Final Test Flashcards
What are the three phases of the therapeutic relationship
Engagement phase
Working phase
Termination Phase
When does the termination phase of the therapeutic relationship begin?
First contact
Describe the role of the psychiatric nurse
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
Describe the job of a psychiatric nurse
To assist individuals in finding answers that are most congruent with their own values
Describe transference vs countertransference
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
In regards to change we need to reflect on what three things
The what
The so what
The now what
Describe the four RPN code of ethics
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
Describe the steps in making ethical decisions
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
Clients have the rights
To informed consent
Refuse treatment
Advanced health directives
Provision of least restrictive type of mental health care
Confidentiality and privacy
Legal duty to disclose information in what cases
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
Counsellors have the duty to protect when
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
Maintaining boundaries are always the responsibility of who
Psychiatric nurse
In regards to boundaries counsellors must
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
Describe boundary crossing vs boundary violation
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
Characteristics of boundary violations include
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
Are dual relationships a boundary violation?
Yes
Describe the different categories of boundary violations
Role, Time, Place and space, financial, physical contact, social media
Describe prejudice
Judging someone without knowing them, on the basis of what they look like or what group they belong too
What typically leads to microaggressions
Unconscious biases
Guidelines for working effectively with diverse backgrounds include
Identify basic assumptions
Learn more about own background
Willing to identify and examin personal worldviews
Pay attention to common ground
Be flexible
What are the six levels of validation
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
Describe Reciprocal communication strategies and name 5 ways to do this
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
Who developed psychoanalysis
Freud
How does psychoanalysis determine behaviour?
Irrational forces, unconscious motivations, biological and instinctual drives
Describe libido
Understood as a source of motivation that encompasses sexual energy but goes beyond to include all life instincts
According to psychoanalytic theory, what determinants make people act as they do?
Aggressive and sexual drives
Describe the unconscious
Lies deep below the surface and includes drives and instincts
What are the 3 parts of the freuds personality theory and describe each
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
Describe the Freuds psychosexual stages
First year - Oral
Ages 1-3 - Anal
Ages 3-6 - Phallic
Ages 6-12 - Latency
Ages 12-60 - Genital
Ego defense mechanisms often operate on what level? List them
Unconscious
Repression/denial
Reaction Formation
Projection
Displacement
Rationalization
Sublimation
Regression
Introjection
Identification
Compensation
Describe Eriksons psychoanalytic theory
Expanded Freuds theory into different psychosocial Crisis based on different basic virtue
Describe Jungs perspective on personality development
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
According to Jungs perspective on personality development how are dreams seen
As messages from the collective unconsciousness
Describe the goal of the psychoanalytic therapy process
Goal is to make the unconscious conscious and strengthen the ego so behaviour is based on reality
Describe some aspects of the psychoanalytic therapy process
Very long approach
Blank-screen of the therapists fosters transference
Describe the psychoanalytic therapy steps
Maintaining the analytic framework
Analysis of resistance
Analysis of transference
Free association
Interpretation
Dream analysis
Describe catharsis
The release of tension and anxiety that results from bringing repressed feelings and memories into the conscious
Describe the main concept of behaviour therapy
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
Describe behaviour therapy characteristics
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
Describe classical conditioning
Pavlov dog experiment
What happens prior to learning creates a response through pairing
Describe Operant conditioning
Developed by Skinner
Involves a type of learning in which behaviours change based on positive and negative reinforcement, punishment and extinction
Describe positive, negative reinforcement, extinction and punishment
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
Describe the three steps involved in systematic desensitization
Progressive muscle relaxation
DEvelop a gradual anxiety hierarchy
Client repeatedly imagines confronting situations until it fails to produce feelings of anxiety
Describe in Vivo exposure
Exposing the client to anxiety provoking event rather than imagining it
Describe the two types of flooding
In Vivo flooding: Intense prolonged exposure to the actual anxiety provoking stimuli
Imaginal flooding: Intense prolonged exposure to an imagined life event
Describe EMDR
Used for PTSD
Comprised of bilateral eye movement paired with cognitive techniques
Describe social skills training
Key elements include
Assessment, direct instruction, coaching, modeling, role playing and homework assignments
Describe self-management programs and self-directed behaviour
Helping clients to select realistic goals, translate goals into target behaviours, create an action plan and self-monitor and eveulate their actions
Describe Rogers Person-Centered Therapy
Foundational theory which serves as a basis for psychiatric nursing practice.
Used client rather than patient
Described the importance of therapeutic relationship
Describe the view of human nature by person-centered therapy
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
Person-Centered Therapy challenges the traditional beliefs of
Assumption counselor knows best
Validity of advice giving or teaching
Belief that clients cannot resolve their own problems without help
Person-Centered therapy emphasizes what
Personal characteristics of the therapist
Quality of the therapeutic relationship
Counselors creation of a growth-promoting climate
Describe the three attributes that create a growth-promoting climate
Congruence
Unconditional positive regard
Accurate empathic understanding
What are six conditions that are necessary for personality changes to occur
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
The person-centered therapist must
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
Describe Person-Centered Expressive Arts Therapy
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
Describe Emotion-Focused therapy
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
Describe mindfulness
Mindfulness involves paying attention to your thoughts, feelings, physical sensations and actions in the here and now and comes from a place of curiosity
Explain the difference between formal and informal mindfulness practice
Formal practice include mindfulness related to or incorporating mindfulness
Informal practice involves bringing focus and awareness to daily activities
Describe Mindfulness based stress reduction
Developed by Zinn
Involves mindfulness mediation, body awareness, yoga and exploration of patterns of behaviours
Describe mindfulness and acceptance based therapies
Centers on
An expanded view of psychological health
Broad view of acceptable outcomes in therapy
Acceptance and mindfulness
Creating a meaningful life
Describe mindfulness-based cognitive therapy
Mindfulness that also incorporates principles and practices of Cognitive behavioral therapy
Describe motivational Interviewing
Developed by miller and rollnick.
Deliberately directive and aimed at reducing client ambivalence about change and increasing intrinsic motivation
When should MI be used and not used
Used when the individual has any ambivalence about change
Describe the principles of MI
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
When using MI the clinician must not ask what type of questions
Questions that will signal resistance
What must the clinician do when change talk occurs
Reflect, affirm, and ask for elaboration or examples
Describe change talk
Statements that signal a desire, ability, reasons, need or commitment to change
Describe rolling with resistance
When the therapist encounters resistance the clinicians can
Highlight clients right to autonomy , join in resistance, reflection is helpful and do not give advice
Motivation to change focuses on
Importance of change (willingness)
Confidence in change (ability)
Priority (Readiness)
Describe the steps of the change process
Precontemplation
Contemplation
Preparation
Action
Maintenance
Describe the different stages of MI
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
Describe OARS
Open-ended questions
Affirmations
reflective listening
Summaries
Describe the different types of reflection
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
Describe the premise of CBT
Psychological distress is largely a function of disturbances in cognitive processes
CBT focuses on
Changing cognitions to produce desired changes in affect and behaviour
Describe the CBT thought triangle
Thoughts and attitudes bring feelings, behaviours and physical sensations
INcludes thoughts, behaviours and emotions
CBT interventions include
Eliciting automatic thoughts/cognitive distortions
Testing cognitive distortions
Behavioural experiments
Activity scheduling
Graded task assignments
Describe Rational Emotive Behaviour Therapy
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
Describe CBT-Beck
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
Describe CBT-Beck assumptions
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
Describe Becks negative triad
Negative views about the world, oneself and about the future
List Becks cognitive distortions
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
Describe Strengths Based cognitive therapy - Padesky and Mooney
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
Describe Cognitive behaviour modification - Meichenbaum
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
Describe the three perspectives of DBT
Dialectics (aim to balance acceptance and change)
Zen (Acceptance)
CBT (change principles)
DBT was originally created to treat what?
BPD
DBT helps with what
Emotional, behavioural, interpersonal, cognitive, self dysregulations
Basic assumptions of DBT include
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
Assumptions about DBT Clients are
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
Describe the roles of a DBT therapist
Aim to find balance
Move away from extremes into common ground
Focus on balancing validation and problem solving
Options for solving problems include
Solve the problem
Feel better about the problem
Tolerate the problem
Stay Miserable
Describe the stages of DBT
Improve behavioral control and skills (focus on safety)
Safe expression of emotion
Increase self-respect
Resolve feelings of incompleteness
Describe the components of comprehensive DBT
Skills training group
Individual therapy/treatment
Phone coaching
Consultation team
Skill modules of DBT include
Mindfulness
Emotional regulation
Distress tolerance
Interpersonal effectiveness
Describe some distress tolerance strategies
STOP
- Stop, Take a break, observe, proceed mindfully
TIPP
- Temperature, intense exercise, paced breathing, paired muscle relaxation
Describe interpersonal effectiveness strategies
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
Describe targeting in DBT
Therapists must target the most harmful behaviour then move on to focusing on reasons for session attendance
Describe the steps of chain analysis
Vulnerability
Prompting event
Links
Behaviour
Consequences
Describe dialectical strategies in DBT
Devils advocate
Use of metaphors
Make lemonade out of lemons
Describe communication strategies in DBT
Irreverence - Pointing out incongruent or unexpected responses. Used when the client is stuck
Reciprocal communication
Describe the three components of case management
Consultation to the client
Environmental intervention
Consultation team
Define crisis
Crisis is anything that overwhelms a persons capacity to cope and is time limited
Describe crisis counselling
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
Crisis interventions objectives include
Restoration of psychological balance
Aim to cope with the immediate difficulty
More direct approach on part of the counsellor
Crisis intervention goals include
Help person cope effectively with the crisis situation and return to their usual level of functioning
Decrease anxiety
Teach crisis-management techniques
Steps for crisis intervention are
Listen
Assessment
Develop an action plan
Termination
What are the three basic approaches to developing a crisis action plan
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
List the steps of a suicide assessment
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
When assessing risk and lethality psychiatric nurses look at the
Psychache (subjective mental pain)
Perturbation (sense of tension, anxiety)
Adamance
Things that contribute to a high risk suicide scale are
Helplessness, hopelessness, lethality, impulsivity, resignation and acceptance of suicide equation, ideation, substance use, primary psychiatric disorder, lethality of plan
Protective factors against suicide include
Stoicism
Adaptability and coping capacity
Alternative solution seeking
Spirituality
Supports
Describe individual trauma
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
Common elements of individual trauma include
Unexpected
Person was unprepared
Person could not do anything to stop it
Trauma informed clinicians must not
Avoid discussing trauma
ask for to much detail
Minimize the aspect of trauma has had on persons life
Conduct trauma therapy if not trained
Make sure the nurse acknowledges that what happened to the client was ____ but the client themselves are not ______
Bad and not bad
Key principles of a trauma-informed approach include
Safety
Trustworthiness and transparency
Peer support
Collaboration and mutuality
Empowerment, voice and choice
Cultural historical and gender issues
Describe vicarious trauma
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.
There are three challenges that face clinicians who work with clients with histories of childhood trauma. NAME them
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
