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Wheeler Chapter 1 study guide

Terms in this set (17)

What do mindfulness; self-awareness, personal therapy (for the therapist) and therapeutic-use-of-self have to do with the practice of psychotherapy?
All these principles have client focus and clinician focus.
Question 1 continued: Mindfulness for Client and Clinician
Mindfulness (Client) anxiety management feature, a focus on the present. (Clinician) focus on the here and now of therapy, draw attention to the client-clinician relationship to identify interpersonal conflict, self-care to manage stress and promote wellness.
Question 1 continued: Self-awareness
Self-awareness (client) through processing and integration of past traumas into harmony and balance within the mind. (Clinician) through the acknowledgment of past experiences as they influence patient care, hidden bias
Question 1 continued: Personal therapy
Personal therapy for the therapist - Yaloms belief that the therapist will need to work through their own darkness to be able to lead patients to recovery. Better understand the process of therapy. Appreciate their impact on others.
Question 1 continued: Therapeutic use of self
Therapeutic use of self - the therapist interacting with the client utilizing therapeutic approaches including the Y model (active listening, empathy, reflection, boundaries, therapeutic alliance, interviewing skills.
Question #2: Wheeler states there are four elements common to psychotherapy. The four elements are "pan-theoretical concepts," meaning they apply to all approaches of psychotherapy and practice settings (2011). Name and describe these four elements
Caring, connection, narrative, & management of anxiety.
Question #2 continued: Caring
CARING - central to nursing. Carl's Rogers unconditional positive regard. Mutual nonromantic love based on genuine knowing of the person, trust, and respect reflected in an acceptance of and authentic appreciation for the other. Coparticipants in the process of healing. Respect for autonomy and agency. Understanding of another person's unique configuration of attitudes, feelings, and values from that person's perspective. Empathetic presence.
Question #2 continued: Connection
CONNECTION - the therapeutic relationship between the clinician and the patient. The active ingredient for therapeutic change. Emotional connection promoting interpersonal attunement, attachment, coregulation of physiological states. Related to the many factors of the therapeutic approach
Question #2 continued: Narrative
NARRATIVE - shared experience, the patient sharing their experience and the clinician becoming so involved and understanding that there is understanding. The context of the narrative is what the patient feels is the problem. Revision of the narrative through telling the story, anchoring the experiences into a timeline, and finding meaning through processing. Putting into words the experiences.
Question #2 continued: Management of Anxiety
MANAGEMENT OF ANXIETY - the need to understand how to manage anxiety as key to Peplau's Interpersonal Relation Model for Nursing. Many patients seek therapy due to the overwhelming effects of anxiety on function. Related to the cyclical psychodynamics (see below q3). Encourage patients to tolerate the feared experience and use the anxiety to explore unconscious fears. Keeping the patient within the therapeutic window of arousal (q4). Examples include, managing hypoarousal with mindfulness, self-regulation strategies. Managing hyperarousal with anxiety management techniques of deep breathing, guided imagery
Question #3: What are the components of and what is meant by the term "cyclical psychodynamics?"
Anxiety -> projecting/Acting out -> Depression -> Abandonment -> worsening/cause of anxiety. Centrality of anxiety as key to the patient's problems and the management of anxiety as key to solving these problems. In other words, anxiety leads to negative behaviors that worsened depression and contribute to a sense of abandonment which then causes/worsens anxiety. By eliminating anxiety as a part of the cycle through therapy, the chain can be corrected. Some people seek therapy for anxiety itself, but many people will have presenting problems that are an indication of the persons attempts to avoid anxiety. In an attempt to avoid anxiety, the patient causes a situation in which anxiety is created. It is a self-defeating. IRONY. The key is anxiety and the manner in which the patient is attempting to prevent anxiety through poor protective strategies.
Question #4: What is the "therapeutic window of arousal" and why is it an important concept in the practice of psychotherapy?
The therapeutic window of arousal says that the optimal physiological state for work in therapy is between hypoarousal and hyperarousal. The work of the therapist is to assess the patient's physiological state and utilize strategies to keep the patient within that area. Hypoarousal (depressive states) can be managed with mindfulness, focusing on body sensations. Ways to manage hyperarousal (anxiety states) are deep breathing, guided imagery. If the person is too hyperaroused or hypoaroused, resistane or defences may increase and the work of therapy will be thwarted.
Question #5: Define and describe the components of Maslow's Hierarchy of Needs and how the hierarchy is considered significant to the practice of psychotherapy?
Framework for prioritizing the patient's needs. At the bottom are basic physiological needs (food, water, shelter). Before you can continue on the continuum, you must meet lower needs. So the category of "LOVE" and "ESTEEM" can only be achieved when lower levels like "SAFETY" are met. A therapist needs to assess the patients basic needs during the initial assessment and collaborate with other specialties to meet the patients basic needs. It is important to recognize that these elements are culturally bound as primarily WESTERN ideals.
Question #6: Discuss what the term "Adverse Life Experiences" encompasses and write to how our understanding of adverse life experiences shaped the practice of mental health care?
Adverse Life Experiences are traumas that occur at any time along the life spectrum. There is growing recognition that ALE underline many psychological disorders and medical problems. Studies (listed in the reading) show the relationship between ALE and various medical and psychological disorders. This recognition has led to the attempt to take these traumas and help the mind process and integrate these memories to reestablish equilibrium (hence therapy!)
Question #7: What is the Adaptive Information Processing model (AIP) (Shapiro, 2011)?
The AIP model is based off the effectiveness of EMDR. AIP posits that the brain takes new experiences, and information's and seeks to integrate this new information into previously established neural networks to create equilibrium. Information process is interrupted when trauma/overwhelming experience occurs (influx of neurotransmitters). These associated memories are not integrated but remain in a fragmented state, dependent on the situation when the memory was formed. Remains in implicit or unconscious memory and is easily triggered by events similar to the trauma.
Question #8: Describe the components (and the interrelationship among those components) of Wheeler's "Treatment Hierarchy Framework for Practice," adapted from David and Weiss (2004).
This framework requires the APRN to assess the patients current standing with available external and internal resources. Similar to Maslow's HON, case management helps stabilize safety and basic physiological needs. As stability increases, patients are able to better process past experiences and move toward an enhanced future vision.
Question #9: Define and describe the "Spiral of Treatment Process" (Figure 1.8) including what is meant by, "Processing leads to expansion of consciousness."
Processing involves assisting the patient in constructing a narrative through the exploration of the meaning of significant adverse life events. Processing often leads to a period of instability that requires destabilization through therapeutic process including utilizing internal and external factors. When restabilization occurs, the patient is prepared to process further and the pattern continues. As this process continues, the patient is able to integrate these experiences into neural networks. Processing takes the unconscious, poorly integrated memories and seeks to process them by bringing the fragments to the surface, or increasing consciousness. Thus processing leads to expansion of consciousness.
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