DEFENSE MECHANISMS

DENIAL refusal to admit an unacceptable idea or behavior

REPRESSION involuntary forgetting of painful ideas, events, and conflicts

SUPPRESSION exclusion from awareness anxiety-producing feelings, ideas, and situations

RATIONALIZATION attempts to make or prove that ones feelings or behaviors are justifiable

INTELLECTUALIZATION using only logical explanations without feelings or an effective

component

DISSOCIATION separation of painful feelings and emotions from an unacceptable idea,

situation, or object

IDENTIFICATION attempt to model oneself after a respected person

INTROJECTION incorporating values and attitudes of others as if they were your own

COMPENSATION covering up for a weakness by overemphasizing or making up a desirable

trait

SUBLIMATION channeling instinctual drives into acceptable activities

REACTION FORMATION a behavior is the exact opposite of an unconscious feeling

UNDOING doing something to counteract or make-up for a transgression or wrongdoing

DISPLACEMENT discharging pent-up feelings to a less threatening object

PROJECTION blaming someone else for ones difficulties or placing ones unethical desires on
someone else

CONVERSION expression of intrapsychic conflict symbolically through physical emotions

REGRESSION return to an earlier and more comfortable developmental level

FIXATION immobilization of a portion of the personality resulting from unsuccessful completion

of task in a developmental stage

RESISTANCE overt/covert antagonism toward remembering or processing anxiety-producing

information

SUBSTITUTION replacing the desired gratification with one that is more readily available

THERAPISTS ROLE

- Bring unconscious into consciousness, enabling individuals to work through the past and
understanding their past and present behaviors

INTERPERSONAL PSYCHOTHERAPY MODEL

- Interactional was more important than the intrapsychic.

DEVELOPMENTAL MODEL

ASSUMPTIONS
- Biologic, psychological, social, and environmental factors influence personality development
throughout the life cycle.
- Growth involves resolution of critical tasks at each of the eight developmental stage.
- Lack of resolution of tasks causes incomplete development and difficulties in relationships.
- Change involved re-experiencing and resolving developmental crises. Change is a process of
growth.

GOALS
- Mastering developmental tasks through achievement of insight; continued development
through death; analyzing developmental issues, fears, and barriers to growth to achieve sight.
- Facilitating mastery of developmental tasks with support and problem solving.

PSYCHOANALYTIC MODEL

ASSUMPTIONS
- Individuals are motivated by unconscious desires and conflicts. Personality is developed by early
childhood
- Illness results from childhood conflicts, and ego defenses are inadequate to cope with anxiety
- Change is a process of insight
- All human behavior is caused and can be explained

GOALS
- Insight into unconscious conflicts and processes
- Personality construction
- Using free associations, dream analysis, and analyses of transference and resistance

INTERPERSONAL MODEL

ASSUMPTIONS
- Interpersonal relationships and anxiety facilitate development of the self-system
- Development occurs in stages with changing types of relationships
- Faulty patterns of relating interfere with security and maturity
- Security operations protect against anxiety and interfere with learning
- Change is a process of reeducation

GOALS
- Developing satisfactory relationships and maturity; relative freedom from the interference of
anxiety; learning effective interpersonal skills
- Examining current interpersonal difficulties; using therapist-patient relationships as a vehicle for
analyzing interpersonal processes and testing new skills; consensual validation, validation, reality
testing, and reflecting positive appraisals.

STRESS MODELS

- Selyes Stress-Adaptation Model: Selye defined stress as wear and tear on the body. Selye
viewed stressors as any positive or negative occurrence or as any emotion requiring a response.
- Lazaruss Interaction Model: psychological stress is a relationship between the person and the
environment that is appraised by the person as taxing or exceeding his or her resources and
 endangering his or her well-being. Lazarus believed that the basis of coping is not a result of
anxiety, per se, but of the personal, cognitive appraisal of threat. Anxiety is a response to
threat.

STRESS ADAPTATION SYNDROME

Stage I: Alarm Reaction

- Mobilization of the bodys defensive forces and activation of the potential for fight or flight
(+1 to +2 anxiety)
- Release of norepinephrine and epinephrine, causing vasoconstriction, increase blood pressure,
and increased rate and force of cardiac contraction.
- Increased hormone levels
- Enlargement of adrenal cortex
- Marked loss of body weight
- Shrinkage of thymus, spleen, and lymph nodes
- Irritation of the gastric mucosa

Stage II: Stage of Resistance

- Optimal adaptation to stress within the persons capabilities (+2 to +3 anxiety)

- Hormone levels readjust
- Reduction in activity and size of adrenal cortex
- Lymph nodes return to normal size
- Weight returns to normal

Stage III: Stage of Exhaustion

- Loss of ability to resist stress because of depletion of body resources; fight, flight, or immobilization
occurs (+3 to +4 anxiety)
- Decreased immune response, with suppression of T cells and atrophy of thymus
- Depletion of adrenal glands and hormone production
- Weight loss
- Enlargement of lymph nodes and dysfunction of lymphatic system
- If exposure to stressor continues, cardiac failure, renal failure, or death might occur

Mental Status Examination

General appearance: type, condition, and appropriateness of clothing, grooming, cleanliness,

physical condition, and posture
Behaviors during the interview: degree of cooperation, resistance, and engagement
Social skills: friendliness, shyness, or withdrawal
Amount and type of motor activity: psychomotor agitation or retardation, restlessness, tics,
tremors, hypervigilance, or lack of activity
Speech patterns: amount, rate, volume, tone, pressured speech, mutism, slurring, or stuttering
Degree of concentration and attention span
Orientation: to time, place, person, situation, and level of consciousness
Memory: immediate recall, recent, remote, amnesia, and confabulation
Intellectual functioning: educational level, use of language and knowledge, abstract versus
concrete thinking, and calculations
Affect: labile, blunted, flat, incongruent, or inappropriate
 Mood: specific moods expressed or observed euphoria, depression, anxiety, anger, guilt, or
fear
Thought clarity: coherence, confusion, or vagueness
Thought content: helplessness, hopelessness, worthlessness, suicidal thoughts or plans, homicidal
thoughts or plans, suspiciousness, phobias, obsessions, compulsions, preoccupations, poverty
content, denial, hallucinations, or delusions
Insight: degree of awareness of illness, behaviors, problems, and their causes
Judgment: soundness of problem solving and decisions
Motivation: degree of motivation