Program de Interventie

UNIVERSITATEA DIN ORADEA

UNIVERSITATEA DIN ORADEA

FACULTATEA DE TIINE SOCIO-UMANE

MASTER: PSIHOLOGIE EDUCAIONAL, CONSILIERE COLAR VOCAIONAL

Plan de interventie Student: Negrut ( Ovanescu) ElenaPlan de interventie terapeutic1.PREZENTAREA CAZULUI:Elena este o femeie de 45 de ani. Este foarte religioasa si sufera de anxietate generala si teama de inaltimi. Ea este casatorita si are trei copii. Frica de inaltimi este demonstrata prin evitarea de a zbura cu avionul si de refuzul de a calatori cu masina pe varfurile muntilor. Anxietatea generala este exprimata prin sentimente de tensiune ori de cate ori este criticata sau este pusa in situatii sociale in care trebuie sa poarte conversatii cu persoane straine. Ea crede ca nu este o persoana competenta si de multe ori gandeste despre ea ca este o ,,mama rea. Cand este in astfel de situatii ea de obicei simte tensiune musculara , simte palpitatii la inima , incepe sa transpire si simte ca in stomacul ei este un nod.2. ISTORIC MEDICAL

Cercetarea istoricului medical a subiectului. Avea anumite probleme medicale care sa-I influenteze functionarea psihica?

Antecedente personale patologice?Antecedente heredo-colaterale?3. STATUS MENTAL

Pacienta are un coeficient de inteligenta normal? 4. RELATII FAMILIALE:

- provine dintr-o familie cu multe probleme de sanatate? Exista antecedente in familie, vreun alt membru al familiei prezinta vreo tulburare asemanatoare cu a ei?

-cum este mediul familial? Cum sunt relatiile familiale?

5. RELATII, PRIETENII:

-are prieteni? Se izoleaza de cunoscuti?

CONCEPTUALIZAREA CAZULUI O ABORDARE DIN PERSPECTIVA PSIHOTERAPIEI COGNITIV-COMPORTAMENTALE

1. FACTORI ETIOLOGICI

-determinarea factorilor etiologici

2. EVALUAREA COGNITIILOR SI COMPORTAMENTELOR ACTUALE.

-cand au aparut manifestarile disfunctionale? Ce anume crede ca i-a declansat problema? La ce se gandea in acel moment? Cum s-a simtit?

3. IPOTEZA DE LUCRU

Cum se manifest anxietatea?

La nivel cognitiv-epuizare

-tensiune

-disconfort psihic

-ingrijorare

-ganduri irationale

La nivel afectiv-teama

-nervozitate-neliniste

La nivel biologic

- tensiune muscular;

- transpiraie

- palpitaii;

- mini reci i umede,

- stare de ru, grea,

- senzaie de gol n stomac.La nivel comportamental- evitare;

- oboseal generalizat;

- hiperventilaie;

- exprimare verbal agitat;

- frecarea i agitarea minilor;

- insomnii; etcAceste forme de manifestare duc la aparitia atacurilor de panica.INTERVENTIA PSIHOTERAPEUTICA

SEDINTA 1

1. Se realizeaza lista de probleme:

anxietatea generalizata.

stima de sine scazuta si lipsa de asertivitate, abilitati sociale deficitare atacurile de panica ale Elenei

2. Pacienta se prezinta cu acuze de tipul: neliniste, ritm cardiac crescut, senzatie de nod in gat, si ganduri automate de genul nu sunt o mama buna , senzatie de gol in stomac.

3. I se explica pacientului diagnosticul si i se prezinta modelul cognitiv al atacului de panica.

4. I se explica pacientei pentru inceput o serie de tehnici menite sa reduca amplitudinea atacului de panica: sa respire intr-o punga de hartie pentru a evita hiperventilatia, precum si o alta tehnica: masarea globilor oculari (reflexul oculo-cardiac, prin care frecarea globilor oculari conduce la reducerea ritmului cardiac), urmate de expiratii cat mai puternice (pentru a nu se hiperventila, sa existe o concentratie mai scazuta de oxigen in creier), incheind cu frecarea muschilor gatului (pentru relaxare, pacientul fiind intr-o permanenta stare de incordare in timpul atacului de panica si in afara lui).

5. I se explica de asemenea ca un adult tanar poate suporta un puls de pana la 240 batai/minut fara a i se intampla nimic.

6. Se realizeaza alianta terapeutica, incercand sa obtinem o relatie de incredere cu pacienta, aratandu-i acesteia ca nu este singura care trece prin asa ceva.7. Se realizeaza interviul clinic structurat, impreuna cu terapeutul si se identifica problema tinta prin intrebari de genul: Ce te supara cel mai tare in prezent?", Cand au aparut prima data aceste simptome?" 8. Se stabilesc scopurile terapeutice: reducerea atacurilor de panica, reducerea gandirii distorsionate negative, cu impact asupra anxietatii generalizate , stimularea asertivitatii si dezvoltarea abilitatilor de rezolvare de probleme in vederea imbunatatirii relatiei cu familia, colegii si a capacitatii de solutionare a problemelor practice.

9. Planul de tratament presupune deci:

reducerea atacurilor de panica.

diminuarea anxietatii generalizate.

training asertiv, lucrul asupra stimei de sine si a abilitatilor sociale.

spre finalul terapiei ne propunem un program de prevenire a recaderilor.

Pe parcursul tratamentului, pot fi folosite urmatoarele tehnici:1. Pacientului I se propune sa intocmeasca un jurnal al atacurilor de panica.

MODELUL JURNALULUI.

JURNALUL ATACURILOR DE PANICA

DataSituatiaPrincipalele senzatii fiziologiceGanduri negativeRaspunsuri rationale alternativeNumarul atacurilor de panica

Luni-----

Marti-----

Miercuri-----

Joi-----

Vineri-----

Sambata-----

Duminica-----

Nr. Total atacuri de panica pe saptamana

2. Modelul ABC:

Management comportamental

Model ABC comportamental

determina mentin

A___________B_______________C

Antecedente date neurobiologice,inf.biografice,context fizic(cnd,unde,cu cine)etc.

Consecine- care cresc frecvena unui comportament(ntriri) i care scad frecvena unui comportament (pedepse i penalizri);imediate sau pe termen lung

A: Eveniment declansator

- In momentul de fata ce crezi ca a declansat aceste probleme?"

B: Ganduri si convingeri irationale

Sunt o mama rea, spune Elena si nu are incredere in fortele proprii

I se explica pacientului ca problema este generata de convingerile irationale si de distanta dintre ceea ce este si ce ar trebui sa fie.

I se cere Elenei sa intocmeasca o lista cu situatiile generatoare de anxietate.

Explorarea impreuna cu pacientul strategii de a controla simptomele anxietatii pentru a preveni escaladarea lor cum ar fi distragerea gandurilor.

Sunt combatute pe rand toate gandurile negative care ii creeaza clientului sentimentele de ingrijorare si este invatat sa le inlocuiasca cu alte ganduri rationale.

Se practica o relaxare profunda, in care clientul este solicitat sa retraiasca o scena generatoare de anxietate Metode de relaxare:

respiraie abdominal lent,

imagerie dirijat,

relaxare progresiv,

training autogen etc

UNIVERSITY OF ORADEA MASTERs PROGRAMProfessor Howard Kassinove and Mr. Bruno Broll-BaroneASSIGNMENT FOR March 2012Anger is one of the basic emotions and is a very common experience. In this assignment, you are asked to interview three people about an anger experience they have had.

Please interview one child (age 6 to 10), one adolescent (age 13 to 18), and one adult (age 21 and over). Be careful about these ages. Do not to interview anyone who is age 11 or 12, or age 19 or 20.

Most important, is that you interview these three people in private. The child, adolescent, and adult who you interview is most likely to be honest if parents, friends, or other family members are not present during the interview.

Always begin by helping the person to be comfortable and feel secure. Pick a time when you have at least 20 minutes for each interview. Go slow and allow the person to think about the answers to each question. Again, slowly moving through the questions will increase honesty.

Begin each interview with this statement;

I am taking a course in which we are learning about personal anger experiences. So, I want to know about a time when you felt angry. First, I will ask you to think about a specific time when you felt angry. Then, I will ask some questions about whathappened. Think very carefully about my questions. We are not in a rush. I just want to learn whatever you remember about the anger.My plan is to hold everything you say in confidence, unless you really plan to hurt another person. I will not talk about your answers to your friends or family. However, I will hand in what you say to my own teacher at the University of Oradea. Your name will not be on the paper I hand in, so no one will know that it was you who gave the answers.Thanks for helping me. Do you have any questions? Okay, lets begin.CHILD INTERVIEW (AGE 6 TO 10)Your name:Ovanescu Elena

Date of interview: 12.05.2012

First name of child : Racasan Ioana

This is a GIRL

Birthdate of child: 21.04.2002

Age of child : 10

1) Tell me what happened that made you angry.

Mi-am pierdut jucaria preferata pe care o aveam de cand eram foarte mica2) When did it happen? De 2 luni

Was it in the morning, afternoon, evening, or at night? ziua

3) Where did it happen? (for example, in school or at home or at work or while in a store)

In parc4) Exactly, who were you angry at? Am fost furioasa pentru ca mi-am pierdut-o. (Pe situatie a fost furioasa)

OK, thanks for telling me about this. Lets continue.5) Now, I am going to give you two sentences. Pick the one that sounds most like what you thought about what happened. The words in the sentences are similar. So, think carefully before you answer.

A1) What happened was really awful (or terrible).

A2) What happened was only bad or unpleasant. It was not terrible or horrible.

B1) When I think about it, I know I could have easily dealt with it. I could have just accepted it.

B2) I couldnt stand what happened. I could not take it.

C1) The other person (s) should have acted better. He/she/they must know how to behave.

C2) I wanted the person (s) to act better. But, other people dont have to do what I want.

D1) The other person (s) does lots of things. I like some of them and I dont like other things.

D2) The other person (s) is a really and totally bad person.

Your name: Ovanescu Elena

First name of child:_Racasan Ioana

OK, now, I want to learn about exactly what you felt. Lets continue.6) How angry were you? (read the four choices and circle one)

NOT VERY ANGRY,A LITTLE ANGRY,VERY ANGRY,

EXTREMELY ANGRY

7) For how long were you angry? (read the four choices and circle one)

Was it A FEW MINUTES, A FEW HOURS, A FEW DAYS,

or MORE THAN A FEW DAYS

8) When you were angry, what did your body feel like? What happened in your body? (write exactly what the child said)

Am plans mult, am fost foarte suparata.Now, I want to learn about exactly what you did.9) When you were angry, did you(read each item to the child, and check Yes or No)

NOa) yell or scream.

_YESYESb) cry

YESc) make a bad face or stare at the other person

NOd) throw something or break somethingWhat was it?

NOe) hit, kick, push, or shove the other person

NO f) just keep your anger inside and not tell anyone you were angry

NOg) plan to get even later on. You held a grudge and wanted revenge

NOh) just leave

YESi) do something to calm down.What did you do?

YESi) try to make it better, or talk to the person about what you wanted.

NOj) have something to eat or drink, to help you forget about your anger.

Your name Ovanescu Elena_First name of child_Racasan Ioana

Now, I want to learn about what happened afterwards.10) How did you feel after you were not angry anymore? Did you feel? _happy _sadafraid _satisfied

(Record exactly what was said) Am fost suparata.

11) What was the best part about getting angry?

Nu a fost nici una12) What was the worst part about getting angry?

Am plans mult13) How did your anger affect your relationship with the other person or persons?

This episode had a generally (check one) negative or positive effect. Or, no effect. This anger episode affected a:

School relationship

Friendship

Relationship with Parents and Brothers or Sisters

Relationship with other family members (like grandparent, aunts, uncles, etc.)

Other

Explain Eram suparata pe mama mea pentru ca nu a vazut unde mi-am pierdut jucaria

Great, thanks for telling me all of this.Is there anything else, you want to tell me?

nuOk, thanks again.ADOLESCENT INTERVIEW (AGE 13 TO 18)Your name Ovanescu ElenaFirst name of adolescent : Focos Madalin

This is a BOYBirthdate of adolescent : 24.07.1997

Age of adolescent :141) Tell me what happened that led you to become angry.

Sora mea a plecat sa lucreze ca si stewardeza si nu mai are timp sa si-l petreaca cu mine, decat foarte rar cand vine acasa, deoarece este foarte mult plecata2) When did it happen? De 1 an

Was it in the morning, afternoon, evening, or at night? Ziua


Acasa

4) Exactly, who were you angry at? Faptul ca nu ne mai petrecem timp impreuna


A1) What happened was really awful and terrible.

A2) What happened was only bad. It was not terrible or horrible.







Your name Ovanescu Elena

First name of adolescent Focos Madalin


NOT VERY ANGRY,A LITTLE ANGRY,VERY ANGRY,EXTREMELY ANGRY


Was itA FEW MINUTES, A FEW HOURS, A FEW DAYS, or MORE THAN A FEW DAYS

8) When you were angry, what did your body feel like? What happened in your body? (write exactly what the adolescent said)

Am inceput sa fiu nervos, si sa ma gandesc mult la ea.

Now, I want to learn about exactly what you did.9) When you were angry, did you (read each item to the adolescent, and check Yes or No)

_YES

_YES NO

NO

a) yell or scream or argue. b) cry

c) cross your arms, stare at the other person, or frown, or give a nasty look ;d) throw something or break something.What was it?

_YES

_YES

_NO NO

e) hit, kick, push, or shove the other person

f) just keep your anger inside, boil inside, and not tell anyone you were angry. g) plan to get even later on. You held a grudge and wanted revenge

h) just leave, or do something else to calm down. What did you do?

_YES

_YESi) do something to calm down.What did you do? Ma joc pe playstation

i) try to make it better, or talk to the person about what you wanted.

j) have something to eat or drink, to help you forget about your anger.


First name of adolescent Focos Madalin

Now, I want to learn about what happened afterwards.10) How did you feel after you were not angry anymore? Did you feel? happy _sad _afraid _satisfied

(Record exactly what was said) Vorbeam cu parintii, am inceput sa ma linistesc, sa inteleg ca asta e meseria ei si trebuie sa fie plecata


Am inceput sa fiu mai libera, sa ma imbrac cu hainele pe care le doream.

12) What was the worst part about getting angry?

Nu puteam sa ma concentrez, imi era gandul doar la sora mea, imi era foarte dor de ea.

13) How did your anger affect your relationship with the other person or persons?


School relationship

Friendship



Other

Explain eram suparat si pe parintii mei de ce au lasat-o sa plece

Great, thanks for telling me all of this.Is there anything else, you want to tell me?Ok, thanks again.Adult Interview (age 21 and above)Your name: Ovanescu ElenaFirst name of adult Popus Alexandra

This is a WOMAN

Birthdate of adult 14.07.1986

Age of adult 251) Tell me what happened that led you to become angry.

M-am certat cu seful meu de la locul de munca2) When did it happen? In urma cu 3 luni

Was it in the morning, afternoon, evening, or at night? Ziua


La locul de munca4) Exactly, who were you angry at? Pe seful meu


A1) What happened was really awful and terrible.

A2) What happened was only bad. It was not terrible or horrible.








First name of adult Popus Alexandra


NOT VERY ANGRY,A LITTLE ANGRY,VERY ANGRY,EXTREMELY ANGRY


Was it A FEW MINUTES, A FEW HOURS, A FEW DAYS, or MORE THAN A FEW DAYS

8) When you were angry, what did your body feel like? What happened in your body? (write exactly what the adult said)

Am fost extrem de dezamagita Now, I want to learn about exactly what you did.9) When you were angry, did you(read each item to the adult, and check Yes or No)

NO

NO NO

NOa) yell or scream or argue. b) cry

c) cross your arms, stare at the other person, or frown, or give a nasty look d) throw something or break something.What was it?

NO

NO

NO

NOe) hit, kick, push, or shove the other person

f) just keep your anger inside, boil inside, and not tell anyone you were angry. g) plan to get even later on. You held a grudge and wanted revenge

h) just leave, or do something else to calm down. What did you do?

NO _YES YES i) do something to calm down.What did you do? M-am intalnit cu sotul meu si am mers prin orasi) try to make it better, or talk to the person about what you wanted.

j) have something to eat or drink, to help you forget about your anger.

Now, I want to learn about what happened afterwards.10) How did you feel after you were not angry anymore? Did you feel? _happy _sad _afraid _satisfied

(Record exactly what was said) Ma simt foarte bine, am un nou job unde sunt apreciata


Am invatat multe din acea experienta12) What was the worst part about getting angry?

Pentru cateva zile, mi-am pierdut increderea in fortele proprii13) How did your anger affect your relationship with the other person or persons?


School relationship

Friendship



Other

Explain

Great, thanks for telling me all of this.Is there anything else, you want to tell me?

Acum ma simt mai puternica Ok, thanks again.

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