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MOI NOV 2011
QUIZ 3
| Question | Answer |
|---|---|
| Thoughts and ideas that we are aware of | Conscious |
| Somewhere in between, thoughts can become conscious from unconscious (dreams, slips of tongue, free association) | Preconscious |
| Things we are not aware of; repressed material | Unconscious |
| __________ is key area to understand for Ego therapy | Unconscious |
| Goal of Ego Psychology is? | To make the unconscious motives conscious, for only then can an individual exercise choice. |
| The Development of Personality - _____stage, First year, Related to later mistrust and rejection issues. | Oral Stage |
| The Development of Personality - _____stage, Ages 1-3, Related to later personal power issues | Anal Stage |
| The Development of Personality - _____stage, Ages 3-6, Related to later sexual attitudes | Phallic Stage |
| The Development of Personality - _____ stage, Ages 6-12, A time of socialization | Latency Stage |
| The Development of Personality - _____stage, Ages 12-60, Sexual energies are invested in life | Genital Stage |
| The Demanding Child is the ____ | ID |
| The Traffic Cop is the _______ | EGO |
| The Judge is the _____ | SUPEREGO |
| The ____ is ruled by the pleasure principle | ID |
| The _____ is ruled by the reality principle | EGO |
| The ______ is ruled by the moral principle | SUPEREGO |
| ____ includes dreams, symbols, and behavior | ID |
| ____ equals the behavior | Ego |
| All psychodynamic theories emphasize the importance of ___________ and ___________ | -Stages of psychosocial (or psychosexual) development -Unconscious mental processes on human behavior. |
| Why have psychodynamic theories come under attack in the past 50 years? | -Overly abstract -Unstructured -Impractical for today's practise environment that encourages more specific problem solving processes |
| Proponents of psychodynamic practice argue that many newer theories are _______ and ______ | -Relatively superficial -Fail to appreciate the complexity of human behavior. |
| _________ is concerned with individuals in the context of their psychosocial environment | Ego Psychology |
| _________ has a stronger focus on interpersonal relationships and their effects on individual functioning | Object relations |
| Three components of the mind AKA "The Structure of Personality" | ID EGO SUPEREGO |
| The _____ represents innate drives | id |
| The _____ is part of the mind that adapts the drives to socially acceptable outlets. | ego |
| The _____ represents the conscience or internalized value system | superego |
| Your "ego" is largely (but not completely) your conception of ___________. It is part of your personality that is responsible for negotiating between __________________. It is where cognition occurs. | Who you are internal needs and the demands of social living |
| _______ mental processes also influence conscious thinking | unconscious |
| __________ are unconscious distortions of reality, frequently come into play as we attempt to manage our interpersonal and other conflicts | Defense (or coping) mechanisms |
| ________________is only a thin slice of the total mind | consciousness |
| Clinical evidence for postulating the unconscious... | Dreams Slips of the tongue Posthypnotic suggestions Material derived from free-association Material derived from projective techniques Symbolic content of psychotic symptoms |
| Ego Psychology was developed as a theory of human behavior that focuses on the role of the ego rather than __________ | the mind’s other two components |
| The "ego" is the part of one’s personality that is responsible for negotiating between _____ and _______ | Internal needs Demands of social living |
| The ego is where __________ occurs, but _____________ influence conscious thinking | cognition unconscious mental processes |
| 4 Major Assumptions of Ego Psychology - People are born with ___________ to adapt to their _______ and this capacity develops over time through _____ and ______ | innate capacity environment learning and psychosocial maturation |
| 4 Major Assumptions of Ego Psychology - Social influences on psychological functioning are _______, and many of these are transmitted through _________ | Significant The family unit |
| 4 Major Assumptions of Ego Psychology - Name the 4 assumed motivators... | Mastery and competence are important motivators, along with pleasure and aggression |
| 4 Major Assumptions of Ego Psychology - Problems in social functioning can occur at any stage of development due to _______ and _____ | person-environment As well as internal conflicts |
| Major Ego Functions (9) | Awareness of external environment Judgment Sense of identity Impulse Control Thought process regulation Interpersonal (object) relations Defense Mechanisms Stimulus regulation Autonomous functions |
| _______________, which are unconscious distortions of reality, frequently come into play as we attempt to manage our interpersonal and other conflicts | Defense (or coping) mechanisms |
| Ego-defense mechanisms (3 points...) | Are normal behaviors that operate on an unconscious level and tend to deny or distort reality, help cope with anxiety and prevent the ego from being overwhelmed, have adaptive value if they do not become a style of life to avoid facing reality |
| Ego Defense Mechanisms are ______, ______ responses that enable us to minimize ________ or keep them out of awareness entirely | Unconscious Automatic responses Perceived threats |
| Ego Defense Mechanisms are coping mechanisms used by all people to protect themselves against becoming overwhelmed by ________ | Anxiety |
| Ego Defense Mechanism ________ to varying degrees because they provide us with a _______ perspective on a situation that is biased toward preserving a sense of _______ | Distort reality Conscious Security |
| Evaluate Ego Defense Mechanisms in use in the following ways: | Flexibility vs Rigidity Future vs Past orientation General reality adherence vs significant distortion |
| _______ occurs when the client reacts to the therapist as he did to an earlier significant other | Transference |
| _______ occurs when the reaction of the therapist toward the client may interfere with objectivity | Countertransference |
| _______allows the client to experience feelings that would otherwise be inaccessible | Transference |
| _________ allows the client to achieve insight into the influence of the past | ANALYSIS OF TRANSFERENCE |
| Ego Assessment requires...(3 things) | Requires a review of significant past experiences Identify unsuccessful transitions between stages Knowledge of stages of development |
| What are the three Psychodynamic Therapeutic Goals? | To become conscious of underlying factors which impact reactions, behavior and functioning, Resolve developmental conflicts, i.e. to get un ―stuck, Development of normal, adult psychic functions, i.e. reality testing and regulating self esteem |
| ______ and _____ are major supervision issues with ego psychology | transference and counter-transference |
| What are 4 components of Contemporary Psychoanalysis? | Relationship is collaborative, Problems are grounded in past, but focus is on alleviating current problems, Incorporates modern therapy techniques,Psychoanalytic Family Therapy-rather than emphasizing instincts/drives,the focus is on attachment objects. |
| Stregnths of Ego Psychology? | Short-term strategies can be flexibly used with clients of varied backgrounds, value of client/therapist relationship, |
| Criticisms of Ego Psychology? | Focus on vague concepts, intervention strategies are abstract and diff to operationalize, theory appears to be deficit oriented, interventions techniques are open ended therefore impractical for todays timelimited practise settings |
| Does Ego Psychology adequately faciliate the pursuit of social change activies? | Nope! |
| What are tthree main meanings of Object Relations? | Quality of a person’s interpersonal relationships A person’s internalized attitudes toward others and self How those attitudes determine one’s approach to new relationships |
| Object Relations - Concerned with how what is ―outside (_________) gets ―inside (___________) | Outside=Relationships Inside=feelings about those relationships |
| Object Relations - Concerned with a person’s ability to have a relationship with the self (_________) | (apart from others) |
| Object Relations is the bridge between the study of _______ and of ________. Focus on ___ to focus on ______. | Persons, Family Systems Drives to Relationship |
| Within object relations there is a focus on _______ and it recognizes the influence of _________. | Developmental Theory Focus Recognizes the influence of the environment on human development and social functioning |
| _______ is a central concept to object relations. Satisfactory human development is dependant on healthy early ______. | Attachment / Attachments |
| People have an inherent biological need to _______ with others in order to experience healthy development and to meet their ____ needs. | Form attachments Emotional Needs |
| The process of ______ is the psychological "taking in" of the characteristics of other people. Process of carrying images of others with us | Introjection |
| A ______ is the content, or result of introjection.It is something like the "mental picture."The quality of images are crucial to our dev of stable or unstable object rel. Cognative construction and emotional feeling from interaction to represent object | Representation |
| ________ are the set of a person's internalized attitudes towards other people and toward the self. Our interations with early caregivers are especially signifcant in determining later _____ with others. | Object Relations |
| An ____ can refer to an actual person in the physical world or one's mental representation of a person or a part of a person | Object |
| A ______ refers to one or several characteristics that we have internalized about a person but not the "total" person. It can be one-dimensional(really good or really bad).It does not percieve the the "total" person with both strenghts and limitations. | Part Object |
| ______ others into parts can help child avoid feelings of disappointment and rejection, percieving the person as bad. This is normal in children, but if it persists it can make the person fragile in relationships and even cause what they fear rejection | Splitting |
| A ______ is the internalization of all aspects of another person. The person integrates experiences of gratification and frustration. | Whole object |
| A _______ is an internal representation of one's own self. We internalize aspects of ourselves (in whole or part) as well as our experiences of others. | Self-Object |
| A _____ is a self-image (or self-object representation)in which we recognize that we possess a variety of characteristics and needs, we work to meet those needs. have value | True Self |
| ______ is a self image in which ones personal needs are devalued and suppressed in deference of others. The person organizes life around desire to please others. overemphasize or downplay +/-'s | False Self |
| ____ is a mature psychological state in which we are able to maintain whole-object representations of signifcant people in our lives even when we are seperated from them. do not vary over time. | Object Constancy |
| Within Object Relations we assess the following 4 things.. | Relationships Interpersonal conflicts Behaviors – past experiences repeated, master old traumas Connections to childhood |
| What are the two main goals of object relations? | To become aware of object representation (other or items) and how it impacts reactions and functioning To develop a healthy, functional self-representation |
| Effectiveness studies of object relations have focused on use of this approach with ___________ most often | personality disorders |
| Self-Object has to be _____ from "other" objects | Differentiated |
| Within assessment you _____________. You encounter them _________ allowing them to explore what they want, and then go from there.. See what emerges.. Moment to moment connections.. | Wait to see what happens rather than go after it. In the moment |
| Overview of Interpersonal Psychotherapy. Three points + Therapists like it because it "makes sense..." | Time-limited(12-16 weeks)individual psychotherapy with adults diagnosed with moderate to severe, non-delusional depression in an outpatient setting Structured, manualized treatment that has been used in research protocols Demonstrated efficacy. |
| Empirical basis of Interpersonal Psychotherapy? | interpersonal (IP) issues are linked to depressed mood and depression impairs IP functioning |
| Theoretical Base of Interpersonal Psychotherapy? | Bowlby’s attachment theory Based in animal research, Assumes that attachment is a biologically-based behavior sensitive to environmental conditions, Develops over time, Determines infant’s inner sense of security. Meyers/Sullivan |
| _________either seek proximity or contact or else greet the parent at a distance with a smile or wave | Infant Secur |
| __________easy to get close to others, comfortable depending on others and having others depend on them. | Adult Secure |
| __________avoids the parent because of history of parental unresponsiveness to child’s cries for help. | Infant Avoidant |
| ___________somewhat uncomfortable being close to others; difficult to trust others completely, difficult to allow themselves to depend on others. | Adult Avoidant |
| ______ either passively or actively show hostility toward the parent. | Infant Anxious/Ambivalent |
| _______ find that others are reluctant to get as close as they would like. Often worry that their partner doesn't really love them or won't want to stay with them. | Adult Anxious / Ambivalent |
| What are the 4 interpersonal relationship patterns that are most important to treat when working with someone who is depressed. you only pick one to focus on! | Grief, Interpersonal Disputes, Role Transitions, Interpersonal Deficits |
| ______ is used very rarely only when no other interpersonal relationship pattern applies. Least successful | Interpersonal Deficits |
| ______requires death of an important person in the patient’s life | Grief |
| _______any relationship where there is nonreciprocal expectations | Interpersonal disputes: |
| _________ any major life event | Role Transitions |
| _________ a default category; reflective of longterm interpersonal problems; worst prognosis. | Interpersonal Deficits |
| Five key concepts of Interpersonal Psychotherapy..... | • Medical model is good! • Mood is related to life events • Depression is a medical illness with interpersonal triggers and consequences • Symptom reduction occurs by focusing on current interpersonal functioning • Time-limited treatment is effectiv |
| Describe "time-limited" aspect of Interpersonal Psychotherapy... | • Goals differ from long-term therapy –Explicit focus – Target symptoms –Not character change • Time as leverage |
| Describe Assessment in Interpersonal Psychotherapy... | • Structured – Timeline – Interpersonal inventory – Hamilton Depression Rating Scale (Ham-D) – Beck Depression Inventory (BDI) – Geriatric Depression Scale (GDS) • Systematic • Directly related to intervention |
| Describe Therapists Role in Interpersonal Psychotherapy... | Active, Non-neutral–Biased towards client, Responsible for assessment& DSM-IV diagnosis, Defines treatment–Therapist tells client what type of interpersonal relationship issue they will focus on. If client disagrees, the therapist will modify conclusions. |
| Describe Client's Role in Interpersonal Psychotherapy... | Client is given a “sick role,” similar to a person with diabetes; i.e. in need of professional support/intervention Responsible to work as a client to get better • Different from strengths-based, or humanistic-existential approach |
| IPT is divided into three phrases.. provide time frames.. | Initial (1-3/4 weeks), Middle (4/5-8 weeks), Termination (9-12 session). |
| Describe Initial Phase | Assessment and problem area identification. • Establish rapport • Diagnosis of depression • Psychoeducation • The Sick Role • Interpersonal inventory • Establish the problem area • Interpersonal formulation • Instill hope |
| Describe Middle Phase | Focus discussion to problem area–link mood to current interpersonal situation or events and vice versa, Attend to client’s affect in the session & therapeutic relationship, Address resistance IF interfering with tx,Weekly systematic assessment of symptoms |
| Describe Termination Phase | Conclude acute treatment–acknowledge the role transition,Bolster patient’s sense of independence & competence, Relieve guilt & blame if tx has not been successful; explore alternative txs,Contract for continuation OR boosters, repeat formal assessments |
| Tx techniques of Interpersonal Psychotherapy... | • Psychoeducation – Provide accurate info about depression • Advising • Modeling • Problem-solving –Help the client explore options • Limit-setting |
| Goals of Interpersonal Psychotherapy... | General • Symptom Relief from depression • Improved Interpersonal Functioning Specific • The middle section of each problem area has specific goals and objectives |
| Meat & Potatos of initial sessions... | Blame the Depression (not the patient)Provide psychoeducation about Depression Conveys hope (problem is well understood and treatable), Normalizes the problem (1 out of 5 women),Identifies the problem as time-limited,Clarifies that client has active rol |
| Psychoeducation about Depression | –Very common (1:5 women will experience an episode during their lifetime) –Biologic origins –Heritability (“this runs in your family”) – Treatable disorder –Medical illness (“no different than the flu”) |
| Tx techniques of Interpersonal Psychotherapy... | • Psychoeducation – Provide accurate info about depression • Advising • Modeling • Problem-solving –Help the client explore options • Limit-setting |
| Goals of Interpersonal Psychotherapy... | General • Symptom Relief from depression • Improved Interpersonal Functioning Specific • The middle section of each problem area has specific goals and objectives |
| Meat & Potatos of initial sessions... | Blame the Depression (not the patient)Provide psychoeducation about Depression Conveys hope (problem is well understood and treatable), Normalizes the problem (1 out of 5 women),Identifies the problem as time-limited,Clarifies that client has active rol |
| ________ is non-reciprocal role expectations between patient and another important person in his/her life. Disputes can be overt or covert | Interpersonal Dispute (ID) |
| Psychoeducation about Depression | –Very common (1:5 women will experience an episode during their lifetime) –Biologic origins –Heritability (“this runs in your family”) – Treatable disorder –Medical illness (“no different than the flu”) |
| Goals of Interpersonal Dispute (ID)? | – Identify dispute – Choose plan of action – Modify expectations or faulty communication to bring about a satisfactory resolution |
| Meat & Potatos of middle sessions... | Focus discussion to problem area–link mood to current interpersonal situation or events and vice versa, Attend to affect in the session & thrptc reltinship, Adrs resistance IF interfering with treatment, Weekly systematic assessment of symptoms, homewor |
| Interpersonal Dispute (ID) Strategies.. | Review depressive symptoms-Relate symptom onset to overt or covert dispute with significant other with whom patient is currently involved, Determine stage of dispute (Renegotiation,Impasse,Dissolution), paralells in other relationships? |
| Info RE: Grief in IPT | • Also referred to as “Complicated Bereavement” • Special case of Role Transition • Goals – Facilitate the mourning process –Help the patient reestablish interests and relationships to substitute for what has been lost |
| Stage of dispute in Interpersonal Dispute (ID) ________increase disharmony in order to reopen negotiation | Impasse |
| Grief Strategies in IPT... | Review depressive symptoms, Relate symptoms to onset of death of sig other, Reconstruct patient’s relationship with the deceased,Describe the sequence and consequences of events just prior to, during,& after death, Explore associated feelings(+/-) |
| ________ is non-reciprocal role expectations between patient and another important person in his/her life. Disputes can be overt or covert | Renegotiation |
| Goals of Interpersonal Dispute (ID)? | – Identify dispute – Choose plan of action – Modify expectations or faulty communication to bring about a satisfactory resolution |
| Intervening at the impasse stage | Determine feasibility of change • Evaluate chronicity – Can some aspects of the dispute be changed? – Try shifting from impasse to renegotiation • may increase tension/disharmony initially • rule out physical abuse – renegotiation tasks |
| Interpersonal Dispute (ID) Strategies.. | Review depressive symptoms-Relate symptom onset to overt or covert dispute with significant other with whom patient is currently involved, Determine stage of dispute (Renegotiation,Impasse,Dissolution), paralells in other relationships? |
| Role Transition: Examples (5) | Renegotiation |
| Stage of dispute in stage of dispute in Interpersonal Dispute (ID) ________increase disharmony in order to reopen negotiation | Impasse |
| Stage of dispute in stage of dispute in Interpersonal Dispute (ID)______ assist mourning. | Dissolution |
| Intervening at the renegotiation stage | may need to calm the situation down, comm analysis–how are the patient & other person communicating with each other? – explore what has worked and not worked – learning new ways of communicating – assertiveness – adjust expectations – meet needs elsew |
| Role Transition: Strategies Part 1 | Relate depressive symptoms to difficulty in coping with some recent life change, Review positive and negative aspects of old and new roles, Explore feelings about what is lost (both good & bad), Realistically assess what is lost and what is not lost |
| Intervening at the impasse stage | Determine feasibility of change • Evaluate chronicity – Can some aspects of the dispute be changed? – Try shifting from impasse to renegotiation • may increase tension/disharmony initially • rule out physical abuse – renegotiation tasks |
| Role Transition: Strategies Part 2 | • Explore feelings about the change itself (both good and bad) • Explore opportunities in new role • Explore what skills or goals the patient can carry over the new situation |
| Intervening at the dissolution stage.. | One or both parties clearly wants to end the relationship, Elicit sadness, anger, grief over actual or impending loss of the relationship, Ask “what do you want in this situation?” Teach new ways of commun and self assertion,Turns into a “role transition |
| Role Transition: Strategies Part 3 | • Realistically evaluate what is lost • Encourage appropriate release of affect • Encourage development of social support system and new skills called for by new role |
| Role Transition: Examples | Life-Cycle Transitions, Social Transitions, Grief at Loss of Old Role, Poor Adaptation to New Role, Rejection of New Role |
| Role Transition Goals | • Mourning and acceptance of the loss of the old role • Help the patient to regard the new role as more positive and “three dimensional” • Restore self-esteem by developing a sense of mastery of the new role |
| Goals of Interpersonal Deficits | • Goals –Reduce the patient’s social isolation –Help patient understand their problems in relationships – Encourage formation of new relationships |
| Role Transition: Tasks Part 1 | • Review positive and negative aspects of new social or of life after the change – explore feelings about the change – explore opportunities in new role and the need to develop some new skills |
| Contraindications for IPT... | • Psychosis • Active substance abuse • Severe suicidal or homicidal risk • Severe cognitive deficits • Severe interpersonal deficits |
| Role Transition: Tasks Part 2 | • Encourage the development of social support system and new skills called for in new role –adjust expectations – assertiveness training, – risk-taking |
| Role Transition: Strategies Part 1 | Relate depressive symptoms to difficulty in coping with some recent life change, Review positive and negative aspects of old and new roles, Explore feelings about what is lost (both good & bad), Realistically assess what is lost and what is not lost |
| Role Transition: Strategies Part 2 | • Explore feelings about the change itself (both good and bad) • Explore opportunities in new role • Explore what skills or goals the patient can carry over the new situation |
| Role Transition: Strategies Part 3 | • Realistically evaluate what is lost • Encourage appropriate release of affect • Encourage development of social support system and new skills called for by new role |
| _______only chosen if none of the other IP areas exist. Chronic, not acute, problem | Interpersonal Deficits |
| Goals of Interpersonal Deficits | • Goals –Reduce the patient’s social isolation –Help patient understand their problems in relationships – Encourage formation of new relationships |
| Contraindications for IPT... | • Psychosis • Active substance abuse • Severe suicidal or homicidal risk • Severe cognitive deficits • Severe interpersonal deficits |
| Variants of IPT | • Dysthymia (IPT-D), Bipolar (ITP-BP) • Ante and Postpartum IPT • Brief ITP (ITP-B) • Adolescent specific IPT (IPT-A) – Adds problem area – Single Parent Family • Couples (ITP-CM) – Adds problem area – Marital satisfaction |
| IPT-A | Structure and techniques same as IPT, Content is somewhat different, Addition of Single Parent Family problem, Sessions are more flexible, including increased telephone contact & school visits, Sick role no excuse 2 miss school, Involve parents initially |
| Strengths of IPT | Established a structured, time-limited treatment that was as effective in the treatment of moderate to severe depression as other psychotherapies and pharmacotherapies.Has been adapted for use with adolescents, geriatric pops, & couples |
| Other populations that IPT is effective for.. this is also a strength.... | Other depressed populations include HIV, primary care, and antepartum and postpartum. Other diagnoses include bulimia, anxiety disorders (including social phobia, panic disorder |
| Limitations of IPT? Part I | Does not address chronic issues such as character pathology, distant familial conflict or other psychiatric disorders • Research suggests IPT is not indicated for use with substance abuse treatment; results were equivocal or worse than treatment as |
| Limitations of IPT? Part II | Use has been limited to clinical trials until recently,& limited info is available regarding its value in the community, Tx fidelity is significantly correlated with tx outcomes. In other words, if you stray from the pgrm, the tx is less effective. |
Created by:
sodaman