Psychological Phenomena

Question 1

Id

Answer 1

Biological urges, instincts; maximizes pleasure, acts according to pleasure principle

Question 2

Ego

Answer 2

Realistic thinking, postpone pleasure until appropriate, mediates between desires of id and superego; acts according to reality principle

Question 3

Superego

Answer 3

Values, conscience ego-ideal; how the ego should behave

Question 4

Defense mechanisms

Answer 4

Unconscious ways by which ego wards off anxiety and control unacceptable instinctual urges and unpleasant affects or emotions by manipulating, distorting, or denying reality

Question 5

When do defense mechanisms become pathological?

Answer 5

When its persistent use leads to maladaptive behavior such that the physical or mental health of the individual is adversely affected

Question 6

Denial

Answer 6

Primitive defense to avoid pain or anxiety; reality is refused in favor of internally generated, wish-fulfilling fantasies

Question 7

Projection

Answer 7

Falsely attributing to someone else your own unacceptable feelings, impulses, or thoughts. Most typical are projections of physical and sexual impulses

Question 8

Regression

Answer 8

Escape anxiety by returning to earlier level of adjustment during which gratification was ensured; more childish and childlike behaviors

Question 9

Identification

Answer 9

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.

Question 10

Repression

Answer 10

Memories, feelings, and drives associated with painful and unacceptable impulses are excluded from consciousness

Question 11

Reaction formation

Answer 11

Managing unacceptable thoughts, feelings, or behaviors by exaggerating those thoughts, feelings, and behaviors that are opposite

Question 12

Isolation of affect

Answer 12

Separating ideas from feelings originally associated with them; emotional component of idea is repressed while the cognitive component remains conscious

Question 13

Intellectualization

Answer 13

Shift emphasis from immediate interpersonal conflict to abstract ideas and esoteric topics; avoid painful feelings by focusing on ideas

Question 14

Displacement

Answer 14

Redirecting an emotion from its original target to a more acceptable substitute; most commonly involves anger

Question 15

Sublimation

Answer 15

Divert unacceptable drives into socially acceptable channels

Question 16

Altriusm

Answer 16

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

Question 17

Suppression

Answer 17

Conscious decision to postpone paying attention to an unpleasant subject, impulse, or conflict; this is the only conscious defense mechanism

Question 18

Humor

Answer 18

Unconscious or forbidden feelings are expressed via socially acceptable outlets; joking in effort to lighten and diffuse a tense or sad situation

Question 19

Level 1 of Defense Mechanisms

Answer 19

Pathological defenses - psychotic denial, delusional projection

Question 20

Level 2 of Defense Mechanisms

Answer 20

Immature defenses - fantasy, projection, passive aggression, acting out

Question 21

Level 3 of Defense Mechanisms

Answer 21

Neurotic defenses - intellectualization, reaction formation, dissociation, displacement, repression

Question 22

Level 4 of Defense Mechanisms

Answer 22

Mature defenses - humor, sublimation, suppression, altruism

Question 23

Transference

Answer 23

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

Question 24

Factors that increase transference

Answer 24

Vulnerable personality (impulsive, little capacity for reflection), rigid expectations, anxiety about physical or psychological safety, frequent contact with physician

Question 25

Managing transference

Answer 25

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

Question 26

Countertransference

Answer 26

Physician unconsciously transfers feelings and attitudes from a person or situation in the past on to patient

Question 27

Shame

Answer 27

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

Question 28

Physical manifestations of shame

Answer 28

Blushing, sweating, freezing, fainting, sense of weakness

Question 29

Behavioral manifestations of shame

Answer 29

Natural urge is to hide or disappear, break eye contact, anxious laughter, withdrawal, avoidance

Question 30

Cognitive manifestations of shame

Answer 30

Feeling defeated, exposed, deficient, a failure, inadequate, worthless, wounded

Question 31

What are some shame-inducing events in the medical settings?

Answer 31

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)

Question 32

Adaptive reactions to shame in the medical setting

Answer 32

Response appears and disappears within seconds, strengthening of vulnerable aspect of self, humor or laughter

Question 33

Maladaptive reactions to shame in the medical setting

Answer 33

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

Question 34

Strategies to manage shame - environmental and procedural

Answer 34

Create an atmosphere that is welcoming, caring and respectful; minimize delays; minimize interruptions during appointments, be mindful of privacy

Question 35

Strategies to manage shame - interpersonal

Answer 35

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

Question 36

Strategies to manage shame - assessment and treatment

Answer 36

Discuss the pt’s perspective of the problem, recommend support groups, establish the pt’s goals/concerns; don’t force your agenda

Question 37

Who experiences more shame, men or women?

Answer 37

Women

Question 38

What are some frequent shaming topics?

Answer 38

Sexual behavior, teeth, and weight

Question 39

What are the most common specialties of shaming?

Answer 39

Family practice, gynecologists, and dentists

Question 40

To improve outcomes and reduce reactance, doctors should:

Answer 40

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

Question 41

What are the fxns of emotions?

Answer 41

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.

Question 42

Validation

Answer 42

Communicating to a person that his or her experience makes sense; informs a person that you understand the reason for his/her emotion

Question 43

Levels of validation

Answer 43

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

Question 44

Invalidation

Answer 44

Counter-arguments, interrogation, command, warning/threatening, evading/missing/avoiding the point, trying to make sense

Question 45

Active listening

Answer 45

Focus on framing understanding of the person, affirm and summarize what they said

Question 46

Intentional listening

Answer 46

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