Psychological Phenomena Flashcards
Id
Biological urges, instincts; maximizes pleasure, acts according to pleasure principle
Ego
Realistic thinking, postpone pleasure until appropriate, mediates between desires of id and superego; acts according to reality principle
Superego
Values, conscience ego-ideal; how the ego should behave
Defense mechanisms
Unconscious ways by which ego wards off anxiety and control unacceptable instinctual urges and unpleasant affects or emotions by manipulating, distorting, or denying reality
When do defense mechanisms become pathological?
When its persistent use leads to maladaptive behavior such that the physical or mental health of the individual is adversely affected
Denial
Primitive defense to avoid pain or anxiety; reality is refused in favor of internally generated, wish-fulfilling fantasies
Projection
Falsely attributing to someone else your own unacceptable feelings, impulses, or thoughts. Most typical are projections of physical and sexual impulses
Regression
Escape anxiety by returning to earlier level of adjustment during which gratification was ensured; more childish and childlike behaviors
Identification
Some traits or attributes of another person that are taken as your own. Identification with loved object may serve as defense against the anxiety or pain that accompanies separation from loss of the object, whether real or threatened.
Repression
Memories, feelings, and drives associated with painful and unacceptable impulses are excluded from consciousness
Reaction formation
Managing unacceptable thoughts, feelings, or behaviors by exaggerating those thoughts, feelings, and behaviors that are opposite
Isolation of affect
Separating ideas from feelings originally associated with them; emotional component of idea is repressed while the cognitive component remains conscious
Intellectualization
Shift emphasis from immediate interpersonal conflict to abstract ideas and esoteric topics; avoid painful feelings by focusing on ideas
Displacement
Redirecting an emotion from its original target to a more acceptable substitute; most commonly involves anger
Sublimation
Divert unacceptable drives into socially acceptable channels
Altriusm
Kindness, concern for the welfare of others; adaptive defense mechanism against feelings of inferiority, lack of fulfillment; helps alleviate feelings of emotional isolation, lack of significance
Suppression
Conscious decision to postpone paying attention to an unpleasant subject, impulse, or conflict; this is the only conscious defense mechanism
Humor
Unconscious or forbidden feelings are expressed via socially acceptable outlets; joking in effort to lighten and diffuse a tense or sad situation
Level 1 of Defense Mechanisms
Pathological defenses - psychotic denial, delusional projection
Level 2 of Defense Mechanisms
Immature defenses - fantasy, projection, passive aggression, acting out
Level 3 of Defense Mechanisms
Neurotic defenses - intellectualization, reaction formation, dissociation, displacement, repression
Level 4 of Defense Mechanisms
Mature defenses - humor, sublimation, suppression, altruism
Transference
Patient unconsciously transfers feelings and attitudes from a person or situation in the past on to a person or situation in the present. Transference is at least partly inappropriate to the present situation; it is the transferring of a relationship dynamic; it involves transfer of one aspect of a relationship, not the entire relationship
Factors that increase transference
Vulnerable personality (impulsive, little capacity for reflection), rigid expectations, anxiety about physical or psychological safety, frequent contact with physician
Managing transference
Recognize the importance of the relationship to the patient, be reliable and consistent, maintain professional boundaries and clear limits in treatment, interpretation when patient can understand and use it
Countertransference
Physician unconsciously transfers feelings and attitudes from a person or situation in the past on to patient
Shame
Painful feelings caused by the lowering of one’s pride, self-respect, or self concept. Shame - state of the self. Humiliation - temporary status of self
Physical manifestations of shame
Blushing, sweating, freezing, fainting, sense of weakness
Behavioral manifestations of shame
Natural urge is to hide or disappear, break eye contact, anxious laughter, withdrawal, avoidance
Cognitive manifestations of shame
Feeling defeated, exposed, deficient, a failure, inadequate, worthless, wounded
What are some shame-inducing events in the medical settings?
Examining physical and psychological deficits, treatments with side effects, dying without dignity, fear of stigmatization, fear of alienating others, medical terms (such as heart failure, lazy eye)
Adaptive reactions to shame in the medical setting
Response appears and disappears within seconds, strengthening of vulnerable aspect of self, humor or laughter
Maladaptive reactions to shame in the medical setting
Becoming subdued, withdrawn, lying or withholding information, counter humiliating, long lasting grudges, avoidance of future appointments, changing doctors, seeking care away from the community, complaining, speaking to patient care representative, suing
Strategies to manage shame - environmental and procedural
Create an atmosphere that is welcoming, caring and respectful; minimize delays; minimize interruptions during appointments, be mindful of privacy
Strategies to manage shame - interpersonal
Refer to pt by proper title and name, support the pt’s identity, self disclose when possible and appropriate, avoid using shame and humiliation as motivational tools, validate and praise the patient for seeking help, be mindful of your emotional reactions
Strategies to manage shame - assessment and treatment
Discuss the pt’s perspective of the problem, recommend support groups, establish the pt’s goals/concerns; don’t force your agenda
Who experiences more shame, men or women?
Women
What are some frequent shaming topics?
Sexual behavior, teeth, and weight
What are the most common specialties of shaming?
Family practice, gynecologists, and dentists
To improve outcomes and reduce reactance, doctors should:
Try to keep the conversation focused on the behavior (not the person); avoid intentionally inflicting shame or guilt; guide communication such that pts reach their own conclusion about unhealthy behaviors
What are the fxns of emotions?
Emotions prepare us for action, communicate to others and to ourselves. Emotions serve as an evolutionary function (fear, anger, shame, guilt). It is difficult to change or stop feeling emotions until their fxn is served.
Validation
Communicating to a person that his or her experience makes sense; informs a person that you understand the reason for his/her emotion
Levels of validation
Listening, paying attention, reflecting, acknowledging the other’s points, working to understand, asking questions, making hypotheses, understanding the problems in context, normalizing responses when they are normative, extending/matching with your own vulnerability
Invalidation
Counter-arguments, interrogation, command, warning/threatening, evading/missing/avoiding the point, trying to make sense
Active listening
Focus on framing understanding of the person, affirm and summarize what they said
Intentional listening
Involves simultaneous examination of self during the process; involves the possibility of being vulnerable; invites influence; is focused on listening as a reciprocal process not merely an outward skill directed at another
