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Y4 Psychiatry SA > 16 - Psychotherapy > Flashcards

16 - Psychotherapy Flashcards

1
Q

What is psychotherapy?

A

The systematic use of a relationship between a patient and a therapist to produce changes in feelings, cognition and behaviour

Uses support, suggestion, persuasion, re-education, reassurance, and insight in order to alter maladaptive patterns of coping, and to encourage personality growth

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2
Q

What is the difference between psychotherapy and counselling?

A

Counselling: non-judgemental support encourage person to clarify their current problems and find solutions. Does not usually explore therapeutic relationship. Usually for immediate problems e.g job loss

Psychotherapy: Long standing problems of a more serious nature. Therapist needs supervision, ongoing training and self-awareness

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3
Q

What are the different classifications of psychotherapy?

A

Who is involved

  • Individual
  • Groups
  • Couples
  • System (extended family)

Content and methods used

  • Analytic/Dynamic
  • Interpersonal
  • Cognitive
  • Behavioural
  • Art
  • Play
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4
Q

What are the common characteristics of all psychotherapies?

A
  • Intense confiding relationship with helpful person (therapeutic relationship)
  • Rationale containing explanation of patient’s distress
  • Provision of new information about the nature and origins of the patient’s problems and ways of dealing with them
  • Development of hope in the patient that they will be helped
  • Facilitation of emotional arousal
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5
Q

Who are ideal candidates for psychotherapy?

A
  • Patients who are able to verbalise their problems
  • Pyschologically minded (able to see psychological processes could contribute to their problems)
  • Take responsibility for the resolution of their difficulties (motivated)
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6
Q

Which type of patients are not suitable for psychotherapy and why do we need to identify those who are not suitable?

A

Don’t want to waste limited resources or cause harm to the patients by stirring up issues that they cannot safely manage after the session

  • Psychosis
  • Serious dependence on illegal drugs
  • Caution with patients that have suicidal ideation
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7
Q

What psychotherapies are available on the NHS?

A
  • Cognitive
  • Behavioural
  • Interpersonal (IPT)
  • Psychodynamic
  • Group/Family
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8
Q

What type of psychotherapy is best for the following groups:

  • PTSD
  • Depression
  • Anxiety disorders
A
  • PTSD: Trauma focused CBT. Do NOT debrief
  • Depression: Cognitive or Interpersonal
  • Anxiety disorders: Cognitive Behavioural (CBT)
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9
Q

What type of psychotherapy is best for the following groups:

  • Somatic complaint with psychological component
  • Eating disorders
  • Personality disorders
A
  • Somatic complaint with psychological component: CBT
  • Eating disorders: CBT, IPT, Family
  • Personality disorders: DBT, psychoanalytic day hospital programme, and therapeutic communities
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10
Q

What theory is CBT based on?

A

Learning theory - Conditioning and Operant Learning

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11
Q

What is cognitive therapy and how does it work?

A

Addresses the role of dysfunctional thoughts and beliefs in producing and maintaining undesirable emotional sites and behaviours

Structured, problem-orientated and time limited (6-15 session for 1 hour)

Very active, patient given homework tasks e.g experiment with new behaviours, identify and challenge negative thoughts, collect evidence for or against beliefs

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12
Q

What is behavioural therapy and how does it work?

A

Techniques involving some form of exposure to reduce avoidance and permit habituation

Aim to alter the behaviour first with the theory that if these change then our thoughts and feelings will also evolve

Good for phobias and sexual dysfunction

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13
Q

What are some of the different methods used in behavioural therapy?

A
  • Relaxation training
  • Systematic densensitisation (graded exposure with relaxation training, more ethical than flooding, good for phobias)
  • Response Prevention (good for OCD compulsions)
  • Flooding
  • Thought stopping (good for OCD obsessions)
  • Social Skills training
  • Token economy
  • Modelling and role play
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14
Q

key difference between cognitive and behavioural therapy

A

cognitive - aims to change maladaptive thinking - distorted think leads to negative emotions and behaviours
behavioural - aims to change maladaptive behaviours that can be unlearned

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15
Q

difference between when cognitive vs behavioural therapy should be used

A

cognitive - Depression, anxiety, PTSD, eating disorders
behavioural - OCD, phobias, ADHD, autism and substance misuse

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16
Q

What is CBT and how does it work?

A

Helps change unhelpful thoughts (cognitions) and actions (behaviours). Altering these changes how we feel about the world, other people, and ourself

Focuses on here-and-now problems, tackling the current state of mind rather than exploring past causes of distress or developmental experiences

Therapist can advise and encourage but cannot ‘do’ it for the patient. Patients need to be active in their own recovery

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17
Q

What is some homework that a patient might be given whilst doing CBT?

A
  • Keep a daily diary to identify cognitive distortions
  • Examine evidence for and against cognitive distortions
  • Restart pleasurable activities they gave up on the onset of difficulties even if they don’t enjoy them yet
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18
Q

What disorders is CBT useful for?

A
  • Depression
  • Anxiety disorders e.g Panic, Social, OCD, PTSD, phobias
  • Eating disorders
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19
Q

What disorders may you want to use CBT with caution or not use it at all?

A

• Severe depression

• Poor concentration

• Difficulties talking about feelings

• Patient focused on childhood events

• Poor motivation to change

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20
Q

What theory is psychodynamic therapy based on?

A

Unconscious conflicts, childhood experiences

Freud’s approach to psychoanalysis, attachment theory. Much less intense, once a week

Psychoanalysis: Long term intensive treatment (most days of the week over many years) used to restructure personality

21
Q

What is psychodynamic therapy, how does it work and how long do you do it for?

A

Evolution of conscious understanding by interpreting what the patient does and says during a therapy session and through inter-subjectivity of the therapeutic relationship

Addresses issues of transference** and **psychological defence mechanisms

Sessions are unstructured and therapist has benign neutrality

Once or twice weekly for 50 minutes from 4 months to 1 year

22
Q

What is counter transference and how is this avoided in psychodynamic therapy?

A

therapist’s emotional reactions to the patient, which are influenced by the therapist’s own unconscious feelings, past experiences, or unresolved conflicts.

23
Q

Apart from the therapeutic relationship and becoming aware and understanding personal problems, how else can psychodynamic therapy be of therapeutic benefit to patients?

A

Patient’s may feel strong emotional experience when therapist is able to tolerate thoughts and feelings that the patient previously considered intolerable

24
Q

What disorders can psychodynamic therapy be used in?

A

Disorders

  • Personality disorders - Focuses on maladaptive patterns formed in early life and poor sense of self
  • Depression - Focuses on maladaptive patterns formed in early life and poor sense of self
  • Eating disorders - Addresses self-image, control issues, and early family dynamics
  • Some anxiety disorders

Other

  • Recurrent chronic interpersonal relationship difficulties
  • Psychological conflict
  • Alienation
25
In CBT the cause of the problem is thought to be thoughts and behaviours of now. What is the cause of the problem in psychodynamic therapy?
Past experiences of childhood trauma or deficiency
26
Where might a therapist figure out some of the unconscious activity is in a patient when undergoing psychodynamic therapy?
* Dreams * Artistic and scientific creativity * Hysterical symptoms * Abreaction * Parapraxes, a ‘slip of the tongue’
27
What are some characteristics that a person needs to be able to undergo psychodynamic therapy?
* **Psychological understandibility** * **Psychological mindedness** * **Motivation** for insight and change * **Intelligence and verbal fluency** * **Introspectiveness:** The ability to reflect and think about their feelings * **Dreams**: The capacity to remember dreams * **Ego strength:** The ability to tolerate frustrating or distressful feelings without engaging in impulsive behaviour * **Capacity to form relationships**
28
How many psychodynamic sessions does someone with depression need?
Only 8
29
What is interpersonal therapy and who is it for?
is a structured, time-limited psychotherapy that focuses on improving a person's relationships with OTHERS and social functioning to help reduce psychological distress—especially depression. Link between onset of depressive symptoms and current interpersonal problems **Does not make assumptions about aetiology or enduring aspects of personality** but **addresses current relationships** **Time limited** weekly sessions for **depressed patients**
30
What theory is family/systemic therapy based on and how does it work?
Roots in anthropology and cybernetics **Target the system that generates the problematic behaviour,** the system being the family unit, does not target individual symptoms Therapist uses methods to bring about change to the family system. The focus is on getting the family to discuss the problems that are putting a strain on their relationship
31
What disorders is family therapy used in?
* Intervention for children * Eating disorders * Adjunctive treatment in Schizophrenia
32
What are some of the different family therapy models?
* **Systemic—**focus on family beliefs, patterns, and meanings with no objective truth * **Structural—**focus on a family’s hierarchies and rules; if these are broken a ‘problem’ individual is blamed * **Solution focused—**focus on the family, setting, the task, and their goals * **Narrative—**focus on family ‘scripts’ which are ways to live; problems emerge when individuals deviate from the ‘dominant family narrative’; the therapist helps the family to develop a new encompassing narrative. * **Transactional—**focus on the problem actually serving a purpose (eg difficult child prevents parents divorcing)
33
Triangulation and Scape Goating are two dysfunctional family patterns. What is meant by these two patterns?
34
What are some indications and contraindications for group therapy?
**_Indications_** **•** Personality disorders **•** Drug and alcohol dependence **•**Victims of childhood sexual abuse **•**People with difficulties in socialization **•**Major medical illnesses—eg breast cancer **_Contraindications_** * Severe depression * Acute schizophreni * Hypochondriacs * Extreme schizoid personality (cold, aloof, hypersensitive introverts) * Extreme antisocial behaviour and perpetrators of abuse (especially paedophilia) as the group itself can condone or normalize past thoughts or actions rather than weaken them.
35
What is the technique with group therapy?
Forming, Storming, Norming, Performing 1. Group selection procedure by an experienced psychotherapist. Each group is limited to 6–8 members, balanced for sex, and avoiding mixing extremes of age 2. **Settling-in period** when members are on their best behaviour, seeking to be loved by the therapist, and looking to them for directive counselling 3. **Conflict,** as each person strives to find their place in the group other than through dependency on the leader.Learning that expressing negative feelings need not lead to rejection is a vital prelude to the next stage 4. **Intimacy**, in which the group starts working together.
36
What is play therapy and how does it work?
Used in children Directive: Therapist takes lead e.g CBT Non-Directive: Child left to play e.g Psychodynamic
37
Why do some patient's in psychotherapy often get worse before they get better?
* **Internal conflict** where one part of him or her wants to change, hence coming to sessions, and another part, the unwell part, is frightened of change and resisting it with all its might * **Uncovering unmourned loss**
38
How did Freud describe the human psyche with the iceberg model?
**ID:** Primitive urges e.g anger, desire **Ego**: Rational part of the ego. Finds a middle point between ID and superego **Superego:** Ethical and moral ideas you take on from your parents, religion, culture. The idea of the type of person you should be
39
# Define the following defence mechanisms:
40
What is transference?
41
What is psychodynamic psychotherapy used for?
42
What are the different types of exposure you can use in behavioural therapy?
* Graded * Focused * Prolonged * Repeated
43
What is the main difference between CBT and psychodynamic therapy?
CBT is focused and time limited Psychodynamic is open and longer
44
What is the vicious cycle of reduced anxiety?
45
What is the hot cross bun model?
Used in CBT If we change one it will change the others
46
What is the Five Areas Model?
Changing CBT into jargon free language ***Area 1: Situation, relationships and practical problems*** ***Area 2: Altered thinking*** ***Area 3: Altered emotions*** ***Area 4: Altered physical symptoms*** ***Area 5: Altered behaviour***
47
Why is family therapy in Schizophrenia good?
Reduces relapse/readmission rates in families who show high expressed emotion
48
What is IPT used for?
severe Depression
49
What is reaction formation?
**Defence mechanism** Fixation in [consciousness](https://www.merriam-webster.com/dictionary/consciousness) of an idea, affect, or desire that is opposite to a feared unconscious impulse A mother who bears an unwanted child, may react to her feelings of guilt for not wanting the child by becoming extremely [solicitous](https://www.merriam-webster.com/dictionary/solicitous) and overprotective to convince both the child and herself that she is a good mother.

Y4 Psychiatry SA (18 decks)

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