Psychotherapy Midterm

self reflection

"what does that patient bring up for you personally?" -know how this impacts your interactions with that patient -helps bring objectivity to your practice

Humanism

A belief that emphasizes faith and optimism in human potential and creativity

Existentialism

A philosophy based on the idea that people give meaning to their lives through their choices and actions

The Existential themes AKA the Givens of Existence

Choice Freedom Responsibility Awareness Aloneness Meaning Anxiety Death Awe

C Trauma

Complex Traumas- Racism poverty homophobia bullying oversaturation in media domestic violence child abuse multiple deployments vicarious trauma (witnessing)

Pantheoretical

Concepts that apply to all approaches of psychotherapy and across all practice settings. The elements of psychotherapeutic relationship are: Caring Connection Narrative Anxiety Management

Psychological conditions necessary for personality growth:

Congruence (therapist) Unconditional positive regard Accurate empathic understanding

Emotion Focused Therapy

EFT is an evidence-based, short-term humanistic-existential psychotherapy approach. "You need to feel to heal" and "I feel, therefore I am" are mantras frequently touted in the EFT community. Emotions exert influence on cognition and behavior

What happens in the therapeutic window of arousal or RZ?

Enhance Stabilization Build Reflective Skills (patient self-reflection) Create Resources Skill Building Safe Relationship

Responsibility

Existential therapy is rooted in the premise that people are responsible for their lives, their actions, or their failure to take action

Death

Existentialists believe that those who fear death also fear life; thus the fear of death must be faced before one can truly live

Name the Microskills found in Wheeler Chpt 4

Explore Validate Reflect Paraphrase Summarize Attend Listen Silence

Describe the therapeutic relationship in existential therapy

It supports equality in the therapeutic relationship and an encounter characterized by mutuality, authenticity, openness, immediacy, and dialogue. The use of the therapeutic self is the core of therapy

Little T

Little Traumas: dog bites routine surgeries falls invasive dental or medical procedures minor car accidents

Peplau

Mother of psychiatric nursing

Name the Clinical Skills of Attending and Active Listening (video)

Step 1: Feedback (what happened) Step 2: Their interpretation Step 3: Their feelings Step 4: Their Commitment Step 5: Did I get that right

The Y Model

The Y model symbolizes these ideas with the core of all therapies being the stem and the arms of the Y being distinct therapy schools.

accurate empathic understanding

The act of perceiving accurately what is said to what is intended. Check in with patient to determine this: Is this what you mean? Do I understand you to mean?

How does Resilient zone evolve into therapeutic window?

Where grounding and stabilization brings the patient into the resilient zone then patient is open to therapy in that therapeutic window. Based on continuum of patient emotion, is dynamic, can change in a heartbeat

Resilience Zone

Therapeutic window of arousal/tolerance, or resilient zone. The best physiological state for thinking clearly and functioning well. Sits between the Sympathetic Nervous system (outer top) and Parasympathetic Nervous system (outer bottom)

What do humanism, Existentialism and Phenomenology have in common?

They are foundational to all human beings

Why are the existential themes significant?

They are universal human conditions

Holistic Model of Care

This is what psychotherapy is based on: Medication (outer ring) Relationship (middle ring) Self Care (center ring) Aim is to Heal

How does therapeutic use of self facilitate healing?

Through consciousness, intent, and presence

Awareness

Through self-awareness, people are able to choose their actions and create their own destiny.

Purpose for ACES study

Trauma focused and care as a whole should be trauma informed/trauma focused

What affects resilience and response to stressful events?

complexities of patient (diagnoses) strengths resources

Huge element to psychotherapy

empower the patient to envision the possibility of change

Therapeutic use of self

facial expressions body language creating milieu

Common themes of Humanism, Existentialism, and Phenomenology:

human freedom, personal choice, commitment, responsibility; how an individual values or sees their life

sympathetic nervous system

the division of the autonomic nervous system that arouses the body, mobilizing its energy in stressful situations -If engaged in therapy then patient is into hyperarousal state and out of RZ

Phenomenology

the individuals' own unique, lived experience "What is it like to be you?"

The therapeutic alliance is:

the most important determinant for successful outcome for psychotherapy

Recovery Oriented Principles

-Having hope -Belief that people can heal, having a philosophical viewpoint of that person -Not for therapists who are realists or pessimists

goals of psychotherapy

-Reduction of symptoms -Improvement of functioning -Relapse prevention -Increased empowerment -Collaborative goals set with the patient

SOLUTION-FOCUSED THERAPY

-The subjective experience of the patient is most important and valued -Problems and solutions take shape and have meaning within a dialogic context. -Patients are viewed as experts about their own lives. -Patients are cocreators and cofacilitators of the therapy process. -Hierarchy and power differential increase the potential for exploitation. -Therapist and patient are collaborative in the psychotherapy structure and process. -Knowledge and skill of the therapist are not as paramount as the relationship. -Therapists disavow the role of expert.

7 themes of Humanistic-Existential Psychotherapy

1. Commitment to the phenomenological perspective: The phenomenological perspective strives to understand the subjective experience of the patient. 2. Centrality of the therapeutic relationship: The therapist-patient relationship is the primary source for constructive change. The relationship is meant to be a collaborative, authentic, dialogic encounter. 3. Holism: views people as unique, whole individuals who cannot be reduced to separate parts. 4. Focus on the here and now: emphasizes that authentic contact and change can happen only in the present. 5. Emphasis on humanistic-existential themes: these themes are concerned with the universal human experiences of life (the givens of existence), including awareness, authenticity, freedom, choice, responsibility, meaning, and self-actualization. 6. Prominence of process: humanistic-existential therapies focus more on the process than the content of therapy. 7. Use of experiential techniques: Therapists do not interpret or give advice, but use experiential techniques that are reflective and experimental in style.

Psychotherapy competencies

1st: supportive (stabalize)-to calm and soothe person to tune in and participate (window of tolerance) 2nd: psychodynamics: exploring the why

ACES Study

Adverse Childhood Experiences (ACE) Study is one of the largest investigations of childhood abuse and neglect and later-life health and well-being. -Health outcomes: those with ACEs were more likely to be diagnosed with obesity, diabetes, chronic heart issues, and other illnesses. -ACEs are common across all populations. Almost two-thirds of study participants reported at least one ACE, and more than one in five reported three or more ACEs. -Some populations are more vulnerable to experiencing ACEs because of the social and economic conditions in which they live, learn, work and play. -The ACE score is the total sum of the different categories of ACEs reported by participants. Aa the number of ACEs increases so does the risk for negative outcomes.

Therapeutic Window of Arousal

Based in neuroscience. This is when the patient is in the Resilient zone and is able to participate and facilitate change in a therapeutic mindset.

Big T

Big Traumas: natural/man-made disasters War zone experiences acts of terrorism sexual assaults child abuse acts of violence death of love one(s) car accidents catastrophic illness vicarious trauma (witnessing)

Metamodel of Psychiatric Nursing

Neuro-physiology based Resilience Relationship Patient-Centered

Choice

People are free to choose, not predetermined

Aloneness

People enter and depart the world alone, nevertheless they desire to create close relationships with others while accepting the existential aloneness

Trauma Focused

Recognition of what the ACES study taught of prevalence and impact of trauma on the person and society as a whole. Care as a whole should be trauma informed.

Biomedical/Allopathic Medical Model

Relationship (outer ring) Medication (inside ring) Aim is to Cure which does not take into account the process of psychotherapy Symptoms thought to be the cause of the problem

parasympathetic nervous system

The division of the autonomic nervous system that calms the body, conserving its energy. -If engaged too much it can place patient into hypoarousal state and out of RZ

Describe presence in existential therapy

The existential psychotherapist cultivates the quality of presence the experience of being here and now in a relationship and intending, at a very deep level, to participate as fully as one is able to maintain full presence to the patient's experience in the moment and to closely attend to patient's immediate inner flow of experience. "Be there!" and "Insist that the patient be there!"

Meaning

The existentialist position encourages people to search for meaning by living fully and responsibly, accepting the consequences of their choices, and engaging in a commitment to creating, loving, working, and building a meaningful life (Frankl, 1963).

Goals of Person-Centered Therapy

The goal of person-centered therapy is for the patient to become a fully functioning person engaged in the process of self-actualization. -When achieving this level of development, the patient is able to live life more authentically and cope well with current and future problems. -The therapist provides a climate conducive to helping the person achieve these goals.

Cyclical Psychodynamics (know image)

a key characteristic of this pattern is irony; the person ends up in the very position that he or she was trying hard to avoid. For example, the person who is fearful of feelings of anger may act overly nice, unassertive, and maintain a passive stance toward others. This allows others to ignore his or her needs and, consequently, he or she begins to feel frustrated and devalued, which leads to more anger and more anxiety, and the pattern is repeated in the person's zeal to avoid the feared abandonments, that person inadvertently creates the very situation that he or she is trying so hard to avoid

What is the Adaptive Information Processing model (AIP)

a metamodel for all psychotherapy based on how the brain works -regulation of self-healing=neurophysiological harmony -information connected adaptively and flowing to other memory networks (trauma disrupts this flow) -forged and revised by experience -relationship regulates physiology and provides the context for change and growth

Self reflective practice

a mini competency: you being aware of what the patient reminds you of and the impact it can have on how you interact; brings objectivity

Awe

a state of being that incorporates wonder, dread, mystery, veneration, and paradox. Cultivating awe in existential therapy requires a movement away from many contemporary values of consumerism, conventionality, mindless entertainment, competitiveness, and the "quick fix," efficiency-oriented culture

neurophysiological model

a triggering event is going to change you emotionally and mentally

Existential Anxiety

accepting existential anxiety as a condition of living. As awareness of the consequences of freedom, choice, responsibility, isolation, and death increases, anxiety is inevitable. Existential anxiety is a stimulus for growth and an appropriate response to having the courage to be. The aim of therapy is not to eliminate anxiety but to be aware of it and embrace it in order to live a fulfilling life.

immediacy as a technique in Person-centered therapy

addressing what is specifically going on between the patient and therapist in any given moment

trauma

all events and situations that are experienced by the person as overwhelming and affect brain functioning through the interruption of information processing

What is vestigial emotion according to Cozolino?

an emotion that no longer serves us but all of us still have, need to give a new way to think about it and leverage it against our own conditioning (i.e. turn anger into fighting core shame)

Presence as a technique in Person-centered therapy

being completely attentive to and immersed in the patient's expressed concerns

Examples of stabilization/ supportive techniques?

breathing techniques grounding techniques visual imagery yoga

What does healing look like?

moving from impaired state of mind to lesser levels of that, not curing

Therapeutic relationship strategies

no matter what model, the thinking and directives applied are consistent to the literature

Brenner's Model compared to stages of learning

novice = unconscious incompetency advanced beginner = conscious incompetency competence = conscious competency proficient/ expert = unconscious competency

Importance of relationship

one of the 5 domains of functioning and assessing the patient for therapy -the ability to create and sustain a healthy relationship with you the therapist, if they struggle with you, they most likely struggle with others (important in patient-centered approach)

Freedom

openness, readiness, and flexibility to grow and change, free to shape their destiny

EXPERIENTIAL REFLECTION

patients to experientially reflect on how their life is being lived in the present and challenged to grapple with complexities and paradoxes of the human condition and to face the givens of existence. What is the purpose of your life? Where is the source of meaning for you? You want to live an authentic life, yet you stay in a relationship and a job that give you little satisfaction. How are you keeping yourself stuck? What might be accomplished in treatment that would help you live a more authentic life?

Resilience

recovery oriented model strengths based

9 signs of good mental health

satisfied with who you are engaged with meaningful activity sense of connection to others sense of self control forgive others optimism and hope tolerance gratefulness sense of humor

Therapeutic relationship

the primary source for constructive change in the humanistic-existential approach -The relationship, described by Martin Buber as a genuine "I-Thou" encounter, stresses a collaborative, authentic, dialogic encounter. -Based on improving from where the patient is (meeting them where they are) -to mutually discuss and change therapeutically The goal is to promote positive clinical or health outcomes.

Why are stabilization and supportive techniques used?

they enhance stabilization and facilitates the patient to re-enter the therapeutic window

What is core shame according to Cozolino?

things you feel badly about with no basis in reality (like feeling unlovable)

Most important thing in therapeutic model

to promote self efficacy and self care

Why is the Holistic Model important?

to promote self-efficacy and self care

reflective skills

type of material you can discuss within the window is "absorbed"

conditions needed for facilitative counseling

unconditional positive regard empathic understanding congruence These facilitate a therapeutic outcome

Core of Phenomenology:

understanding; emphasis on the patient's lived experience