Psychotherapy Flashcards
What is conscious vs unconscious vs preconscious? This is the topographic model.
Conscious - what you are aware off
Unconscious - What you are not aware of but still influences you
Preconscious - what you can be made aware of with effort
How does the topographic model of the mind explain psychiatric illness?
Symptoms are the result of repressed memories or ideas which can be treated with lifting the repression -> memories can be recalled and symptoms resolved
What are the problems with the topographic model?
Some memories cannot be made conscious
It did not adequately treat patients
What are the three components of the structural model of the mind? What is each of their functions?
- Ego - integration of data, mediates other two components and deals with conflict
- Id - unconscious focuses on sex and aggression (controlled by ego / superego) - the devil
- Superego - our moral conscience in values - the angel
In the structural model, what causes psych symptoms and when is a defense needed?
When the superego, ego, and id are in conflict -> anxiety and other symptoms
Defense is needed when these conflicts occurs
What is the role of a defense mechanism?
They are a compromise in conflicts, result in psychiatric symptoms by gratifying the wishes of the id in a disguised form
- > used by everyone to prevent anxiety / depression
- > may be adaptive or maladaptive
Is denial a defense mechanism?
Yes
What is regression? Give an example
Involuntary return to an earlier phase of development to avoid facing challenges associates with present level
-> toilet trained child begins bed-wetting after moving to new house
What is somatization?
Converting emotional pain or other affect state into physical symptoms
What is projection vs projective identification? Give an example
In both cases, the defensive person attributes their feelings to a target
In projective identification ONLY - target is changed and begins assuming these attributes
You become angry so you say you tell your boss “Why are you so angry??”. If this makes boss angry -> projective identification. If not -> projection
What is acting out? Example?
Enacting an unconscious wish impulsively - avoids talking about painful emotions
Class example: Patient is pissed about therapist leaving when he will need her, so he misses therapy sessions without notice.
Better example: tantrums
What is idealization and when is it used?
Attributing perfect qualities to others while ignoring any flaws (to ignore negative thoughts)
- > avoids anxiety or negative feelings such as contempt, envy or anger
- > if you are anxious about your cancer, this might be a defense to make yourself feel like you’re in good hands
What is splitting and who is this common in?
Compartmentalizing experiences into good or bad so that ambiguity is impossible
Common in borderline personality disorder
What is passive-aggressive behavior?
Aggression towards another person is demonstrated as an indirect opposition in a nonconfrontation manner
When is repression? How does this differ from denial and suppression?
Involuntary withholding of an unacceptable idea / impulse from consciousness
Denial -> Refutation of external data. Repression is denial of inner data
Suppression -> Intentional and temporary withholding of an unacceptable idea / impulse
What is displacement?
Shifting of feelings associated with one idea or person to another
-> you get mad at your boss so you yell at your wife
What is dissociation? Give an example.
A drastic, temporary modification of identity / character to avoid emotional distress
-> feel numb and detached when thinking about abusive event
What is intellectualization?
Using excessive facts and logic to emotionally distance oneself from a stressful situation
-> i.e. focusing only on mechanism of action or survival rates of a new diagnosis rather than how you feel
What is identification? Give an example?
Unconscious assumption of the characteristics, qualities or traits of another person or group. This happens when you internalize the qualities of someone as part of their identity, and you want to be like them.
I.e. a child who stays up late to be like his parents
What is reaction formation vs sublimation?
Reaction formation -> doing the opposite of an unacceptable wish or impulse. I.e. going to a monastery when you feel like having sex, overcompensating but not being genuine.
Sublimation -> channeling those feelings into something positive / something that does not conflict with your value system -> i.e. former cocaine addict works for a substance abuse hotline to help others after he feels like smoking da crack
What is Isolation of Affect? Example?
Separating feelings from ideas and events
-> i.e. describing murder in graphic detail with no emotional response, as if he was describing the weather
What is rationalization?
Justifying unacceptable attitudes, beliefs, behaviors, or outcomes to make them tolerable to oneself, even if the justification is not a good one and you know it internally -> will still feel uncomfortable after the justification
What is altruism and when can it be used negatively?
Committing oneself to the needs of other over and above one’s own needs
- > alleviate negative feelings via unsolicited generosity
- > can be used negatively in narcissism (want to win big prize) and guilt (remorse for bad actions)
What are the four mature defenses?
SASH
Sublimation
Altruism
Suppression - conscious holding of unpleasant / troubling ideas from consciousness
Humor - to break the tension / negative feelings of personal discomfort
How does suppression differ from repression and denial?
Suppression is conscious
Repression and denial are not conscious
What is learning based on in classical conditioning?
Association of environmental events occurring closely together
What are the UCS, UCR, CS, and CR for Pavlov’s experiment?
UCS - meat
UCR - salivation to meat
CS - ringing bell (at same time as meat)
CR - salivation to bell
What is it called when the CS no longer evokes the CR after several times of the CS not being paired with the UCS?
Extinction
What is stimulus generalization vs discrimination?
Stimulus generalization - CR occurs to a stimulus similar to CS, like chimes in the dog example
Discrimination - dog would only salivate to a specific type of bell
What is a punishment vs a reinforcement in operant conditioning?
Punishments - try to decrease a behavior
Reinforcements - try to increase a behavior
What is positive vs negative in operant conditioning?
Positive - Application of a stimulus to increase / decrease the behavior (beating your kid is a positive punishment)
Negative - removal of a stimulus to increase / decrease the behavior (taking away video games for a week is a negative punishment)
What is continuous vs partial reinforcement and how do these reinforcement schedules differ with respect to learning and extinction?
Continuous - action always produces reinforcing stimulus
- > most rapid learning but most rapid extinction if reinforcement is removed
(i. e. paying at a vending machine)
Partial reinforcement
- > better for maintenance, slower learning, but slowest extinction if not rewarded
(i. e. playing slot machine)
What is transference?
Patient projects feelings about formative or other important persons on the therapist (i.e. therapist reminds patient of mother, so patient starts to feel about the therapist like she does her mother)
What is countertransference?
Therapist projects feelings about formative or other important persons on the patient (patient reminds therapist of younger sibling or previous patient)
What is the therapeutic alliance?
Assumed shared positive feelings between therapist and patient which support goals of treatment
What is resistance? Give an example.
Forces within the patient, both conscious or unconscious, which oppose the goals of treatment
i.e. patient is repeatedly late for sessions, despite saying she wants help
Why is rapport important and how should you establish it?
Relation or connection which, without establishment, can lead to ineffective care
-> put patient at ease, be compassionate, but maintain authority / expertise
What are clarification and interpretation as therapist’s tools?
Clarification - statement / question with goal to make patient’s current thoughts & behavior more clear
Interpretation - therapist tries to link patient’s conscious thoughts / behavior to unconscious motivations, based on what they have said
Are all psychotherapies very different? Are they effective? How are they made?
No, there’s a lot of overlap between them
They are as effective as medication in studies, and may have a longterm protective effect
Made by combining techniques from multiple therapies
What are the three types of group psychotherapy? All the rest are individual psychotherapy.
Family Therapy
Group Therapy
Couple/Marital Therapy
What is psychodynamic psychotherapy / what is it based on?
Based on Freud’s psychoanalytic theory
- > symptoms result from early experiences with buried conflicts
- > uncovering the unconscious results in improved self-understanding and conflicts can be resolved
- > uncover the conflicts, repressed feelings, and issues from early life
What is the most intensive and rigorous psychotherapy and how does it work?
Psychoanalysis
Patient is seen 3-6 times per week by a psychoanalyst, using psychodynamic principles. Patient lies on couch with therapist behind them so they can talk unimpeded and uninfluenced
What is behavioral therapy?
Uses classical and operant conditioning to modify maladaptive observable behaviors
-> little focus on past history
What is systematic desensitization / how does it work?
Technique of behavioral therapy: approach the feared situation gradually using relaxation techniques.
- Construct hierachy of anxiety provoking scenes
- Move through the hierarchy via imagined scenarios until you are desensitized. Paused for relaxation whenever needed
How does graded exposure differ from systematic desensitization?
Graded exposure = doing systematic desensitization in real life.
i.e. moving through the hierarchy when you have a fear of flying by looking at pictures, then going to airport, flying on plane short trip, etc
What is flooding and why is it not often done?
Behavioral therapy technique where you give the most anxiety-provoking stimulus first
Not done often due to low compliance
What is implosion?
Carrying out flooding in imagined scenarios
-> Implosion is to systematic desensitization as flooding is to graded exposure
What is token economy?
A form of positive reinforcement used in behavioral therapy
Using an economy of tokens, patients are given a reward for behaving in appropriate ways. Tokens can be spent for positive reinforcers
What is cognitive therapy? What is therapy centered around?
Therapy based on belief that people constantly process / interpret sensory information, and biases in this processing can lead to maladaptive / negative ideas
-> therapy is centered around exposing automatic thoughts and challenging these thought processes by challenging the underlying beliefs which lead to them.
What is cognitive behavioral therapy? How does this relate to psychoeducation?
A combination of cognitive and behavioral therapy.
Cognitive:
Focused around stopping maladaptive automatic thoughts and challenging negative core beliefs. Psychoeducation is teaching patient to challenge these on their own
Behavioral part:
Teaching coping / relaxation strategies, for instance
What type of therapy is indicated specifically for borderline personality disorder and how does it work? What is the goal?
Dialectical Behavioral Therapy (DBT)
Individual and group therapy which draws from CBT and supportive psychotherapies.
- > see individuals weekly for 1 year. Taught to be mindful of present, regulate their emotions, and accept negative feelings
- > goal is to reduce self destructive / self harm behaviors and improve interpersonal skills
What is the purpose of interpersonal psychotherapy (IPT)?
Addresses how the patient interacts with others
- > therapy for focusing on current relations / improving patient’s interpersonal life
- > can be good for interpersonal deficits (you were raised in a sheltered environment and need to know basic interpersonal skills)
- > grief, role transition, and interpersonal conflicts
What is the domino effect of interpersonal relationships in depression?
Depressive episodes are triggered, which leads to negative interpersonal encounters, which further lowers mood and social functioning
-> IPT can be useful to reverse this and improve mood
What is supportive psychotherapy?
A very general type of therapy which examines symptoms / relationships / patterns of emotional responses and basically the whole picture.
Aims to improve these symptoms and restore self esteem and ego function.
How does family therapy differ from individual therapy and what are its main goals?
Focuses on family as a unit rather than individual, knowing that the family unit attempts to maintain homeostasis
Goals:
Change maladaptive roles in the house
Improve communication
Decrease blaming / scapegoating
What are the advantages of general group therapy for a condition rather than individual therapy? Give an example of a group therapy group.
Immediate feedback from patient’s peers
Chance to observe patient’s responses / interactions to a variety of people
Example: Alcoholics anonymous
What is Milieu therapy?
A type of group therapy used on inpatient psych wards to help increase patients’ ability to relate to world and others
What is the goal of couple / marital therapy?
By treating the relationship as a patient, we try to modify the interaction of the two people in conflict and improve the relationship
What is the most efficacious treatment plan for most patients?
A combination of psychotherapy and pharmacotherapy
Mild disorders -> therapy alone may be indicated
Severe (bipolar or psychotic) -> treatment with therapy as adjunct
What are a few indications for recommending psychotherapy?
Pregnancy / breastfeeding -> meds often teratogenic
At patient’s request or if patient has symptoms despite pharmacologic treatment
Who can be a psychotherapist?
Just about anyone with a healthcare degree in psychology -> be weary
Try to remain positive and introduce a patient to a specific therapist if possible
Is one psychotherapy better than the others?
No. It’s effective but all about equal according to JAMA metaanalysis
