Psychotherapy Flashcards
How do terms such as manipulation, malingering, Med-seeking, borderline etc affect our interactions and decision making processes with clients?
Negative/hater talk generates disgust. Clients will sense disgust and may become aggressive of refuse to participate.
What are two possible reasons for why clients and referral sources request specific interventions versus telling us about their problems and goals from treatment?
- They don’t have the words for it.
- It is an invisible part of the healthcare flow.
What are the four expectations of medical and behavioral health patients?
- Whats wrong?
- What’s causing it?
- How much is it going to cost?
- How long is it going to take?
What is the EVT for working with teens with conduct disorder?
Multi systemic therapy
How does multi systemic therapy help teens with conduct problems?
The community wraps around the client imposing more and more boundaries on the client. This pens in the client and makes his pain vectors turn inward so he will accept help.
How does MCOT assist with clients with conduct problems?
MCOT can encourage collateral to enforce boundaries on client, in a mini MST fashion with the idea of changing the client’s pain vectors.
What is normalization?
Normalization is a process by which the clinician can help reduce the stigma about certain issues. This lets the client know that what they are experiencing is normal.
How can normalization help segue into difficult or sensitive topics?
Clients may be more willing to talk about sensitive topics if they feel it is normal.
What is the template for normalization?
Given who you are, and what you’ve experienced, how you are feeling makes sense.
What is the technique of paraphrasing?
The clinician summarizes, but adds implied information while removing the irrelevant.
How can paraphrasing be used to shift the focus of the assessment or intervention from irrelevant to relevant material?
Clinician summarizes, but deletes irrelevant information while adding relevant but implied information.
What are some appropriate ways therapists can teach people to distract using intense discomfort?
- ice cubes
- hot or cold shower
- Tabasco on the tongue
- rubber band snapping
What does DBT say about avoiding self-harm?
You can replace self-injury with other intense sensations so long as it is legal, within your religious framework, doesn’t harm others, and doesn’t cause permanent body injury.
Who is Linehan?
Linehan is the psychologist credited with developing dialectical behavior therapy.
What are the components of DBT?
Mindfulness, acceptance, distress tolerance, emotional regulation, and interpersonal effectiveness.
How do we help make accepting help more tolerable for the client?
Tell a version of the truth that may be more tolerable for the client.
What is the therapeutic alliance?
An emergent quality of partnership and mutual collaboration that is built principally on a positive emotional bond between client and therapist and their ability to achieve consensus.
On what things must the therapeutic alliance encourage consensus?
Problem definition, goals of treatment, and tasks to achieve such as goals.
What questions must a counselor ask about the therapeutic alliance?
Is there something I like/respect about the client; can the client tell; are we collaborating?
Why is the therapeutic alliance more difficult when working with a family?
Clinician must maintain multiple simultaneous alliances with people with different needs, expectations, and abilities
What is critical to establishing a strong therapeutic alliance?
Responding in a non-defensive manner to a client’s hostility and negativity.
What is Robert Plutchik responsible for?
Theory of emotion
What are the 5 aspects of Plutchik’s theory of emotion?
- stimulus event
- cognitive appraisal
- affective reaction
- behavioral reaction
What is an emotion according to Plutchik?
Emotion is the cognitive appraisal, affective reaction and behavioral reaction
According to Plutchik, what are the basic emotions?
Sadness, fear, anger, surprise, disgust, trust, joy and anticipation
What is the function of sadness?
Reattach to lost object
What is the stimulus for sadness?
Loss of a valued object
What is the cognitive appraisal for sadness?
Abandonment
What is the behavioral reaction for sadness?
Cry or cling
What is the function of fear?
Ensure safety
What is the stimulus for fear?
A threat
What is the cognitive appraisal for fear?
Danger
What is the behavioral reaction for fear?
Escape
What is the function of anger?
Destroy obstacle
What is the stimulus of anger?
Obstacles
What is the cognitive appraisal for anger?
Enemy
What is the behavioral response for anger?
Attack
What is the function of surprise?
Gain time to reorient
What is the stimulus of surprise?
Unexpected events
What is the cognitive appraisal for surprise?
What is it?
What is the behavioral reaction for surprise?
Stop
What is the function of disgust?
Eject poison
What is the stimulus for disgust?
Unpalatable object
What is the cognitive appraisal for disgust?
Poison
What is the behavioral reaction for disgust?
Vomit
What is the function of trust?
Mutual support
What is the stimulus for trust?
Members of ones own group
What is the cognitive appraisal for trust?
Friend
What is the behavioral reaction for trust
Groom
What is the function of joy?
Gain resources
What is the stimulus for joy?
Gain of valued object
What is the cognitive appraisal for joy?
Possess
What is the behavioral reaction for joy?
Retain or repeat
What is the function of anticipation?
Gain knowledge of new territory
What is the stimulus of anticipation?
New territory
What is the cognitive appraisal for anticipation?
Examine
What is the behavioral reaction for anticipation?
Map
Why is it important to avoid a firm “no” early in a crisis call or MCOT encounter?
Most clients are expecting no. It may promote the client to reject us before we can reject them.
How can we do a side-step when the client has unrealistic expectations or irrelevant requests?
Set up the contact with scripting and interrupt when necessary to set things aside for later consideration.
What does client-centered, family/community based evaluation mean?
Clients are usually embedded in a complex collection of different groups or individuals.
What is important to do when a client is embedded in a system?
Evaluate the client through the lens of each part in the system.
How can a two-person team avoid overwhelming the client while enhancing safety?
One person leads, other documents and watches for safety
How are the concepts of compassion, acceptance, mindfulness, and sitting with suffering helpful with many of the clients we serve?
For many of our clients there is no cure. These help them tolerate the inevitable suffering.
What is the Buddhist core?
Compassion, acceptance, mindfulness, and sitting with suffering.
How do role functioning and client satisfaction impact time to gain improvement?
Increased role functioning and increased satisfaction = decreased time to gain improvement
