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110 Cards in this Set
- Front
- Back
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Freud
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id, ego, superego : defense mechanisms are an unconscious means to reduce anxiety.
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Erikson
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psychosocial - trust, autonomy, … integrity.
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Piaget
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cognitive development.
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Maslow
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hierarchy of needs.
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Kohlberg
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moral development.
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Short-term psychodynamic therapy
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client - must be well-organized
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Short-term psychodynamic therapy
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focused - rapid assessment ; limited sessions ; concrete goals
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Short-term psychodynamic therapy
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goals - decrease severe s/s ; present-oriented ; treatment - not cure!
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transference
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the tendancy of clients to to relate to thier therapist in ways reflecting thier own past experiences
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Rational-Emotive Therapy
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A = activating event - person , circumstance
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Rational-Emotive Therapy
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B = belief system - rB = rational belief ; iB = irrational belief
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Rational-Emotive Therapy
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C = consequence - emotional , bx
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Rational-Emotive Therapy
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D = dispute iB’s ; support rB’s.
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Cognitive Therapy
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monitor self-talk
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Cognitive Therapy
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see link between thought, mood, and bx
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Cognitive Therapy
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compare automatic thoughts with reality
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Cognitive Therapy
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change negative beliefs that distort experiences.
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Behavioral Therapy
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modeling and operant conditioning
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Behavioral Therapy
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self-control therapy
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Behavioral Therapy
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systematic desensitization
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Behavioral Therapy
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aversion therapy.
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Milieu Therapy
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groups
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Milieu Therapy
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social interaction
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Milieu Therapy
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goal-setting
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Milieu Therapy
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modeling with brief therapy
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Factors in Therapeutic Relationship
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genuineness
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Factors in Therapeutic Relationship
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empathy
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Factors in Therapeutic Relationship
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positive regard - attitude , actions , attending , suspending value judgments
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Factors in Therapeutic Relationship
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help develop resources.
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narcissism
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elevating RN by focusing on client’s negative attributes at the cost of supporting positive attributes.
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Transference
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unconscious & inappropriate displacement of emotion / bx from the past to a present relationship
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Transference
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intensified in authority relationships
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Transference
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may manifest as : desire for affection/respect; hostility; jealousy; competitiveness; love
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Countertransference
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therapist displaces “old” feelings onto client
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Countertransference
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may be evoked when client has transference to RN
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Countertransference
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can be a strong + or - reaction to client
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Countertransference
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overidentification with client - difficulty R/T client’s problem - because it’s closely R/T RN’s problem, power struggles, competition with client, arguing with client
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Preorientation
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identifying RN’s fears, concerns, attitudes -for example :, safety, insecurity of communication skills, vulnerabilities R/T personal experiences/crises.
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Orientation
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establish trust, set the purpose , goals, contract - client’s responsibility and participation - RN is doing something with the client not for the client (vs med-surg), confidentiality, termination - date; follow-up.
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Working
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maintain therapeutic relationship, increase data, increase client’s problem-solving skills, self-esteem, use of language, assist with bx changes, overcome resistance, evaluate problems & goals, practice alternative adaptive bx.
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Termination
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symptom relief, increase functioning, more adaptive bx, goals met OR --, unable to progress.
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Testing bx’s
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change focus from client to RN, use RN as caretaker, sexual advances, late for meetings.
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Impediments to communication
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emotions, language skills ( e.g., vocabulary ), knowledge level, cultural differences, physical factors - noise, room temperature, privacy.
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Verbal communication
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beliefs & values, perceptions, meanings, convey interest/understanding or convey insult/judgment, convey message clearly or convey conflicting or implied messages, convey clear, honest feelings OR disguised,distorted feelings.
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Nonverbal communication
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Positive Communication: restating
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repeating the main idea & repetition of the same key words the client used
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Positive Communication: reflecting
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question or observation that assists client to increase understanding of thoughts/feelings
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Positive Communication: paraphrasing
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say the message in a simple, precise way - check with client if this was the message.
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Positive Communication:
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exploring - “ Tell me more … … …”
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Positive Communication:
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silence - time to reflect ; may encourage client to open up.
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Negative Communication:
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giving approval - client may try to please RN rather than focus on self ; also - things that are not approved are seen as “bad”
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Negative Communication:
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advising - interferes with client’s ability to make own decisions ; may send message that RN sees client as incapable of making good decisions
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Negative Communication:
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“why” questions - implies criticism ; seen as intrusive and judgmental ; makes client defensive.
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Groups:
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increase knowledge & information ( e.g., AA - s/s of ETOHism ), instills hope
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Groups: altruism
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members value themselves more as they learn they can help others, resolve family of origin conflicts
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Groups:
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increase socializing skills, role-modeling.
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Groups:
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cohesiveness - “ we “ instead of “I.”
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Groups: catharsis
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the expression of feelings, positive or negative, in a safe setting.
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Anxiety
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strong sense of dread, increased P , R ,B/P (autonomic nervous system ), may have no specific source or reason for emotions.
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Mild Anxiety
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tension of day-to-day life, alert perceptual field, motivates learning to cope with new factors.
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Moderate Anxiety
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focus on immediate concerns, narrowing of perceptual field, selective inattention.
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Severe Anxiety
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focus on specific detail, perceptual field greatly reduced.
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P A N I C ! !! !!!
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sense of awe, dread, and/or terror, loss of control, personality disorganization.
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Immature defense mechanisms:Passive - aggressive
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indirect / unassertive aggression, masked resentment / hostility, behavioral signs -- procrastination / stubbornness.
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situational crisis
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( e.g., accident, job loss, illness)
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maturational crisis
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(adolescent, mid-life )
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cultural crisis
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(refugees )
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community crisis
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( natural disasters).
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Generalized Anxiety Disorder
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excessive anxiety / dread, s/s are out of proportion to any real threat, present more days than not over 6 months, multi-focused, difficult to control, significant distress/impairment in functioning, 3 or more s/s : restlessness ; easily fatigued ; difficulty concentrating ; irritability ; muscle tension ; sleep disturbance, 4-7% incidence rate over lifetime.
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Panic Disorder
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discrete episodes of intense anxiety with abrupt onset, peak in about 10 minutes, 4 or more of the following s/s : increased P; palpitations; diaphoresis; trembling; SOB; sensation of choking; CP; N; dizziness; fear of losing control; fear of dying; numbness/tingling; chills or hot flushes; sense of altered reality; strong wish to run away/escape situation, reduced residual anxiety between attacks but anticipatory anxiety can develop.
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PD - Cluster C - Dependent PD
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submissive, clinging, difficulty with decisions without excessive advice, needs others to assume responsibility for major life areas, difficulty expressing disagreement, uncomfortable/helpless when alone, urgently seeks relationships as source of nurturance and support.
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PD - Cluster C - Obsessive - Compulsive D/O
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preoccupied with details; perfectionism interferes with task completion, excessive devotion to work, overconscientious R/T morals, ethics, unable to discard worn-out or worthless objects, rigid, stubborn.
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PD - Cluster C - Passive-Aggressive D/O
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PD NOS in DSM, pervasive negativity, passive resistance to social/job demands, procrastination, stubbornness, intentional inefficiency.
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Hallmarks of Personality D/O
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lack of ability to implement changes, deeply ingrained, inflexible responses to anxiety, cause others extreme agitation, coping strategies are maladaptive - especially in interpersonal context, approaches are self-centered (work/social), patterns persist throughout life, blame others for problems.
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PD - Cluster B - Borderline PD
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frantic efforts to avoid real or imagined abandonment, pattern of unstable relationships, unstable sense of self, self-damaging impulsivity ($, sex, substance abuse, driving), recurrent suicidal ideation/attempts; self-mutilation, chronic feelings of emptiness, inappropriate anger, black/white thinking, difficult to treat; attempt to split staff when inpatient.
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Histrionic PD
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uncomfortable if not the center of attention, inappropriate sexually seductive or provocative bx, rapid emotional shifts (labile), uses physical appearance to draw attention to self, exaggerated expression of emotion.
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Narcissistic PD
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grandiose sense of self-importance, fantasies of unlimited success, power, fame, believes self to be unique and special, requires admiration, sense of entitlement, interpersonally exploitive, arrogant; lacks empathy.
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PD - Cluster C - Avoidant PD
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unwilling to get involved with people unless certain to be liked, restrained in intimate relationships - fear of shame/ridicule, feelings of inadequac, reluctant to take personal risks.
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Somatization disorder
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multiple physical complaints without an apparent physiological cause, .13% incidence, tends to occur in families (secondary gain?).
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Hypochondriasis
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preoccupied with fear of having a serious disease based on misinterpretation of symptoms, fear is unallayed by diagnostic tests or doctors’ reassurances.
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Conversion Disorder
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formerly known as “hysteria”, symptoms unexplained by any medical/neurological condition, symptoms can be : seizures, paralysis, loss of touch/pain sensation, blindness, deafness, hallucinations.
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Somatization disorder
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multiple physical complaints without an apparent physiological cause, .13% incidence, tends to occur in families (secondary gain?).
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Hypochondriasis
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preoccupied with fear of having a serious disease based on misinterpretation of symptoms, fear is unallayed by diagnostic tests or doctors’ reassurances.
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Conversion Disorder
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formerly known as “hysteria”, symptoms unexplained by any medical/neurological condition, symptoms can be : seizures, paralysis, loss of touch/pain sensation, blindness, deafness, hallucinations.
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Dissociative disorders
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persistent/recurring feeling of being detached from one’s mental processes or body but with intact reality testing
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dissociative amnesia
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- can’t remember personal information, NOT ordinary forgetfulness; memories of certain things may be intact
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dissociative fugue
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- travel away from home, inability to remember identity (all/part)
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dissociative identity D/O
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2 or more distinct identities that switch control between them.
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Therapeutic tools: cognitive restructuring -
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Identify negative thought, be more realistic, use calming, positive thought
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Therapeutic tools:relaxation training -
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Progressive Muscle Relaxation
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Therapeutic tools:modeling
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- demonstrate that anxiety is not equated with the situation
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Therapeutic tools:systematic desensitization -
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“baby steps”
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Therapeutic tools: flooding
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“thrown into the pool”
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Therapeutic tools: response prevention
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slowly cut down the number of episodes and length of episodes
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Therapeutic tools: thought-stopping
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“rubber band.”
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Factitious Disorder
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physical or psychological symptoms intentionally produced to gain attention from potential caregivers, AKA Munchausen’s Syndrome, complex interweaving of truths and falsehoods, not the same as malingering, which has an objective goal (e.g., avoiding work).
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Domestic Violence - risk factors
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physical problems - health, housing, diet, financial - unemployment, poverty, debt burden, emotional, substance abuse, chronic physical / mental illness, overwhelming caregiving responsibilities.
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Child -- s/s physical abuse
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bruises/welts, various stages of healing - may show the shape of object used, human bite marks, burns - hands (dorsal); scalding (glove-like burn), fractures - spiral of upper extremities, skull, jaw, nose - X-ray shows healing or healed fx without hx of tx; multiple fx, malnutrition, lacerations, abrasions, shaken-baby - whiplash, retinal hemorrhage, repeated “accidental” injuries, chunks of hair missing.
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Child - s/s neglect
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malnourished, hungry, poor hygiene, dirty, tired, clothes dirty, inappropriate for weather, lacking medical/dental/eye care, unsupervised for extended times.
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Child’s Behavior of physical abuse
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school absences, or comes in very early or late ; hangs around after school, demanding, unpleasant, causes trouble, disobedient, OR is shy, withdrawn, wary of adults, may be anxious to please, substance abuse, story of injury not believable.
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Munchausen syndrome by proxy
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often undetected by health care providers, difficult to diagnose and treat, parent invents or induces child’s illness/symptoms, then seeks medical attention, s/s not easily seen in child, only by parental report, parents appear to be very caring, 10% of victims die each year.
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rape
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leaves emotional scars that can impede interpersonal and intimate relationships forever.
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Panic d/o - Pharmacology
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Tricyclic antidepressants, clomipramine (Anafranil), imipramine (Tofranil), desipramine (Norpramin), amitryptyline (Elavil), clonidine (Catapres)
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Obsessive-compulsive d/o - meds
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Antidepressants: clomipramine ( Anafranil) { TCA }, fluvoxamine (Luvox) {SSRI}, fluoxetine (Prozac) {SSRI}
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Anxiety d/o - Psychopharmacology
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-pams, Benzodiazepines, lorazepam (Ativan), diazepam (Valium ), alprazolam (Xanax ), chlordiazepoxide (Librium), clonazepam (Klonopin), temazepam (Restoril )
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Anxiety d/o - other anxiolytics
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buspirone (Buspar), hydroxyzine HCl (Atarax, Quiess), hydroxyzine pamoate (Vistaril), propranalol (Inderal)
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Paranoid PD
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- distrustful;suspicious; suspect others are exploiting, harming, or deceiving them; reluctance to confide in others; bear grudges
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Schizoid PD
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- pervasive pattern of detachment from social relationships; restricted range of emotions (“cold”); no desire for close relationships; solitary activities
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Schizotypal PD
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- acute discomfort in relationships; cognitive/perceptual distortions; eccentric bx; ideas of reference; magical thinking.
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Antisocial PD
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- pervasive pattern of disregard for rights of others; repeated acts that are grounds for arrest; lying & conning others; assaults; lack of remorse, having hurt another.
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