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88 Cards in this Set
- Front
- Back
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Freud dreamwork consist of:
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1. condensation
2. displacement 3. symbolic representation 4. secondary revision 5. manifest content 6. latent content 7. after alteration (anxiety, punishment dreams) |
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Based on Kohut conceptualization. what are the two original attempts to restore the dysrupted state of primary narcissistic bliss
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grandiose self
idealized parental image |
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what is Freud definition of narcissism?
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the libidinal investment of the ego or the self
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two examples of primary process thought
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psychosis
dreams |
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what is the primary operating principle within the primary process and secondary process respectively?
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pleasure principle
reality principle |
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what is selfobject?
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the caretaker during childhood that fulfulls the function of meeting psychologically essential selfobjects needs
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what is transmuting internalization
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For KOhut, it is a process of psychological structure foramtion that leads to a gradual replacement of self-objects and their funtions with self and its funtions
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in which psychosexual developmental stage the superego develop?
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latency stage
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in which psychosexual developmental stage gender identity develops?
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phallic stage 3-5 y/o (oedipal complex)
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name primary autonomous ego function
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perception, language, intuition, thinking, comprehension, motility, intelligence, learning,
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name the major ego functions
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judgment
realty testing thought process, control and regulation of instinctual drive defense mechanism object relationspsychological mindness autonomous ego functions synthetic ego funtions (organization,coordinating,generalizying or simplying large amount of data) |
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narcissistic defences
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denial,
distortion projecntion projective identification splitting primitive identification |
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immature defenses
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passive agressivebehavior
projection acting out hypochondriasis schizoid fantasy regression somatization blocking identification introjection |
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neurotic defences
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controlling
displacement rationalization repression reaction formation isolation of affect intellectualization dissociation externalization sexualization inhibition |
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mature defences
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altruism
humour asceticism sublimation supression |
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Erich Fromm (1900–1980): identified five character types that are common in western culture:
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(1) the receptive personality is passive; (2) the exploitative personality is manipulative; (3) the marketing personality is opportunistic and changeable; (4) the hoarding personality saves and stores; and (5) the productive personality is mature and enjoys love and work.
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kohut self object transferences
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grandiose self=mirror trasnference
alter ego self=twinship transference idealied paretnal image= idealizing transference |
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What is anima and animus by Carl Jung?
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anima: man underdevelop femininity
animus: female underdevelop masculinity |
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What are the sense of self stages develop by Daniel Stern?
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Emergency self (0-2m)
core self (2-3 m) subjective self (7-9 m) verbal self (15-18m) |
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Describe Otto Kernberg Borderline personality organization criteria
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1. non specific manifestations of ego weakenss: lack of anxiety tolerance/ lack of impulse control/lack of developed subliminatory channels.
2. shift toward primary process thinking 3. specific defensive operations: splitting/primitive idealization/projective identification/denial/omnipotence and devaluation. 4. pathological internalized object relations. |
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How long may an inmate be left in a court holding cell ?
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12 hours
Title 15; 1006 JB 02-26-11 |
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kohut's dyamic understanding of narcissistic PD
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1. well funtion people who have a vulnerable self-esteem.
2. differentiates them from BPD 3. no definition of NPD inner worlds as emphasis is on internalization of missing functions 4. normal self is developmental arrested 5. view self as nondefensive 6. aggression is secundary to narcissistic injury 7. accepts idealization as normal developmental phase making up for missing psych structure. |
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Kornberg's dynamic understanding of NPD
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1. most are primitive, agressive, arrogant, haughty grandiosity coexisting with shyness.
2. strikingly similar to BPD, just with better ego funtioning. 3. primitive defenses and object relations typical as BPD 4. highly pathological self composed of fusion of the ideal self, the ideal object and the rel self. 5. gransdiose self view as a defensive agains investment or depencdency on others 6. emphasizes in envy and aggresion 6. idealization is view as a dfensive againts envy,rage,devaluation and contempt. |
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Kohut's psychotherapeutic technique working with NPD
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1. views mirror and idealization transference as part of 2 different poles of a bipolar or tripolar self.
2. accets idealization of patient as normal development 3. emphathizes with patient's feelings as an understandable reaction to failures of parents and others 4. accepts patient comments at face value. viewing resistence as healthy psych activity that safeguard the self. 5. looks at the positive side of patients experiences 6. calls attention to patient progress. 7. treatment goal: helping patient to have the ability to identify and seek out appropriate selfobjects. |
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Kornbpsychotherapeutic technique working with NPD
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1. view mirror and idealization aspect of transference related to projection and reintrojection of patient's grandiose self
2. interprets idealization as a defence 3. help patient see his own contributions to problems in relatinship 4. confront and interrupts resistance as defensie maneuvers 5. examine both positive and negative aspect of patient's experiences. 6. focus in envy and how it prevents patient from acknowledging and receiving help. 7. treatment goal:help pt to develop guilt and concern and to integrate idealization and trust with rage and contempt. |
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goal of supportive therapy
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support reality testing
provide ego support maintain or reestablish usual level of funtioning |
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slection criteria for supportive therapy
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healthy pt faced wtih overwhelming crisis
patient with ego deficits |
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technique in supportive therapy
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time as needed.
therapy available and predictable interpetration used to strengthen defenses therapist maintain working, reality based relationship based in support, caring and problem solving suggestion/reinforcement/advice/cognitive restructuring/reality testing and reassurance psychodynamic life narrative medication |
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indication of supportive pscychotherapy
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ego deficits
lack of psychological midedness severe life crisis poor frustration tolerance poor impulse control poor reality testing severely impaired object relations low IQ little capacity for self obervation tenuous ability to form a therapeutic alliance organic based cognitive dysfunction |
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insight oriented (expressive therapy)
indications |
psychological mindedness
strong motivation to undertand ability to regress in the service of the ego tolerance to frustration capacity to think in therm of analogy or metaphor (self-observation) meaningful object relations intact reality testing ability to sustain work refelctive response to a trial of interpretations good impulse control |
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psychotherapeutic interventions from expressive to supportive
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interpretation
confrontation clarification encouragement to elaborate empathic validation advise and praise affirmations |
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According to Marmar what are the 8 common factors to all psychotherapies
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1. good pt-therapist relationship
2. patient's reliease of tension 3. cognitive learning (therapist as a teacher) 4. operational conditioning (implicit or explicit) 5. suggestion/persuasion (overt/covert) 6. identification with therapist = trasnference ( cons or uncons) 7. repeated reality testing 8. emotional support from the therapist. |
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contraindication for psychoanalytic therapy
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>40 y/o ( inflexibility to change)
low intelligence life events that cannot be modified ASPD |
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J meloy 5 clinical featues that contraindicate psychotherapy for ASPD
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violent behv towars others
no remorse for such behavior very superior or mildly retarded intelligence hx of incapacity to form emotional attachements countertrasnference; fear of attack without any celar ppt. |
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what is included in a psychodynamic fprmulation
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descriptive DSM IV dx
interactions among axes I-IV Characteristic of the ego (strengh and weakness/defense mechanism and conflicts/relationship to superego) Quality of object relationships (family relationships. trasnference-contratrasnference patterns/inference about internal obhects relations) characteristics of the self ( self cohesivenees and self-esteem,self continuity, self boundaries, mind-body relation) |
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who spoke about inferiority complex
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Alfred adler
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corrective emotional experiences and specificity hypothesis
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Frans Alexander
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Bion
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projetive identification
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innovator of object relations
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Fairbairn
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self actualization theory
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Abraham Maslow
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treatment principle in short therapy
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1, revrsal of traditional analytic stance of passivity
2. a focus in tx is agreed upon and actively maintained 3. an early establishment of a strong therapeutic alliance 4. a persistance analysis of resistance 5. an early an dvigorous use of transference feelings 6. an emphasis on learning how to solve emotional problems 7. careful attention to the time limit and the process of termination |
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what is abreaction?
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a method of becoming conscious of repressed traumatic events ( a type of catharsis)
def: reliving an experience in order to purge it of its emotional excesses |
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types of group psychotherapy
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behavioral GT
supportive GT analytically oriented GT psychoanalysis of groups transactional GT |
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General inclusion and exclusion criteria fpr group therapy
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inclusion: ability to perform the group task
problems areas compatible with goals of group motivation to change exclusion: marked incompatibility with group norms for aacceptable behavior inability to tolerance group setting severe incompatibility with 1 or more of the members tendency to assume the deviant role |
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therapeutic factors in group psychotherapy
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1. abreaction
2. catharsis 3. consensual validation 4. reality testing 5. identification 6. universalization 7. ventilation 8. empathy 9. trasnference 10. altruism 11. contagion 12. inspiration 13. interaction 14. interpretation 15. insight 16. corrective familiar experience 17. imitation 18. learning 19. cohesion 20. acceptance |
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goals for short therapy inpatient group
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teaching that talking can help
problem spotting engaging patient in therapeutic process alleviate hospital related anxiety decrease isolation allowing patients to be helpful |
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technique for short term inpatient group
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provide support
use a short term frame emphasize the here and now provide structure |
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who originated the genogram?
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Bowen
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models of family therapy
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structural: Minuchin
stratgic; Haley Behavioral social exchange: Liberman psychodynamic: Ackerman Famil sytems: Bowen experiential: Satir |
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Behavior therapy techniques
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1. systematic desensitation
2. flooding 3. graded exposure 4. aversion therapy 5. reinforcer,emts 6. relaxation techniques 7. participant modeling 8. token economics 9. Assertiveness and social skills training |
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terms associated with classical condictioning
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1. unconditioned stimulus (UCS): an enviromental stimulus that may elecit an unconditioned response (UCR) w/o prior learning.
2. UCR: an unlearned response or behavior triggered by specific stimulus 3. Neutral stimulus: stimulus no normally associated with a respond. 4. Conditioned stimulus: a stimulus, which produces a response due to classical conditioning. eg; the bell ( elicit salivation after paired with food) 5. Conditioned response: the response elicited by a CS as a result of conditioning procedure eg. salivation when the bell rings. |
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Classical condition
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naturally occurring stimulus is paired with a response. Then, a previously neutral stimulus is paired with the naturally occurring stimulus. Eventually, the previously neutral stimulus comes to evoke the response without the presence of the naturally occurring stimulus. The two elements are then known as the conditioned stimulus and the conditioned response.
sequence of events occurs regardles of the subject's behavior. |
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Operant conditioning
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Operant conditioning is the use of a behavior's antecedent and/or its consequence to influence the occurrence and form of behavior.
the subject's behavior results in a particular effect (reward or punishement). |
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Terms associated with Operant conditioning
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1. + reinforcement: presenting an stimulus after desired behavior so as to increase the probablity of that behavior reoccuring. eg: child eat supper so gets desert.
2. Negative reinforcement: taking away an aversive stimulus after desired behavior has occured to inceased the probablity of tha behavior reoccurring. eg; child cleans rooms, so parents stop nagging him. 3. Positive punishment: presenting an adversive stimulus after an undesired behavior: child must clean wall after coloring them 4. Neg punishment: taking away a pleasure stimulus in order to reduce an undesirable behavior; eg; child can't play with crayons if he continues to color on the walls. 5. Extintion: behavior ceases to be emitted cus behavior no longer available. |
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schedules of reinforcement
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Continuous reinforcement: learning and extintion occurs most easily with this.
Intermittent schedule: extintion and learning occurs more slowly |
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Types of intemittent Reinforcement:
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Fixed ratio: reinforcement given after a fixed number of resposes.
Variable ratio: reinforc. given after a variable number of responses ( most effective for maintaining behavior) Fixed interval: reinforc occurs after a fixed time interval Variable interval: after a variable time interval: |
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Behavior therapies based on classical conditioning
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systematic desesntitation (SD)
assertiveness training (AT) positive counter conditioning: SD + AT Aversive counter conditioning Flooding: desensitation based on extintion to reduced avoidance behavior through invivo exposure |
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Assertive training
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based on reciprocal inhibition
rationale: if not active assertively can lead to increased anxiety goal: weaken bond btwen anxiety and self expression increase assertive behavior techniques: behavior rehersal,modeling and relaxation training indications: anxiety related to inability to express feeling in personal and social effective ways |
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Aversive counter conditioning
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an unpleasant UCS is repeatedly paired with an undesired behavior in order to creat the CR of avoidance, eliminating the undesired behavior.
indications: alcoholism (antabuse), enuresis, sexual deviancy, cigarette smoking, self injury behavior associated with autism |
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Behavior therapies based on operant conditioning
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1. contingency managment: contingency rpesentation or withdrawal of reinforcement or punishment in order to change behavior eg in AN
2. Contingency contract: defining the consequences of specific behavior 3. Token economy: 4. The premack principle: high positive behavior are positive reinforcer in order to oincrease the likelihood of a low frequency behavior eg. child allowed to watch tV after doing homework 5. Shaping: to elicit target behavior that is unlikely to occur. + reinforcement is applied after bahvior that are increasingly similar to the target behav 7. Implosion: similiar to flooding but us imagery instead of invivo . 8. Time out: from positive reinforcemntet . a form of negative punishment in which undesired behavior is followed by withdrawal of the child from social interaction |
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what is reciprocal inhibition
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refers to the inability to be anxious and relaxed simultaneously
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What is behavior therapy?
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the application of learning theory principles to the alliviation of psychological problems.
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What is cognitive therapy?
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aims to identify coginitive distortions with the goal of replacing them with more helpful cognitions
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what are cognitive distortions?
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when thoughts or judgments are incorrect self defeating and maladaptive causing emotional disturbances.
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Differences between systematic desensitization and systematic rational restructuring?
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the first one is part of behavioral therapy and the second one is cognitive therapy.
systematic rational restructuring set up a hierarchy of feared situations and use role playing or imagery as exposure to be feared scene. use anxiety as cue to maladaptive conditions. identifythoughts when feeling anxious.then cognitive interventions are used to change replace these cognitions. |
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Describe Beck's cognitive triad
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NEgative view of self (worthlessness)
Negative view of the world (demanding/punishing) Negative view of future (expectation of continued failure/suffering |
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Goals of Cognitive Behavior therapy
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identify and challenge negative cognitions
develop alternative/more flexible schema rehearse new cognitive/behavioral responses. |
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cognitive Behavior therapy technique
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collaborative empiricism
structure and directive assigned readigns homework and behavioral techniques identification of irrational beliefs and automatic thoughts identification of attitudes and assumptions underlying negatively biased thoughts |
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Diference between operant and classical conditions:
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Operant conditioning is distinguished from classical conditioning (also called respondent conditioning) in that operant conditioning deals with the modification of "voluntary behavior" or operant behavior. Operant behavior "operates" on the environment and is maintained by its consequences, while classical conditioning deals with the conditioning of reflexive (reflex) behaviors which are elicited by antecedent conditions. Behaviors conditioned via a classical conditioning procedure are not maintained by consequences.
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Evidence for mindfulness in psychiatry
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1. decrease in frequency of panic attacks and avoidance and panic disorder
2. decrease in binge eating disorder 3. decreased in chronic pain 4. decreased in self harm behavior |
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explain transference, when prescribing medications
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1. the decision to comply or not with the doctor's recommendations activates unconscious issues of parental expectations.
2. symbolism of pills (feeling dependent, vulnerable, shut down, punishment, fear of addiction, control, fear of medication induced suicide/homicide) 3. pills may function as a transitional object for some, allowing them to maintain some sense of connectedness with their psychiatrist. 4. Lack of medication response or early response related to attachment pattern with pychiatrist |
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explain Contratransference, when prescribing medications
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1. over-prescriptions is a reflection of the despair of the treating psychiatrist
2. med. can be viewed as a way to deal with countertrasnference anxiety. 3. narcissistic injury, anger, helplessness can lead to difficulties 4. Collusion with the patient re; medication changes or DC/noncompliance can arise |
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explain resistance, when prescribing medications
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1. illness may be preferable to health for many reasons ( 2nd gain, disability)
2. Denial of illness is a common cause of resistance to pharmacotherapy 3. patient who have a relative taking or who took the same medication may identify with that person, leading to resistance, particularly if the relative had an unfavourable outcome. OR he may demand to have a certain medication |
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what is EMDR
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eye movement desensitizationand reprocessing.
imaginal exposure component with elicitation of saccadic eye movements good for PTSD |
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couple therapy interventions
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Behavior marital therapy
cognitive and cognitive behavior marital therapy emotion focused marital therapy |
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Arbitrary inference
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coming to a conclusion without adequate evidence or despite contradictory evidence.
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CBT strategies in SCZ
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engagement: therapeutic alliance is fomed. share explanation of psychological facotrs involved in developing the illness
Assessment: for comorbid conditions that can be target during CBT Develop alternate explanation of sx: use a vulnerability stress model. Focus on specific positive sx. Hallucinations( analize patients beliefs of voices. attempt to normalize them. use of vocie diary, reattribution of cause of voices. coping strategies such as focusing or distracting) Delusions: use of successive questioning to determine underlying belief, then attempt graded realitiy testing and exploring alternatiive explanations. Thought disorder: ask patient to fill the gaps inthough blocking or clarify neologism NEg sx: can use behavioral experiments. work on this after pos sx has been targeted. |
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Bowen family therapy focus in
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family system and intergenerational focusing on differentiation and enmeshment "emotional triangle"
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Structural family therapy by Minuchin focus on
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alliances and split within the family. Establish of hierarchy. Clarity and firmness of boundaries
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Erickson/Haley strategic family therapy focus on
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symotoms maintaining sequences using Paradoxic injunction
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name a mechanism of defense seen in
1.phobia 2.paranoia 3.depression 4.eating disorder 5 dependent personality |
1. phobia: displacement and avoidance
2. paranoia: projection and splitting 3. MDD: turning into self 4.ED:egression 5. Dependent PD:reversal |
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Cognitive techniques in somatization D/O
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1. identification and modification of neg thoughts:
a. mood or body sxx shifts provide an excellent opportuniry to identify neg thoughts. b.guided discovery through inductive questions c. examining the evidence exercise d. reattribution technique e. dysfuntional thought record. 2. Identificationand modification of maladaptive core beliefs: a. identify pattern of thinking through oberving series of neg thoughts. b. pro-con analysis of theses core beliefs c. 4 cell grid including adbantages and disadvantages of having or not having these core beliefs. d. generate alternate core beliefs through rolep lay, imagery, guided discovery and test them out. e. practice revised core beliefs. |
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Behavioral techniques in CBT for somatization disorder
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1. identify and modify maladaptive cognitions:
role play, 2. techniques to change dysfuntional behavior graded exposure schedule exposure problem solving |
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CBT for sleep
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1. Education aboutn ormal sleep
2. stimulus control (instrctions designed to reassociate the bed/bedroom with sleep and to reestablish a consistent sleep-wake schedule. 3. Sleep restiction: a method for limiting time in bed to actual sleep time, thereby creating mild sleep deprivation, which results in more consolidated and more efficient sleep. 4. Relaxation training: Methods aimed at reducing somatic tension or intrusive thoughts interfering with sleep. 5. CT: aimed at changing faulty beliefs an attitudes about sleep and insomnia 6. Sleep hygiene education: general guidlines about health practices and environmental factors that my affect sleep. |
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What is stimulus control in CBT for insomnia?
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The patient and due to the insomnia is no l0nger able to respond to the typical sleep stimuli with drowsiness and sleep but, instead associated these stimuli with wkefulness.
It consist of 5 simple intructions: 1. go to bed only when sleepy 2. use bed or bedroom only for sleeping. 3. get out of bed when unable to sleep 4. arise at the same time every morning. 5. Do not nap during the day. |
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components of a session in CBt for sleep
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1. asserting progress from last week.
2. Reviewing the sleep diary for the past week 3. Ascertaining problems in home practice and level of adherence to treatment. 4. Negotiating plans for better adherence. 5. Launching the new treatment component and explaining its rationale 6. distributing help material |
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Screening tool for Sleep apnea
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Overnight oximetery:
normal if AHI ( apnea hypopnea index) less than 5 per hour of sleep. Note: it isn ot completely necesary to stop sleep meds to do this test, but preferred. If negative and hifh level of suspisciousness for sleep apena do the polysomnography. |
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Polysomnography test and MSLT from Dr Laura Chapman OSCE feedback)
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Polysomnography is an overnight sleep study including sleep measurements
it is usually done before the MLST, which is a daytime sleep study. The patient has nap every 2 hours x 20 mins. Narcolpesy: sleep latency is less than 5 min and there are > 2 sleep onset REM. SLeep apnea: 5- 10 min sleep latency. andn o REM at onset of sleep Hypersomnia: no REM and les than 10 min. usually in hypersomnia they have goodn ight of sleep during polysomnography. |
