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Module 6 DF Flashcards

Terms in this set (75)

9th stage of psychosocial development (Erikson)
Gerotranscendence
- emphasizes ongoing growth over decrements
Erikson's Stages of Psychosocial Development
● Psychosocial stages of development are divided into 8 stages.

● His psychosocial stages are meant to be reference for what social dynamics individuals are dealing with as primary focus of development at stage of life

● Example of applying Erikson's stages to a school-aged child that is noted by the therapist to be in the industry versus inferiority stage.
○ The therapist's knowledge of the child's developmental goal of trying to achieve competence at school and home would drive the early assessment Erikson's.

● This holds true for the therapist's assessment of an elderly individual in the integrity versus despair stage who may be contemplating what they've done with their life.
Two developmental frameworks that are most helpful in guiding therapists in thinking about where children/adolescents are in their developmental journeys:
○ Erikson's stages of psychosocial development

○ Piaget's stages of cognitive development
Piaget's Stages of Cognitive Development
● Stages of cognitive development are divided into 4 stages.

● The purpose of the stages is to describe the process by which we assimilate knowledge and learn throughout development

● This informs evidence-based psychotherapy practice more for children and adolescents than for the geriatric population.

● Example of applying Piaget's stages to an adolescent who is assessed to be in the formal operational stage.
○ The therapist would need to be aware of Piaget's stages to know that asking the adolescent to make a hypothetical decision is possible here.

● Whereas, asking the aforementioned school-aged child to make a hypothetical decision is beyond their capabilities.

● Preferred type of play aligned with reversal of Piaget's stages with the exception of the imagination involved in symbolic play.
According to Erikson, school-aged children are working through the _____________ stage.
industry versus inferiority
Child therapy involves ______, whereas adolescent therapy relies on _______
Play; Language
Adolescent therapy settings offer the patients:
● flexibility to choose what appeals to them.
○ Various seating arrangements, including chair-to-chair or table settings, can be used.
○ Additional items such as Legos and art supplies will often be provided to help increase the patient's comfort level during the session.
Adolescent sessions are structured with a......
● beginning, middle, and end.
Factors that make children & adolescents appear more vulnerable than ever:
○ Safety concerns (school shootings, increase in public violence...)

○ Changes in child learning and education

○ Changes in family and community life
The perspective of APPNs who treat children is on:
● prevention and promoting resiliency
Scope of practice for child psychiatric nurses sets down several areas of emphasis:
- Value of the relationship

- A health focus

- View of the child in relation to social systems

- Application of the science to treatment that is both psychological interventions and the neurobiology of the illness
2 groups of APPNs who are trained, certified, and licensed to provide child psychotherapy:
- Child and Adolescent Clinical Specialists (C/A CSs)

- PMHNPs
APPNs who are just starting out may want to use a ________________________ approach when providing therapy to children and/or adolescents or a manualized approach/specific method.
common elements/transdiagnostic
When treating children, __________ is the prominent organizing principle of mental health treatment.
resiliency
Moves the field of child therapy to a strength-based approach that revolves around a stance of therapeutic optimism:
resiliency
4 underlying assumptions that differentiate child therapies from adult psychotherapy:
1. Developmental considerations
2. Family involvement
3. Child's systems surround
4. Resiliency
Egocentric thinking
- refers to an inability to see a situation or event from another person's point of view.

- Normal in children who are in the pre-operational stage of thought (ages 2-6).

- Piaget
Self-regulation
- Key goal in child therapy.

- The therapist should aim to turn emotional and/or behavioral dysregulation into effective self-regulation through attention, self-awareness, or cognitive controls.
3 ways to approach self-regulation:
- emotional regulation
- executive functioning
- effortful control
Self-regulation issues can be shown in (disorders):
- ADHD
- PTSD
- maltreatment
- depression
- anxiety
Problems in a preschool child's self-regulation have also been tied to subsequent issues with:
- aggression
- social withdrawal
- conduct problems.
Family involvement
- Begins when treatment is initiated.

- Therapists need to enlist the parent's view of treatment needs and establish goal congruence (consensus about the goals of therapy and the means to accomplish these goals).

- The patient-family-centered care approach should be firmly integrated into all aspects of treatment planning.

- Focused efforts to involve family in care is critical as the treatment proceeds to improve outcomes and reduce treatment drop out.
5 parenting styles the therapist needs to take into consideration when developing a treatment plan.
1. Authoritarian
2. Permissive
3. Authoritative
4. Neglectful
5. Over-involved
Child's systems surround:
- Consideration of the systems that promote a child's ongoing development, including family, school, peers, and community

- The APPN will need to identify how the family functions as a supportive, healthy, holding context in which the children can grow, and if they are not then how can they help to do so?

- A goal of treatment should include a focus on improvements in critical areas of a child's life and the socioemotional skills they need to succeed in school and with peers.

- Community support system
Resiliency
- viewed as a grounding conceptual framework for intervention programs that promote competency and minimize stress

- Interventions focus on strengths and promoting protective processes in families and systems relating to the child instead of a diagnosis and its pathology.

- The goals of helping a child build resilience are regulation and connection with social supports
A child dealing with anxiety will need to learn regulation skills grounded in:
cognitive behavioral techniques
During therapy, children will use toys to communicate:
- thoughts, strengths, fears, joys, and struggles
Toys/materials for a therapeutic playroom:
- puppets, drawing boards and associated materials, fidgets, sensory boards, doll house and dolls, kinetic sand trays, blocks, books, etc.
Focus of therapy in school-aged children:
Self-regulation
When interviewing adolescents, it is best to:
Follow their lead
Those APPNs specializing in child and adolescent behavioral health must know:
family and developmental theory
Piaget's stages of cognitive development provide further insight into:
a child's preparation for academic and social activities
The Erikson phases describe the:
interplay between a child and their surroundings
When addressing behavioral & emotional issues in children, the objective is to:
get them to recognize how they are acting in situations, learn problem-solving skills, build on their strengths and help them learn to manage their weaknesses
The APA recommends teaching children who've experienced trauma to:
play, saying "children who grow up afraid don't learn how to play. They learn how to survive".
Some suggested play for children who've experienced trauma is:
- "Simon Says", "legos" or other problem-solving games, meditation and breathing exercises, and listening to music, singing/dancing.
Child Psychotherapy Evidence-Based Practice Issues
- Currently, there are no EBP guidelines for every diagnosis.

- Psychiatric diagnoses in childhood or adolescence are not fixed, and not all behaviors or presentations will fit into a diagnostic category

- In addition, the role of the family is overlooked or limited in EPBs.

- Currently, not enough EBPs exist for children and adolescents with comorbidities or specialized needs.
Psychotherapy Approaches for Children & Adolescents
- Psychodynamic therapy, Interpersonal Therapy (IPT), Cognitive Behavioral Therapy (CBT), EMDR, and Motivational Interviewing (MI) have adaptations that are used very successfully with children and teens

- The theoretical framework is the same as in adults, but the therapy is delivered in a developmentally appropriate way for the age/stage of the child or adolescent

- Parent management training (PMT) and problem-solving skills therapy (PSST) are also evidence-based approaches and used for disruptive behaviors.
When a specified method is utilized in treatment planning in order to address the presenting problems:
A manualized approach
Example of a manualized approach for children who have experienced trauma:
Trauma-focused cognitive behavior therapy (TF-CBT)
Complex developmental trauma
defined by cumulative, poly-victimization, which often results in greater impairment marked by problems in multiple developmental domains such as affect regulation, attachment, behavioral control, cognition, and self-concept.
Trauma-Focused Cognitive Behavior Therapy (TF-CBT
- components-based treatment where within a relationship-based approach, parents and the child learn how to manage emotions, cope with stress, manage and process thoughts related to the trauma, and enhance feelings of safety.
TF-CBT implementation involves parents and child learning:
- emotion management, coping with stress, processing trauma, and increasing feelings of safety
The acronym, PRACTICE, represents:
- components of TF-CBT
Strengths of a manualized approach:
- there are specific interventions tailored to specific diagnoses and a wider base of research supporting efficacy
Weaknesses of a manualized approach:
- a novice practitioner will not be familiar or well-trained enough to execute the different types for different diagnoses

- there are not enough specialized approaches for specific behaviors or diagnoses
Common Elements Approach
- Refers to an individual treatment approach such as affect regulation or psychoeducation that are component parts to many manualized treatments.

- This approach is now considered one method of a transdiagnostic approach.
Examples of common elements approaches:
- problem solving skills
- parent management training
- affect regulation
- psychoeducation
Approach that assesses the evidence-based strategy's application and relevance to the intervention and diagnosis in order to apply it is most logical:
Common Elements Approach
Transdiagnostic Approach
Refers to the use of a single protocol for an identified problem that cuts across diagnostic categories

- Targets cognitive or emotional problem that drives behavioral & diagnostic categories
Using transdiagnostic models that cut across traditional diagnostic boundaries is necessary to treat
multiple disorder manifestations
Transdiagnostic CBT (TCBT)
Employs the same set of treatment principles across several mental disorders, like anxiety disorders and depression, and has been developed to improve the clinical functionality of standard diagnosis-specific CBT programs
Unified Treatment Protocol for Emotional Disorders
Based on the assumption that an increased negative affect and attempts to avoid these emotions are the cause of emotional disorders (EDs)

- Includes 3 principles that target commonalities between emotional disorders; ex. increased mindful awareness of emotions, increased cognitive flexibility, and reduced emotion avoidance

- This approach has demonstrated a large reduction of anxiety and depression.
The Unified Protocol for Children (UP-C)
a transdiagnostic CBT group intervention for children & caregivers targeting the treatment of children's EDs.

- integrating various techniques, and emphasizing caregiver engagement, the UP-C solves the drawbacks of conventional CBT treatments.
Super Skills for Life (SSL)
- developed to treat depression and anxiety diagnosed in children through skills training, behavioral activation, and video-feedback with cognitive preparation
FIRST
a child-oriented transdiagnostic intervention applicable to children dealing with anxiety, depression, and conduct issues by using 5 core principles
5 core principles of FIRST
1. Techniques to self-calm
2. Increase motivation to make adaptive behavior more rewarding
3. Repair thoughts
4. Problem-solving
5. "Trying the opposite" Technique
Common elements approach may be more appropriate to use for APPNs when a child presents with:
- multiple issues
Strengths of combining & implementing common elements & transdiagnostic approach:
- broader application and its' applicability to clients with a trauma history and subsequent regulation and behavioral issues, clients who were delayed in entering treatment, or when TF-CBT is unable to be implemented
Weknesses of combining & implementing common elements & transdiagnostic approach:
- that due to it having such widespread application, it may not be as effective if EBP interventions were implemented for a known diagnosis
FIRST (Acronym)
For younger children, __________________________ is the treatment of choice as it facilitates the child's emotional and experiential expression via play, painting, and other nonverbal means
psychodynamic psychotherapy
Psychodynamic Psychotherapy
This method of treatment is effective for internalizing disorders, characterized by inwardly focused responses to negative emotions, such as sadness

- beneficial for younger children
Therapy that is also helpful for increasing teenage autonomy:
Motivational Interviewing (MI)
Parent Management Training (PMT)
- aimed at treating antisocial conduct in children and is particularly beneficial for children with disruptive behavior
Interpersonal psychotherapy with adolescents (IPT-A)
- typically combined with cognitive behavioral therapy (CBT)

- sessions usually run for one hour, and adolescents are encouraged to develop autonomous answers to their difficulties.

- The working phase focuses on difficulties in relationships, life adjustments, interpersonal conflicts
Framework of a CBT session
- check-in from the previous session
- agenda formulation
- homework/action plan review
- working on difficulties
- summary
- feedback
- assignment of new homework
Play Therapy
- beneficial for allowing youngsters to express their thoughts and feelings and is commonly used to treat children with dissociative disorders
3 kinds of personal and social-environmental elements that contribute to resilience
- Mastery

- Relationships are fostered in social situations defined by available and reliable adults

- Ability to Self-Regulate Emotional Reactivity
Attachment Theory (Bowlby)
- Explains that healing traumatized child will allow for stability in mind-body connection, allowing for interpersonal connection to take place
Play Therapy
- the use of play as a means of creating a rapport, a method to discover what is troubling a client, and bringing resolution

- Type of psychodynamic therapy
Play Therapy
- Useful with internalizing disorders (depressed teen who has self-blame when there is conflict in the home), mild to moderate externalizing disorders (temper tantrums, substance use, conduct disorders), developmental difficulties, and maladaptive responses to life events.
Play Therapy - Opening Phase
- The course of therapy is open ended, and the length is based on the child's progress.

- The role of the therapist is to be dependable, empathetic, nonjudgmental, and predictable.

- The play begins to change and resolve as the child works through their concerns.
Play Therapy - Middle Phase
- The process of repetition and elaboration is the middle (working through) phase.

- Some regression is anticipated when the child's progress indicates it is time to terminate therapy.
Play Therapy - Termination Phase
- The therapist addresses gains made, issues of dependency and separation, and addresses issues of loss and separation activated in the parents with the close of therapy
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