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Lecture 8

Lecture 8 (and 7 continued).docx

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Zachariah Campbell

Lecture 7: Treatment Planning Neurocognitive Rehabilitation (cont.) DOMAINS OF NCR Techniques for Memory Impairment Nature of impairment can be deceiving • Comprehensive memory evaluation • Allows for appropriate accomodations Candidacy/improved prognosis related to preserved: • Attention & short-term memory • Procedural memory • Premorbid memory (familiarity/skillset) o Name, address o How to do certain tasks Pneumonic training Def.: get the person to practice something over and over so that they learn things by repetition Pneumonic strategies • Learning techniques • Recording techniques Pneumonic aids: external device that aids in memory recall • Diaries, phones Executive Function Impairment Treatment is demanding and difficult – types of impairments make it very difficult Typical impairments • Initiation • Planning • Inhibition • Organization • Awareness Treatment of Dysexecutive Syndrome Evaluation beyond standard assessment: necessary because if you have poor awareness problems, you probably don’t know how to identify it. The patient may play off symptoms or may not be aware of it. Approaches • Environmental modification: using physical changes, people, alarms to get people to engage in appropriate behaviours at the right time • Task-specific learning • Learning to strategize/plan • Self-instruction techniques: ways so that they are able to fit in with the rest of society • Awareness enhancement Impaired awareness of functional limitations is not exclusive to FL damage • Mixture of psychological and neurological factors • People may be trying to hide that they are worse off so appear better, as a defense mechanism Measurement is inferred • Comparison of sources and observed functioning o Will ask for those around them, not just the main patient Successful enhancement of awareness is dependent upon the severity of impairment Techniques • Educational o Review of strengths/weaknesses, medical history, contrasting perspectives – get the person to internalize what other people have said about them. Show them the course of treatment and test scores in comparison to what the person thinks they should get o Client and caregiver Procedural Training and Environmental Support (PTES) • Used when person no longer has any awareness • Give them as many procedures to allow them to function • Set up environmental support Lecture 8: Psychotherapeutic Intervention Individual Therapy Def.: Two individuals interacting: the therapist and the client Therapist is trained in the art and science of therapy IT Ethical Issues APA Code of Conduct • Sanctions that may be implemented if ethics violation detected Confidentiality • Everything said to the therapist/in therapy remains in that context • Except certain circumstances – must be explained to the client o Client shall harm someone else o Client will harm themselves o There is a child that is at risk of abuse o When the client is a child, telling the guardian about the treatment Boundaries • Established at the outset o Monitored throughout • Narrowed expectations • Avoidance of harm o Especially sexual-based Therapeutic Modalities Psychodynamic Freud’s Tripartite Theory & Stages of Personality Development Major concepts in psychodynamic theory • Levels of consciousness • Structures of personality • Governing principles • Defense mechanisms • Stages of psychosexual development Modern psychoanalysts • May modify Freud’s methods of analysis to fit modern constraints • Meet with their patients 1/week for 1-2 years • Condensed phases • Focus: development of transference Cognitive-behavioural Behaviourism Classical conditioning (Pavlov) Operant conditioning (Watson/Skinner) Incipient techniques (e.g., ABA – Applied Behavioural Analysis) • Works with inpatients with behaviours that are immediately putting them at risk Contemporary techniques • REBT (Ellis) – Rational Emotive Behavioural Therapy o Arguing with the person about their flawed behaviours and thoughts • CBT (B
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