Module 4

• Trust vs Mistrust " rusty 1" 
• Birth-1y
• *Hope 
• * trusting relationships/environment
• bad= suspicion/fear

• Autonomy vs Shame and Doubt
• " Shane rides an automatic bike with 2 wheels" 

1y-3y 

• * Will 
• self control/self esteem
• bad outcome: shame/doubt

• Initiative vs Guilt ( 3y-6y)
• " Tree sounds like 3, next to a initiative inn with quilts " guilt" 

• self starter/goals/purpose
• bad: guilt, lack of self initiated behavior, fear of trying new things

• Industry vs Inferiority 
• Age 6-12: school age 

" 4 big industry makes old factor inferior"

• * competence 
• - ability to work, sense of competency, achievement
• * Friends/classmates play a role in progression
• - proficiency at play/school= sense of competence/pride/self concept
• - bad outcome = inferiority

Identity vs Role Confusion ( 12-20y: adolescent) 

• * fidelity 
• " At 5 the doc gave his ID card to the nurse which confused her role"

• - personal identity ( unique/integrated)
• bad: role confusion

Intimacy vs Isolation : 20-35y 

• " intimate 6 at isolated beach"
• * love 
• - committed relationship
• bad: cant form affectionate relationship

• Generativity vs Stagnation ( 35-65y: middle adulthood) 
• * Care 
• " went to 7/11 bought a generator w a stahom"

• - give time/care to others: family/society/parenting 
• bad outcome: concern for self

• Integrity vs Despair ( 65y to adulthood)
• * Wisdom
• " 18 a grity ( integrity) pear which makes me feel despair" 

• - fulfillment with life, willing to face death , integrity
• bad: dissatisfied w life, despair over death

• 0-2y 
• * Object permanence
• Infant explores through direct sensory, motor control

• 2-7y 
• ** magical thinking 
• - symbol ( word/image) to represent object
• - ability to pretend, no logic, egocentric

• 7-11y 
• * understand conservation
• - think logically about concrete objects, reversibility

• 12+ 
• * Use logic, abstract 

Abstract reasoning, thinking hypothetical Ex. science, algebra

• Oral: birth-1 
• Anal: 1-3y: control bladder

• Phallic: 3-6y: genitals ( normal to play with)
• Latent: 6-puberty: libido inactive

• Puberty--> death
• - maturing sexual interest

• Focus = goal directed
• NON CONFRONTATIONAL
• * open ended quest to pt
• * empathetic
• * affirmations of pt positive trait
• * reflective listening

Pt doesnt think there is a problem, no intention to change 

• *provide info + feedback to raise persons awareness of prob
• DONT give prescriptive advice

" tell me about your current substance use..how...?"

Pt aware theres a prob, not ready to change ( thinking about it) 


** help the person see the benefits of changing and the consequences of not changing

pt decided to change ready for actions 

" what are the steps in the plan you made?"

• * Help find change strategy:
• ***- realistic, acceptable, accessible, appropriate, effective

• Pt engaging in action
• support + be an advocate

• Engaging in behavior to prevent relapse
• * help identify relapse prevention

• " When"
• " What led.."

• Aaron Beck
• Goal: change irrational/negative distortions

• Change maladaptive behavior---> active behavior
• Ex. exposure, relaxation, skills training, prob-solving, role play, modeling

Change thought pattern, conscious/unconscious beliefs, attitudes, behavior--> achieve a goal 

therapist + pt identify the prob--> strategize addressing it 

• Ex. * journal, progressive relaxation, cognitive restruct, 
• meditation, exposure response

CBT vs Cognitive= choose CBT

• Marsha Linehan
• good for borderline personality disorder 

• DBT Goals
• ** decrease SI
• - less emotional reactivity, crisis gen behav
• - more realistic decision making

• type of existial therapy focus on finding meaning of life 
• ( search for purpose, freedom of will)

allieviate psychological distress by addressing a sense of meaningless/empowing individuals

• Target 12-17y
• * antisocial, problematic behavior with serious criminal offense by empowering parents with resources, skills 

** home based model to reduce barriers that keep families from accessing services 

focus: empower parents, improve effectiveness by identifying strengths

address mental health need of children/adolescent, families suffereing from destructive effects of early trauma 

** tx is sensitive to unique prob of youth with PTSD/mood

• * Emphasizes accepting freedom, making responsible choices 
• Goal: focus on the present and " purpose" , live authentically 

• NP: understand pts subjective experience 
• - good for terminal illness, suicide, life transition

** understand pts subjective experience

• Carl Rogers
• * Person-centered theory 

concept: ** self-directed growth, self actualization

• people are naturally good 
• ( every person can find meaning, be true self)

• unconscious process are manifesting in present behavior
• goal: self awareness, understanding influence of past/present

• how unconscious mind influences thoughts/behaviors
• Ex. look at childhood experience

• ** focus on interpersonal issues that create distress
• - help people identify, modify, interpersonal prob
• Ex. marital conflict

• Form of behavioral + exposure therapy ( good for PTSD to achieve adaptive resolution) 
• DIB...

• - Desensitization phase:
• visualize trauma-->neg thought/belief/phys sense while maintaining rhythmic eye movement 
• --> block out neg thought, breathe, verbalize feeling 

- Installation Phase : increase positive thought replacement 

- Body Scan: visualize trauma with positive thoughts--> scan body to identify tension

promote resilience in children, reduce social anxiety, improve relationships

reduce stress--> less cortisol--> less pain + circ

Ex. husband + wife but only 1 shows up = reschedule

• family members are asked to talk with eachother 
• see how they interact 
• --> map/modify structure

Bowen 

Focus on chronic anxiety in family--> goal: increase each member function ** self differentiation 

Key words = triangles, triangulation, self differentiation 

• Triangles = dyads that form triads to decrease stress
• - low family adaptation = more triangle

• Assess subsystem * boundaries, hierarchies 
• within a family 
• focus = direct interactions between members 

• Goal: strucutral change in the family org to effect manage prob
• ** hierarchy boundaries

** problem focused interventions ( more s/s focused than structural)

• ** Paradoxical directions
• - negative task assigned to family member resistant to change ( the member is expeced to be non-compliant) 

Straightforward directive: test with expectation of compliance 

Reframing belief system: problematic beh labeled with positive meaning ex. jelous--> caring

Use solutions that have worked before--> apply to present prob

Goal: prob resolution through cog-prob solving

** miracle quest: " miracle happened when you woke up, find the prob is gone what would you do different?"

pain + depression

CVD, Fx, DM, obesity, unintent preg, STD, dep, anxiety, COPD, chronic bronchitis, sleep dis, eating dis, dissoc dis, alcohol

NO schizophrenia

• look beyond mental illnesss
• ** Tx isnt focused on full s/s resolution but emphasizes resilience + control over prob + life 

** not about " getting rid" of he prob --> recog, foster abilities, interest, dream

• recovery isnt step by step
• * learn from experience

health, home, purpose, community

mental health services are provided in he community setting 

** not restrictive/hospital setting to people w serious mental illness

goal: less hospital relance, community integration

* Tx centered around pt personal strength, needs desires for the future

• 2-7y: magical thinking 
• ** attribute feeling sick to something more personal ex. because they hit a dog 
• - let them know sickness isnt their fault 

8-12y: more logical

Ex. ** age 11 teach about nicotine use, parents and providers can explain logical complications of nicotine use to let them know of the dangers of smoking

Jean Watson

Caring = essence of nursing 

• * holistic and transpersonal concept that goes beyond physical aspects of care
• * emphasize humanistic + holistic aspects of nursing care, nurturing mind, body spirit during healing process

approach to org change to focus on strength rather than weakness

provider uses any payment/ compensation to encourage pt to come to the office or encourage another medical provider to come

• instillation of hope
• universality ( similar prob)
• altrusim ( share self to help other)
• increase social skill
• imitate behavior
• interpersonal learning
• group cohesiveness
• catharsis 
• existential factors 
• corrective refocusing

relationship between 2+ people with unclear personal boundaries

• Feedback: Offer non-judgemental feedback to raise awareness
• - Ex. risks of health
• Responsibility: encourage to take responsibility + consequences
• - help understand they have control over their choices/behav
• Advice: provider clear + personal adviced 
• - share info of benefit of change 
• Menu: present variety of options 
• - allow them to choose 
• Empathy
• Self efficiency: communicate confidence/ ability to change
• - remind of reasons to change

child takes on adult role emotionally, financially, other without support