NSG 527-Midterm Exam Study Guide Latest 2024/2025

The midterm exam consists of 50 multiple choice questions and covers modules 1-6. Exam Topics: Existential Psychotherapy Gestalt Therapy Dyadic Developmental Psychotherapy Relational Cultural Psychotherapy Transtheoretical Model of Change Motivational Interviewing Repetitive Transcranial Magnetic Stimulation Deep Brain Stimulation Module I: Existential Psychotherapy • Key themes and principles - Central focus is on a person’s experience, helping people come to terms with their issues in life, experiential and relational approach, patients can make their own choices and stress freedom and personal awareness; the therapist tries to understand the patient’s world • Founders - Rollo May and Irvin Yalom in the US, Emmy van Deurzen-Smith in the UK. • The existential therapist and the subjective world • Anxiety in existential therapy – normal anxiety is an unavoidable part of the human condition; Anxiety arises from our personal need to survive, to preserve our being, and to assert our being; can be neurotic or normal • Guilt in existential therapy – Similar to anxiety, can be neurotic, normal, or towards ourselves for not living up to our potential; Neurotic guilt feelings (generally called guilt) often arise out of fantasized transgressions. Other forms of guilt, which we call normal guilt, sensitize us to the ethical aspects of our behavior • The “Givens” of existence – death, freedom, meaningless, and isolation per Yalom • The three forms of the world- “being in the world” - Umwelt (Natural world), the Mitwelt (Public world), and the Eigenwelt (Private world), and Uberwelt (ideal world) • Existential approach and philosophy Module II: Gestalt Therapy • Key themes and principles – Focus on the here and now and encourage patients to be more aware and move from an area of environmental support to self-support. Phenomenology (awareness of what is felt subjectively right in that moment), learning to be aware, dealing with an impasse, and accepting personal responsibility; commitment to dialogue, inclusion, and presence; there are no ‘shoulds’, only independence and self-determination • Founder – Frederick and Laura Perls • Awareness in Gestalt – only goal in Gestalt therapy is awareness; awareness as content and awareness as a process • “Here and Now” – ‘now’ is the current awareness of the client; ‘now’ is applied to the present moment, not past happenings • Impasse – if a patient meets an impasse it means they are challenged to connect to their feelings, have few external supports, and feel paralyzed; important to work through an impasse and have patients experience their feelings • Dialogue – existential dialogue, based on genuineness and responsibility; the therapeutic relationship accentuates four attributes: inclusion, presence, commitment to dialogue, and dialogue is lived • Goals of Gestalt – the only goal is awareness and self-determination • Empty chair – goal is to ‘address unfinished business’ by sitting across from an empty chair and having a dialogue with whatever ‘person’ the patient needs to talk to (parent, partner, boss, etc) Module III: Dyadic Developmental Psychotherapy • Key themes and principles – attachment based, experiential and family focused; made solely to help kids with trauma; focuses on the safety and security of children and those in foster care that need attachment; works to ensure a trusting relationship with caregivers • Founder – Daniel Hughes • Maslow’s hierarchy • PACE – playful, accepting, curious, and empathetic; this describes the attitude of the therapist to set a healing pace to therapy Module IV: Relational-Cultural Therapy • Key themes and principles – relational type of therapy focusing on the connections we make; embraces social justice and the feminist movement; isolation is one of the greatest causes of human suffering; relationships are the indicators for, and healing mechanisms towards, positive mental health • Founder – Jean Baker Miller • Central Relational Paradox - assumes that we all have a natural drive toward relationships, and in these relationships we long for acceptance. However, we come to believe that there are things about us that are unacceptable or unlovable. Thus, we choose to hide these things; we keep them out of our relationships. In the end, the connections we make with others are not as fulfilling and validating as they otherwise might have been. • Goals – to have mutually growth fostering relationships; In these healthy relationships, all of the involved parties experience what is known as the Five Good Things. These include: 1) a desire to move into more relationships, because of how a good relational experience feels; 2) a sense of zest, or energy; 3) increased knowledge of oneself and the other person in the relationship; 4) a desire to take action both in the growthfostering relationship and outside of it; 5) an overall increased sense of worth. • Feminist and multicultural movements - RCT complements the multicultural/social justice movement by (a) identifying how contextual and sociocultural challenges impede individuals’ ability to create, sustain, and participate in growth-fostering relationships in therapy and life and (b) illuminating the complexities of human development by offering an expansive examination of the development of relational competencies over the life span. Module V: Transtheoretical Model of Change and Motivational Interviewing • Key themes and principles The Transtheoretical Model is an integrative model of behavior change that developed from many different psychological theories, such as Social Cognitive Theory and Learning Theory. Motivational interviewing: is directive and client centered, the examination and resolution of ambivalence is the primary purpose; supports self-efficacy, building rapport is key aspect of MI, remember to listen for ‘change talk’ • Founders – Transtheoretical model: Prochaska and Velicer, Motivational interviewing: Miller and Rollnick • Six Stages of Change of Transtheoretical model 1. Precontemplation: The individual is not aware that his/her actions are problematic and thus is not likely to take action. 2. Contemplation: The individual has the beginning awareness that the behavior is causing a problem and starts to consider the pros and cons of the problematic behavior. 3. Preparation: The individual intends to take action in the immediate future and may take small steps towards change. 4. Action: The individual takes explicit action to change the problematic behavior, and positive changes occur as a result. 5. Maintenance: The individual actively works to prevent relapse; this stage lasts as long as the problematic behavior no longer occurs. 6. Termination: The individual has no desire to return to their unhealthy behaviors and habits. • Why people do not change. – the timing is not right, they are not motivated, they are afraid to change, they have failed in the past and are afraid to fail again, they don’t want to change, addiction. *People will only change when they are ready, willing, and able* • Principle of behavioral change • The interactive style of MI • When not to use – if a patient is suicidal • Process – There are eight steps of MI that promote the therapeutic process and they are: establishing rapport (a basis of trust is essential), setting the agenda (without an agenda the patient can attempt too much too quickly), assessing readiness to change (help identify barriers and supports for change), sharpening the focus (focus on what the patient wants to change), identifying ambivalence (show that there are reason for and against change the patient can identify), eliciting self-motivating statements (promote the patient making positive statements and identify successes), handling resistance (use reflection to help with resistance) and shifting the focus (also helpful in handling resistance) • Spirit of MI - The spirit of MI encompasses collaboration in all areas of MI practice; eliciting and respecting the client’s ideas, perceptions and opinions; eliciting and reinforcing the client’s autonomy and choices; and acceptance of the client’s decisions. In the absence of MI spirit one would not be practicing MI. • Interviewing phase • Acronyms of MI strategies – strategies used throughout MI is OARS (open-ended questions, affirm, reflective listening, summarizing), preparatory change talk is DARN (statements of desire, ability, reasons, and need for change), mobilizing change talk is CAT (commitment, activation, and taking steps to change) • Listening for change talk – change talk is a patient’s own arguments for change; Change talk falls into four categories: recognizing disadvantages of the status quo, recognizing advantages of change, expressing optimism about change, and expressing intention to change. In eliciting change talk, patients hear themselves explaining their own reasons for change, which in turn strengthens the patient’s commitment to change • General principles – use empathy, develop discrepancy, roll with resistance (avoid argumentation), use collaboration, and autonomy/ self-efficacy Module VI: Repetitive Transcranial Magnetic Stimulation & Deep Brain Stimulation • Deep Brain Stimulation (DBS) device – consists of a lead or electrode placed into the brain, neurostimulator placed under skin near collarbone, thin extension wire that connects the lead to the neurostimulator; done in two surgical stages; once inserted electrical pulses travel from the neurostimulator to the brain resulting in a block in the electrical signals that cause tremors or movement disorder symptoms; doesn’t damage nerve cells and can be reversed if needed • Its uses – severe Parkinson’s disease, Essential tremor, Dystonia, Arm tremors related to multiple sclerosis, Tourette syndrome (in rare cases), Obsessive-compulsive disorder, Major drepression that does not respond well to medicines, Epilepsy • Complications – allergic reaction, difficulty concentrating, dizziness, infection, leakage of CSF, loss of balance/coordination, speech/vision problems, shocks, pain, tingling, and general risks of product breaking and brain surgery • The outcome of resistance to a clinician - ? • Repetitive transcranial magnetic stimulation (rTMS) – FDA-approved, costeffective, non-invasive, non-drug outpatient treatment; patients get 5 treatments/week for 6-8 weeks; can drive home after treatment • Electrical current through wire in scalp causes depolarization of nerve cells resulting in change in brain activity; we don’t really know how it works just decided to zap people and hoped they didn’t die • Possible treatment for auditory hallucinations, major depressive disorder as an add-on to drug therapy, or as an alternative to ECT in treatment resistant depression • Super rare side effects: memory loss and seizures