Theoretical Models Flashcards
Freud theoretical assumptions
Preconscious: forgotten memories Conscious Unconscious: memories that cannot be brought to consciousness Id: instinctual drives Ego: rational self Superego: perfection principle
Freud Key concepts
Relief behaviors to reduce stress
Ego Defense mechanisms: compensation, denial , displacement, identification, intellectualization, introjection, isolation, projection* , rationalization*, regression**, sublimation **, suppression **, undoing
- primitve/narcissitic
- imature
- ** Neurotic
- *** Mature
Freud goals and techniques
Goals:
Make the unconscious conscious
Strengthen the ego
Techniques:
Interpretation of behaviors and thoughts
Free association
Psychodynamic: emphasis on the past, intrapsychic, transference, working alliance
Address conflicts from the past
Best matched with the client who has mature defenses and some object constancy
Interpersonal Theory (Harry Stack Sullivan) Key Concepts
Anxiety chief disruptive force
Interpersonal security: feelings associated with relief from anxiety
Integration of the: “good me”, “bad me”, “not me”
“not me” develops in response to intense anxiety; denial of feelings is used to relieve anxiety
Treatment of depression & anxiety
Interpersonal Theory: Harry Stack Sullivan
Major themes & Coping strategies
Major themes: Grief Role disputes Role transitions Interpersonal conflicts
Coping Startegies:
Security operations: system of defense against anxiety
Selective inattention: not attending to details that cause anxiety
Dissociation: Putting threatening thoughts out of awareness
** Examine communication patterns; role play; interpersonal communication
Transactional Analysis (Eric Berne) Key concepts
Focuses on past and current decisions
Emphasis on thinking, feelings, and behavior
Ego States: P-A-C; Parent: shoulds/oughts; Adult: objective reasoning; Child: impulses & feelings
Strokes: positive, conditional, unconditional, negative, games, rackets, life scripts
Transactional Analysis (Eric Berne) Therapeutic Strategies
Structural analysis: awareness content and functioning of the PAC ego states
Transactional analysis: description of what people say/do to themselves and others
Family modeling: imagining past situations and role of others in interactions
Analysis of rituals and pastimes: how they structure time
Analysis of games and rackets: understanding transactions with others
Script analysis: life patterns are identified and analyzed
Gestalt Therapy (Frederick Perls) Key Concepts
Individual is responsible for finding his own way in life
Individuals must accept personal responsibility
The now: the past is gone the future is not yet here
Unfinished business: nags at the person until confronted
Avoidance: means to keep from facing unfinished business
Layers of neuroses: Superimposed “growth disorders”
Gestalt Therapy (Frederick Perls) Therapeutic Strategies
Increased awareness of the self: Patient feelings Awareness of the moment Body messages Energy Avoidance Blocks to awareness
Dialectical Behavioral Therapy (Marsha Linehan)
Central tenets
Therapist position is one of guidance in persuasive dialogue leading to a different perceptual view
Change and acceptance
Clients are doing the best they can, getting better is hard work
Therapist is a change agent, compassionate flexibility
Dialectical Behavioral Therapy
Elements
Weekly one hour therapy sessions
Weekly group skills training
Skills coaching by electronic connections
Team consultation for therapist to assure fidelity
Dialectical Behavioral Therapy
General principles
Time is needed to learn and practice
Missing more than one session necessitates a therapy hiatus
Suicide and self-harm behaviors are problems to be resolved
Mindfulness is used to manage emotional escalation
Distress tolerance, emotional regulation, interpersonal effectiveness (communication), and self-management
Boundaries of relationship are made clear
Dialectical Behavior Therapy
Stages
Stage one: Focus is on therapy-engaging and therapy interfering behaviors. Diary cards
Stage two: Focus on non-traumatizing therapies. Regulation of emotions while thinking through the dialectics of emotional mindedness and rational mindedness into “wise mindedness”
Stage three: Skills development to deal with trauma. Exposure therapy
Stage four: Focus on self efficacy move toward termination
DEARMAN: describe, express, assert, reinforce, be mindful, appear confident, and negotiate
Person Centered Therapy (Carl Rogers)
Key Concepts
Client has the potential for becoming aware of problems and means to resolve them
Focus on development of self-direction
Health: congruence of ideal self and real self
Person Centered Therapy (Carl Rogers)
Therapeutic Strategies
- Provide a safe climate conducive to client self-exploration
- Enable client to move toward: openness, greater trust in self, willingness to process, increased spontaneity
- Relationship is of primary importance
Person-centered Therapy (Carl Rogers)
Therapist qualities/techniques
- Genuineness; warmth; accurate empathy; respect; permissiveness; unconditional positive regard
- stresses attitudes of therapist
- active listening and hearing
- reflection on feeling, clarification, and “being there”
MI OARS
- Open-ended questions
- Affirmations
- Reflections
- Summaries
MI DARN-CAT
Preparatory phase: Desire, Ability, Reason, Need
Predictive phase: Commitment, Activation, and Taking Steps
Behavioral Therapy (Pavlov, Skinner, Bandura, Wolpe) Therapeutic Strategies
- Change cognition, affect, and behaviors: alter dysfunctional thinking
- Change self-defeating emotional conflicts
- Abnormal behaviors seen as “problems of living” that need to be adjusted
- Focus is on here and now
- Treatment is individually tailored to each client focused on behaviors
Relational-Emotive Therapy (Albert Ellis)
Key Concepts
- Neurosis is irrational thinking and behavior
- Emotional disturbances are rooted in childhood but continue through re-indoctrination in the now
- The client’s belief system is the cause of emotional problems
- Clients examine validity of certain beliefs
Relational-Emotive Therapy (Albert Ellis)
Strategies
- Eliminate client’s self-defeating outlook on life
- Assist clients to acquire a more tolerant and rational view of life
- Therapist functions as teacher and client as student
- A personal relationship is not essential
- Client gains insights into problems and then practices to change self-defeating behaviors
Cognitive Behavioral Therapy (Aaron Beck)
Key concepts
- Based on personality theory that asserts how one thinks largely determines how one feels and behaves
- The processing of information is crucial for the survival of any organism
- Cognitive distortions created by pathologies like depression and anxiety create a “systematic bias”
Cognitive Behavioral Therapy (Aaron Beck)
Tenets
*Collaborative Empiricism: Therapist and client collaborate to identify and address dysfunctional interpretations
Cognitive Therapy: Each disorder has its own cognitive content requiring differing treatment approaches
* Techniques: Link symptoms, conscious beliefs, and current experiences through talk therapy to alter old patterns
*Primary thinking recognizes the negative and irrational part of the human experience; Secondary thinking views the world in positive and rational terms
Cognitive Behavioral Therapy (Aaron Beck)
CBT approaches to cognitions
- Collaborative guided discovery
- Socratic dialog: Memory, translation, interpretation, application, analysis, synthesis, evaluation
- Downward arrow: If this is true, then what happens
- Labeling cognitive distortions
- Reattribution: Critical examination of one’s role in outcomes
- De-catastrophizing
- Automatic thoughts record
- Thought stopping
- Cognitive restructuring
Cognitive Behavioral Therapy (Aaron Beck)
CBT approaches to behavior
- Assertiveness training
- Contingency management
- Other techniques: bibliotherapy, cinema therapy, guided relaxation, social skills training, psychoeducation
Trauma Informed Care
Key concepts
- Exposure to stressful events are stored dysfunctionally in the brain
- Characteristic symptoms: hyperarousal, avoidance, intrusive thoughts, and dissociation
- Goals of care are safety, developing awareness through mourning, meaning, transcendence, and incorporation of the trauma event into on’e life
- Evidence-based Strategies: CBT and EMDR; goal is “adaptive resolution”
Hidegard Peplau 6 nursing sub-roles
Mother-surrogate: Provide basic needs
Technician: Perform technical aspects of nursing
Manager: Manage environment for health improvement
Socializing agent: Enhance patient’s social life
Health teacher: Educate patient, family, community
Counselor/psychotherapist: assist patients in developing adaptive coping skills
Group Therapy: Yalom’s Therapeutic/Curative Factors
- Principle of Universality: Appreciation for commonality of experience
- Experience hope that problems can be solved
- Education
- Increased self-esteem through helping others
- Correction of maladaptive behaviors; Social skills development
- Role modeling; insight through interaction with others
- Security through a sense of belonging
- Express emotions in a safe environment; catharsis
- Existential factors: find life direction; accept responsibility for quality of life
Group Therapy
- Forming
- Stroming
- Norming
- Performing
- Adjourning
Family Systems Theory (Murray Bowen)
Key Concepts
*Family: interlocking relationships
*Anxiety: Reaction of an emotional unit to perceived threat
*Differentiation of self: individual identity
*Fusion: Ways that people borrow/lend self to another
*Cutoffs: Immature separation of people
*Emotional reactivity: Reactions without separating thoughts and feelings
*Triangles: Building blocks of any emotional system
Use “I think” rather than “I feel” responses
Strategic Family Therapy (Haley & Erickson)
Key concepts
- Families inadvertently develop strategies to solve problems that become problems
- Focus on the expression of dysfunction vs. the history of the problem
- Therapist designs novel strategies for eliminating problematic behaviors
Structural Family Therapy (Minuchin)
Key concepts
- Three elements of family organization: Structure, Subsystems, Boundaries
- Diffuse boundaries (enmeshed): more chaos
- Rigid boundaries (disengaged): less emotional support
Solution Focused
- Focused on finding solutions
- Prisons, schools, legal systems, clinically
- Miracle questions
