded task assignments

79
Q

Describe Rational Emotive Behaviour Therapy

A

Ellis.

People disturb themselves as a result of the rigid and extreme beliefs they hold about events more than the events themselves

ABCDE framework
- Activating event (does not cause the consequence)
- Belief about activating event (causes the consequence)
- Consequences (emotional and behavioral)
- Disputing (client begins to recognize and challenge irrational beliefs)
- (developing a new) effective philosophy

Involves “must” statements

80
Q

Describe CBT-Beck

A

Insight-focused therapy with an emphasis on changing negative thoughts and maladaptive beliefs.

Believes that psychological problems are an exaggeration of adaptive responses resulting from commonplace cognitive distortions

81
Q

Describe CBT-Beck assumptions

A

Peoples thought processes are accessible to introspection
Peoples beliefs have highly personal meaning
People can discover these meanings themselves rather than being taught or having them interpreted by a therapist

82
Q

Describe Becks negative triad

A

Negative views about the world, oneself and about the future

83
Q

List Becks cognitive distortions

A

All or nothing thinking
Overgeneralization
Mental filter
Disqualifying the positive
Jumping to conclusions (both mind reading and fortune telling)
Magnification (catastrophizing and minimization)
Should statements
Labeling and mislabeling
Personalization
Emotional reasoning

84
Q

Describe Strengths Based cognitive therapy - Padesky and Mooney

A

Involves identifying and integrating clients strength at each phase of therapy

Has four step model
- Search: What is going right
- Construct: What are the obstacles
- Apply: Teach skills
- Practice: Practice skills to increase resistance

85
Q

Describe Cognitive behaviour modification - Meichenbaum

A

BAsic assumption is that distressing emotions are typically the result of maladaptive thoughts and that as a prerequisite to behaviour change; clients must notice how they think, feel, and behave and what impact they have on others

86
Q

Describe the three perspectives of DBT

A

Dialectics (aim to balance acceptance and change)

Zen (Acceptance)
CBT (change principles)

87
Q

DBT was originally created to treat what?

A

BPD

88
Q

DBT helps with what

A

Emotional, behavioural, interpersonal, cognitive, self dysregulations

89
Q

Basic assumptions of DBT include

A

Clarity and compassions are utmost importance in conducting DBT
Therapeutic relationship is a real relationship between equals
DBT therapists can fail
DBT can fail even if the therapist doesnt

90
Q

Assumptions about DBT Clients are

A

Clients cannot fail
Clients are doing the best they can
Clients must learn new behaviours in all contexts
Clients may not have caused their problems but must solve them

91
Q

Describe the roles of a DBT therapist

A

Aim to find balance
Move away from extremes into common ground
Focus on balancing validation and problem solving

92
Q

Options for solving problems include

A

Solve the problem
Feel better about the problem
Tolerate the problem
Stay Miserable

93
Q

Describe the stages of DBT

A

Improve behavioral control and skills (focus on safety)
Safe expression of emotion
Increase self-respect
Resolve feelings of incompleteness

94
Q

Describe the components of comprehensive DBT

A

Skills training group
Individual therapy/treatment
Phone coaching
Consultation team

95
Q

Skill modules of DBT include

A

Mindfulness
Emotional regulation
Distress tolerance
Interpersonal effectiveness

96
Q

Describe some distress tolerance strategies

A

STOP
- Stop, Take a break, observe, proceed mindfully

TIPP
- Temperature, intense exercise, paced breathing, paired muscle relaxation

97
Q

Describe interpersonal effectiveness strategies

A

DEARMAN
- Describe, express, assert, reinforce, mindful, appear, negotiate

GIVE
- Be gentle, act interested, validate, use easy manner

FAST
- Be fair, no apologies, stick to values, be truthful

98
Q

Describe targeting in DBT

A

Therapists must target the most harmful behaviour then move on to focusing on reasons for session attendance

99
Q

Describe the steps of chain analysis

A

Vulnerability
Prompting event
Links
Behaviour
Consequences

100
Q

Describe dialectical strategies in DBT

A

Devils advocate
Use of metaphors
Make lemonade out of lemons

101
Q

Describe communication strategies in DBT

A

Irreverence - Pointing out incongruent or unexpected responses. Used when the client is stuck

Reciprocal communication

102
Q

Describe the three components of case management

A

Consultation to the client
Environmental intervention
Consultation team

103
Q

Define crisis

A

Crisis is anything that overwhelms a persons capacity to cope and is time limited

104
Q

Describe crisis counselling

A

Is the employment of a variety of direct and action-orientated approaches to help individuals find resources within themselves and/or externally deal with a crisis

105
Q

Crisis interventions objectives include

A

Restoration of psychological balance

Aim to cope with the immediate difficulty

More direct approach on part of the counsellor

106
Q

Crisis intervention goals include

A

Help person cope effectively with the crisis situation and return to their usual level of functioning

Decrease anxiety

Teach crisis-management techniques

107
Q

Steps for crisis intervention are

A

Listen
Assessment
Develop an action plan
Termination

108
Q

What are the three basic approaches to developing a crisis action plan

A

Start by being non-directive

Be collaborative by working together on a joint plan

Be directive if the person does not or will not make a plan

109
Q

List the steps of a suicide assessment

A

IDentify risk factors
Assessment of mood symptoms
Explore suicidal ideation
Explore suicidal plan
Determine intent
Assess clients level of self control
Develop a plan to keep the client safe

110
Q

When assessing risk and lethality psychiatric nurses look at the

A

Psychache (subjective mental pain)
Perturbation (sense of tension, anxiety)
Adamance

111
Q

Things that contribute to a high risk suicide scale are

A

Helplessness, hopelessness, lethality, impulsivity, resignation and acceptance of suicide equation, ideation, substance use, primary psychiatric disorder, lethality of plan

112
Q

Protective factors against suicide include

A

Stoicism
Adaptability and coping capacity
Alternative solution seeking
Spirituality
Supports

113
Q

Describe individual trauma

A

Results from event or events that is experienced or witnessed by an individual as physically, emotionally harmful or life threatening that has lasting adverse effects on the individuals functioning

114
Q

Common elements of individual trauma include

A

Unexpected
Person was unprepared
Person could not do anything to stop it

115
Q

Trauma informed clinicians must not

A

Avoid discussing trauma
ask for to much detail
Minimize the aspect of trauma has had on persons life
Conduct trauma therapy if not trained

116
Q

Make sure the nurse acknowledges that what happened to the client was ____ but the client themselves are not ______

A

Bad and not bad

117
Q

Key principles of a trauma-informed approach include

A

Safety
Trustworthiness and transparency
Peer support
Collaboration and mutuality
Empowerment, voice and choice
Cultural historical and gender issues

118
Q

Describe vicarious trauma

A

Is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain, fear, and terror that trauma survivors have endured.

119
Q

There are three challenges that face clinicians who work with clients with histories of childhood trauma. NAME them

A

Instances when client doesnt report a history of childhood trauma (could be due to no memory, embarrassment, or shame)
Mandatory reporting requirements may affect relationship/honesty
Impact that the work has on the workers themselves

69:261: Individual Counselling (1 decks)

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