Ch 2 Relevant Theories and Therapies – Flashcards

-Freud was known as the "father of psychoanalysis"; revolutionized thinking about mental health disorders with his theory of personality structure, levels of awareness, anxiety, role of defense mechanisms and the stages of psychosexual development -*believed the vast majority of mental disorders were due to unresolved issues that originated in childhood* -

-*"talk therapy"* used by Freud; allows patients to get relief by talking out their previously repressed emotions. Now referred to as *"getting things off our chests"* -evolved to include "free association" which requires full and honest disclosure of thoughts and feelings as they come to mind; -dream alalysis became an essential part bc he believed urges and impulses of unconscious mind were symbolically played out in dreams -he concluded talking about difficult emotional issues had the potential to heal the wounds causing mental illness

- contains all the material a person is *aware of* at any one time, including, perceptions, memories, thoughts, fantasies, and feelings; the "tip of the iceburg"

-just below the surface of awareness; contains material that can be retrieved rather easily through conscious effort

-includes all repressed memories, passions, and unacceptable urges lying deep below the surface; memories and emotions associated with trauma are placed here because they are too difficult to deal with; the unconscious exerts a powerful unseen effect on the conscious thoughts and feelings of the pt -Usually unable to retrieve this material without the assistance of a trained therapist

-at birth we are all ID; the id is the source of all drives, *instincts*, reflexes, needs, genetic inheritance and capacity to respond, as well as the wishes that motivate us; lacks the ability to problem solve, is not logical and *operates according to the pleasure principle*; cannot tolerate frustration and seeks to discharge tension and return to more comfort level of energy, *only needs that count are it's own*; *example*: a hungry, screaming infant

-within the 1st few yrs of life as the child begins to interact, the ego develops; ego is the problem solver and reality tester; able to differentiate subjective experiences, memory images and objective reality; attempts to negotiate with the outside world; *follows the reality principle* which says "you have to delay gratification for right now; example: a hungry man feels tension arising from the id that wants fed, ego allows him to think about the hunger and plan when and where he can eat, this is known as reality testing

-the last portion of the personality to develop; *represents the moral component*. Consists of the *conscience* ("should nots" internalized from parents) and the *ego ideal* ("shoulds" internalized from parents). represents the ideal rather than the real and opposed to seeking pleasure and reason; *Seeks perfection*.

-the three systems of personality--the id, ego, and superego--work together as a team under the *administrative leadership of the ego* -if the id is too powerful, the person lacks control over impulses; if the superego is too powerful, the person is self-critical and suffers from feelings of inferiority

-used to ward off anxiety by preventing conscious awareness of threatening feelings -defense mechs are *developed from the ego* ; *all operate on an unconscious level (except suppression) and they deny, falsify, or distort reality to make it less threatening* -we cannot live without them, but its possible for def mech to distort reality to such a adegree that we exp difficulty with healthy adjustment and personal growth

-Mastery of gratification of oral needs, beginning of ego development; Development of trust in the environment, with the realization that needs can be met. Conflict is weaning; -fixation at this stage assoc with passivity, gullibility, dependence, sarcasm, orally focused habits such as nail biting and smoking

-Beginning of development of a sense of control over instinctual drives; Ability to delay immediate gratification to gain future goals; Control of impulses; Conflict is toilet training. -fixation assoc with anal retentiveness (stingy, rigid thought patterns, OCD) or anal-expulsive character (messiness, destructiveness, cruelty)

-Sexual identity with parent of same sex. Beginning of superego development. Conflict is Oedipus and Electra; -fixation result in reckless, self-assured and narcissistic person; lack of resolution results in inability to love and difficulty with sexual identity

-Growth of ego functions (social, intellectual, mechanical) and the ability to care about and relate to others outside the home; development of skills needed to cope with environment. -fixations result in difficulty identifying with others and dev social skills, leads to inadequacy and inferiority

-Development of satisfying sexual and emotional relationship. Emancipation from parents-planning life goals and sense of personal identity; Ability to be creative and find pleasure in love and work. -fixation inability to negotiate this stage may derail emotional and financial independence, impair personal identity, future goals and disrupt ability to form satisfying intimate relationships

-Feeling that the patient has toward health care workers that were originally held toward significant others in his or her life; when transference occurs, these feelings become available for exploration with the patient and this helps the patient to better understand certain feelings and behaviors.

-Unconscious feelings that the health care worker has towards a patient; exp: if the pt reminds you of someone you don't like, you may unconsciously react as if the pt were that person; Underscores the importance of maintaining self-awareness and seeking supervisory guidance as therapeutic relationships progress.

-was a follower of freud but believed his theory was too restrictive and negative; thought *culture and society* also exert significant influence on personality and it develops throughout the life span -described development as occurring in 8 Stages of Development, with each having 2 possible outcomes

Infancy. Forming attachment to mother, which lays foundations for later trust in others. Trust - Sound basis for relating to other people; trust in people; faith and hope about environment and future Mistrust - General difficulties relating to people effectively; suspicion; trust-fear conflict; fear of future

Early Childhood. Gaining some basic control of self and environment (e.g., toilet training, exploration) Autonomy - Sense of self-control and adequacy; will power Shame and Doubt - Independence/fear conflict; severe feelings of self-doubt

Preschool. Becoming purposeful and directive. Initiative - Ability to initiate one's own activities; sense of purpose Guilt - Aggression/fear conflict; sense of inadequacy or guilt

School age. Developing social, physical, and school skills. Industry - Competence; ability to work Inferiority - Sense of inferiority; difficulty learning and working

Adolescence. Making transition from childhood to adulthood; developing sense of identity. Identity - Sense of personal identity; fidelity Role Confusion - Confusion about who one is; weak sense of self

Early adulthood. Establishing intimate bonds of love and friendship. Intimacy - Ability to love deeply and commit oneself Isolation - Emotional isolation; egocentricity

Middle adulthood. Fulfilling life goals that involve family, career, and society; developing concerns that embrace future generations. Generativity - Ability to give and to care for others Self-absorption - inability to grow as a person

Later years. Looking back over one's life and accepting its meaning. Integrity - Sense of integrity and fulfillment; willingness to face death; wisdom Despair - Dissatisfaction with life; denial of or despair over prospect of death

Follows the psychoanalytic model by using many of the tools of psychoanalysis, such as free association, dream analysis, transference, and countertransference; however, the therapist has increased involvement and interacts with the patient more freely than in traditional psychoanalysis. -The therapy is oriented more to the here and now and makes less of an attempt to reconstruct the developmental origins of conflicts -lasts longer than other therapies, can extend to 20+ sessions; best candidates are the "worried well" -pts w/psychosis, severe depression, bipolar, etc. are not approp candidates for this treatment - supportive therapies are more appropriate for pts with these disorders

-Sullivan focused on interpersonal processes that could be observed in a social framework; he defined personality as behavior that can be observed within interpersonal relationships. -*believed the purpose of all behavior is to get needs met thru interpersonal interactions and decrease or avoid anxiety*; -defined *anxiety* as any painful feeling or emotion arising from social insecurity or prevents biological needs from being satisfied; -coined the term *security operations* to describe measures employed to reduce or avoid anxiety and make up the self-system -very similar to freuds def mech; both are processes we are unaware of and used to reduce anxiety, but sullivans are interpersonal relationship activities that can be observed

Effective *short-term therapy* derived from the school of psychiatry that originated with Adolph Meyer and Harry Stack Sullivan. The assumption is that *psychiatric disorders are influenced by interpersonal interactions and the social context*. The goal of interpersonal psychotherapy is to reduce or eliminate psychiatric symptoms (particularly depression) by improving interpersonal functioning and satisfaction with social relationships.

-Peplau known as the mother of psychiatric nursing -mainly concerned with the *processes by which the nurse helps patients make positive changes in pt health care status and well-being*. She believed that illness offered a unique opportunity for experiential learning, personal growth, and improved coping strategies and that psychiatric nurses play a unique role in facilitating this growth. Nurse provides care, compassion, and advocacy and enhances the patients comfort and well-being.

-hypothesized that the psychic component was a *learned association between two events*. Found that when a neutral stimulus (a bell) was repeatedly paired with another stimulus (food that triggered salivation), eventually the sound of the bell alone could elicit salivation in the dogs.

Personality traits and responses-adaptive and maladaptive-were socially learned through *classical conditioning*. Thought that *controlling the environment could mold behavior* and that anyone could be trained to be anything, from a beggar man to a merchant.

Voluntary behaviors are learned through *consequences*, and behavioral responses are elicited through *reinforcement*, which causes a behavior to occur more frequently.

The presentation of a reward immediately following a behavior, making the behavior more likely to occur in the future.

Increasing the probability of a behavior by *removing unpleasant consequences*

Involves applying a stimulus after a behavior in order to reduce likelihood that the behavior will occur again in the future.

Based on the assumption that *changes in maladaptive behavior can occur without insight into the underlying cause*. This approach works best when it is directed at specific problems and the goals are well defined. *Behavior therapy is effective in treating people with phobias, alcoholism, schizophrenia, and many other conditions.*

The therapist provides a role model for specific identified behaviors, and the patient learns through *imitation*. The therapist may do the modeling, provide another person to model the behaviors, or present a video for the purpose.

Therapy that involves the development of behavior tasks *customized to the patient's specific fears*; these tasks are presented to the patient while using learned relaxation techniques

1.The patient's fear is broken down into its components by *exploring the particular stimulus cues* to which the patient reacts. For example, certain situations may precipitate a phobic reaction, whereas others do not. Crowds at parties may be problematic, whereas similar numbers of people in other settings do not cause the same distress. 2.The *patient is incrementally exposed to the fear*. For example, a patient who has a fear of flying is introduced to short periods of visual presentations of flying—first with still pictures, then with videos, and finally in a busy airport. The situations are confronted while the patient is in a relaxed state. Gradually, over a period of time, exposure is increased until anxiety about or fear of the object or situation has ceased. 3.The patient is instructed in *how to design a hierarchy of fears*. For fear of flying, a patient might develop a set of statements representing the stages of a flight, order the statements from the most fearful to the least fearful, and use relaxation techniques to reach a state of relaxation as they progress through the list. 4.The patient *practices these techniques every day*.

Used widely to *treat behaviors such as alcoholism, sexual deviation, shoplifting, hallucinations, violent and aggressive behavior, and self-mutilation*. Aversion therapy is sometimes the treatment of choice when other less drastic measures have failed to produce the desired effects. *Includes Punishment, Avoidance, and Pairing of a maladaptive behavior with a noxious stimulus so that anxiety or fear becomes associated with the once-pleasurable stimulus*.

The aim is to *eradicate core irrational beliefs* by helping people recognize thoughts that are not accurate, sensible, or useful.

It is based on the underlying theoretical principle that *feelings and behaviors are largely determined by the way people think about the world and their place in it*. Test distorted beliefs and change way of thinking to reduce symptoms. Homework assignments play an important role.

Encourages nurses to provide caring and comforting interventions. She emphasizes the importance of the nurse-patient relationship and the *importance of teaching and coaching* the patient and bearing witness to suffering as the patient deals with illness.

Emphasizes the role of the nurse in promoting *self-care activities* of the patient; this has relevance to the seriously and persistently mentally ill patient.

Emphasizes the role of nursing in assisting patients to *adapt so that they can cope more effectively* with changes.

Emphasizes the role of nursing in assisting patients to discover and use *stress-reducing strategies.*

Emphasizes the role of nursing in *affirming the suffering* of the patient and in being able to *alleviate that suffering* through *communication skills* used appropriately through the stages of the nurse-patient relationship.

Using a bad outcome (or a few bad outcomes) as evidence that nothing will ever go right again

Maintaining a negative view by rejecting information that supports a positive view as being irrelevant, inaccurate, or accidental

An extreme form of magnification in which the very worst is assumed to be a probable outcome.

Assuming responsibility for an external event or situation that was likely outside personal control.

*Physiological Needs* - *basic needs* Food, water, oxygen, elimination, rest and sex *Safety Needs/=* - Security, protection, stability, structure, order, and limits *Love and Belonging Needs* - Affiliation, affectionate relationships and love *Esteem* - Self-esteem related to competency, achievement, and esteem for others *Self-Actualization* - Becoming everything one is capable of Self- Transcendence -founder of *humanistic* psychology; self-actualization and human motivation CHARACTERISTICS OF SELF ACTUALIZED PERSONS: • Accurate perception of reality. Not defensive in their perceptions of the world. • Acceptance of themselves, others, and nature. • Spontaneity, simplicity, and naturalness, do not live programmed lives. • *Problem-centered rather than self-centered orientation*. Possibly the most important characteristic. SAs have a sense of a mission to which they dedicate their lives. • Pleasure in being alone and in ability to reflect on events. • Active social interest. • Freshness of appreciation. SAs don't take life for granted. • Mystical or peak experiences. A peak experience is a moment of intense ecstasy, similar to a religious or mystical experience, during which the self is transcended. • SAs may become so involved in what they are doing that they lose all sense of time and awareness of self (flow experience). • Lighthearted sense of humor that indicates "we're in it together" and lacks sarcasm or hostility. • Fairness and respect for people of different races, ethnicities, religions, and political views. • Creativity, especially in managing their lives. • Resistance to conformity (enculturation). SAs are autonomous, independent, and self-sufficient.

Philosophy of care in which all parts of the environment are considered to be therapeutic opportunities for growth and healing. Includes the people (patients and staff), setting, structure, and emotional climate.

Table 2-6 ;

• Sigmund Freud advanced the first theory of personality development. • Freud articulated levels of awareness (unconscious, preconscious, conscious) and demonstrated the influence of our unconscious behavior on everyday life, as evidenced by the use of defense mechanisms. • Freud identified three psychological processes of personality (id, ego, superego) and described how they operate and develop. • Freud articulated one of the first modern developmental theories of personality, based on five psychosexual stages. • Various psychoanalytic therapies have been used over the years. Currently, a short-term, time-limited version of psychotherapy is common. • Erik Erikson expanded on Freud's developmental stages to include middle age through old age. Erikson called his stages psychosocial stages and emphasized the social aspect of personality development. • Harry Stack Sullivan proposed the interpersonal theory of personality development, which focuses on interpersonal processes that can be observed in a social framework. 3435 • Hildegard Peplau, a nursing theorist, developed an interpersonal theoretical framework that has become the foundation of psychiatric mental health nursing practice. • Abraham Maslow, the founder of humanistic psychology, offered the theory of self-actualization and human motivation that is basic to all nursing education today. • Cognitive-behavioral therapy is the most commonly used, accepted, and empirically validated psychotherapeutic approach. • A biological model of mental illness and treatment dominates care for psychiatric disorders. • Milieu therapy is a philosophy of care in which all parts of the environment are considered to be therapeutic opportunities for growth and healing. The milieu includes the people (patients and staff), setting, structure, and emotional climate

ans C - Erikson placed greater emphasis on the role of the ego. He also stressed that an individual's development is influenced by more than the restricted mother-child-father triangle and that culture and society exert significant influence on personality. Sigmund Freud advanced the first theory of personality development and articulated levels of awareness (unconscious, preconscious, conscious) and demonstrated the influence of our unconscious behavior on everyday life, as evidenced by the use of defense mechanisms. Freud identified three psychological processes of personality (id, ego, superego) and described how they operate and develop and articulated one of the first modern developmental theories of personality, based on five psychosexual stages. Reference: pp. 22-23

ans A - Central to Maslow's theory is the assumption that human beings are active rather than passive participants in life, striving for self-actualization. Maslow (1968) focuses on human need fulfillment, which he describes in six incremental stages, beginning with physiological survival needs and culminating in self-transcendent needs (see Figure 2-5 in the text). Although these needs are present in all human beings, the behaviors that emanate from them differ according to a person's individual biological makeup and environmental factors. This picture is broader and more holistic. Maslow does not address moral development, the potential for success, or interactions directed toward interpersonal relationships. Reference: pp. 31-32

ans A - The premise underlying behavior therapy is that behavior is learned and can be modified. Behaviorists agree that behavior can be changed without insight into the underlying cause. Reference: p. 27

ans C - According to Erikson, the task of adolescence is to achieve identity rather than to be left in role confusion. A sense of identity is essential to making the transition into adulthood. Reference: p. 23; Table 2-2

ans C - According to Sullivan, the purpose of all behavior is to get needs met through interpersonal interactions and decrease or avoid anxiety. He viewed anxiety as a key concept and defined it as any painful feeling or emotion arising from social insecurity or blocks to getting biological needs satisfied. Reference: p. 24

ans A - This statement reflects the larger thinking of the profession. Reference: p. 24

ans B - Interpersonal therapy is considered to be effective in resolving problems of grief, role disputes, role transition, and interpersonal deficit.

ans A - Cognitive therapists help clients identify, reality test, and correct distorted conceptualizations and dysfunctional beliefs, such as realizing that doing a stupid thing does not mean the person is stupid.

ans D - Ignoring the tantrum provides no reinforcement of the undesirable behavior. Instead, approval and reinforcement are given when the child is behaving in the desired way. This is an example of absence of reinforcement, or extinction. Reference: pp. 24-25

ans B - The ego develops defenses or defense mechanisms to ward off anxiety by preventing conscious awareness of threatening feelings. Reference: pp. 20-21

answer A

answer C

answer A

answer C

answer A

ans A - Freud's theory of the unconscious is particularly valuable as a baseline for considering the complexity of human behavior. By considering conscious and unconscious influences, a nurse can develop and begin to think about the root causes of client suffering. Reference: pp. 21-22`

answer C - Freud described the conscious part of the mind as the tip of the iceberg. It contains all of the material that the person is aware of at any one time. Reference: pp. 20-21

answer B - At birth we are all id. The id is the source of all drives, instincts, reflexes, needs, genetic inheritance, and capacity to respond as well as all the wishes that motivate us. Reference: pp. 20-21

answer D - Sullivan demonstrated that a psychotherapeutic environment, revolving around an accepting atmosphere that provides numerous opportunities for practicing interpersonal skills and developing relationships, is an invaluable treatment tool. This method is used today in virtually all residential and day hospital settings. Reference: pp. 24-25

answer A - Maslow describes safety as a basic need, meaning that it is so basic to existence that it must be resolved to reduce the tension associated with it. These needs have the greatest strength and must be satisfied before a person turns his attention to higher-level needs. Reference: p. 31

answer B - The value of Maslow's model in nursing practice is twofold. First, the emphasis on human potential and the client's strengths is key to successful nurse-client relationships. The second value lies in establishing what is most important in sequencing of nursing actions in the nurse-client relationship. Reference: pp. 31-32

answer C - According to Freud's psychosexual stages of development, this client is exhibiting the oral (0-1 year) personality traits: fixation at the oral stage is associated with passivity, gullibility, and dependence; the use of sarcasm; and the development of orally focused habits (e.g., smoking, nail biting). Reference: p. 21

answer D - Interpersonal psychotherapy is considered to be effective in resolving problems of grief, role disputes, role transition, and interpersonal deficit. Reference: pp. 24-25

answer B - In modeling, the therapist provides a role model for specific identified behaviors, and the client learns through imitation. The therapist may do the modeling, provide another person to model the behaviors, or present a video for the purpose. Some behavior therapists use role-playing in the consulting room for modeling therapy. Reference: p. 27

answer B - B. F. Skinner (1904-1990) represented the second wave of behavioral theorists and is recognized as one of the prime movers behind the behavioral movement. Reference: p. 26