Theoretical Models, Therapies, and Nursing Theories Flashcards
Mental processes out of awareness but easily recalled.
Preconscious
Mental processes that are within awareness.
Conscious
Mental processes that are inaccessible but influence behavior and feelings.
Unconscious
Pleasure principle, locus of biological drives/instincts, unconscious.
Id
Reality principle, mediates between Id and Superego.
Ego
Perfection principle, forms conscience by holding social values and more.
Superego
Force or impetus to fulfill basic biologic needs; includes libido and aggression; instinctive and unconscious.
Drive
Strong feelings of worry and dread.
Anxiety
Adaptive and maladaptive behaviors of sleeping, smoking, cursing, fidgeting, drinking, laughing, talking, eating, crying, pacing, nail-biting, daydreaming, exercise, seeking answers.
Relief behaviors for stress/anxiety
Unconscious processes to decrease anxiety; include compensation, denial, displacement, identification, intellectualization, introjection, isolation, projection, rationalization, regression, sublimation, suppression, undoing.
Defense mechanisms
To offer interference with exploring unconscious mental processes.
Resistance
Therapies with an emphasis on past, focus on expression of emotions, identification of patterns and ways to change, working with resistance, considering intrapsychic issues such as dreams and fantasies, emphasis on transference and working alliance. Conflicts from past continue to influence present; goal is to develop alternatives to patterns of managing anxiety.
Psychodynamic psychotherapy
Overachievement in one area to compensate for failure in another area.
Compensation
Refusal to accept reality or facts.
Denial
Satisfying an impulse or relieving anxiety with a substitute object/person. Ex. yelling at coworker after getting yelled at by boss.
Displacement
Minimizing threatening individuals or behaviors by emulating aspects of their behavior, possibly adopting their mannerisms, repeating phrases or language patterns and mirroring character traits.
Identification
Standing back from stressor and evaluating from neutral view.
Intellectualization
Adopting environmental stimuli as own ideas or beliefs (i.e. religion, politics). May also be replicating observed behaviors (sibling-to-sibling, parent-to-child).
Introjection
Separating ideas or feelings from other thoughts (compartmentalizing).
Isolation
Transferring ideas, fears, anxieties onto others. Ex. person afraid of crossing a bridge might accuse friend of a fear of heights in effort to avoid stressor without owning insecurity.
Projection
Explanations or excuses for behavior; minimizing consequences/impact of behavior.
Rationalization
Reverting to behaviors from earlier age/time.
Regression
Transference of negative/destructive anxiety into positive energy/socially-acceptable behaviors. Ex. releasing aggression through organized sports.
Sublimation
Conscious attempt to redirect thinking away from negative or stressful thoughts to other thoughts/feelings. Ex. suppression of feelings/thoughts of attraction toward friend’s spouse.
Suppression
Attempts to rectify behaviors that cause guilt or shame through acts or apologies.
Undoing
Pointing out, explaining, and teaching meaning of behavior manifested in dreams, free associations, resistances, and therapeutic alliance itself.
Interpretation
Patients flow with any feelings and/or thoughts by reporting such things immediately without censorship.
Free association
Interpersonal relationships determine self-esteem, sense of security, and sense of self. Anxiety is disruptive force in interpersonal relations and Interpersonal Security is feelings associated with relief from anxiety/sense of well-being. Difficulty in living comes from inability to satisfy needs to achieve interpersonal security.
Interpersonal theory (Harry Stack Sullivan)
Integration of the “good me”, “bad me”, and “not me”, self-systems which are collections of experiences or security measures to protect against anxiety. Major themes include dealing with grief, role disputes, role transitions, and interpersonal conflicts like an inability to sustain close relationships.
Interpersonal theory (Stack Sullivan)
Develops in response to positive feedback, feelings of pleasure, contentment, and gratification.
Good me (Stack Sullivan)
Develops in response to negative feedback, feelings of anxiety, discomfort, displeasure, and distress.
Bad me (Stack Sullivan)
Develops in response to intense anxiety, feelings or horror, dread, awe, and loathing. Denial of these feelings is used to relieve anxiety, leading to serious implications for disorders in adult life.
Not me (Stack Sullivan)
Measures used to reduce anxiety and enhance security, making up a system of defense against anxiety.
Security operations (Stack Sullivan)
Not attending to meaningful details of one’s own living that might cause anxiety.
Selective inattention
Putting threatening thoughts or feelings out of awareness before triggering overwhelming and intolerable anxiety sets in.
Dissociation - in Stack Sullivan
Focus on past and current decision-making, emphasis on thinking, feelings, and behavioral aspects of personality. Ego states of Parent (shoulds/oughts), Adult (objective processor of data), and Child (feelings/impulses). Goal is to assist patient in making new decisions about present behavior/life, gaining new insight.
Transactional analysis (Eric Berne)
Forms of recognition when one person recognizes another. Positive, conditional, unconditional, negative, games, rackets, life scripts.
Stroke (Berne)
Person becomes aware of content and functioning of the parent, adult, and child ego states.
Structural analysis
Description of what people do, say to themselves, and say to each other.
Transactional analysis (definition)
Imagining past situations and influence of significant others in the interactions.
Family modeling
Identification of rituals and pastimes that are used in structuring time.
Analysis of rituals and pastimes (Berne)
Means for understanding transactions with others (1) and identification/analysis of life patterns (2).
1 - Analysis of games and rackets, 2 - script analysis (Berne)
Individual is responsible for finding own way in life and must accept personal responsibility to achieve mastery. Individual must learn to live in the now, confront unfinished business and process uncomfortable emotions to work through “superimposed growth disorders”.
Gestalt therapy (Frederick Perls)
Existential encounter between people resulting in patient moving toward increased awareness of self with focus on feelings, awareness of moment, body messages, energy, avoidances, and blocks to awareness.
Gestalt strategies
Focus on development of self-direction, health is achieved through congruence of ideal self and real self. Therapist uses an unconditional positive regard, provides safe environment for self-exploration, assists patient in working toward openness, self-trust, willingness, and increased spontaneity. Therapeutic relationship is of primary importance.
Person-centered therapy (Carl Rogers)
Techniques of active listening, positive therapist attitude, reflection on feelings, warmth, empathy, respect, and permissiveness. Does not use diagnostic testing, interpretation, taking history, or questioning/probing for information.
Person-centered therapy
Collaborative, person-centered therapeutic technique to elicit change. Evoking and drawing out patient ideas about change with emphasis on autonomy of patient.
Motivational interviewing (MI)
Helplessness and passive behaviors/self-critical (1), engaging in activities with a “pay-off” (2), and engaging in activities because they are fun/interesting (3).
1 - amotivation, 2 - extrinsic motivation, 3 - intrinsic motivation
OARS of MI (list them)
Open-ended questions, affirmations, reflections, and summaries
Patient statements that reveal motivation for change; clinician guides patient to expression of change.
Change talk
Stages of change model for readiness to change: DARN CAT
Desire, ability, reason, need, commitment, activation, taking steps.
Not currently considering change, lack or readiness; therapist to validate lack of readiness and clarify the decision is theirs, encourage re-evaluation of behavior and self-exploration.
Pre-contemplation
Ambivalent about change but recognition or possible problem; therapist to validate lack of readiness, clarify decision is theirs, encourage evaluation of pros and cons, identify positive outcome expectations.
Contemplation
Trying to change, planning to act within a month; therapist to assist in problem-solving, help identify social support, verify underlying skills to support change.
Preparation
Practicing new behavior for 3-6 months; therapist to restructure cues and social support, bolster self-efficacy, combat feelings of loss.
Action
Continued commitment to new behavior for 6 months to 5 years; therapist to plan for follow-up and reinforce internal rewards.
Maintenance
Resumption of old behaviors; therapist to evaluate trigger for relapse, reassess motivation and barriers, and plan stronger coping strategies.
Relapse
Broad range of procedures with differing theoretical rationales and frameworks bound by 2 principles: understanding human behavior differs fundamentally from traditional psychodynamic model; strong emphasis on scientific method to include overt and testable conceptual framework with measurable outcome.
Behavioral Therapy (Pavlov, Skinner, Bandura, Wolpe)
Direct extension of Skinner’s radical behaviorism. Framework of operant conditioning in which all behavior is a result of its learned consequences.
Applied behavior analysis
Primary principle of classical conditioning, based on research of Pavlov and Guthrie, and uses incremental model of mediating and intervening variables that create consequence and affect behaviors.
Neobehavioristic Mediational Stimulus Response Model (S-R Model)
Behavior is based on three separate but interacting regulatory systems: external stimulus events, external reinforcement, and cognitive mediational processes. (Pavlov’s dog study)
Social Cognitive Theory
Strategies and goals are to change behaviors and affect to learn new coping skills, improve communication, learn to change maladaptive habits, change self-defeating emotional conflicts, focus on here and now, and treatment is individualized.
Behavioral Therapy
Therapeutic techniques include problem identification and assessment, assessment methods to include self-monitoring/record-keeping and observation of patient interactions in natural environment, cognitive restructuring through altering dysfunctional thinking to improve affect and behavior, and assertiveness and social skills training.
Behavioral Therapy
Concepts include belief that irrational thinking and behaviors are rooted in emotional disturbances from childhood and belief systems that cause emotional problems must be examined for validity. Goal is to eliminate self-defeating outlook, acquire more rational view of self and gain insight into problems to practice changing self-defeating behaviors. Therapeutic relationship is teacher-student.
Rational-emotive therapy (Albert Ellis)
Hallmark therapeutic approach most in use today. Asserts that how one thinks is how one feels; cognitive distortions are created by certain pathologies; processing of information is crucial for survival.
Cognitive behavioral therapy (CBT - Aaron Beck)
Therapist and patient create a collaboration to identify dysfunctional interpretations and modify them. Patient is viewed as practical scientist to examine where/when thought distortions have occurred and reformulate more appropriate thought processes.
Collaborative empiricism (CBT)
Core beliefs from earlier adaptations which can be difficult to change and lead to personality disorders.
Schemas (CBT)
Thinking which recognizes the negative and irrational part of the human experience.
Primary cognitive processes (CBT)
Thinking which views the world in positive and rational terms.
Secondary cognitive processes (CBT)
Techniques use gentle guided discovery of distortions, collaboration vs. confrontation, and questioning through Socratic dialogue to uncover automatic thoughts and challenge logic of thoughts. Goal is self-discovery, recognition of dysfunctional cognitions, learning how cognitions contribute to feelings, and changing behaviors/cognitive restructuring “reframing”.
CBT
Structured into 4 elements: weekly 1-hour therapy sessions, weekly group skills training, skills coaching PRN, team consultation for therapist. Central belief that change and acceptance are essential to survive. Patients are doing the best they can and cannot fail, only therapy fails. General principles include: time for learning and practice, firm adherence to predetermined number of sessions, suicide and self-harm indicate treatment failure, mindfulness is used to manage emotions, and clear therapeutic boundaries are established. Useful in treating people with trauma and borderline personality disorder, among others.
Dialectical behavioral therapy (DBT - Linehan)
Techniques include: mindfulness, distress tolerance, emotional regulation, interpersonal effectiveness (communication), self-management, and movement from emotional mindedness to wise mindedness. Practice DEARMAN technique (list mnemonic).
DBT; Describe, Express, Assert, Reinforce, be Mindful, Appear confident, Negotiate
Applying healing process through constructing a new narrative through mourning, meaning, transcendence and incorporation of trauma event into one’s life. Avoidance of language and techniques that retraumatize individuals in treatment.
Trauma-informed care (CBT strategies)
Guide the patient in processing affective, cognitive, or somatic material through bilateral stimulation in form of eye movements, alternating sounds, or alternating taps on hand and knee. Trauma treatment.
EMDR (eye movement desensitization and reprocessing)
Therapy is to solve some focal problem/circumscribed complaint for patient motivated to change. Developed through crisis models of care for veterans but found effective for short-term therapy of crises events.
Brief individual psychotherapy
Therapy which reinforces patient’s healthy and adaptive thought patterns and functional behaviors especially in those moderately to severely impaired and potentially vulnerable to relapse with more aggressive/confrontational approaches.
Supportive psychotherapy
Pretreatment, beginning, middle, end/termination, follow-through
Phases of therapy
Patient identifies goals, describing how therapy can meet goals, expected time frame for resolution.
Pretreatment phase of therapy
Develop rapport and therapeutic alliance, confront resistance and negative transference, identify focus/central issues, set therapeutic limits/boundaries, contract for number of sessions.
Beginning phase of therapy
Working through and increasing awareness, clarifying/redefining focus, confrontation (if applicable), interpretation of resistance (if applicable), monitor progress.
Middle phase of therapy
Extraction of therapist from successful therapeutic alliance. Additional appointments and follow-up may be necessary.
End phase of therapy and follow-through
Patient transfer of thoughts and feelings, positive or negative, onto practitioner.
Transference
Practitioner transfer of thoughts and feelings, positive or negative, onto patient.
Countertransference
Peplau 6 nursing sub-roles
Mother-surrogate (provides basic needs), technician (performs technical aspects of nursing), manager (manages environment for health improvement), socializing agent (enhancing patient social life), health teacher, counselor/psychotherapist (development of coping skills).
Lasts for one or more meetings in which therapist and patient establish each other as distinct persons and establish trust. Relationship parameters are set, immediate issues addressed, communication of goals, contracting, establishing confidentiality, and termination parameters are set.
Orientation phase of therapeutic relationship
Collecting information, applying problem solving skills, enhance self-esteem, support behavior change, work through resistance, help patient develop adaptive coping skills, discuss termination.
Working phase of therapeutic relationship
Occurs when therapeutic goals are met, therapeutic accomplishments are discussed, methods to sustain growth are discussed, feelings regarding termination are discussed and guidelines for further communication are set if needed.
Termination phase of therapeutic relationship
Management of therapeutic environment involving multidisciplinary team which uses structured activities, a safe environment, support and validation to observe interactions among diverse patients and support therapeutic growth.
Therapeutic milieu
Focus is on group relations and interactions. May be used to complete a specific task, educate, develop adaptive coping skills and promote mental health, and provide self-help through resource referrals for patients with specific problems. Eight members is ideal.
Group therapy/group interventions (Yalom)
Commonality of experiences, members see that they are not alone and their problems are not unique.
Universality (Yalom Curative Factors)
Increased self-esteem through helping others
Altruism
Gaining personal insight through interactions with others, sharing of personal experiences.
Catharsis
Leader and members work together to establish rules. Leaders orient members to processes, encourage participation, promote trust. Members may be overly polite and have a fear of not being accepted.
Orientation phase of group therapy
Completion of tasks, problem-solving, decision-making, cooperation with differences, disagreements confronted and resolved. Leaders become more of facilitators and members learn to accept criticism. Subgroups may form and group members primarily manage conflict
Working phase of group therapy
Sense of accomplishment or loss and leaders review goals and outcomes. Members may feel accomplishment or loss.
Termination phase of group therapy
Group therapy in which “actors” (group members) reenact life situation to allow protagonist to confront and resolve issues in safe environment.
Psychodrama
Family is emotional unit of network of interlocking relationships and goals are to focus on family rather than individuals and coach family members to develop a more solid self to stand against anxiety and triangles.
Family Systems Theory (Murray Brown)
Tendency to react without separating thoughts and feelings.
Emotional reactivity (Brown)
Building blocks of any emotional system. Person focuses on different object, idea, or person to manage anxiety between him/her and another person in family. Analyzing allows for increased differentiation of self and decreased emotional reactivity
Triangle (Family Systems Theory - Brown)
Families inadvertently develop strategies to solve problems but the strategies become problems. Focus on current expression of dysfunction versus understanding history or development of problem.
Strategic Family Therapy (Haley and Erickson)
Family is organized structure with interdependent functioning and pervasive automatic expectations of behavior. In different family subgroups, individual members may behave differently. Boundaries form to control levels of interpersonal interactions.
Structural Family Therapy (Minuchin)
Diffuse boundaries within families that create chaos.
Enmeshment
Rigid boundaries within families that create less emotional support
Disengagement
Goals are to challenge maladaptive reactive expectations of behavior, develop generational boundaries, and establish unified views of discipline, responsibilities, and behaviors.
Structural Family Therapy (Minuchin)
Short-term (10-15 sessions) family therapy which integrates attachment theory, person-centered therapy, gestalt therapy, and neuroscience of emotions. Assumes primary emotions are hidden from couple/family and secondary emotions based on fear and anxiety dominate interactions.
Emotionally-focused Family Therapy
Process of change through which individuals improve health and wellness, live a self-directed life, and strive to reach their full potential. Recovery is person-centered (sense of hope and self-determination), exchange-centered (taking on social roles), and community-centered (social connections and community integration).
Recovery Model of Care for Patients
Change from old term of compliance meaning an agreement or commitment to a plan; use of a partnership in treatment planning.
Adherence
