Gail Notes

Overview:

Psychotherapy is the techniques facilitate or allow people to modify their feelings, attitudes and beliefs. Two people come together for the purpose of relieving emotional pain, treating mental illness, and facilitating growth and change. The dialogue is focused on issues important to the client. Factors that motivate the client to seek therapy are a strong perceived need to understand themselves, to make some kind of change in themselves, or to get relief from pain (psychosocial, emotional, and physical).

Supportive therapy:

Allows the client to express feelings, explore alternatives, and make decisions in a safe, caring relationship. It may be needed briefly, intermittently for years, or over a period of months. The therapist reinforces the clients existing coping mechanisms.

Re-education Therapy:

Involves new ways of perceiving and behaving. The client explores alternatives in a planned systemic way (it requires more time). Talking about alternative ways of coping opens new options that the client may decide to try. Examples of this type of therapy include, short-term, brief, solution orientated, reality, cognitive restructuring, and behavior modification. The majority of therapy is in this general category.

Reconstructive therapy:

Requires deep psychotherapy or psychoanalysis (Freud, Jung). It may require 2-5 years of therapy and delves into all aspects of the client’s life. Emotional and cognitive restructuring of the self takes place. Positive outcomes include the following:

1. Greater understanding of self and others.
2. More emotional freedom
3. Development of potential abilities
4. Heightened capacity for love and work

The hallmarks of psychoanalysis are transference and resistance and the hallmark of psychotherapy are collective unconsciousness, archetypes, and individualism.

1. Introductory stage: The client and therapist meet and begin to work together. Client history including medications and medical illnesses are gathered. Exploration of the client’s background and problems will include any precipitating factors or events that led the client to seek help. They are asked to discuss their perception of their challenge, problems, needs, or expectations and their desired outcome of therapy sessions. The therapist forms preliminary ideas about the client’s needs. The client and the therapist form ideas about each other regarding personality and compatibility. This phase may last from 1-3 sessions. The goal of this stage is to establish trust.
2. Working Stage: The client begins to trust, disclose more information, explores feelings thoughts and behaviors that led to the pain or problem. This process may be completed in 20 sessions. Increased trust allows the client to experience greater recall and insight and to express previously repressed feelings. As the client understands and functions more effectively the last stage is reached.
3. Working through stage: The client understands a higher understanding of self and relationships with others and begins to try new ways of thinking, perceiving, feeling and behaving. The client uses newly acquired coping skills and may need a great deal of support and encouragement. Translating insight and understanding into new behaviors is the final aspect of this stage. Practicing new behaviors is highly reinforced. Termination of therapy is viewed as a kind of separation and loss and the client may experience grief.

Congruence, unconditional positive regard, and accurate empathetic understanding are qualities that promote a therapeutic relationship.

Congruence: feelings, thoughts and behaviors of a person are consistent.

Unconditional positive regard: absolute acceptance for the client but not the client’s behavior.

Accurate empathetic understanding: Involves feeling and experiencing with the client almost as if the therapist were having those feelings and experiences.

Therapy is a joint effort in which the challenges or problems, the alternatives and the choice to change belong to the client

Insight: consciously becoming aware of thoughts or feelings that have been repressed

Intellectual insight: understanding the origins and consequences of a symptom or behavior.

Emotional insight (AKA catharsis): understanding and re-experiencing painful, frightening or angry feelings associated with a symptom or behavior. It frees a persons fixed emotions and allows for emotional growth.

Repression:

Free association: The free expression of thoughts and feelings as they come to mind. It is the primary method of treatment in psychoanalysis and in much of psychotherapy.

Resistance: The client resists receiving information or recalling feelings. It often occurs as blocking (unable to finish a thought or idea). Blocking involves repression of painful knowledge and feelings and resisting recalling and understanding the thought.

Reworking: emotional relearning

Transference: It is a major tool used in psychotherapy. The client transfers feelings and attitudes held towards significant others (mother, father, siblings, spouse, children etc) onto the therapist. The client often reacts to the therapist in the same way they react to their significant others and this time the client receives a different response (than they receive from the significant other). The client realizes that transference and projection contribute to and feed into current relationships and maintain faulty, incongruent, and inappropriate perceptions and behaviors.

Countertransference: the therapist transfers his or her feelings for significant others onto the client. Usually something about the client will trigger this (behavior, mannerisms, voice, looks, appearance). An unusual like or dislike about the client is a clue to the therapist to analyze the reaction. This can cause problems if not detected. Be open to comments by staff about spending too much time with the client or giving privileges.

Ambivalence: the experience of two strong opposing feelings or wishes toward the same object or person and results in conflict when these approach and avoid tendencies are both present. The opposing feelings are usually love-hate, love-fear, or need-fear. Anger and learned helplessness are the end- products of ambivalence.

Ambiguity: the experience of uncertainty

Object constancy: The general feeling that people are reliable and the world is a pretty good place.

Acting in: resistance that circumvents therapy through blocking, forgetting, changing the subject, or trying to elicit the therapist’s approval or disapproval while trying to recall or express feelings.

Acting out: The client substitutes actions for thinking or feeling. The actions are learned and often become a defensive pattern. Common defenses are substance abuse, sexual promiscuity, running away, and fighting. Work or exercise may be used or overused as a defense.

Interpretation: The important aspect of interpretation is the client’s own explanation and understanding of the feelings and behavior.

Solution focused therapy: emphasis is on the belief that all individuals have the resources and are capable of solving their problems. Final solutions are constructed by the client who knows their situation and himself or herself better than the therapist does. It focuses on clear, realistic goals; uses tasks; and develops client cooperation and efficacy. It emphasizes, "change talk" to build the expectation of change.

Reframing: taking information or beliefs and putting them into a different perspective.

Cognitive therapy: The client has the key to understanding and solving a psychological disturbance within the scope of his/her own awareness. Problems are derived from distortions of reality based on assumptions that originated in defective learning during the cognitive developmental stage. It is important to teach people to hear themselves. The goal is to help clients unravel their distorted thinking and to learn more realistic ways to respond to their experiences.

Paradoxical intention: These are interventions where the therapist promotes the continuation or worsening of the problem. This can actually work to solve the problem.

Invariant prescription: therapist argues not to change the behavior and the symptom is ultimately within the family. Parents are to leave the home with no warning (without seeing any extended family) the length of time the parents are gone are from a few hours to a whole weekend.

Rational-Emotive Therapy: Encourages flexibility, minimizes emotional disturbances through rational thinking, and allows the client to separate emotionally from illogical, inconsistent and unworkable values.

Catastrophizing- exaggerated thoughts or when a hypothesis is equated with a fact

(boyfriend is late and that means he wants to end the relationship)

Erica is having difficulty after the loss of her fiancé in a car accident involving a drunk driver. She has problems sleeping, concentrating, and argues with her family especially with her father who "drinks too much".

1. Erica has an appointment with a nurse who has first suggested that: responsibilities of the client and therapist are outlined, goals determined, approaches and possible solutions are discussed and evaluated, and a suggested time- frame for therapy are identified.
2. Erica invites the therapist to attend a play with her the therapist should reply by saying: Thanks but our relation is defined as therapeutic and can only be effective when we concentrate on therapy and not social activities.
3. Erica’s therapist was able to identify specific body movements with different feelings and provides feedback immediately this is an example of the following therapist: Milton Erickson’s total presence
4. Erica stated that she came to the therapist because she knew that he would solve all her problems the therapist should reply: this is a joint effort coupled with your courage and honesty.
5. Late for her third appointment with no explanation Erica sits off center in the chair and angrily states to the therapist " that shirt looks like something my father would wear." This is an example of acting out and transference
6. Erica and her therapist resolved issues by defining her beliefs about responsibility, identifying irrational parts, and believing that she could make change. This is an example of rational-emotive therapy

SoutheasternNurse

Thank You Gail!

Class of 2001!