Therapy Flashcards

0
Q

Maudsley model for anorexia

Phase 1

A

Focus on refeeding to reduce risk of death and health damage

Initial family meal with therapist. Parents asked to get child to eat one more mouthful than they want to

Therapist interrupt any parental structure that erode parental authority, inconsistency, relying on siblings

Review shopping

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1
Q

Systematic approach/therapy

A

It sees any social group as a “system”

Each and every person’s behaviour affects others

It looks for:conflict, coalitions, codependency, split

No objective truth, everyone’s interpretation affects their role in the system

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2
Q

Maudsley mode for anorexia

Phase 2

A

Negotiating a new relationship

Shift focus on refeeding to on family relationship

Negotiate to allow adolescent to have responsibility for eating

Peer relationship and sexuality explored in relationship to food

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3
Q

Maudsley model for anorexia

Phase 3

A

Adolescent issues and finish

Continue focus on adolescent social world

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4
Q

Counselling and psychotherapy

A

An interactive client beneficial relationship set up to approach a client issues. These issues can be social, cultural, and emotional. A client can be a person, or a family group, or an institution

Counselling psychology aims to work with clients to examine mental health issue and explore the underlying problems that may have caused them

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5
Q

Clinical psychology

A

Aims to reduce psychological distress and to enhance and promote psychological wellbeing

They deal with mental and physical health problems including anxiety, depression, addition

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6
Q

Carl Rogers therapy

A

Therapist (congruence)
Client (incongruence)

Unconditional positive regard
Empathic understanding of client’s internal world

Therapist use clarification and reflection

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7
Q

Historical perspective of therapy

A
  1. Freudian psychoanalysis (unconscious)
  2. Skinner behaviourism (conditioning)
  3. Rogers person-centred
  4. Cognitive therapy
  5. Beck CBT
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8
Q

3 different schools in NHS

A
  1. Psychoanalytic
  2. Systematic
  3. Cognitive behavioural

4: overall of these 3–person centered therapy

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9
Q

The Dodo effect

A

States that different therapies are all generally equally as effective and cannot be judged in the same way that medical treatment are

It is the therapeutic alliance that is the key to a successful therapy

More than just the content of a therapy is important when considering whether it will work

Key feature;

  • therapist factor (how experienced the therapist are)
  • therapy factor (how the boundary)
  • client factor (what he believes)

== therapy efficacy ( it’s not about which school is better than other)

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10
Q

Evidence based practice

A

Theoretical research –> professional consensus –> clinical guideline + clinical judgement (at the time of therapy) = clinical practise

Practice based evidence = efficacy of use of a certain therapy

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11
Q

Who does therapy

A
Clinical psychology 
Counselling psychologist 
Psychiatrist 
Counsellor 
CBT therapist/ family therapist 
IAPT low intensity therapist 
Mental health workers 
Nurse therapist
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12
Q

Formulation in psychological therapy

A

Explanation of current difficulty accusing go specific psychological theory

  • to help patient understand their difficulties in a psychological way
  • to structure information in a theoretically guided way
  • to provide a working hypothesis to guide psychological intervention
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13
Q

Psychoanalytic psychotherapy

A

Explore of the cause of distress by seeking to understand unconscious process that lead to internal conflict and anxiety

Target: Unconscious process & internal conflict –>anxiety

Therapist interpret client’s internal world in relation to past

Therapist as expert making interpretation on client’s situation

Need to be able to cope with anxiety

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14
Q

Behavioural therapy

A

Identification of problem behaviour and changing environment/ trigger to replace behaviour with healthier one

Has structured sessions

Target: problem behaviour
Therapy: learning theory and animal studies

Analyze problem behaviour and alter behaviour

Good for learning disabilities, depression substance misuse

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15
Q

Cognitive behaviour therapy

A

Identification of thinking patterns that keep problem behaviour going. Testing out new ways of thinking and behaviour to change these cycles

Targets: situation ->thoughts-> feelings-> behaviour

Theory: information processing model: change thinking to change feeling

Structure; structured session toward goals, behavioural experiment and skill learning

Views therapeutic relationship as test ground for new skills and behaviours

Client and therapist as collaborators working toward a common goal

Good for particular identifiable problem

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16
Q

Systematic therapy

A

Understand problem in a context and focus on shifting dynamics in relationships to improve problem

Target: observable interaction within a system

Theory; problem fundamentally interpersonal, not situated in person

Structure; reflecting teams, communication pattern
Looking from another perspective

Often more than one therapist

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17
Q

Person centred therapy

A

Humanists therapy focus on self-development, growth and responsibilities. They seek to help individual recognize their strength, creativity and choice in the “here and now”

Target; person growth rather than pathology

Theory; 3rd wave in psychology development. Emphasis in subjective meaning

Structure: helping people to fulfil their own inherent “self-actualizing tendencies”

See the client as the driving force for change

Good for working toward better quality of life

-dementia

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18
Q

3rd wave cognitive Behavioural therapy

A

Target: thinking process vs thought content (how they think rather than what they think)

Theory: 3rd major development in CBT

Structure; focus on relationship with thoughts vs arguing with content.

Use or exercise, de-centring, mindfulness

Good for working toward better quality of life ( not specific problem focus)

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19
Q

Psychodynamic therapy

A

Allows the client to explore why a difficulty might have developed

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20
Q

Cultural formation approach in acute psychiatry

The difference from exciting DSM IV CF

A

Capture cultural identity in different way

For all ethnic group, not exclusively for minority ethnic group

A clinical interactive use of the CF, narratives from CF interview are circulated both to patient and carers, to the clinical team; and developed further as well as integrated into clinical care

21
Q

Evidence of CF

A

1)cultural formation interviews have some clinical efficacy: improved both assessment and rapport with patients

2) complexity of setting, sample size
3) did not improve outcome or patient satisfaction score

22
Q

What is cultural formulation in acute psychiatry ?

A

An approach that involve a sustained and continuing cultural dialogue between patient and clinician

A method that seeks to enhance therapeutic engagement and enrich clinical assessment for patients of all cultural backgrounds

Aimed at eliciting a structured narrative account of suffering, deploying the metaphor of “culture”

Allows patient an opportunity to systematically narrate their suffering in their own cultural vocabulary

Enable clinician to reflect how their own cultural identity might influence engagement, assessment, diagnosis and treatment

Actualize patient’s concept of culture, not clinician’s assumption of culture

Requires innovation in individual settings to be determined by local context, problem, and desired outcome

23
Q

Cultural formulation is NOT

A

Not a technical fix

Does not yield a score or generate psychometric score

Not a one off interview that can solve the problem of “culture”

Not a diagnostic instrument it a standardized interview to be cloned

Does not replace a diagnosis and treatment plan, but enhances it

Not for exclusive use with Black and Minority Ethnic patient

24
Q

Self management

A

Self-management program can be self guided or supported by a clinician

People are encouraged to become experts in their own recovery in self management program

Self management can be delivered in person, or through written or online material

Self management program often aim to teach problem solving skills

25
Q

Techniques in mindfulness based therapy are based upon a type of;

A

Meditation.

26
Q

Ethics and clinical care

A

1) non-maleficence (doing no harm)
2) autonomy (respecting patients’ right to make decision)
3) beneficence (making sure that we act in the patient’ best interest)
4) justice (being fair in decision about which patients receive which treatment)

27
Q

Communication technique

A

Active listening
Mirroring
Reflecting back
-mirroring the words, paraphrasing

28
Q

Mental state examination (MSE)

A
A&B=appearance and behaviour 
S=speech 
M= mood 
T=thought 
P=perception 
C=cognition 
I=insight
29
Q

History -what to include

A
Medical history
Family history of mental/physical health problem
Current living condition 
Substance use 
Family background
Recent trauma 
Educational background 
Criminal record 
History and current risk of self harm 
Coping strategy 
Expectation and goal of the treatment
30
Q

Diagnosis vs formulation

A

Diagnosis: specific disorder label

Formulation; individual based
Why does this person has this particular problem at this particular time (specific)
Helps trailor intervention to specific individual

31
Q

Behavioural intervention

A
Active scheduling 
Behavioural activation 
Problem solving training 
Assertiveness training 
Sleepy hygiene 
Graded exposure
32
Q

Cognitive intervention

A

Identifying cognition
Distraction/attention retraining
Identifying cognitive bias
Reappraising negative automatic thoughts and images
Developing new perspective
Testing negative automatic thought and images
Modifying unhelpful rule and core beliefs

33
Q

Cognitive bias

A
Black & white thinking 
Catastrophisation 
Over-generalization 
Jumping to conclusions
Emotional reasoning 
Mind reading (assuming you know what other are thinking)
34
Q

Physical intervention

A
Relaxation training 
Controlled breathing 
Physical activity/exercise 
Sleep intervention 
Medication
35
Q

Protocol for CBT 6-12 sessions

A

Session 1-3

  • assessment, formulation, treatment plan
  • begin activity scheduling
  • increase physical activity
  • address bad sleeping pattern

Session 4-6

  • continue monitoring activity scheduling
  • explore and challenge NAT using thoughts record

Session 7-9

  • identify and explore cognitive bias
  • identify and challenge unhelpful rules
  • behavioural experiment

Session 10-12

  • identify and challenge core beliefs
  • relapse prevention
36
Q

What is self-management

A

The individual plays a central role in managing their own care: they become an expert in their own recovery

Develop skills like problem solving, decision making, taking goal oriented action which can be learnt

Less reliant on information-given than psycho-education

37
Q

Common components of mental health self management

A
Recovery principle 
Illness psychoeducation 
Wellness maintenance strategies 
Relapse prevention and crisis planning 
Accessing resource and support
Medication management and psychoeducation 
Goal setting
38
Q

Peer support in mental health

A

A peer is someone who is or was receiving mental health service and self identifies as such

Peer support is social/emotional support mutually offered and provided by people with mental health problem to bring about desired change

A system of giving and receiving help founded on respect, shared responsibilities and mutual agreement of what is helpful

39
Q

Types of peer support

A

Informal peer support

Mutual peer support

Intentional peer support

Peer mental health workers

40
Q

Potential benefit of self management

A

Can be assessed any time, any where
Free
No waiting list
Self-generated idea -increased likelihood of service user complying
Independent of medication -no risk of dependency
Empowerment-taking ownership of techniques and methods
Similarity of condition and expediency-increase empathy
Shared knowledge of receiving service and medication
Level playing field -professional patient boundary diminished
Trust built through self-disclosure
Possibility for promoting culture-change within service

41
Q

Setting up a peer-supported, self management program

A
Funding arrangement 
Employment arrangement 
>interview process 
>recruitment check 
>type of employment 
Management and support. 
>line management 
>supervision 
>relationship with CRT
Providing the intervention consistently 
>training 
>session logs
42
Q

Balanced care model

A

Mixture of service type including hospital beds and spectrum of others

Service close to home, mobile big static

Intervention for disabilities and symptoms

Treatment specifics to diagnosis and needs

Service are coordinated

Service reflect priorities of service users, family and friends

43
Q

Balanced care -steps

A

Step 1) primary care with specialist support (lower resourced counties and regions)

Step 2) general mental health service (middle income)
England in 1950-1990

Step 3) generalized/specialized mental health service (high resource)
England in 2000-

44
Q

IAPT (improving access to psychological therapy)

A

IAPT-stepped care (mainly CBT)

Nearly 1 million per year is treated

Practitioners: one year post-gras certificate, low intensity CBT role

45
Q

Current state of acute mental health care service

A

Acute wards - lack of beds

Crisis team -lack of continuity of care

Crisis house-popular but not clear if it’s an alternative to hospital

Day hospitals/ recovery centre -old fashion and seen as institutional

46
Q

Secondary mental health service

A

Community mental health team

Early intervention 
Psychosis team 
Teams for people with severe non psychotic illness 
Personality disorder team
Assertive outreach 
Rehabilitation 
Perinatal (before after childbirth) 
Liaison -in general hospital 
Forensic 
For kids and LD
47
Q

Mental health nurse

A

Predominantly profession in face to face care in secondary care

Clinical nurse therapist: specialist training in a therapy
Ascended practitioner: manage own caseloads, make complex decision, deliver treatment
Academic nurse: engage in teaching

48
Q

Social worker

A

Generic mental health work (care coordination) with focus on social and families, and on the law.

49
Q

Occupational therapist

A

Work to assess and improving physical & social functioning across range of sessions and care coordinator