Psychotherapies Flashcards
28 yo woman –> fear of flying (feels trapped and extremely anxious) –> great deal of anticipatory anxiety about any upcoming flight –> wants to get rid of this fear. Best tx option?
a. ID patient’s maladaptive assumptions about flying
b. Individual psychodynamic psychotherapy
c. Group therapy with patients also afraid of flying
d. Systematic desensitization
e. Alprazolam prn before flying
d. Systematic desensitization
Tx of choice for cases of clearly identifiable anxiety-provoking stimuli
Three steps:
1) relaxation training;
2) hierarchical construction of anxiety provoking situations;
3) desensitization to stimulus
Alprazolam would appease anxiety but not get rid of phobia
45 yo man diagnosed as having diabetes will req insulin. His physician explains the use of the medication and tells pt that he will need to be seen at frequent intervals until his glucose levels come under good control. Pt says angrily “You doctors are always the same! You always want control–of my time, of my money, and now of my every action!”
Explanation of this patient’s reaction to doctor?
Experiencing transference to this authority figure
Transference = projection of feelings, thoughts, and attitudes once connected to important figures in pt’s past onto another important figure (often an authority figure).
In this example, it is likely that this patient has experienced authority figures in his past who have attempted to control him in unwelcome and oppressive ways.
A 45 yo woman comes to the psychiatrist requesting help in coping with her life. Pt. states both of her parents have recently been diagnosed with cancer and her husband has just instituted divorce proceedings. She states she feels overwhelmed and anxious, with bouts of crying and panic attacks. Which one of the following therapies should be offered to this pt?
a. Medication mgmt
b. Psychoanalytic psychotherapy
c. Psychodynamic psychotherapy
d. Family therapy
e. Supportive psychotherapy
e. Supportive psychotherapy
Generally the preferred choice in cases where patients are undergoing acute life crises and are feeling overwhelmed
Pt is injecting feces into IV lines.
Dx?
What is also seen in these pts?
Dx: Factitious Disorder
Splitting is common.
A pt in psychodynamic therapy has been coming late to the last few sessions and complaining in the sessions that he has nothing to talk about. His therapist points out that up until several weeks ago, they were making very rapid progress into uncovering some of the difficult thoughts and feelings the patient had about his parents. What therapeutic principle best exemplifies the recent changes in the patient’s behavior?
a. Countertransference
b. Ego strength
c. Abreaction
d. Projective identification
e. Resistance
e. Resistance
Freud noticed that patients, in spite of their suffering and their overt desire to change, tended to cling to their symptoms and resisted the analyst’s efforts to produce insight. He called these powerful internal forces that oppose change resistance. Resistance takes place at any point in the tx, and particularly when unacceptable impulses or thoughts threaten to come into consciousness or a maladaptive defense mechanism is challenged.
The awareness that a patient is not alone or unique in his or her suffering and that others share similar symptoms and difficulties
A powerful healing factor in group therapy
Universalization
A 45 yo woman comes to a therapist with the chief complaint of feeling depressed. The therapist asks the patient to talk about her experiences, both in daily life and in the past. As the therapy progresses, the patient realizes that much of her depressive emotion comes from her feelings of abandonment as a child, when her mother was hospitalized for a long illness and was thus unavailable. The patient sees the therapist once a week. The therapist uses primarily clarification, confrontation, and interpretation as tools. Which of the following therapies is this patient most likely undergoing?
a. Dynamic psychotherapy
b. Cognitive therapy
c. Behavioral therapy
d. Psychoanalysis
a. Dynamic psychotherapy
Psychoanalysis would also use the understanding of the patient and the recreation of the past through clarification, confrontation, and interpretation, but typically the patient comes to the office more frequently than once per week, and often, though not always, the patient lies on a couch facing away from the therapist.
External reality is grossly rearranged to conform to internal needs
Distortion
Expelling or withholding of an idea or feeling from consciousness (For example, a woman who has just been told she has a dx of cancer goes home that evening and tells her husband that everything is fine. When confronted by this error, she seems genuinely surprised to hear the cancer dx).
Repression
The substitution of an unacceptable feeling or thought with its opposite (For example, a person who is very angry at his wife brings home flowers for her.)
Reaction formation
Achieving of impulse gratification and the retention of goals by altering a socially objectionable aim or object to a socially acceptable one
(For example, a person who wishes to be admired by everyone channels this behavior into doing charity work)
Sublimation
Sublimation allows instincts to be channeled rather than blocked or diverted. Sublimation is a mature defense, together with humor altruism, anticipation, and suppression).
The conversion of psychic derivatives into bodily symptoms and reaction with somatic manifestations rather than psychic ones
(For example, a person who is extremely anxious about her relationship with her husband begins having abdominal pain when in his presence).
Somatization
Excessive use of intellectual processes to avoid affective expression or experience
(A person who has gotten into a disagreement with his best friend spends hours objectively analyzing the conversation to understand what happened.)
Intellectualization
Splitting or separation of an idea from the affect that accompanies it but that is repressed
(A person told that he has been fired from his long time place of work appears unemotional about the fact).
Isolation of affect
Perception of and reaction to unacceptable inner impulses and their derivatives as though they were outside the self.
(A person who is angry at her friend is convinced that the friend is angry at her instead).
Projection
