Treatment, Counseling, and Referral Flashcards
4 treatment modalities
- Detox,
- Inpatient (residential treatment programs,)
- intensive outpatient, 4. outpatient
What is the function of treatment plans?
To give each counseling session focus, direction, and purpose.
What should the goals of a treatment plan be?
SMART (Specific, Measurable, Attainable, Relevant, and Time-based)
What are the three levels of awareness in Sigmund Freud’s psychoanalytic theory?
- Conscious
- Preconscious
- Unconscious
What is the Oedipus/Electra Complex?
At four or five, a child falls in love with the parent of the opposite sex and feels hostility towards the parent of the same sex.
Defense Mechanisms
Unconscious or conscious actions or thoughts that protect the ego from anxiety.
Freudian Slips
Overt actions with unconscious meanings.
Free association
A method to discover the contents of the unconscious by associating words with other words or emotions.
Transference
When feelings, attitudes, or wishes linked with a significant figure in one’s early life are projected onto others in one’s current life.
Countertransference
When the feelings and attitudes of the therapist are inappropriately projected on the patient.
Resistance
Anything that prohibits a person from retrieving info from the unconscious.
Fixation
Someone bogged down in one stage of development.
Freud’s Stages of Development
Oral, Anal, Phallic, Latent, Genital
Freud’s personality structure.
Id (pleasure), ego (reality principle), superego (evaluates and judges behavior)
Freudian Defense Mechanism: Compensation
Protection against feelings of inferiority stemming from real or imagined personal defects or weaknesses.
Freudian Defense Mechanism: Conversion
Psychic pain felt in parts of the body
Freudian Defense Mechanism: Denial
Avoidance of some painful aspect of reality
Freudian Defense Mechanism: Displacement
Investing repressed feelings in a substitute object.
Freudian Defense Mechanism: Association
Altruism
Freudian Defense Mechanism: Identification
Becoming like another person in one or more respects.
Freudian Defense Mechanism: Identification with the Aggressor
Transforming from the threatened person into the one making the threat.
Freudian Defense Mechanism: Introjection
Absorbing an idea or image so it becomes part of oneself.
Freudian Defense Mechanism: Inversion
Turning against the self.
Freudian Defense Mechanism: Isolation of Affect
Separation of ideas from the feelings originally associated with them
Freudian Defense Mechanism: Projection
Ascribing a painful idea or impulse to the external world.
Freudian Defense Mechanism: rationalization
Effort to give a logical explanation for painful, unconscious material to avoid guilt and shame.
Freudian Defense Mechanism: Reaction Formation
Replacing in conscious awareness a painful idea or feeling with it’s opposite.
Freudian Defense Mechanism: Regression
Withdrawal to an earlier phase of psychosexual development.
Freudian Defense Mechanism: Repression
Obliterating material from conscious awareness.
Freudian Defense Mechanism: Reversal
Type of reaction formation aimed at protection from painful thoughts or feelings.
Freudian Defense Mechanism: Splitting
Seeing external objects as either all good or all bad.
Freudian Defense Mechanism: Sublimation
Redirecting energies of instinctual drives to more positive goals.
Freudian Defense Mechanism: Substitution
Trading one affect for another (rage masks fear)
Freudian Defense Mechanism: Undoing
Performing the opposite of an evil act to cancel it out or balance it.
Adlerian Therapy
Strengths-based therapy based on assumption people desire to connect with others, overcome inferiority, and create a personal style of life.
Four Phases of Adlerian Therapy
- Engagement (establishing a therapeutic alliance)
- Assessment
- Fostering Insight
- Providing reorientation and reinforcement for change.
Gestalt therapy
Fritz Pearls, creative interaction so client can gain an ongoing awareness of what is being sensed, felt, and thought. Integration of the self and world awareness.
Gestalt Boundary Disturbances
- Projection
- Introjection (accepting beliefs/opinions of others w/o question
- Retroflection (turning back on oneself what is meant for someone else)
- Confluence (merging with environment)
- Deflection (interfering with contact).
Gestalt Techniques
- Playing the projection
- making the rounds
- Sentence completion
- Exaggeration
- Empty-chair dialogue
- Dream-world
- Reminiscence
Person-Centered Therapy
Carl Rogers, incongruence results from discrepancy between one’s self-image and ideal self.
Congruence
Inner feelings match outer actions.
Unconditional Positive Regard
Therapist sees patient as person of intrinsic worth.
Empathetic understanding
Being a sensitive listener.
Classical Conditioning Theory
Addicts have conditional response (psychological or physical) associated to the circumstances which drugs and alcohol were involved.
Operant Conditioning Theory
Response of conditioned individual to positive and negative reinforcers.
Social Learning Theory
Bandura, People learn from watching other people.
Contingency Management
Client is rewarded with tokens, gift cards, or positive reinforcers for meeting predetermined target behaviors.
Motivational Interviewing
Strengths-based model that uses behavior therapy techniques to decrease ambivalence by reinforcing and enhancing the client’s motivation to change.
Matrix Model
Combo of behavioral, social, and emotional approaches including support groups, relapse prevention, and psychoeducation.
12-Step Facilitation Therapy
Mutual support groups use social support to promote treatment engagement and abstinence.
Assertiveness Training
Teaches drug-resistance skills and healthy ways for clients to get their needs met.
Cue Exposure
Exposing client’s to triggers that induce cravings while introducing techniques that reduce this reaction.
Counterconditioning
Pairing a negative behavior with an undesirable consequence (ex: disulfram after drinking alcohol).
Rational Emotive Behavior Therapy
Albert Ellis: Irrational thought patterns must be changed to change irrational behavior.
A (activating event), B (beliefs around event) C (consequences), D (dispute irrational thoughts), E (effect of D), F (new feeling)
Cognitive Behavioral Therapy
Beck, emotional distress results from cognitive distortions. Depression results from dysfunctional thoughts about oneself, others, and the future.
Dialectical Behavior Therapy
Individuals with SUD and co-occurring disorders experience childhoods in which emotions were dismissed or minimized. Synthesis of dialectical polarities embedded in acceptance and change.
DBT: Therapeutic Alliance
Creates trust and counteracts negative experiences.
DBT: Radical Acceptance
We can’t change present facts even if we don’t like them.
DBT: Unconditional Positive Regard
Support and acceptance of the person no matter what they say or do.
DBT: Therapeutic Tasks
- Integrate opposing dialects (change and acceptance)
- Foster distress tolerance and acceptance.
- Create substance specific target behaviors.
- Enhance treatment adherence
- Help with emotional regulation.
- Teach assertiveness strategies.
4 Stages of DBT
- Client exhibits harmful behaviors and emotional distress.
- Client makes behavioral changes but remains emotionally inhibited.
- Clients successfully apply coping skills.
- Clients experience belonging and connectedness.
Reality Therapy
Assumes reality is not based on actual events, but on a person’s perception of those events. Helps clients take responsibility for their present feelings, thinking, and behavior. Failure identities to success identities.
Solution-Focused Therapy
Differentiates methods that are effective from those that are not and to identify areas of strengths that can be used in problem-solving. Change is possible, but individual must deal with problems in the real world. Uses questioning.
Types of Questioning in Solution-Focused Therapy
1.pre-session (did anything change from when you made the appt to now?)
2. Miracles
3. Exception
4. Scaling (evaluate problem on 1-10 scale)
5. Coping (how are you managing?)
Brief therapy
Time-sensitive, goal-oriented therapeutic model pioneered by Sigmund Freud.
Transtheoretical model of the stages of change.
Prochaska and Diclemente, based on theoretical models of motivation and behavioral change.
Stages of Change: Precontemplation
Lack total or partial awareness of behaviors requiring change.
Stages of Change: Contemplation
Ind. realize there are behaviors in need of change, but there is a lack of readiness and ambivalence.
Stages of Change: Preparation
Pros outweigh cons and individuals commit to change.
Stages of Change: Action
Ind. begin modifying behaviors.
Stages of Change: Maintenance
Continuation of committed changes
Motivational Interviewing
Evidence-based practice using a person-centered, strengths based approach to reduce ambivalence and evoke lasting change.
OARS
- Open-Ended Questions
- Affirmation
- Reflective Listening
- Summarization
MI: Rolling with Resistance
Strategy used to decrease sustain talk, used in the earlier stages of change.
MI: Flexible pacing
Used to help the counselor stay with the client or jump ahead instead of allowing client to go at their own pace.
MI: Collaboration
Clients are viewed as partners and they work with the counselor to establish treatment goals.
MI:Evoking
Exploring a client’s intrinsic motivation to change. Counselors are encouraged to tip the decisional balance so they can move from contemplation to preparation.
MI: Autonomy
Emphasize the client’s responsibility and capacity for self-direction.
MI: Compassion
Expressing warmth and support as client begins to make positive life changes.
What do general family system theorists believe?
Families marked by chaos and inconsistency attempt to adapt and change in an effort to maintain balance, or homeostasis.
Murray Bowen’s Family Systems Theory
- Role of thinking vs. feeling
- Emotional triangles
- Generationally repeating family issues
- Undifferentiated family ego mass (lack of separateness)
- Emotional cutoff (a way of managing issues with family members)
Assessment in Family Systems Theory includes…
- Dysfunction
- Family hierarchy (who is in charge?)
- Evaluation of boundaries
- How does the symptom function in the family?
Virginia Satir’s Experiential/Humanistic Approach
Role theory concepts (placater and rescuer). Emphasis on individual growth to change behavior and deal with developmental delays.
Satir: Four issues that block family communication
- Placating (pleasing others).
- Blaming (pointing outward when an issue creates stress).
- Irrelevance (displaces problem with other activity)
- Responsible analyzer (being overly reasonable.
Structural Family Therapy
Minuchin, strengthens boundaries when families are enmeshed and increases flexibility when families are too rigid.
Structural Family Therapy:
Joining
Worker’s attempt at greeting and bonding with family.
Structural Family Therapy: Enactment
Enacting the unhealthy family dynamic.
Structural Family Therapy: Boundary Making
Boundaries are needed because conflicts often arise out of confusion about each person’s individual role.
Structural Family Therapy: Mimesis
Therapist mimics positive and negative behavior patterns of different family members.
Strategic Family Therapy
Jay Haley, What payoff is there for the family for allowing a symptom to occur?
-Focuses on problem-focused behavioral change (parental power.)
-Helplessness, incompetence, and illness provide power positions.
Strategic Family Therapy: Circular Communication
Occurs when a behaviorally reinforced feedback loop maintains the family’s homeostasis and dysfunction.
Johnson Model of Intervention
Planful, strategic, and confrontational. Goal is to help person with SUD accept treatment and centers around an intervention team.
Unilateral family Therapy
Based on contingency management, provides family members with support to motivate a family member with SUD to seek treatment. Repairs broken relationships, minimizes conflict and stress, and ensures safety of all family members.
Community Reinforcement Training
Evidence-based practice for AUD that uses psychoeducation to teach families AUD is a disease, not a moral failing.
ARISE Intervention Program
A Relational Intervention Sequence for Engagement, person of concern is substance user, concerned other is a family member. Emphasizes users do not have to hit rock bottom before seeking treatment. Motivates user to seek treatment and comply willingly.
Secular Self-Help Groups
SMART Recovery, Sobriety/Save Ourselves, LifeRing Secular Recovery
Religious Recovery Groups
Celebrate Recovery
AA
Alcoholism is a progressive disease of the mind, body, and spirit. 12 steps outline aspirational principles like honesty, integrity, humility, and willingness.
