Bryan Chow Psychotherapies PowerPoint Flashcards
what type of therapy is supportive therapy
non directive
what are the goals of supportive therapy
symptom relief + adaptation
–> ameliorate symptoms
–> foster STABILITY and improve FUNCTION
–> improve SELF ESTEEM
–> support adaptive efforts to decrease relapse risk
describe the therapeutic stance in supportive therapy
conversational
transparent
collaborative
psychoeducation
describe a conversational therapeutic stance
active listening, not interrogating
RESPONSIVE–> diminish anxiety and fear
empathic, direct, supportive
what does it mean to have a transparent and collaborative therapeutic stance
explain reasons for questions
agree on topics for discussion
list 6 techniques used in supportive therapy
- focus on present
–> express interest, acceptance, respect, empathy, understanding - get to know your patients
–> including supportive people int heir lives - build self esteem and reduce anxiety
–> praise accomplishments
–> provide honest reassurance and encouragement - advice, teaching, guidance
- clarify, summarize and paraphrase
- discuss maladaptive behaviours if present
–> use MI techniques to motivate change
what should you NOT do in supportive therapy
interrupt feelings prematurely
problems solve for the patient
structure the session
be too active
assign homework
what SHOULD you do in supportive therapy
make an emotional connection
follow affect
build alliance
encourage catharsis
emphasize strengths
where do the techniques of supportive therapy fall on the “expressive-supportive” continuum
who coined the term alexithymia
peter sifneos
list 4 therapists associated with various forms of short term psychodynamic psychotherapy
Sifneos
Mann
Malan
Davanloo
which therapists is associated with the form of short term psychodynamic psychotherapy known as “short term anxiety provoking psychotherapy”
Peter Sifneos
what is the focus of short term anxiety provoking psychotherapy
anxiety-provoking confrontations–> direct attack on patients defenses
understand mechanisms used in dealing with oedipal conflicts
focus on OEDIPAL CONFLICT with goal of resolution
development of INSIGHT
what techniques are used in short term anxiety provoking psychotherapy
use of positive transferrence
maintain focus
anxiety provoking confrontations
what are the tasks of the therapist in short term anxiety provoking psychotherapy
build alliance
contract about focus
work through–> CORRECTIVE EXPERIENCE
what are indications for short term anxiety provoking psychotherapy
depressive disorders
some anxiety disorders
adjustment disorder
how often and for how long does short term anxiety provoking psychotherapy happen
10-20 sessions–no set number tho!!
once weekly
who developed the “triangle of conflict” and “triangle of person”
Malan
what is Malan’s triangle of person
current (others) <–> past (parents) <–> transference (therapist)
what is Malan’s triangle of conflict
defense <–> anxiety <–> impulse
what is a key element of short term psychodynamic psychotherapy in Malan’s conceptualization
linking the triangle of person and triangle of conflict
what did Malan call his conceptualization of short term psychodynamic psychotherapy
brief focal psychotherapy
what is the focus of Malan’s brief focal psychotherapy
internal conflict present since childhood–> development of insight is imperative
identify transference early–> link transference to relationship with PARENTS
how long does Malan’s brief focal psychotherapy last
average 20 sessions–> termination date set in advance!
who developed “time limited psychotherapy” as a form of short term psychodynamic psychotherapy
Mann
how long is time limited psychotherapy
only 12 sessions
what is a major focus of time limited psychotherapy
termination
what are the overall therapeutic foci of time limited psychotherapy
present and chronically endured pain
particular image of the self
conflicts likely to be encountered:
–independence vs dependence
–activity vs passivity
–unresolved vs delayed grief
–adequate vs inadequate self esteem
who developed short term dynamic therapy (as a form of short term psychodynamic psychotherapy)
Habib Davanloo
how long is short term dynamic therapy
no set number of sessions
indications for short term dynamic therapy
depressive d/o
some anxiety d/o
adjustment
SOMATOFORM
HYPOCHONDRIASIS
CLUSTER C TRAITS
what are the therapists tasks in short term dynamic therapy
build therapeutic alliance
rapidly reduce resistance
ACCESS UNCONSCIOUS via rage, guilt, other patient feelings
increase patient awareness
work to change way patient related to others
what techniques are associated with short term dynamic therapy
CENTRAL DYNAMIC SEQUENCE
problem inquiry, pressure, challenge, access unconscious
analyze transference, explore conflict, consolidate
terminate
what is psychodynamic psychotherapy
“involves attention to the therapist-patient interaction, with carefully timed interpretation of transference and resistance, embedded in a sophisticated understanding of the patient and an appreciation of the therapist’s contribution to the two-person field”
is psychodynamic psychotherapy indicated for the worried well
no
where does psychodynamic psychotherapy rank in the CANMAT depression guidelines
third line for acute MDD
what type of therapy is associated with Mann
time limited psychotherapy
12 sessions
focus on present and chronically endured pain, particular image of the self
what type of therapy is associated with Malan
brief focal psychotherapy
uses the triangles of self and triangles of conflict–> link the triangles in therapy
focus on internal conflict present since childhood, emphasis on developing insight
identify transference early and link to relationships with parents
what type of therapy is associated with Sifneos
anxiety provoking psychotherapy
direct attack on patients defenses, focus on oedipal conflict
what type of therapy is associated with Davanloo
short term dynamic therapy
access unconscious
central dynamic sequence
what are indications for psychodynamic psychotherapy
non psychotic, complex, long standing, treatment resistant:
GAD
chronic depression
unresolved trauma
personality disorders
multiple comorbidities
list signs and symptoms of unresolved trauma
narrative incoherence
alexithymia
mentalizing deficits
fearful/disorganized attachment
emotional dysregulation
relational problems
how and why do you aim to access the “zone of optimal arousal” in psychodynamic psychotherapy
address unresolved trauma
do this by validating distress
allows patient to think, feel, reflect and mentalize
list key concepts in psychodynamic psychotherapy
- Some of mental life is unconscious
- The past influences the present–> Trauma & neglect are sources of pathology
- Transference & countertransference–> Data for understanding patients
- Defense & resistance–> Mind may keep unpleasant thoughts out of awareness, but can emerge to cause symptoms or difficulties
- Subjectivity–> Reflecting, mentalizing, inner subjective experiences–> improve agency, authenticity
what is transference
REACTIONS based on perceptions of, and responses to a person in the HERE AND NOW that REFLECTS PAST FEELINGS about, or responses to, important people earlier in one’s life–> especially parents and siblings
what is resistance
the patients attempt to PROTECT THE SELF by AVOIDING the anticipated emotional discomfort that accompanies the emergence of conflictual, dangerous or painful experiences, feelings, thoughts, memories, needs and desires
how do the ideas of counter transference differ between Freud and Winnicott+contemporaries
Freud–> counter transference is the therapists transference
Winnicott–> idea of “objective countertransference”–> idea that strong feelings of the therapist towards the patient may reflect WHAT THE PATIENT EVOKES IN OTHERS rather than it being a sole product of the therapists own unconscious conflict–> can be useful in therapy
list the “primitive” defense mechanisms
splitting
projective identification
denial
dissociation
idealization
acting out
somatization
list the neurotic defense mechanisms
introjection
identification
displacement
intellectualization
isolation of affect
rationalization
list the mature defence mechanisms
humour
anticipation
altruism
suppresion
sublimation
asceticism
what is the focus of “insight oriented psychodynamic psychotherapy”
focus on individual and INTERPERSONAL RELATIONS
focus on AFFECT and expression of EMOTION
*explore attempts to avoid aspects of experience, identify recurrent themes and patterns
what techniques are emphasized in insight oriented psychodynamic psychotherapy
mentalizing techniques
i.e communication of mental states, reflection of mental states, wondering about intentions
collaborate in creating a coherent narrative –> use a “not knowing” stance
who developed interpersonal therapy
Gerald Klerman and Myrna Weissman
list indications for interpersonal therapy
depression
post partum depression
bipolar disorder
binge eating disorder
how many phases are there in IPT
3
how many sessions are in interpersonal therapy
8-16
is interpersonal therapy empirically supported
yes
what are the goals of interpersonal therapy
alleviate suffering
remit symptoms, improve functioning
resolve CURRENT interpersonal problems
improve communication and relationships
what theoretical idea underlies interpersonal therapy
“depressogenic cycle”
–> unwittingly evoke distance from others, can be disempowering and perpetuate isolation and despair
what are the functions of the initial phase of interpersonal therapy
form alliance, assess, psychoeducation
ASSIGN SICK ROLE
do INTERPERSONAL INVENTORY
choose FOCUS of therapy
what is the function of the middle phase of interpersonal therapy
focus specific
COMMUNICATION ANALYSIS
what is the structure of the ending phase of interpersonal therapy
review changes and gains
CONTINGENCY planning
good goodbye
what are the four possible foci of interpersonal therapy
grief –> bereavement
role transitions –> adapting to lifes changes
role disputes –> improve understanding and communication
interpersonal sensitivity –> decrease social isolation
CBT is based on what theoretical underpinning
learning theory (i.e classical, operant and social learning theory)
who is associated with classical conditioning
pavlov
watson
wolpe
who is associated with operant conditioning
skinner
who is associated with social learning theory
bandura
ideas of positive and negative reinforcement are associated with what type of learning
operant conditioning
what is classical conditioning
NEUTRAL stimulus associated with a NATURAL response (pavlovs dogs)
what is operant conditioning
specific CONSEQUENCES are associated with a VOLUNTARY behaviour
explain the differences between positive reinforcement, negative reinforcement, positive punishment, and negative punishment
are ideas in operant conditioning
BOTH positive and negative REINFORCEMENT work to INCREASE the likelihood of a behaviour being repeated, just in different ways–> positive reinforcement involves GIVING something to increase likelihood of a behaviour, and NEGATIVE reinforcement involves taking something AWAY to increase likelihood of a behaviour
positive and negative punishment are the same ideas but involve trying to DECREASE the likelihood of a behaviour being repeated
what is the focus of therapy in CBT
on MAINTENANCE factors rather than historical factors (i.e what is perpetuating the problem rather than what caused it in the first place)–> causes or motives are NOT NECESSARY
behavioural assessment and self monitoring
setting specific and measurable goals
measuring outcomes
list behavioural interventions that are based on CLASSICAL conditioning
systematic desensitization
flooding
interoceptive exposure
therapeutic exposures
exposure and response prevention
list behavioural interventions based on operant conditioning
behavioural modification
contingency management
aversion-based approaches
what do you use systematic desensitization for
phobias
how does systematic desensitization work
by RECIPROCAL INHIBITION
imagined anxiety situations are paired with RELAXATION (counter conditioning)
what is flooding used for
phobias
how does flooding work
engage with MOST feared situation, in a controlled setting, with relaxation PRN
EXTINCTION–> decreasing fear and maladaptive anxiety
what is interoceptive exposure used for
panic disorder
how does interoceptive exposure work
exposure to bodily sensations
extinction–> reduce fear response with repeated, prolonged contact with feared stimulus in the absence of a panic attack
habituation–> intensity of fear response decreases with repeated presentation of physiological sensations
what are therapeutic exposures used for
anxiety disorders
how do therapeutic exposures work/how are they structured
planned, prolonged and repeated
construct FEAR HIERARCHIES with SUDS–> graduated exposures
can do imagined or in vivo
operate on principles of extinction and habituation
what do you use exposure and response prevention for
OCD
how does behavioural modification work
reinforcement and punishment to acquire new behaviours
continuous or intermittent schedules of reinforcement
shaping + chaining
what is “shaping” in behavioural modification
reinforcing successive approximations to goal
what is “chaining” in behavioural modification
teaching sequence of behaviours until goal
how do contingency management programs work
token economy programs
rewards or punishes according to contracted rules
spells out series of behaviours to be expected in contingencies
how to aversion based approaches work
PUNISHMENT paired with response to be extinguished
for efficacy–> high intensity, immediate, continuous (initially)
LAST RESORT
list some other interventions classified as “behavioural”
behavioural activation
problem solving therapy
social skills training
relaxation training
habit reversal (trichotillomania)
name the 3 propositions upon which CBT is based
access hypothesis
mediation hypothesis
change hypothesis
what does CBT’s access hypothesis posit
with appropriate training + motivation + attention, one can become AWARE of the content and process of one’s thinking
what does CBT’s mediation hypothesis posit
MANNER in which one thinks about, interprets and construes events INFLUENCES emotional and behavioural responses
what does CBT’s change hypothesis posit
by INTENTIONALLY modifying cognitive and behavioural responses to situations one can become MORE FUNCTIONAL and adaptive
who is associated with cognitive theory (CBT)
Aaron Beck
–> cognitive theory
–> beck depression inventory
what is Beck’s cognitive triad
negative view of self <–> negative view of future <–> negative view of world <–> (is a triangle)
–> certain characteristic cognitive biases are associated with specific psychiatric conditions
based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:
depressive
negative view of self, experience, future
based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:
hypomania
inflated view of self, future
based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:
suicidality
hopelessness
deficiencies in problem solving
based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:
anxiety
sense of physical or psychological danger
based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:
phobias
fear of danger in specific, avoidable situations
based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:
panic disorder
catastrophic interpretation of bodily/mental experiences
based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:
paranoia
attribution of bias towards others
based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:
conversion
concept of motor or sensory abnormality
based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:
OCD
repeated warning about doubt and safety—> acts to ward off
based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:
anorexia
fear of being fat
based on Beck’s cognitive triad, what is the idiosyncratic cognitive content associated with the following disorder:
IAS/SSD
attribution of serious medical disorder
what are the 10 principles of CBT according to Beck
how might you approach a CBT cognitive formulation
what are schemas in CBT
core beliefs
“schemas are deep cognitive structures that enable an individual to interpret his or her experiences in a meaningful way”-beck
central ideas about self, other, world
characteristic, recurrent themes in thought
upon activation–> INFLUENCE PERCEPTIONS of experiences
develop early in life
global, rigid, overgeneralized, absolute
LEAST AMENABLE TO CHANGE
what are automatic thoughts
automatic negative and dysfuncitonal thoughts–> cognitive distortions
typically INITIAL TARGET in cognitive therapy
list some of the cognitive distortions (burns)
list some of the cognitive distortions (gabbard)
what are the goals of CBT’s cognitive techniques
COGNITIVE RESTRUCTURING
–> use the socratic questioning and behavioural experiements
–> develop alternative, more productive thoughts and perspectives
when might group CBT be preferred over individual
social anxiety
chronic pain
what is the first wave cognitive/behavioural therapy
behavioural therapy
what is the second wave cognitive/behavioural therapy
CBT
what is the third wave cognitive/behavioural therapy
DBT
MBSR
MBCT
ACT
what are the therapeutic factors of group therapy (list)
universality
altruism
instillation of hope
imparting information
corrective recapitulation of primary family group
developing socializing techniques
imitative behaviour
interpersonal learning
existential factors
catharsis
group cohesiveness
what is the primary dialectic of DBT
ACCEPTANCE of clients as they are
+
CHANGE in order to reach their goals
what does “dialectical” mean
integration of opposites
what are the 4 components of a DBT program
skills training group
individual DBT therapy
phone coaching
therapist consultation team
what are the four areas of focus in DBT as a therapy
mindfulness
distress tolerance
interpersonal effectiveness
emotional regulation
what are the components of DBT that are focused on the “acceptance” part of the dialectic
mindfulness
distress tolerance
what are the component of DBT that focus on the change part of the dialectic
interpersonal effectiveness
emotional regulation
how do you prioritize treatment targets in DBT?
- life threatening behaviours are FIRST–> suicidal, non suicidal, self injury, SI, suicidal communication
- therapy interfering behaviours are SECOND–> coming late, cancelling, being non collaborative
- quality of life interfering behaviours are THIRD–> mental disorders, relationship problems, financial/housing crisis
- skill acquisition is FOURTH–> replace ineffective behaviours to achieve goals
what are the four stages of treatment in DBT
stage 1–> achieving BEHAVIOURAL control
stage 2–> full EMOTIONAL experiencing
stage 3–> life of ordinary HAPPINESS
stage 4–> ongoing CAPACITY for experiences of joy and freedom
what is “defusion”
skill learned in mindfulness
distancing oneself from, letting go of unhelpful thoughts, beliefs, memories
how do MBCT and CBT differ?
who came up with structural family therapy
salvador minuchin
what are the goals of structural family therapy (5)
- creating an EFFECTIVE HIERARCHICAL STRUCTURE in the family
- helping parents become effective PARENT SUBSYSTEM
- aiding children to become SUBSYSTEM OF PEERS
- increasing FREQUENCY of interactions and NURTURANCE (if disengaged)
- DIFFERENTIATION of family members (if enmeshed)
what are the two assumptions made in structural family therapy
- families possess the skills to solve their own problems
- families generally act with good intentions
–> have problems with carrying out good intentions
name 5 techniques used in structural family therapy
joining
enactment
boundary making
reframing
restructuring
define the following technique used in structural family therapy:
joining
empathic relationship with the family in order to modify current functioning
define the following technique used in structural family therapy:
enactment
therapist constructs interpersonal scenario in session where dysfunctional transactions among family members are played out
define the following technique used in structural family therapy:
boundary making
maintaining clear boundaries around subsystems (healthy)
define the following technique used in structural family therapy:
reframing
examining a situation in a new perspective so that the meaning is changed
define the following technique used in structural family therapy:
restructuring
changing the structure of the family
what is the main goal of Bowen family therapy
facilitating AWARENESS of how the emotional system functions
INCREASE LEVELS OF DIFFERENTIATION–> focus making changes for self
–> diffuse anxiety by focusing on patterns that develop in families–> perception of either TOO MUCH CLOSENESS or TOO MUCH DISTANCE
–> determined by levels of external stress, sensitivities to themes
–> transmitted down generations
the genogram is associated with what type of family therapy
Bowen family therapy
describe the concept of triangles as seen in Bowen family therapy
when inevitable anxiety arises in a dyad, this is relieved by involving a vulnerable third party who either takes sides or acts as a detour for the anxiety
avoidance of the original anxiety
triangles tend to repeat across generations
what is the understanding of the nuclear family emotional system in Bowen family therapy
couples conflict/symptoms in a spouse–> projection on to children
what is the understanding of the family projection system in Bowen family therapy
children with the least emotional separation from parents are the MOST vulnerable
what is motivational interviewing?
directive, client centered counseling style for eliciting behaviour change by helping clients EXPORE and RESOLVE ambivalence
what is a mnemonic for motivational interviewing principles
DEARS
Discrepancy
Empathy
Ambivalence
Roll with resistance
Self efficacy
what is a mnemonic for motivational interviewing spirit
PACE
Partnership
Acceptance
Compassion
Evocation
what is a mnemonic for the motivational interviewing process
EFEP
Engagement
Focusing
Evoking
Planning
what is a mnemonic for motivational interviewing communication
OARS
Open ended questions
Affirmations
Reflections
Summarizing
