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157 Cards in this Set

  • Front
  • Back
What is milieu therapy?
Manipulating the environment to improve psychological health and functioning.

Like in-patient rehab
What are the levels of psychotherapy?
1. Supportive - therapist reinforces existing coping mechanisms.

2. Re-educative therapy - client involves learning new ways of perceiving and behaving.

3. Reconstructive therapy - emotional and cognitive restructuring of self...pt gains greater understanding of self and others, more emotional freedom, and the development of potential abilities.
What is Skinnerian conditioning?
Operant conditioning. Rewards/consequences. Pt is Active agent.
What is Pavlonian conditioning?
Classical conditioning. Pt is passive agent. Puff of air and tone cause blinking. Pretty soon tone causes a blink.
What kind of therapy does the therapist help to change the way the pt thinks?
Cognitive therapy
What are the stages of group development?
1. Initial stage - group roles are established.

2. Working stage - conflict and cooperation surface and members do the problem solving

3. Termination stage - members feelings are explored regarding their accomplishments and impending termination of the goup.
What is psychoanalytical goup psychotherapy?
Therapist holds main position, each pt has relationship with therapist, communication focuses on the unconscious, semiconscious, and conscious info.
What are Freud's 3 ego states?
Id - focuses on pleasure/natural desires

Ego - understands other people have needs. Tries to meet the demands of the id while having consideration for others. Mediates superego and id.

Superego - conscience.
What is compensation?
Defense mechanism where a person puts forth extra effort to achieve in areas where one has a real or imagined deficiency.
What is conversion?
Expression of emotional conflicts through physical symptoms.

Ex. You see a murder and then go blind.
What is denial?
Disowning consciously intolerable thoughts and impulses.

Ex. Denying physician's dx of cancer and seeking a 2nd opinion.
What is displacement?
Taking out impulses on a less threatening target.

Ex. Slamming a door instead of hitting a person
What is dissociation?
Dissociation is when a person loses track of time and/or person, and instead finds another representation of their self in order to continue in the moment.
What is fantasy?
gratification by imaginary achievements and wishful thinking.
What is fixation?
Never advancing to the next level of emotional development and organization; persistence in later life of interests and behavior patterns appropriate to an earlier age.
What is identification?
Unconscious attempt to change one-self to resemble an admired person.
What is insulation?
Withdrawing into passivity and becoming inaccessible so as to avoid further threatening situations.
What is intellectualization?
Situations dealt with at cognitive level. Reasoning to avoid feelings.

Ex. Focusing on the details of the funeral rather than the grief.
What is introjection?
Type of identification in which the individual incorporates the traits or values of another into himself.
What is isolation?
Person blocks feelings associated with an unpleasant experience.
What is projection?
Transferring one's internal feelins, thoughts, and unacceptable ideas and traits to someone else.
What is rationalization?
Attempt to make unacceptable feelings and behaviors acceptable by justifying the behavior.
What is reaction formation?
Developing conscious attitudes and behaviors and acting out behaviors opposite to what one really feels.

Ex. You hate your boss, so you are overly kind to show publicly how much you don't like him.
What is regression?
Returning to an earlier developmental stage to express an impulse to deal with reality.

Ex. Teen starts bedwetting. Adult under stress refuses to get out of bed.
What is repression?
Unconscious process in which the pt blocks undesirable and unacceptable thoughts from conscious expression.
What is sublimation?
Replacement of an unacceptable need, attitude, or emotion with one more socially acceptable.

Ex. Person exercises instead of acts out on sexual impulses that are undesirable. CHANNELING ENERGY ELSEWHERE
What is substitution?
Replacement of a valued unacceptable object with one more acceptable to the ego.
What is suppression?
CONSCIOUS forgetting of unacceptable or painful thoughts, ideas, and feelings

Repression is unconscious.
What is symbolization?
Conscious use of an idea or object to represent another actual event or object; often meaning is unclear b/c it may represent something unconscious.
What is undoing?
Doing the opposite of a previous unacceptable behavior, thought, or feeling trying to make up for it.

(Hurt your spouse, then spend next hour praising them.)
What is projection?
Transferring one's internal feelins, thoughts, and unacceptable ideas and traits to someone else.
What is rationalization?
Attempt to make unacceptable feelings and behaviors acceptable by justifying the behavior.
What is reaction formation?
Developing conscious attitudes and behaviors and acting out behaviors opposite to what one really feels.

Ex. You hate your boss, so you are overly kind to show publicly how much you don't like him.
What is regression?
Returning to an earlier developmental stage to express an impulse to deal with reality.

Ex. Teen starts bedwetting. Adult under stress refuses to get out of bed.
What is repression?
Unconscious process in which the pt blocks undesirable and unacceptable thoughts from conscious expression.
What is sublimation?
Replacement of an unacceptable need, attitude, or emotion with one more socially acceptable.

Ex. Person exercises instead of acts out on sexual impulses that are undesirable. CHANNELING ENERGY ELSEWHERE
What is substitution?
Replacement of a valued unacceptable object with one more acceptable to the ego.
What is suppression?
CONSCIOUS forgetting of unacceptable or painful thoughts, ideas, and feelings

Repression is unconscious.
What is symbolization?
Conscious use of an idea or object to represent another actual event or object; often meaning is unclear b/c it may represent something unconscious.
What is undoing?
Doing the opposite of a previous unacceptable behavior, thought, or feeling trying to make up for it.

(Hurt your spouse, then spend next hour praising them.)
What is Rogerian therapy?
FEELINGS. Help members of a group express and clarify feelings.
What is Gestalt therapy?
"Here and now". Awareness of problems in the here and now allows the client to change them.
What is interpersonal group therapy?
Promoting the individual's comfort with others in the goup, which then transfers to outside relationships.
What does cognitive therapy do?
Examine how a pts thoughts and feelings contribute to the difficulties.
What does cognitive mean?
Perception
What is another term for milieu therapy?
Therapeutic community

Focuses on a living, learning, or working environment.
What is the term for a subjective experience that includes feelings of apprehension, uneasiness, uncertainty, or dread?
Anxiety
What is chronic anxiety?
Anxiety that persists as a characteristic response to daily activies.
What are the levels of anxiety?:
Mild - can be motivating and produce growth

Moderate - Learning and problem solving can still occur, but the perceptual field is narrowed.

Severe - Feeling that something bad is about to happen, focus is on minute or scattered details, behavior aimed at relieving the anxiety, individual needs direction to focus.

Panic - Dread, terror, sense of impending doom, disorganized personality, increased motor activity, loss of rational thoughts, can lead to exhaustion and death
What is the first thing you do when a client is experiencing anxiety?
Provide a calm environment, decrease environmental stimuli
What interventions do you take for an anxious client?
FIRST DECREASE ENVIRONMENTAL STIMULI

Help client identify the source of anxiety.
Promote relaxation techniques such as breathing exercises or guided imagery.
Monitor vitals, administer antianxiety meds.
Use a low-pitched voice.
Provide clear, simple statements.
Provide gross motor activity.
How do you assist a client having a panic attack?
Remain with them, attend to physical symptoms, assist identification of the thoughts that aroused the anxiety and identify the basis for these thoughts, assist changing the unrealistic thoughts to more realistic thoughts by cognitive restructuring, administer antianxiety meds.
What are the symptoms of PTSD?
Emotional numbness, detachment, depression, anxiety, sleep disturbances/nightmares, flashbacks, hypervigilance, guilt about surviving the event, poor concentration and avoidance of activities that trigger the memory of the event.
What interventions can be taken for a client with PTSD?
Be nonjudmental and supportive.

Assure pt the feelings/behaviors are normal.

Assist pt to recognize association b/w feelings/behaviors and the trauma experience.

Encourage expression of feelings.

Assist development of coping mechanisms and relaxation techniques.

Encourage support groups.

Facilitate progressive review of trauma experience.

Encourage re-establishment of relationships.

Inform pt that hypnotherapy or systematic desensitization may be used as tx.
3 Parts of PTSD
Remembering - nightmares, flashbacks

Avoiding - detachment

Arousal - easily startled (jump at loud noises), insomnia, hypervigilance
What is acrophobia?
Fear of heights
What is agoraphobia?
Fear of open spaces
What is astraphobia?
Fear of electrical storms
What is claustrophobia?
Fear of closed spaces
What is hematophobia?
Fear of blood
What is hydrophobia?
Fear of water
What is monophobia?
Fear of being alone
What is mysophobia?
Fear of dirt or germs
What is nyctophobia?
Fear of darkness
What is pyrophobia?
Fear of fires
What is social phobia?
Fear of situations in which one might be embarrassed or criticized; fear of making a fool of oneself.
What is xenophobia?
Fear of strangers
What is zoophobia?
Fear of animals
What are the nursing interventions for a person experiencing anxiety due to a phobia?
Stay with the client, promote safety and security. Never force the client to have contact with the phobic object or situation.


Relaxation techniques, desensitization therapy, talk about the anxiety producing object frequently (1st step in desensitization)
What is an obsession?

What is a compulsion?
Obsession - persistently intrusive thought

Compulsion - ritual designed to prevent some event, divert unacceptable thoughts, decrease anxiety.
What are the interventions for OCD?
Ensure basic needs are met.

Identify the situations that precipitate the compulsive behavior; encourage client to verbalize concerns and feelings.

Be empathetic toward client and aware of his need to perform the compulsive behavior.

Do not interrupt the compulsive behavior unless they jeopardize the safety of the client or others.

Allow time for client to perform the compulsive behavior, but set limits on behviors that interfere with client's physical well being.

Implment a schedule that distracts from the behaviors (activities, games, tasks)

Establish written contract with client to decrease the frequency of the compulsive behaviors gradually.

Recognize and reinforce positive nonritualistic behaviors.
What are the somatoform disorders?
Conversion disorder, hypochondriasis, somatization disorder

persistent worry or complaints regarding physical illness without supportive physical findings.

Pt may unconsciously use somatization for secondary gain such as increased attention and decreased responsibilities
What is conversion disorder and what are the symptoms?
Physical symtoms suggested loss or altered body functions related to psychological conflict.

Most common blindness, deafness, paralysis, inability to talk.

No organic cause.

La belle indifference - unconcerned with symptoms

May have to do with guilt, anxiety, inadequacy, unexpressed anger, secondary gain
What is hypochondriasis?
Preoccupation with having a serious disease when no evidence of physical illness exists. Significantly impairs social functioning.

anxiety, difficulty expressing feelings, preoccupation with physical functioning, extensive use of home remedies or nonprescription meds are all symptoms
What is somatization disorder?
Pt has multiple physical complatins involving numerous body systems.

Complains of pain, denies emotional problems, signs of anxiety, fear, low self esteem, may unconsciously be using it for 2ndary gain.
What are the interventions for pts with somatoform disorders?
Assist cliet to relate feelings and conflicts to physical symptoms.

Convey understanding that it is real for the client.

Assure pt physical illness has been ruled out.

Assess and report new physical complaints.

Encourage relaxation techniques, treat the pain.

Antianxiety meds, diversional activities.

ALLOW SPECIFIC TIME PERIOD FOR PT TO DICUSS PHYSICAL COMPLAINTS BC THE PT WILL FEEL LESS THREATENED IF THIS BEHAVIOR IS LIMITED RATHER THAN STOPPED COMPLETELY. AVOID GIVING POSITIVE REINFORCEMENT.
What is dissociative disorder?
Disruption in integrative functions of memory, consciousness, or identity. Associated with exposure to an extremely traumatic event.
What is dissociative identity disorder?
Multiple personalities.

Host is primary personality, the others are referred to as alters.

Has to do with stress or trauma, is sudden, is a method of distancing and defending one's self from anxiety and traumatic experiences.
What is dissociative amnesia?
Inability to recall important personal information b/c it provokes anxiety.

Localized - blockage of all memories in a specified period.

Selective - client recalls some memories for time period

Generalized - client has loss of all memory about past life
What is dissociative fugue?
Client assumes a new identity in a new environment.

Pt drifts from place to place, develops few social relationships, when fugue lifts, pt returns home and is unable to recall the fugue state.
What are the interventions for dissociative disorders?
Psychotherapy, orientation, nondemanding simple routines, stress reduction, explore coping methods, identify sources of conflict
What is catatonic posturing?
Holding bizarre postures for long periods
What is anergia?
Inability to initiate activity

Associated with schizophrennia
What is circumstantiality?
Before getting to the point or answering a question, client gets caught up in countless details and explanations
What is confabulation?
Filling a memory gap with detailed fantasy
What is flight of ideas?
Constant flow of topics in rapid succession, connection b/w topics exists, but it is difficult to see. Seen in mania.
What is looseness of association?
Haphazard, illogical, and confused thinking and interrupted connections in thought

seen in schizophrenia
What is a neologism?
Client makes up words that have meaning only for the individual, often part of a delusional system
What is thought blocking?
Sudden cessation of a thought in the middle of the sentence. Sudden new thoughts come up unrelated to the topic.
What is word salad?
Mixture of words and phrases that has no meaning
What is echolalia?
Repeating speech of another person
What is echopraxia?
Repeating movements of another person
What is waxy flexibility?
Having one's arms or legs placed in a certain position and holding that same position for hours.
What is a delusion?
False belief held to be true even when there is evidence to the contrary.
What is a delusion of grandeur?
False belief that one is a powerful and important person.
What is a delusion of jealousy?
Flase belief that one's partner or mate is going out with other persons.
What is a delusion of persecution?
Thought that one is being singled out for by harm by others.
What interventions do you take for delusions?
Ask client to describe the delusion.

Focus conversation on reality-based topics, rather than on the delusion.

Encourage expression of feelings that the delusions generate.

If client obsesses on the delusion, set firm limits on the amount of time for talking about the delusion.

Do not argue with client or try to convince them the delusion is not real.

Validate if part of the delusion is real.
What is an illusion?
misinterpretation or misperception of reality
What are the positive symptoms of schizophrenia?
Hallucinations, delusions, disorganizationized speech, bizarre behavior
What are the negative symptoms of schizophrenia?
blunted affect, poverty of thought (alogia), loss of motivation (avolition), inability to experience pleasure or joy (anhedonia)
What are the cognitive symptoms of schizophrenia?
Inattention, easily distracted, impaired memory, poor problem solving skills, poor decision making skills, illogical thinking,impaired judgement
What are the depressive symptoms of schizophrenia?
dysphoria, suicidality, hopelessness
What interventions do you take for a hallucinating client?
Ask directly about hallucination, avoid reacting to hallucination as if it's real, decrease stimuli, do not negate experience, focus on reality-based topics, engage pt attention through concrete activity, avoid touching client, monitor for signs of increasing anxiety or agitation
What is delirium?
ACUTE confusion
What are the interventions for schizophrenia?
Set limits on behavior.
Maintain safe environment.
Initiate one-on-one interaction and progress to small groups as tolerated.
Avoid touching client.
Limit the time of interaction with client.
Avoid an overly warm approach; a neutral approach is less threatening.
Brief, frequent contact.
Do not "go along" with delusions or hallucinations.
Provide simple activities like puzzles or word games.
Initially, do not offer choices to client. Gradually assist client in making his or her own decisions.
Use canned or packaged food, especially with a paranoid schizophrenic.
Provide radio at night for insomnia.
Decrease stimuli.
Assist alternative means of expressing feelings, such as music or art therapy, or writing.
What are the interventions for active hallucinations?
Assess content.
One-on-one contact.
Decrease stimuli.
Respond verbally to anything real client talks about.
Avoid touching the client.
Encourage expression of feelings.
Attempt to engage client's attention through a concrete activity.
Safety is first priority - ensure there is no auditory command telling him to harm self or others.
Administer meds.
What do you NEVER do in front of a paranoid pt?
Whisper or laugh
What are interventions for paranoid disorders?
Avoid direct eye contact.
Remain calm, nonthreatening, and nonjudgmental.
Ackowledge pt's feelings, but tell them you do not share his interpretation of an event.
Provide daily schedule of activity.
Diversionary activitieks.
Gradually introduce lpt to groups.
Involve client in noncopetitive taks.
Limit physical contact.
Monitor for agitation, decrease stimuli
What are the cluster A personality disorders?
The odd, eccentric types - schizoid, schizotypal, and paranoid.
What is schizoid personality disorder?
Inability to form warm, close social relationships.

Lack of interest in others.
What is schizotypal personality disorder?
Displays abnormal or highly unusual thoughts, perceptions and throughts

Suspicious, paranoid, magical thinking, odd thinking and speech, relationship defecits
What is paranoid personality disorder?
Suspiciopus, distrusting, argumentative, hostile, aloof, rigid, critical, controlling of others, thouhts of grandiosity.
What are the cluster B personality disorders?
The over-emotional, erratic types - histrionic, narcissistic, antisocial, and borderline
What is histrionic personality disorder?
Overly dramatic and intensely expressive behavior, poor interpersonal relations, appears theatriccal, overly concerned with appearance, easily bored, enjoys being the center of attention.
What are the characteristics of anti-social personality disorder?
Perceives world as hostile
Superficial charm and hostility
No shame or guilt
Self-centered
Unreliable
Easily bored
Poor work hx
Inability to tolerate frustration
Poor judgment
Impulsive
What are the cluster C personality disorders?
anxious, fearful types of personality disorders - OCD, avoidant, dependent personality disorders
What are the interventions for personality disorders?
Maintain safety against self-destructive behaviors.

Allow choices, encourage independance.

Identify splitting behavior (seeing things as all good or all bad)

Written safety or behavioral contract.

Encourage journaling, group participation, nonmanipulative behavior.

Set limits on manipulative behavior and remove pt from group situations when attention seeking behavior occurs.
What is agnosia?
Inability to recognize familiar objects despite intact sensory function.

Symptom of Alzheimer's
What are the interventions for personality disorders?
Maintain safety against self-destructive behaviors.

Allow choices, encourage independance.

Identify splitting behavior (seeing things as all good or all bad)

Written safety or behavioral contract.

Encourage journaling, group participation, nonmanipulative behavior.

Set limits on manipulative behavior and remove pt from group situations when attention seeking behavior occurs.
What is amnesia?
Loss of memory caused by brain degeneration

Symptom of Alzheimer's
What is agnosia?
Inability to recognize familiar objects despite intact sensory function.

Symptom of Alzheimer's
What is aphasia?
Language disturbance in understanding and expressing spoken words.

Symptom of Alzheimer's
What is amnesia?
Loss of memory caused by brain degeneration

Symptom of Alzheimer's
What is apraxia?
Inability to perform motor activities, despite intact motor function

Symptom of Alzheimer's
What is aphasia?
Language disturbance in understanding and expressing spoken words.

Symptom of Alzheimer's
What is the priority intervention with Alzheimer's pts?
SAFETY
What is apraxia?
Inability to perform motor activities, despite intact motor function

Symptom of Alzheimer's
What are the interventions for Alzheimer's pts?
Reinforce retained skills

Orient pt to environment and furnish with familiar possessions

Remind client how to perform self-care

Provide exercise

Avoid activities that tax memory

Provide mental stimulation and distraction - tv, radio, coloring, simple games/activities
What is the priority intervention with Alzheimer's pts?
SAFETY
How do you communicate with an Alzheimer's pt?
Firm, low pitched voice standing directly in front of the client, maintaining eye contact. Short words/simple sentences. Repeat questions, do not rephrase.
What are the interventions for Alzheimer's pts?
Reinforce retained skills

Orient pt to environment and furnish with familiar possessions

Remind client how to perform self-care

Provide exercise

Avoid activities that tax memory

Provide mental stimulation and distraction - tv, radio, coloring, simple games/activities
What med do you avoid with Alzheimer's pts?
Hypnotics. They increase the sundown effect.
How do you communicate with an Alzheimer's pt?
Firm, low pitched voice standing directly in front of the client, maintaining eye contact. Short words/simple sentences. Repeat questions, do not rephrase.
What is it called when a person likes to inflict pain for sexual gratification?
Sadism
What med do you avoid with Alzheimer's pts?
Hypnotics. They increase the sundown effect.
What is it called when a person likes to inflict pain for sexual gratification?
Sadism
What is it called when a person likes to receive pain for sexual gratification?
Masochism
What is frotteurism?
Sexual arousal when rubbing against a nonconsenting person
What are the interventions for alterations in sexual behavior?
Assess sexual hx for trauma, abuse, and precipitating events.

Encourage exploration of client's personal beliefs.

Be nonjudgmental.

Provide supportive psychotherapy.
What is general adaptation syndrome?
Alarm reaction, resistance, exhaustion
What is a diathesis?
Costitutional predisposition to a disorder

When diathesis is combined with environmental factors, abnormal behavior results.
What is the concept of object relations about?
Freud's concept.

Person has a love object in childhood (usually mom). As the apron strings are cut, this relationship influences other relationships. Child imitates love object as a child (mom) and then becomes like her in adulthood.

This is why sometimes the abused becomes the abusers.
What is transference? Countertransference?
Transference - displacement of thoughts, feelings, and behaviors originally associated with significant others from childhood onto a person in a current therapeutic relationhip.

Countertransference - therapist's feelings to pt
How did Adler affect psychology?
Believed motivating force was inferiority.
What did Carl Jung create?
Analytical psychology.

Extroversion vs Introversion

Personna (what a person appears to be to others as opposed to what they really are) replaced idea of ego and superego
How did Karen Horney affect psychology?
Rejected penis envy and oedipal complex.

Said women are like they are b/c of ACTUAL environmental factors (no right to vote, no econmonic independence, etc).
What did Carl Rodgers contribute to psychology?
The concept of empathy
Describe Maslow's hierarchy of needs
1. Physiologic/survival (air, water, food, sex)
2. Safety and security (shelter, predictable environment)
3. Love/belonging (affection and acceptance from family/friends, enduring intamacy)
4. Esteem (self worth)
5. Self actualization
What is Albert Bandura social cognitive theory?
Monkey see, monkey do.

We learn what we see.

Ex Violence on tv = more aggressive children
Describe Erikson's stages -

Trust vs Mistrust
Birth - 18months

If needs are regularly met, infant learns the world is dependable and reliable.

If needs are not regularly met, infant learns world is undependable and dangerous.
Describe Erikson's stages -

Autonomy vs Shame and Doubt
2 stage.

18mo-3years

If parents let child explore and encourage self-sufficiency, a sense of autonomy develops.

If parents are overly protective or critical, child feels they can't handle problems and are reluctant to accept new challenges.
Describe Erikson's stages -

Initiative vs Guilt
3rd stage

3-6years (Preschool)

Child needs to be able to accomplish tasks. If they are encouraged, they develop initiative. If they are dismissed as silly or they undertake tasks too difficult, they develop guilt and shame about needs.
Describe Erikson's stages -

Industry vs Inferiority
4th stage

Age 6-12

"How can I be good?"
Children need to be praised for accomplishments. If they are ridiculed, they develop a sense of inferiority (lack of motivation/self esteem)
Describe Erikson's stages -

Identity vs Role Confusion
5th stage

12-19years old

Who am I? Where am I going?
Describe Erikson's stages -

Intimacy vs Isolation
6th stage

Young adults (20-40years)

Spend life together or alone? Get married?
Describe Erikson's stages -

Generativity vs Stagnation
7th stage

Middle adulthood (40-65years)

Produce something of lasting value. Contribute to society.