mental health exam 1 study guide

moral treatment movement leads improved treatment and services for the mentally ill

WWI creates need for restorative aides and rehabilitation services.  OT begin working within the ,medical model and healthcare system.

medicare/medicaid programs become law and a trend towards deinstitutuionalization of people with mental illness

research reveal a biological basis for some behavioral disorders, development of effective psychiatric mediations.  sensory integration and cognitive disabilities models are developed, the ADA law is passed

occupation science is developed, the WHO develops the ICF and the AOTA publishes the OT

1.areas of occupation

adl,iadl,education,work,play,leisure, social participation

2.performance skills

motor skills, process, communication/interaction skills

3.performance patterns

habits, routines, roles

4.context

cultural, physical, social, personal, spiritual, temporal, virtual

5.activity

objects used & their properties, space demands(relates to physical context), social demands(relates to social & cultural contexts), sequencing & timing, required actions, required body functions, required body structures

6.client factors(mind set)

body functions, body structures

freud-id,ego, superego

person's ability to love and to work

self-identity, interpersonal relationships

impacts all areas of occupation

observing clients doing a task has significant values. art project is frauedian.

common elements of ego function

1.reality testing

egos ability to use perception and judgement to differentitate between internal needs and external demands

shaping and reshaping one's views

adapting to the environment

• OT/reality testing
• -consensual validation: members share their perceptions of themselves and the world with others

-exploring outer reality:  concrete tasks-provide reality testing on a sensory level.  manipulation of objects & materials provides sensory input; taste, touch, smell, vision, hearing and proprioception

• 2.sense of self X's 3
• -self-concept/self-identify-when the infant begins to differentiate self from mother.
• -body image-is the perception of one's physical self that form the basis of self-awareness
• -self-esteem-the subjective feeling on one's own ability

3.OT & thought processes

provide a secure and safe environment

problem solving/cognitive skills; cooking group


memory activities, word games, solitaire, reminiscing

comprise; sharing, taking turns,  negotiating, problem solving through team activities

4.self-control

control the instinctual drives from the id

impulse control is encouraged

• OT groups:
• -consider others in the group
• -listen to them
• -wait your turn
• -share tools and material

5.defense mechanisms

ways of warding off anxiety and ensuring the safety and preservation of an intact ego

• denial-projection
• reationalization
• regression-idealization
• identification
• sublimation
• substitution
• compensation

• OT & defense mechanism
• -sublimation: rechanneling or unacceptable drives into constructiove activity

projection-parts are split off and projected onto an external object or person

mastery/competency-an organism's capactity to interact effectively with its environment, language and motor skills cognition and higher thought process.

function-a functiong adult is free of conflicts and fixations and is able to satisfy his needs and direct his drives in way that fit in with social environment and culture.

• ego is in control and defense mechanisms
• are not exaggerated

dyfunction-inadequate psychosexual development, the presence of conflicts and fixations, and imbalance

• these abnormal states produce symptoms of:
• neurosis
• psychosis
• character disorders

1. parallel

• lowest level
• side by side
• individual tasks
• little interaction

2.project

• taask accomplishment
• interaction w/ shared materials, tools, work
• interaction outside of task not expected(2 or more people to complete task)

3. egocentric-cooperative

• members select & implement task
• tasks are longer/social interaction
• members respond to one another's social & emotional needs

therapist facilitates this process

4. cooperative

member are encourgaged to identify & gratify each other's social/emotional needs w/ task accomplishment

5.mature

the therapist is a co-equal member

group members take on all necessary leadership roles to balance task accomplishment & and need satisfaction of members

ex:  AA, weight watchers

abnormal behavior can be changed, if the practitioner changes the consequences of the behavior.

both normal & abnormal behavior is learned

basic assumptions:

observable & measurable-behavioral goals

conditioning & habits

shaping & chaining

reinforcement

rehearsal & practice, modeling, & reinforcement

behavioral concepts

behavioral goals & objectives

• reinforcement:
• -positive reinforcement is a reward
• -negative reinforcement, something desirable is removed

• rehearsal & practice
• -assertiveness training

• role-play
• -forum for practice & rehearsal of new behaviors in a safe/positive environment

• goals for OT
• 1.should be written in specific, measurable terms
• 2.set by client & therapist
• 3.progress towards goals is openly discussed with the group

learning theory is foundation for cognitive rehabilitation

Learning-relatively permanent change in behavior potentiality that results from experience and cannot be attributed to temporary body states induced by illness, fatigue, or drugs.

works best when information or task to be learned is meaningful

Role acquisition/behavioral

teaching of all daily living, work, and leisure skills as one participates in a variety of social and productive roles

• TX planning
• 1.Involve the patient in identifying problems and goals for treatment  and evaluating progress. discuss

2.  choose goals and activities that reflect the patient's interests, personal & cultural values, & present and future life roles. EX: ethnicity,, social class, culture

3.select goals and activities that provide a realistic challenge but are consistent with the patient's present level of ability

4. increase challenges and demands as the patient's capacity increases

5.present skills in their natural development sequence

6.the patient should always know what he is supposed to be learning and why

7.the patient shuld be made aware of the effects of his actions

8.skills need to be practiced repeatedly and then applied to new situations (generalization)

9.if a task is too complex or time consuming...teach one step at a time, but show the whole activity

10.people learn by imitating others

• classification:
• -social skills can be grouped together as behaviors that are needed in a given situation, such as?

-skills grouped by content or purpose

generally, social skills can be classified into 4 groups

social skills

1.self-expressive

2.other-enhancing skills

3.assertive skills

4.communication skills

4 phases of social training sessions:

motivation

demonstration

practice

function

Denial

refusing to believe something that causes anxiety

ex. a mother plans for her child who is a mentally retarded to be a doctor

projection

believing that an unacceptable feeling of one's own belongs to someone else

ex. self-isolating pt in a work group says that other patients won't talk to him

rationalization

making excuses for unacceptable behavior or feelings

ex: a teenager says he didnt do his homework becuz he didn't have the right kind of paper

conversion(unconscience)

conflicts turned into real physical symptoms

ex:  a girl with poor coordination gets a migrane headache when it is time for volleyball

regression

functioning at a more primitive developmental level than previously; going back to an immature pattern of behavior

ex:  a 7 year old child who is hospitalized for major surgery begins to walk on tiptoes and suck his thumb

compensation

efforts to make up for personal deficits; this can also be a conscious effort

ex:  a woman, blind from birth, learns to travel w/o a cane or any other aid

Self-actualization-need to accomplish personal goals

• esteem needs-need to be recognized by others.
• *many psychiatric patients have problems with work:
• little or no experience

no real understanding of the behaviors expected in a work setting

others may have cognitive disabilities that prevent them from making sense of work or the work environment

some fail over and over becuz they act w/o thinking, relate hostility, fail to organize their tasks or do not take responsibility for their behaviors

love and belongingness needs-to be accepted and loved, unconditionally

safety needs

physiological needs(lowestlevel)

FOOD, WATER, SHELTER, SLEEP, SEX, EXERCISE

assertive

ability to state one's needs, thoughts, and feelings in an appropriate, direct, and honest way

standing up for one's personal rights and expressing thoughts, feelings and beliefs in direct, honest and appropriate ways which do not violate another person's rights

• tyoes of assertion:
• 1. basic assertion

standing up for rights

when interrupted say"excuse me i'd like to finish my thought and what i was saying..."

2.empathic assertion

sensitivity in addition to expressing feeling or needs

statement recognizing the other person's situation or feelings, followed by a statement which supports the speakers rights

3.escalating assertion

when one has given a basic assertive response which the receiver has ignored and instead, has continued to violate the speaker's rights

4.confrontive assertion

most effectively when the person's words contradict what he has done

• 3 steps:
• 1.objectively describe what the other person said would be done
• 2.state what he actually did
• 3.state what the speaker wants
• ex: go to the movies if you clean your room

• 5. I-language assertion
• guide for helping people to assertively express difficult negative feelings.
• 4 part statement:
• 1.when you ____________
• 2.The effects are _________________
• 3.I feel _________________________
• 4.I prefer __________________________

6. Broken Record

technique in which the speaker keeps repeating the same message over and over in a calm, monotonous tone of voice responding in a superficial manner

aggressive

• an attack on a person or object;
• can be verbal, physical or both

• reasons for dev. aggressive behavior:
• 1.excessive feelings of powerlessness
• 2.prior non-assertion/past unresolved emotional experience
• 3.false beleifs about aggression
• 4.skill deficit

passive

non-assertive

• reasons for non-assertive behavior:
• 1.mistaking firm assertion for aggression

2.mistaking non-assertion for politeness/helpfulness

3.failure to accept personal rights

4.anxiety about negative consequences

5.deficient learning and/or lack of reinforcement

1.problem-focused

change the stressful situation

2.emotion-focused


change the stress rresponse to the situation

-physiological-aimed@ the bodies response to stress

-cognitive-aimed @ negative thoughts

-behavioral-aimed @ actions taken by the patient*(OTis actively orientated)

time management group:

1. analyzing each person's time use patterns using activty configuration

2.focus on developing skills

-prioritization

-using lists

-organizing one's day

being able to identify, express and act on one's feelingscontributes to a sense of personal identity and improves the quality of one's life

being able to assert oneself, manage one's feelings with self-control and dignity and channel stress into successful outcomes are all useful skills.

OT's apply this to life

Task roles

• develop in relationship to the group's goals, the problems it must solve to reach them
•  initiator/contributor
• information seeker
• information giver
• opinion giver
• opinion seeker
• elaborator/clarifier
• coordinator
• diagnostician
• orienter/summarizer
• energizer
• procedure developer
• secretary
• evaluator/critic

group maintenance/social

roles are needed to promote and maintain cohesiveness and closeness amoung group members(frequently the leader)

• supporter/encourager
• harmonizer
• tension reliever
• conciliator
• gatekeeper
• feling expresser
• follower

antigroup or egocentric roles

serve the needs of individuals but interfere with the group process(destructive)

• blocker
• aggressor
• deserter
• dominator
• recognition-seeker
• joker
• cynic

motivate by encouraging their enthusiam

• interaction encouraged in:
• sharing
• processing
• generalization

setting limits

goal is to acheive balance between control and leniency

• have member express:
• thoughts
• feelings
• opinions

Leadership styles:

autocratic

implies complete control of the group with little or noinput from themembers

democractic

allows members to make choices and to have a say in what the group does and becomes

laissez-faire

let the people do as they choose

implies a minimum of control and a deliberate non-interference in the natural forces of a group

highest function