Term
| who does most of the mental health work in the US? |
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Definition
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Term
| what approach is thought to be the most useful for beneficial for pts? |
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Definition
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Term
| is biological understanding sufficient to treat psychiatric pts? |
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Definition
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Term
| what is the biological bias? |
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Definition
| currently, neuroscience has much more pharmaceutical support and psychotherapy has very little. managed care where short/cheap tx is emphasized also contributes to this. |
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Term
| are psychotherapy and medication superior to either alone in schizophrenia and depression? |
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Definition
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Term
| what did the squirrel monkey study find? |
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Definition
| squirrel monkeys separated from their mothers showed chemical changes in their brains such as increased cortisol levels. anti-depressants helped, but re-uniting them w/their mothers was a better tx. |
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Term
| how can psychological trauma be reversed? |
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Definition
| medication (temporary) or undoing the trauma (more permanent) |
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Term
| why do most psychological problems go back to childhood? |
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Definition
| painful events in early life sensitize receptor sites leading to a vulnerability for recurring problems in adult life. |
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Term
| what are the problems with psychotherapy? |
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Definition
| no research, dominance of psychoanalysis, no agreement on standards of theory/technique, too long/too expensive, and strong dependency attachment. |
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Term
| what is evidence based medicine and how as it affected psychotherapy? |
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Definition
| EBM: evaluate the pts problem, search the literature for relevant articles, evaluate the evidence and implement it. the problem for psychotherapy: no research w/double blind studies (single case studies not seen as valid). |
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Term
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Definition
| tx of psychiatric, emotional and somatic difficulties by psychological means. there are over 100 types, but all have their root in psychoanalysis (face-face talking) or behaviorism (behavioral modification, CBT). |
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Term
| what is the most common kind of psychotherapy? |
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Definition
| dynamic psychoanalysis, which can be short term (less than 20 sessions), supportive (support the ego), or expressive (looking for the meaning of the pt's symptoms) - all of which deal w/the pts unconscious mind. |
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Term
| what is cognitive behavioral therapy (CBT)? |
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Definition
| this form of psychotherapy deals w/the conscious minds and works to shape thoughts. on the rise |
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Term
| what is behavioral therapy? |
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Definition
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Term
| what is the basis of psychoanalysis? |
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Definition
| that the human personality embraces more than the traditional concept of the conscious mind is a fundamental discovery by freud. the process of psychoanalysis is making the unconscious conscious by lessening resistance (mainly repression and rationalization). |
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Term
| what is the method of psychoanalysis? |
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Definition
| 3-5x/wk for 45-50 min (10 min for pondering/note writing). the pt lies on the couch and the analyst sits out of sight. free association, dreams, slips of the tongue and transference are used to understand the unconscious. interpretation is used by the analyst and the pt confirms or denies. if the pt confirmed, they would work it through. |
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Term
| when did psychoanalysis start? |
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Definition
| 1881 w/the libido theory. sex was taboo, so a lot of psychological problems went back to it. no longer considered valid. |
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Term
| what is the structural theory? |
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Definition
| freud's theory of the id (strong impulses: sex/violence), superego (conscience: guilt if impulses were "bad"), and ego (mediates id and superego). |
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Term
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Definition
| impulses are repressed due to a strong conscience and neurotic symptoms are formed. |
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Term
| where did adler break w/freud? |
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Definition
| aggression, not sex was at the bottom of things |
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Term
| where did jung break w/freud? |
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Definition
| jung believed in a collective unconscious - and by interpreting symbols and dreams, he could find these common threads. |
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Term
| what are some more recent theories which have basis in psychotherapy? |
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Definition
| ego psychology: emphasis on strengthening the ego. object relations theory: emphasis on early relationships in life. self psychology: emphasis on self. interpersonal theory: emphasis on interpersonal reactions in everyday life. |
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Term
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Definition
| feelings the pt transfers on the analyst from significant people in their past. at times, the dr is the father, mother, or someone else significant in the patient’s life. |
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Term
| what is countertransference? |
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Definition
| feelings the analyst transfers on a pt from his/her past (always a problem in psychotherapy). |
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Term
| what is the goal of psychoanalysis? |
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Definition
| integration of repressed material into the personality, safe release of repression, modified id/ego/superego, stop of impulsive behavior, improved ability to love/work, and increased longevity. |
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Term
| what are the limitations of psychotherapy? |
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Definition
| limited over 40, must be intelligent, time (2 yrs), financial, severe psychopathology, and a previous relationship w/the therapist. |
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Term
| what characterizes dynamic psychotherapy/psychoanalysis? |
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Definition
| this is modified form of psychoanalysis and has many names (psychoanalytic, psychodynamic, expressive, supportive, insight oriented, explorative or intensive). it may be brief (less than 6 mos) or long-term (up to 2 yrs). it may be *expressive (understanding conflicts/modifying defenses) or *supportive (ego building). |
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Term
| how is dynamic psychotherapy different from pure psychoanalysis? |
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Definition
| dynamic psychotherapy is 1-2x/wk, therapist and pt are face-face, less emphasis on transference, more focused goals, less regression and more work on interpersonal and external. |
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Term
| what characterizes important characteristics of pts who will respond well to dynamic psychotherapy? |
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Definition
| pts must be motivated to have therapy (and be psychologically minded), able to tolerate frustration, have meaningful relationships in their life (more of this = strong ego), have good impulse control (if not they will "go off the deep end"), and be able to think abstractly |
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Term
| what characterizes brief psychotherapy? |
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Definition
| mann at BU: 12 sessions, only treated passivity/dependence/inadequacy. sifneos at harvard: anxiety provoking, rapid interpretation of oedipal conflict/aggression toward parent of same sex. mann at tavistock clinic: transference oriented, early relationship w/parents. none of these short term therapies have really stuck. |
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Term
| what is davenloo at mcgill's approach? |
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Definition
| short term dynamic psychotherapy. see pt for 2 hrs @ initial evaluation, picks up on defense mechanisms then blasts them. usually gets good results. |
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Term
| what is behavior therapy? |
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Definition
| alleviating behavior problems by controlling the learning behavior of the pt. can be modified in 3 ways: *change the situation which precipitates the behavior, *change the behavior in the situation or *change the consequences of the behavior. this works w/the conscious mind and stays in the present. |
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Term
| what are the different kinds of behavior therapy? |
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Definition
| operant conditioning, desensitization, and reciprocal inhibition. |
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Term
| what characterizes operant conditioning? |
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Definition
| use of positive reinforcement (better), negative reinforcement, and aversion therapy (severe punishment for a behavior) |
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Term
| what characterizes desensitization? |
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Definition
| either 1) flooding (immerse pt in whatever their fear is) or 2) graded exposure (slower process of desensitization). |
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Term
| what characterizes reciprocal inhibition? |
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Definition
| most beneficial. desensitize pts w/relaxation techniques (hypnosis/medication). this works very well esp w/phobias, obsessions, sexual dysfunction, and smoking. |
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Term
| what is cognitive behavioral therapy? |
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Definition
| this was started by aaron beck who believed that since reality is perceived through cognition, that should be where the work is done. he thought that psychoanalysis focused too much on the way we feel, which prolonged therapy. it was founded to treat depression. cognitive behavioral therapy combines well with behavior therapy, group therapy or medication. since its research can be done double-blind, medicine accepts it. |
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Term
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Definition
| cognitive errors produce negative thoughts (negative schemas). identification of the *depressive triad: negative thoughts about the self, the world ("everybody thinks i'm..."), and the future (negative predictions). identify negative schemas, develop alternative schemas, and rehearse new responses using homework, role play, graded tasks, and diversions. |
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Term
| what dors CBT help you do? |
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Definition
| think more realistically, not just positive thoughts but how to not think negatively. deal w/automatic thoughts and compensatory behaviors (behavioral techniques used w/cognitive techniques). transference and unconscious material not used. |
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Term
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Definition
| clinicians who form groups of pts for the specific purpose of helping individuals w/their psychological and emotional needs. |
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Term
| what was freud's involvement with group therapy? |
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Definition
| freud wrote about large groups (church/army) where reactions occur differently than on the individual level. |
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Term
| what was bion's involvement with group therapy? |
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Definition
| work groups develop a different agenda when the authority structure is lifted instead of pursuing the original goal |
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Term
| what is phase I of group therapy? |
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Definition
| dependency on the leader. subphases: flight, fight, and authority issues |
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Term
| what is phase II of group therapy? |
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Definition
| peer related (don't need a leader). subphases: enchantment, disenchantment and consensual validation. at the end of this = independent and mature working group. |
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Term
| what to the phases of group therapy mimic? |
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Definition
| life. start dependent on parents, have flight/fight phases in adolescence, in young adult life we feel we can rely on friends, in mature adult like we really become independent and depend on ourselves. |
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Term
| what is a concern w/group therapy? |
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Definition
| scape-goating, where the group turns on one person. the therapist has to be very skillful here and have everyone take responsibility for themselves. |
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Term
| what characterizes family therapy? |
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Definition
| the entire family needs to be present. family structure and organization are more important than individual behaviors. family fears need to be dealt with. refusal by any family member to participate cannot be accepted. |
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Term
| what are the different types of family therapy? |
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Definition
| psychodynamic: problems are due to family projections stemming from unresolved conflicts in the family of origin. structural: problems result from a structural imbalance - malfunction of authority struggle. general systems: group in equilibrium - members are drafted into roles to maintain the family unity. |
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Term
| what are the goals of family therapy? |
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Definition
| shift authority and strengthen parental hierarchy. have clear/flexible boundaries. stop acting out (rather, talk). clear communication. integrate differences instead of scapegoating. |
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Term
| what characterizes marital therapy? |
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Definition
| work w/the relationship as opposed to the individuals. deal w/communication problems. get each person to take responsibility for their own problem. restructure the relationship based on the integration of differences. |
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