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152 Cards in this Set
- Front
- Back
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"id, ego, superego : defense mechanisms are an unconscious means to reduce anxiety."
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Freud
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"psychosocial - trust, autonomy, … integrity."
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Erikson
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cognitive development.
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Piaget
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hierarchy of needs.
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Maslow
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moral development.
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Kohlberg
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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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Short-term psychodynamic therapy
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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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transference
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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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Rational-Emotive Therapy
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role playing
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Cognitive Therapy
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teach patients to monitor their negative thoughts
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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, to identify their dysfunctional belief systems"
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Cognitive Therapy
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"This teaches patients to identify negative thoughts, be more realistic and use positive calming thoughts"
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Cognitive Restructuring
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change negative beliefs that distort experiences.
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Cognitive 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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Behavioral 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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Milieu Therapy
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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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Factors in Therapeutic Relationship
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elevating RN by focusing on client’s negative attributes at the cost of supporting positive attributes.
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narcissism
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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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Transference
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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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Countertransference
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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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Preorientation
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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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Orientation
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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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Working
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" symptom relief, increase functioning, more adaptive bx, goals met OR --, unable to progress."
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Termination
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"change focus from client to RN, use RN as caretaker, sexual advances, late for meetings."
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Testing bx’s
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"emotions, language skills ( e.g., vocabulary ), knowledge level, cultural differences, physical factors - noise, room temperature, privacy."
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Impediments to 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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Verbal communication
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Nonverbal communication
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repeating the main idea & repetition of the same key words the client used
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Positive Communication: restating
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question or observation that assists client to increase understanding of thoughts/feelings
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Positive Communication: reflecting
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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: paraphrasing
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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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Positive 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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Negative Communication:
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"increase knowledge & information ( e.g., AA - s/s of ETOHism ), instills hope"
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Groups:
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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: altruism
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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:
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" the expression of feelings, positive or negative, in a safe setting."
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Groups: catharsis
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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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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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Mild Anxiety
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"focus on immediate concerns, narrowing of perceptual field, selective inattention."
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Moderate Anxiety
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"focus on specific detail, perceptual field greatly reduced."
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Severe Anxiety
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"sense of awe, dread, and/or terror, loss of control, personality disorganization."
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P A N I C ! !! !!!
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" indirect / unassertive aggression, masked resentment / hostility, behavioral signs -- procrastination / stubbornness."
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Immature defense mechanisms:Passive - aggressive
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"any event posing threat or challenge. ( e.g., accident, job loss, illness)"
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situational crisis
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"– stage in life where adjustment & adaptation to new responsibilities & life patterns are necessary (adolescent, mid-life )"
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maturational crisis
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culture shock in process of adapting/adjusting to a new culture or returning to original culture after assimilation into another. (refugees )
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cultural crisis
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"– affects entire community – natural disasters, armed conflict, social ills ( natural disasters increased crime, crack houses moving into neighborhood)."
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community crisis
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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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Generalized Anxiety 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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Panic Disorder
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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 - Dependent PD
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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 - Obsessive - Compulsive 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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PD - Cluster C - Passive-Aggressive 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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Hallmarks of Personality D/O
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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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Paranoid 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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Schizoid PD
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- acute discomfort in relationships; cognitive/perceptual distortions; eccentric bx; ideas of reference; magical thinking.
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Schizotypal 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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Antisocial 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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PD - Cluster B - Borderline 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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Histrionic 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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Narcissistic 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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PD - Cluster C - Avoidant PD
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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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Somatization disorder
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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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Hypochondriasis
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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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Conversion 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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Somatization disorder
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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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Hypochondriasis
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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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Conversion Disorder
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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 disorders
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"- can’t remember personal information, NOT ordinary forgetfulness; memories of certain things may be intact"
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dissociative amnesia
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"- travel away from home, inability to remember identity (all/part)"
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dissociative fugue
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2 or more distinct identities that switch control between them.
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dissociative identity D/O
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" Identify negative thought, be more realistic, use calming, positive thought"
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Therapeutic tools: cognitive restructuring -
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Progressive Muscle Relaxation
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Therapeutic tools:relaxation training -
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performing positive behaviors so the patients can see
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Therapeutic tools:modeling
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“baby steps”
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Therapeutic tools:systematic desensitization -
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"saturate with anxiety-producing stimulus, not allow escape, thrown into the pool"
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Therapeutic tools: flooding
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slowly cut down the number of episodes and length of episodes
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Therapeutic tools: response prevention
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“rubber band.”
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Therapeutic tools: thought-stopping
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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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Factitious Disorder
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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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Domestic Violence - risk factors
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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 physical abuse
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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/s neglect
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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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Child’s Behavior of physical abuse
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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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Munchausen syndrome by proxy
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leaves emotional scars that can impede interpersonal and intimate relationships forever.
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rape
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"Tricyclic antidepressants, clomipramine (Anafranil), imipramine (Tofranil), desipramine (Norpramin), amitryptyline (Elavil), clonidine (Catapres) "
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Panic d/o - Pharmacology
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" Antidepressants: clomipramine ( Anafranil) { TCA }, fluvoxamine (Luvox) {SSRI}, fluoxetine (Prozac) {SSRI}"
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Obsessive-compulsive d/o - meds
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#NAME?
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Anxiety d/o - Psychopharmacology
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" buspirone (Buspar), hydroxyzine HCl (Atarax, Quiess), hydroxyzine pamoate (Vistaril), propranalol (Inderal)"
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Anxiety d/o - other anxiolytics
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This type of personality does not do well in group therapy
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Borderline Personality Disorders
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This type of personality tends to focus groups on them selves
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Borderline Personality Disorders
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This type of personality tends to split groups
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Borderline Personality Disorders
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This is the best predictor of future behavior
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Past behavior
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emotional conflict leads to indirect/unassertive aggression
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Passive-aggressive
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"inability to open up to feelings, acts instead to decrease the pressure of emotion (temporarily)."
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Acting out – verbal or physical
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protects the conscious self from an unbearable situation & allows time to absorb fact of incident and work on feelings.
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Dissociation
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"- attribute negative qualities in others, self, or accomplishments (“sour grapes”)"
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devaluation
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- exaggerate positive qualities in others ® disappointment in the other ® devaluation of object of affection – vicious cycle repeated.
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Idealization
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can’t see that positive & negative make up the whole person – either self or others. Particularly so in BPD. Black or white thinking. (For me totally or against me totally).
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Splitting
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"- unconscious rejection of unacceptable features of self, then attributes same to others – blaming, scape-goating."
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Projection
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- ignore unpleasantness; failure to deal with the situation or feelings leads to increased problems.
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denial
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"unpleasant feeling of tension and apprehension, with physiological, psychological, and behavioral symptoms."
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Anxiety
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"intrusive, recurrent, persistent thoughts, images, impulses."
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obsessions
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"– bx or mental act that seem purposeful but are performed in a repetitive, stereotypical way (e.g., handwashing, cleaning, checking, counting)."
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compulsions
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"occurs after a frightening event (accident, crime, battle, natural disaster)."
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PTSD
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"marked by low self-esteem, poor job performance, irresponsible parenting, no respect for norms, poor relationships, extreme impulsivity. Doesn’t learn from punishment, can be socially extroverted (using others – charming), irresponsible with money. 2-3% incidence; 4-7 times male than female. Due to lack of empathy, PD has no restraints on bx that harm others - society requires these restraints."
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Antisocial PD
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"Fear of abandonment plus fear of engulfment; fear the loss of boundary between self & other – leads to a “push-pull” relationships. Defense mechanism = projection. Chronic free-floating anxiety – can never count on having a good day. Poor reality testing. Require firm limit-setting, structure. Poor prognosis. Splitting - see people as either good or bad; unable to see person as a blend of positive & negative traits; can switch attitude towards person quickly. Incidence rates – 2-4%, 4-7 times female than male; 15-25% of inpts have some degree"
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Borderline Personality Disorders
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This is the best time to give benzo's (-pams)
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Mild Anxiety
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"This is the best time for a 1 to 1 session, in terms of anxiety"
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Mild Anxiety
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Anxiety that has an abrupt onset and peaks in ten minutes
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Panic Disorder
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.5-2 mg
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lorazepam dosage
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These people need others to assume responsibility for major issues in their lives
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dependant personalities
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This focuses on changing irrational thoughts
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RET
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This is the incomplete differentiation between the self and the world
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"Egocentrism, or egocentric"
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"This is tendancy to percieve, understand, and interperet the world in terms of self"
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"Egocentrism, or egocentric"
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"This type of person cannot ""put themselves in anyones shoes"""
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"Egocentrism, or egocentric"
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"This type of person believes that what they see is what everyone sees, or what they see is better"
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"Egocentrism, or egocentric"
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You must taper these to avoid grand mal seizures
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Benzo's
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"Rapid onset, more frequent doses"
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Ativan
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"slower onset, lasts longer, allows fewer doses"
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Librium
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Munchausen's mothers are usually this as well
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Borderline Personality Disorders
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"Smooth muscle relaxer, also used in spinal surgery"
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Valium
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This is also used for seizures
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Clonipin
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"This is for sleep, not anxiety"
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Restiral
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This drugs are used particularly in the elderly
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Buspar and Xanax
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This is also used to induce urinary retention
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TCA's
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This is used to detox from heroin and can cause postural hypotension
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Clonidine
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"These types of people are NOS, and perform intentional ineffeciency"
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Passive-aggressive
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