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NURS 764 > Psychotherapy > Flashcards

Psychotherapy Flashcards

1
Q

Transference

A

Refers to the patients thoughts, feelings, and behaviors that are associated with early important relationships with caretakers and significant others and that are felt toward the therapist.

Transference can be positive or negative. Most transference manifestations are subtle. The patient is most likely unaware of these feelings. I can be I the form of body language- how the patient sits, walks, speaks and moves.

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2
Q

Counter transference

A

client triggers emotional reaction in therapist from unresolved issues. Keep in mind that your reaction also help you glimpse how the client may affect other people and may become a source of clinical information.

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3
Q

Supportive Therapy

A

A form of psychodynamic therapy. Based on knowledge of patients psychodynamics, which shapes the approach but the goals of treatment differ considerably. This type of therapy aims to strengthen defenses, promote problem solving, restore adaptive functioning and provide symptom relief. This type of therapy is indicated to assist the person in stabilization and involves increasing external and internal resources.

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4
Q

Motivational Interviewing

A

Definition- a collaborative person-centered communication process designed to help individuals resolve ambivalence and plan for change. (Wheeler, ch. 9).

Origins of MI are from Millers clinical practice in addictions, and research on therapists behavior that illicit info.
Closely aligned with Transtheoretical Model developed around the same time.
Integrated into substance abuse programs
Research has shown that MI combined with CBT results in greater benefit than CBT alone

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5
Q

Guiding Principles of Motivational Interviewing

A

Guiding principles- adapted from Carl Rogers person-centered theory including:

  1. Acceptance
  2. Conveying accurate empathy
  3. Honoring the worth of individuals
  4. Affirming their strengths
  5. Respecting autonomy

Principles added by Miller and Rollick are

  1. Compassion- therapists give priority to the well being of patient over their own needs
  2. Evocation- accepting that individuals have within themselves what they beed to change and it is the practitioners job to “draw it out”.
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6
Q

OARS

A

Open ended questions- cannot be answered with yes or no
Affirming- comments on pt’s strengths and efforts
Reflecting- statements mirroring the content or feelings stated by the person
Summarizing- link together what has been said or adding to the content, feeling, or highlighting discrepancies.

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7
Q

Phases of Change

A
  1. Engagement- phase where a trusting and respectful relationship is established
  2. Focusing- process of clarifying the patients goals and direction.
  3. Evoking- eliciting motivation for a specific change
  4. Planning- a specific change strategy
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8
Q

Psychoanalysis and Resistance

A

Can be seen as an opportunity to increase understanding of the patient. Seen primarily as a defense, shows therapist that the patients anxiety has increased and defenses are up. Can indicate opportunity for insight. However, research shows that the therapist should induce as little resistance as possible while moving the patient toward their goals. Resistance is a manifestation of anxiety, and challenges the patients ability to change.

Groups who are likely to be resistors- adolescents, paranoid or distrustful patients, and those who are forced to go to therapy- spouse wants them to go, court ordered, etc.

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9
Q

Behaviors that are a sign of resistance

A 
Agitation
Demanding behaviors
Silence
Noncompliance
Chronic lateness
Not showing up to sessions
Anger
Eagerness to leave treatment
Superficial chit chat
Paranoia
Irritability
Lack of progress
Requests for special favors
Eating or drinking during sessions
Homework not done
Late payments
Sexual interest in therapist
Frequent requests for personal information from the therapist
Doorknob disclosures- revealing important information right at the end of the session
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10
Q

AIP

A

Adaptive Information Processing
Theory that resistance may reflect blocked processing. This is due to the failure of the therapist to fit the right treatment to the receptivity of the patient.

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11
Q

Psychic Determinism

A

Basis for psychodynamic psychotherapy. Based on idea that a patients spontaneous verbalizations will reveal affectively charged themes. He/She doesn’t need to have a specific topic in mind, but instead can talk about whatever thoughts and feelings arise that are relevant to the agreed problem focus. This allows the patients own experience and ways of interacting to emerge. The therapist can listen for underlying patterns of conflict.

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12
Q

Automatic Thought Record (ATR)

A

A key component of CBT. First introduced by Beck in 1979. . Used as homework after introduced in therapy session, and is intended to capture automatic thoughts both during and between sessions. The individual completes the column in the ATR identifying a troubling situation, resulting emotion, and thoughts associated with both. Afterwards, both therapist and patient work on developing “rational” responses to challenge original reaction. With repetition the clarification and debate to challenge original thought is internalized within the individual.

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13
Q

Process Comments

A

interventions that discuss the therapeutic relationship. Include questions like “ how do you think things are going?”This can open the door to better patient centered communication

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14
Q

16 Basic Strategies of dynamic supportive therapy

A 
formulate the case
	be a good parent
	foster and protect the therapeutic alliance
	Manage the transference
	Hold an contain the patient
	Lend psychic structure
	Maximize adaptive coping mechanisms
	Provide a role model for identification
	Decrease alexithymia
	Make connections
	Raise self esteem
	Ameliorate hopelessness
	Focus on the here and now
	Encourage patient activity
	Educate the patient and family
	Manipulate the environment
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15
Q

CBT

A

Cognitive Behavioral Therapy

CBT definition- collaborative process between therapist and patient based on the belief that psychological health depends on how well a person is able to positively adapt to changing conditions and situations both cognitively and functionally. This results in improved mood and function.

Cognitive adaptation- learning from consequences in a rational useful manner
Functional- Includes modification of behavior skills in response to challenges

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16
Q

CBT Model for Depression

A

Based on the premise that individuals develop and then maintain a negative self-view and this attitude extends to their world, their experiences, and on into the future.
Therapy is based on structured, active, reality-based and time-limited.

Evolved out of work by Aaron T. Beck

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17
Q

CBT Steps

A
  1. Identify and monitor automatic thoughts
    1. Critical examination of evidence
    2. Substitution of objective interpretations for their negative, dysfunctional attributions
    3. Recognize connections between thoughts and feelings
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18
Q

CBT structure

A

Based on the understanding that a persons views of a situation will influence their assumptions, behaviors, and reactions to that situation.

Therapist- conceptualizes and understands patients core beliefs, ways of reacting, behaviors, internal resources and coping skills

in collaboration with therapist, patient develops a structured plan with measurable, reasonable, and specific goals.

Structure-

  1. beginning- set agenda and review homework
  2. middle- work and practice
  3. end- assign homework
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19
Q

Becks Cognitive Triad

A

Based on the belief that dysfunction and maladaptive thoughts are rooted in irrational or illogical assumptions

1. Negative thoughts about oneself
2. Negative thoughts about the future
3. Negative thoughts about the world

Psychotherapy must focus on all three for sustainable change. Cognitive is the center point, if thoughts can be changed, the other two will follow.

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20
Q

Guided Discovery

A

More effective process of inquiry by increasing patients belief in the conclusion, minimizes debate and increases sense of mastery and participation.

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21
Q

Socratic Dialogue

A

Hallmark of CBT. Primary method of communication in CBT.
A mutual discovery in which the therapist guides the patient through a series of questions and answers to elicit automatic thoughts and assumptions and examine the logic an evidence that relates to them.

Involves the the therapist asking specific questions derived primarily from restatement of the individuals own words. This allows the patient to self discover and leads to change

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22
Q

Freud and the three primary psychic structures

A

Topographical Approach-

Conscious- perceptions coming from outside or in the body are brought into awareness. Subjective. Language behavior

Preconscious- mental events, process and context brought into awareness by act of focusing attention. going on behind the scenes. Acts as intermediary to sort out unacceptable thoughts. An edit button.

Unconscious- dynamic. Processes are kept from conscious from being aware through forces of censorship and repression. brought to the mental representation thought to contain mental representation and derivatives of pure instinct. Natural state.

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23
Q

Establishing therapeutic alliance

A

initiated at first contact with the patient

  • essential for successful outcome of treatment no mater what therapeutic model is used
  • studies indicate that the weaker the alliance, the less likely the patient is to continue treatment
  • 3 elements of therapeutic alliance: collaborative nature of patient/therapist relationship; warm, emotional bond between patient and therapist, and agreement on the goals of treatment
  • Competencies: ability to establish rapport, enable the patient to actively participate, establish a treatment focus, provide a healing environment, recognize and repair the alliance as needed
  • Strategies to build therapeutic alliance - asking detailed questions about patient’s main concern, validating affect, explaining the therapy process, listening empathically without “fix it” statements, goal consensus
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24
Q

Behavior Theory

A

All behaviors are acquired through conditioning
Behavior therapy focus on observable behavior, learning experiences that promote change, tailoring tx strategies, assessment and evaluation of behaviors for change

4 areas of Development:

  1. Classical conditioning - Pavlov - stimulus and conditioned response
  2. Operant conditions - specific consequences are associated with a voluntary behavior, reward and punishment
  3. Social learning approach - emphasizes the importance of observing, modelling, and imitating the behaviors, attitudes, and emotional reactions of others
  4. Cognitive Behavior Therapy
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25
Q

Carol Roger’s theory - Person-centered therapy

A

Techniques - reflection, exploring, clarification
3 facilitative conditions needed for positive outcomes: unconditional positive regard, empathic understanding, and congruence
Central Belief: people are basically good and have a vast potential for self growth if their potential is tapped in a therapeutic relationship using the 3 facilitative conditions (above)

The approach outlines three facilitative conditions necessary for positive therapeutic outcomes:

  1. Unconditional positive regard
  2. Empathic understanding
  3. Congruence- having inner and outer experiences that match
26
Q

Key Concepts of person centered theory

A

Key Concepts:

  1. Belief of Human Nature -positive center at the core of all people
  2. Self-concept - set of perceptions about self, state of congruence with high sense of self worth= self image and ideal self are similar to each other
  3. Actualizing tendency - innate drive, basic motivational force and directional process in humans to grow, develop and strive toward fulfillment
  4. Fully functioning person - person who is fully engaged in process of self actualization

-Goal: Patient to become fully functioning person engaged in the process of self-actualization

27
Q

Existential therapy

A

-Centered in resolving life’s existential themes which are choice, freedom, responsibility, awareness, aloneness, meaning, anxiety, death, authenticity, awe

  • Goals: center on the theme of existence and help patients face the anxieties of life, freely choose their life direction, take responsibility for their choices, and create meaningful existence.
  • Not focused on the past, focuses on choices in the present and future.
  • Does NOT identify with specific therapeutic techniques, may draw on techniques from other styles. Important themes include therapeutic relationship, presence, experiential reflection.

The existential psychotherapist is generally not concerned with the patient’s past; instead, the emphasis is on the choices to be made in the present and future.
The first session is extremely important for building an authentic therapeutic relationship.

28
Q

defense mechanisms

A

implicit memory networks that develop through reciprocal interaction with caregiver and interpersonal experiences for the purpose of regulating anxiety, grief, anger, and self esteem keeping from conscious awareness disturbing thoughts and feelings

29
Q

Types of Defense Mechanism

A

Immature - denial, projection, acting out, regression, hypochondria, introjection, somatization, splitting

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

Mature - sublimation, suppression, altruism, humor

30
Q

Psychodynamic Therapy

A

uses interpretations to to expose the person to previously avoided experiences while offering empathy in a safe, therapeutic environment. See figure 5.2, p262. Some techniques are more appropriate for stabilization while others aid in processing. Supportive techniques focus on resource-building, less emotionally laden

psychoanalytic focuses on processing, exposure to trauma, exploration of small and large traumas that impair functioning.

31
Q

Humanistic-existential Theory

A

Do not interpret or give advice.
Use experiential techniques that are reflective and experimental in style.
Emphasis on the here and now.
Tailored to patient’s wants at the given moment.
May include creative arts like drawing, music, movement, may include working with dreams or the empty chair.

32
Q

Schema Therapy

A

A modification of CBT. Techniques: imagery, emotion-focused, identify beliefs that are blocking change

-Schema therapy probes deeply into childhood origins of distorted thinking, can be combined with traditional cognitive therapy, schema therapy is part of classical CBT

Schemas (Wheeler 376)

  • are fundamental core beliefs or assumptions that are part of the perceptual filter people use to view the world
  • in a constant state of change and adaptation throughout life
  • early schemas are more resistant to change than schemas developed later in life
33
Q

CBT therapy techniques

A

Cognitive techniques:

  • Socratic dialogue
  • downward arrow
  • idiosyncratic meaning
  • labeling distortions
  • questioning the evidence
  • examining options and alternatives,
  • reattribution
  • decatastrophizing
  • advantages and disadvantages, paradox or exaggeration, turning adversity to advantage, cognitive rehearsal, automatic thought records, thought-stopping, cognitive restructuring. Behavioral techniques: Use of homework assignments, assertiveness training, behavioral rehearsal, contingency management, bibliotherapy, guided relaxation, social skills training, shame-attacking exercises, exposure therapy
34
Q

Individual supportive therapy

A

(Wheeler, 265) - aims to strengthen defenses, promote problem solving, restore adaptive functioning, and provide symptom relief

  • increase internal and external resources
  • Basic strategies of dynamic supportive therapy are outlined in table 5.7 (Wheeler 265-266)
  • Techniques include reflection, empathic listening, encouragement and helping people explore and express their experiences and emtotions
  • Patient’s attachment style may determine where to intervene on the psychodynamic continuum (i.e. whether to use supportive therapy), Wheeler p 267
35
Q

Empty Chair Technique in Gestalt therapy

A
  • Example of a type of experiment used in Gestalt therapy. Gestalt therapists design and implement experiments to heighten awareness, promote expression, support contact and guide attentional focus
  • Used to complete unfinished business with significant other or 2 conflicted aspects of self
  • Example: Patient is not able to express his or her feelings to another person - put the person in empty chair and tell that person what needs to be expressed
36
Q

Psychoanalytic

A

processing through interpreting unconscious conflict and gaining insight (p260)

37
Q

Supportive

A

Aimed toward stabilization, reducing anxiety, strengthen defenses, and facilitating more effective problem solving

38
Q

Psychodynamic therapy

A

a continuum from supportive psychotherapy to expressive to psychoanalytic
-Derived from psychoanalytic psychotherapy developed by Freud

  • Also referred to as insight-oriented, intensive, exploratory, expressive, and depth psychotherapy
  • What has happened in the past determines what we are doing today
  • 7 key concepts - the unconscious, developmental perspective, transference, countertransference, resistance, psychic determination, and unique subjectivity
39
Q

Gestalt

A

establish I-thou relationship - authentic, nonjudgmental relationship between patient and therapist, attend to the immediate experience. Creative experimentation - to heighten awareness, promote the expression of emotionally lade material, support contact, and guide attentional focus. Experiments can include body awareness, focusing, empty chair, language of responsibility and dreamwork.

40
Q

Emotion focused

A

Developed by Leslie Greenberg in 1980’s. Integrates person-centered therapy, gestalt therapy, and neuroscience of emotions.
Accessing and evoking problematic feelings, primary maladaptive emotions, and maladaptive core schemes using Gestalt therapy style experiments. In-session markers (problematic emotional-processing states) are identified that guide experiments to help patients access and transform their maladaptive primary emotions.

41
Q

Solution-focused

A

Specific questions to help the patient access solutions: pre-session change questions, miracle questions, exception questions, scaling questions, future-oriented questions, coping questions, compliments, ending, subsequent sessions.

42
Q

CBT and cognitive distortions -different types

A

All or nothing, mind reading, emotional reasoning, personalization, global labeling, catastrophizing, should statements, overgeneralization, control fallacies, comparing, heaven’s reward, disqualifying the positive, perfectionism, time tripping, objectifying the subjective, selective abstraction, externalization of self worth, fallacy of the change of others, fallacy of worrying, ostrich technique, unrealistic expectations, filtering, being right, fallacy of attachment, fallacy of perfect effect

43
Q

The Behavior Equation: ABC Sequence

A

Antecedent- situational antecedent of the problem
Behavior- dimensions of the problem behavior
Consequences- of the problem behavior

44
Q

7 characteristics of humanistic-existential psychotherapy that distinguish it from other approaches

A
  1. Commitment to the phenomenological perspective- Understanding the subjective experience of the patient without judgement
  2. Centrality of the therapeutic relationship- The therapist–patient relationship is the primary source of constructive change. The relationship is meant to be a collaborative, authentic, dialogic encounter
  3. Holism- People are viewed as unique individuals who cannot be reduced to separate parts
  4. focus on the here and now- Authentic contact and change can only happen in the present
  5. Emphasis on humanistic-existential themes- Universal human experiences of life are explored, including awareness, authenticity, freedom, choice, responsibility, meaning, and self-actualization
  6. Prominence of process- The flow of action and reaction within a session, rather than its content, is the focus of therapy.
  7. Use of experiential techniques- Therapists do not interpret or give advice, but instead use methods that are reflective and experimental in style
45
Q

Roots of Humanistic- Existential Psychotherapy

A

After WWII in the U.S. Humanism, existentialism, and phenomenology philosophies merged into what is ow humanistic-existential as the third force in the practice of psychotherapy, along side psychoanalysis and behaviorism.

Became part of the great social upheaval movements of 60’s and 70’s, including feminist, civil rights and anti-war

46
Q

Assessment in Person-Centered Therapy

A

Therapist asks patient where to begin
The patient’s phenomenological experience is the focus, rather than the presenting problem
Traditional assessment procedures, such as taking a psychiatric history or using psychometric tests, are not used.
Diagnosis is not highly regarded

47
Q

Types of Psychotherapy

A 
Person-centered
Gestalt
Existential psychotherapy
Emotion-focused psychotherapy (EFT)
Solution-focused psychotherapy (SFT)
48
Q

experiential reflection,

A

in-depth questioning helps the patient recognize the range of life choices, remove obstacles to freedom, find meaning, and take responsibility

49
Q

Emotion schemes:

A

Complex memory networks within the amygdala and neocortex pathways formed in response to emotional life experiences

50
Q

Memory consolidation:

A

A process following an emotional life event when memory of the experience is fragile and can be disrupted

51
Q

Memory reconsolidation:

A

A process that occurs when a memory is reactivated later in life and is again fragile and vulnerable to disruption.
Changing an emotion scheme during EFT occurs during this memory reconsolidation period

52
Q

Memory reconsolidation:

A

A process that occurs when a memory is reactivated later in life and is again fragile and vulnerable to disruption.
Changing an emotion scheme during EFT occurs during this memory reconsolidation period

53
Q

Secondary emotions:

A

emotional reactions to a primary emotion or thought that follow, replace, or obscure a primary emotion
Examples: feeling guilty about feeling angry or feeling angry in response to feeling hurt

54
Q

Instrumental emotions:

A

emotional states that are used to control, manipulate, and elicit support

55
Q

Markers:

A

In-session, problematic emotional-processing states that patients enter during therapy that are indicative of underlying affective problems
Examples: problematic reactions, conflict splits, and unfinished business

56
Q

EFT First Phase- bonding and awareness phase

A

uses concepts from Carl Rogers person-centered theory- emphasizing empathy, congruence, and unconditional positive regard.

Emotional functioning is assessed, including emotional awareness, emotional regulation skills, and emotion schemes

57
Q

EFT Second Phase- evoking and exploring

A

Process-directed, Gestalt therapy–style experiments are implemented.

In-session markers (problematic emotional-processing states) are identified and used to guide experiments that help patients access and transform their maladaptive primary emotions and negative emotion schemes

58
Q

EFT Third phase - generating new emotions and creating new narrative meaning

A

At the end of an intervention, reflection on the experience occurs between the patient and therapist to make sense of the experience.

In this phase, validation for new feelings and support for an emerging sense of self are given.

There is a deep experiential self-knowledge that occurs as new meanings and coherent narratives are created to explain the experience

59
Q

SFT- Solution Focused Therapy

A

A brief psychotherapy embedded in the philosophy of postmodernism and the theory of social constructionism; it is a psychological application of the postmodern worldview

Therapy is solution-focused rather than problem-focused and is present- and future-oriented rather than past-oriented.

Therapy seeks to empower the patient and is positive and non-pathologizing.

Therapy is expected to result in change.

60
Q

solution talk

A

Key concept of SFT. Arises from the belief that language creates reality.

To change a problem, the language must be shifted from problem talk to solution talk, which highlights what the patient wants to achieve through therapy, rather than the problem that made the patient seek help

61
Q

Contingency Management

A

Part of CBT. A behavioral reinforcement-based approach with proven efficacy in the treatment of SUD

Positive outcomes include:
reduced substance use
increased group participation
improved adherence to medication regimens

62
Q

feeling state addiction therapy (FSAT)

A

developed to treat behavioral and substance addictions by addressing the “feeling state” associated with a behavior that leads to urges and cravings

involves a feeling state in combination with EMDR

NURS 764 (3 decks)

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