Test 1 Flashcards
What are the three phases of the therapeutic relationship?
Engagement phase
Working phase
Termination Phase
When does the termination phase of the therapeutic relationship begin?
First contact
To create a climate in which clients can examine their thoughts, emotions, feelings and actions and eventually arrive at a solution that is best for them
The role of the psych nurse
To assist individuals in finding answers that are most congruent with their own values
Job of psych nurse
The unconscious experience in which the client projects emotions or previous experiences onto the clinician
Transference
In regards to change we need to reflect on what three things
Reflection process?
The what
The so what
The now what
Provide safe, competent and ethical practice
Respect for inherent worth and right of choice and dignity of persons
Health, mental health and wellbeing
Quality Practice
RPN Code of Ethics
Identify problem and potential issue
Look at RPN guidelines
Consider laws, regulations, policies and practice guidelines
Seek consultation
Brainstorm possible actions
Reflection on consequences of possible actions
Decide what appears to be the best course of action
Steps of Ethical Decision Making
To informed consent
Refuse treatment
Advanced health directives
Provision of least restrictive type of mental health care
Confidentiality and privacy
Clients Rights
Suspected child abuse or neglect
Client requires hospitalization
Information is made an issue in court
When clients request their records to be released to a third party
Situations where there is a legal duty to disclose
Assess persons risk for danger towards another
Identify persons being threatened
Take appropriate action to protect
Protect suspected child
Suspect abuse of dependent adult or older adults
Counsellors have the duty to protect
Maintaining boundaries are always the responsibility of who
Psychiatric nurse
Establish and maintain trust
Set the tone and direction
Create and maintain a safe environment
Be aware of our responsibility to others
Be cognizant of the need for feedback
Counsellors and boundaries
A deviation from a typical therapeutic activity that is harmless and non-exploitative
Boundary crossing
Frequently appear harmless and often begin as innocent situations
Not recognized or felt as a violation until something goes wrong
Often crossing the line is a process with many small steps before an actual violation occurs
Characteristics of boundary violations
Are dual relationships a boundary violation?
Yes
Role, Time, Place and space, financial, physical contact, social media are all examples of potential
boundary violations
Judging someone without knowing them, on the basis of what they look like or what group they belong too
Prejudice
What typically leads to microaggressions
Unconscious biases
Identify basic assumptions
Learn more about own background
Willing to identify and examine personal worldviews
Pay attention to common ground
Be flexible
Guidelines for working effectively with diverse backgrounds
Level 1: Listens and acts interested
Level 2: Accurately reflects back what client has said
Level 3: Emphasizes articulating the unverbalized back to the client
Level 4: Validated behaviour in terms of cause
Level 5: Normalizes
Level 6: Radical Genuineness
6 Levels of Validation
Balance irreverence as well as the differential by making the treatment provider more vulnerable in a session
Reciprocal Communication
Who developed psychoanalysis
Freud
Irrational forces, unconscious motivations, biological and instinctual drives
How psychoanalysis determines behaviour
Understood as a source of motivation that encompasses sexual energy but goes beyond to include all life instincts
Libido
According to psychoanalytic theory, ____________ and __________ drives make people act as they do
Aggressive and sexual
Describe the unconscious
Lies deep below the surface and includes drives and instincts
What are the 3 parts of the Freuds personality theory
ID
EGO
Superego
First year - Oral
Ages 1-3 - Anal
Ages 3-6 - Phallic
Ages 6-12 - Latency
Ages 12-60 - Genital
Freud’s Psychosexual Stages
Ego defense mechanisms often operate on what level?
Unconscious
Expanded Freuds theory into different psychosocial Crisis based on different basic virtue
Eriksons psychoanalytic theory
______ perspective on personality development includes the following:
Multidisciplinary approach with the emphasis on being compelled to find meaning in life
Achieving individuation is an innate and primary goal of life
Individuation is the harmonious integration of the conscious and unconscious aspects of personality
Jungs
According to Jungs perspective on personality development how are dreams are seen as messages from the _________________
Collective unconsciousness
Goal is to make the unconscious conscious and strengthen the ego so behaviour is based on reality
Psychoanalytic therapy
Describe some aspects of the psychoanalytic therapy process
Very long approach
Blank-screen of the therapists fosters transference
Maintaining the analytic framework
Analysis of resistance
Analysis of transference
Free association
Interpretation
Dream analysis
Psychoanalytic therapy steps
Describe catharsis
The release of tension and anxiety that results from bringing repressed feelings and memories into the conscious
Focuses on the ABC model. Antecedents, behaviour and consequences. All behaviour is communication and that behaviour is influenced by antecedents and consequents.
Client participation is required and the client must be motivated by change
Main concept of behaviour therapy
Always begins with an assessment which is ongoing
Treatment plan is systematically formulated
Goals are determined collaboratively
Objective evaluation
Focus of treatment is on changing actions
Behaviour therapy characteristics
Pavlov dog experiment
What happens prior to learning creates a response through pairing
Classical conditioning
Developed by Skinner
Involves a type of learning in which behaviours change based on positive and negative reinforcement, punishment and extinction
Operant conditioning
the most powerful change agent and involves addition of something of value after a behaviour
Positive reinforcement
- Progressive muscle relaxation
- Develop a gradual anxiety hierarchy
- Client repeatedly imagines confronting situations until it fails to produce feelings of anxiety
3 steps involved in systematic desensitization
Exposing the client to anxiety provoking event rather than imagining it
In Vivo Exposure
Intense prolonged exposure to the actual anxiety provoking stimuli
In Vivo flooding
Used for PTSD
Comprised of bilateral eye movement paired with cognitive techniques
EMDR
Key elements include
Assessment, direct instruction, coaching, modeling, role playing and homework assignments
Social Skills Training
Helping clients to select realistic goals, translate goals into target behaviours, create an action plan and self-monitor and evaluate their actions
Self-management programs and self-directed behaviour
Foundational theory which serves as a basis for psychiatric nursing practice.
Used client rather than patient
Described the importance of therapeutic relationship
Rogers Person-Centered Therapy
Humans at their core are trustworthy and positive
Humans are capable of making changes and living productive, effective lives
Humans innately gravitate toward self-actualization
Given the right conditions, individuals strive to move forward and fulfill their creative nature
View of human nature by person-centered therapy
Assumption counselor knows best
Validity of advice giving or teaching
Belief that clients cannot resolve their own problems without help
Person-Centered Therapy challenges these traditional beliefs
Personal characteristics of the therapist
Quality of the therapeutic relationship
Counselors creation of a growth-promoting climate
Person Centred therapy emphasizes
Congruence
Unconditional positive regard
Accurate empathic understanding
3 attributes that create a growth-promoting climate
Two persons are in psychological contact
The first, the client, is experiencing incongruence
The second, the therapist is congruent or integrated in the relationship
The therapist experiences unconditional positive regard or real caring for the client
The therapist experiences empathy for the clients internal frame of reference and endeavors to communicate this to the client
The communication to the client is of the therapists understanding and unconditional positive regard is minimal
6 conditions for personality changes
Focuses on the quality of the therapeutic relationship
Engage in co-assessment with the client and does not value traditional assessment and diagnosis
Provides a supportive therapeutic environment
Client is the agent of change and healing
Serves as a model of a human being struggling toward greater realness
Therapists must be presence
Use of immediacies
The person-centered therapist must
Founded by Rogers daughter
Creative art forms are used to promote healing, self discovery, self awareness and insight and to connect us to our feelings
Person-Centered Expressive Arts Therapy
Emphasizes awareness, acceptance, and understanding of emotion and the visceral experiences of emotion
Emotional change can be the primary pathway to cognitive and behaviour change
Ex; Tapping
Emotion-Focused therapy
involves paying attention to your thoughts, feelings, physical sensations and actions in the here and now and comes from a place of curiosity
Mindfulness
Explain the difference between formal and informal mindfulness practice
Formal practice include mindfulness related to or incorporating mindfulness
Informal practice involves bringing focus and awareness to daily activities
Developed by Zinn
Involves mindfulness mediation, body awareness, yoga and exploration of patterns of behaviours
Mindfulness based stress reduction
Centers on
An expanded view of psychological health
Broad view of acceptable outcomes in therapy
Acceptance and mindfulness
Creating a meaningful life
Mindfulness and acceptance based therapies
Mindfulness that also incorporates principles and practices of Cognitive behavioral therapy
Mindfulness-based cognitive therapy
Developed by miller and rollnick.
Deliberately directive and aimed at reducing client ambivalence about change and increasing intrinsic motivation
motivational Interviewing
When should MI be used and not used
Used when the individual has any ambivalence about change
Express empathy
Non-judgmental approach
Reflective listening
Explore discrepancies and ambivalence
Reluctance to change is expected
Support clients self-efficacy
Strengthen clients commitments to change
Is not a type of therapy but a way to engage in conversation
Principles of MI
When using MI the clinician must not ask what type of questions
Questions that will signal resistance
What must the clinician do when change talk occurs
Reflect, affirm, and ask for elaboration or examples
Statements that signal a desire, ability, reasons, need or commitment to change
Change talk
When the therapist encounters resistance the clinicians can
Highlight clients right to autonomy , join in resistance, reflection is helpful and do not give advice
Rolling with resistance
Importance of change (willingness)
Confidence in change (ability)
Priority (Readiness)
Motivation to change
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
steps of the change process
Spirit of MI
OARS
Elicit and strength change talk
Recognize/responding to change talk
Rolling with resistance
Develop and negotiate change plans
Consolidate client commitment
Switch between Mi and other counselling styles
different stages of MI
Open-ended questions
Affirmations
reflective listening
Summaries
OARS
repetition and rephrase
Simple reflection
Psychological distress is largely a function of disturbances in cognitive processes
premise of CBT
Changing cognitions to produce desired changes in affect and behaviour
CBT focus
Thoughts and attitudes bring feelings, behaviours and physical sensations
Includes thoughts, behaviours and emotions
CBT thought triangle
Eliciting automatic thoughts/cognitive distortions
Testing cognitive distortions
Behavioural experiments
Activity scheduling
Graded task assignments
CBT interventions
Ellis.
People disturb themselves as a result of the rigid and extreme beliefs they hold about events more than the events themselves
ABCDE framework
- Activating event (does not cause the consequence)
- Belief about activating event (causes the consequence)
- Consequences (emotional and behavioral)
- Disputing (client begins to recognize and challenge irrational beliefs)
- (developing a new) effective philosophy
Involves “must” statements
Rational Emotive Behaviour Therapy
Insight-focused therapy with an emphasis on changing negative thoughts and maladaptive beliefs.
Believes that psychological problems are an exaggeration of adaptive responses resulting from commonplace cognitive distortions
CBT-Beck
Peoples thought processes are accessible to introspection
Peoples beliefs have highly personal meaning
People can discover these meanings themselves rather than being taught or having them interpreted by a therapist
CBT-Beck assumptions
Negative views about the world, oneself and about the future
Becks negative triad
All or nothing thinking
Overgeneralization
Mental filter
Disqualifying the positive
Jumping to conclusions (both mind reading and fortune telling)
Magnification (catastrophizing and minimization)
Should statements
Labeling and mislabeling
Personalization
Emotional reasoning
Becks cognitive distortions
Involves identifying and integrating clients strength at each phase of therapy
Has four step model
- Search: What is going right
- Construct: What are the obstacles
- Apply: Teach skills
- Practice: Practice skills to increase resistance
Strengths Based cognitive therapy - Padesky and Mooney
Basic assumption is that distressing emotions are typically the result of maladaptive thoughts and that as a prerequisite to behaviour change; clients must notice how they think, feel, and behave and what impact they have on others
Cognitive behaviour modification - Meichenbaum
Dialectics (aim to balance acceptance and change)
Zen (Acceptance)
CBT (change principles)
Perspectives of DBT
DBT was originally created to treat what?
BPD
Emotional, behavioural, interpersonal, cognitive, self dysregulation
DBT helps with
Clarity and compassions are utmost importance in conducting DBT
Therapeutic relationship is a real relationship between equals
DBT therapists can fail
DBT can fail even if the therapist doesn’t
Basic assumptions of DBT
Clients cannot fail
Clients are doing the best they can
Clients must learn new behaviours in all contexts
Clients may not have caused their problems but must solve them
Assumptions about DBT Clients
Aim to find balance
Move away from extremes into common ground
Focus on balancing validation and problem solving
role of a DBT therapist
Solve the problem
Feel better about the problem
Tolerate the problem
Stay Miserable
Problem solving options
Improve behavioral control and skills (focus on safety)
Safe expression of emotion
Increase self-respect
Resolve feelings of incompleteness
Stages of DBT
Skills training group
Individual therapy/treatment
Phone coaching
Consultation team
Components of comprehensive DBT
Skill modules of DBT include
Mindfulness
Emotional regulation
Distress tolerance
Interpersonal effectiveness
STOP
- Stop, Take a break, observe, proceed mindfully
TIPP
- Temperature, intense exercise, paced breathing, paired muscle relaxation
Distress tolerance strategies
Describe interpersonal effectiveness strategies
DEARMAN
- Describe, express, assert, reinforce, mindful, appear, negotiate
GIVE
- Be gentle, act interested, validate, use easy manner
FAST
- Be fair, no apologies, stick to values, be truthful
Therapists must target the most harmful behaviour then move on to focusing on reasons for session attendance
targeting DBT
Vulnerability
Prompting event
Links
Behaviour
Consequences
Chain analysis steps
Devils advocate
Use of metaphors
Make lemonade out of lemons
Dialectical strategies
Irreverence
Reciprocal communication
communication strategies in DBT
Consultation to the client
Environmental intervention
Consultation team
three components of case management
anything that overwhelms a persons capacity to cope and is time limited
Crisis
Is the employment of a variety of direct and action-orientated approaches to help individuals find resources within themselves and/or externally deal with a crisis
Crisis counselling
Restoration of psychological balance
Aim to cope with the immediate difficulty
More direct approach on part of the counsellor
Crisis interventions objectives
Help person cope effectively with the crisis situation and return to their usual level of functioning
Decrease anxiety
Teach crisis-management techniques
Crisis intervention goals
Listen
Assessment
Develop an action plan
Termination
Steps for crisis intervention
Start by being non-directive
Be collaborative by working together on a joint plan
Be directive if the person does not or will not make a plan
Developing a crisis action plan
Identify risk factors
Assessment of mood symptoms
Explore suicidal ideation
Explore suicidal plan
Determine intent
Assess clients level of self control
Develop a plan to keep the client safe
steps of a suicide assessment
Psychache (subjective mental pain)
Perturbation (sense of tension, anxiety)
Adamance
Assessing risk and lethality psychiatric nurses look at these
Helplessness, hopelessness, lethality, impulsivity, resignation and acceptance of suicide equation, ideation, substance use, primary psychiatric disorder, lethality of plan
Things that contribute to a high risk suicide scale
Stoicism
Adaptability and coping capacity
Alternative solution seeking
Spirituality
Supports
Protective factors against suicide
Results from event or events that is experienced or witnessed by an individual as physically, emotionally harmful or life threatening that has lasting adverse effects on the individuals functioning
Individual trauma
Unexpected
Person was unprepared
Person could not do anything to stop it
Common elements of individual trauma
Avoid discussing trauma
ask for to much detail
Minimize the aspect of trauma has had on persons life
Conduct trauma therapy if not trained
Trauma informed clinicians must not
Make sure the nurse acknowledges that what happened to the client was ____ but the client themselves are not ______
Bad and not bad
Safety
Trustworthiness and transparency
Peer support
Collaboration and mutuality
Empowerment, voice and choice
Cultural historical and gender issues
Key principles of a trauma-informed approach
Is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain, fear, and terror that trauma survivors have endured.
vicarious trauma
Instances when client doesnt report a history of childhood trauma (could be due to no memory, embarrassment, or shame)
Mandatory reporting requirements may affect relationship/honesty
Impact that the work has on the workers themselves
Three challenges that clinicians face working with clients with histories of childhood trauma
The unconscious experience in which the clinician projects emotions or previous experiences onto the client
Countertransference
Code of Ethics: Provide ____, competent and ethical practice
Safe
Code of Ethics: Respect for _______________ and right of choice and dignity of persons
Inherent worth
Code of Ethics: Health, ____________ and wellbeing
Mental health
Code of Ethics: ___________ Practice
Quality
A harmful or potentially harmful act that transgresses from the psychiatric nurses typical role or actions
Boundary violation
Responsiveness
Self involving self-disclosure
Personal disclosure
Warmth
Genuiness
5 Reciprocal Communication Strategies
Demanding Child, ruled by the pleasure principle and is unconsciousness
id
Traffic cop, ruled by reality principle and is conscious
ego
judge, ruled by moral principle and aims to suppress desires of ID and try to make the ego act more rationally
superego
Repression/denial
Reaction Formation
Projection
Displacement
Rationalization
Sublimation
Regression
Introjection
Identification
Compensation
Defense mechanisms
involves doing a behaviour to escape a negative stimulus
Negative reinforcement
is withholding reinforcement from a previously reinforced event
Extinction
is adding a negative stimulus after a behaviour
Positive punishment
is removing a reinforcing stimuli after a behaviour
Negative punishment
Intense prolonged exposure to an imagined life event
Imaginal flooding
Paraphrasing and reflection of what is not verbalized
Complex Reflection
reflecting back what the client said in an amplified (positive) manner
Amplified reflection
Used to determine ambivalence. Recognize the sustained behaviour talk and the change talk
Double-sided reflection
