16 - Psychotherapy Flashcards
What is psychotherapy?
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
What is the difference between psychotherapy and counselling?
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
What are the different classifications of psychotherapy?
Who is involved
- Individual
- Groups
- Couples
- System (extended family)
Content and methods used
- Analytic/Dynamic
- Interpersonal
- Cognitive
- Behavioural
- Art
- Play
What are the common characteristics of all psychotherapies?
- 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
Who are ideal candidates for psychotherapy?
- 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)
Which type of patients are not suitable for psychotherapy and why do we need to identify those who are not suitable?
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
What psychotherapies are available on the NHS?
- Cognitive
- Behavioural
- Interpersonal (IPT)
- Psychodynamic
- Group/Family
What type of psychotherapy is best for the following groups:
- PTSD
- Depression
- Anxiety disorders
- PTSD: Trauma focused CBT. Do NOT debrief
- Depression: Cognitive or Interpersonal
- Anxiety disorders: Cognitive Behavioural (CBT)
What type of psychotherapy is best for the following groups:
- Somatic complaint with psychological component
- Eating disorders
- Personality disorders
- Somatic complaint with psychological component: CBT
- Eating disorders: CBT, IPT, Family
- Personality disorders: DBT, psychoanalytic day hospital programme, and therapeutic communities
What theory is CBT based on?
Learning theory - Conditioning and Operant Learning
What is cognitive therapy and how does it work?
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
What is behavioural therapy and how does it work?
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
What are some of the different methods used in behavioural therapy?
- 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
What is CBT and how does it work?
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
What is some homework that a patient might be given whilst doing CBT?
- 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
What disorders is CBT useful for?
- Depression
- Anxiety disorders e.g Panic, Social, OCD, PTSD, phobias
- Eating disorders
What disorders may you want to use CBT with caution or not use it at all?
• Severe depression
• Poor concentration
• Difficulties talking about feelings
• Patient focused on childhood events
• Poor motivation to change
What theory is psychodynamic therapy based on?
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
What is psychodynamic therapy, how does it work and how long do you do it for?
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
What is counter transference and how is this avoided in psychodynamic therapy?
Refers to the therapist’s emotional reactions and projections towards a patient, often influenced by the their own experience.
Therapist has their own personal therapy to avoid this.
How many psychodynamic sessions does someone with depression need?
Only 8
What is interpersonal therapy and who is it for?
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
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
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)
Triangulation and Scape Goating are two dysfunctional family patterns. What is meant by these two patterns?
What is the technique with group therapy?
Forming, Storming, Norming, Performing
- Group selection procedure by an experienced psychotherapist. Each group is limited to 6–8 members, balanced for sex, and avoiding mixing extremes of age
- Settling-in period when members are on their best behaviour, seeking to be loved by the therapist, and looking to them for directive counselling
- 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
- Intimacy, in which the group starts working together.
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
Define the following defence mechanisms:
What is transference?
What is psychodynamic psychotherapy used for?
What is the vicious cycle of reduced activity?
What is the hot cross bun model?
Used in CBT
If we change one it will change the others
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
