Psychiatry - Psychotherapy Flashcards
What is psychotherapy?
Psychotherapies are “talking treatments”. Symptoms are relieved by way of professional therapeutic relationships.
Many different types of psychotherapy, all have common features in approaches to treatment:
- trust
- structure
- empathy
- feedback
- testing solutions
This therapeutic alliance is particularly important for positive outcomes and includes:
- ability of the patient to work purposefully in sessions
- agreement about goals and targets
- ability of the patient and therapist to form a relationship
- therapist’s ability to provide empathic understanding
What factors must be considered when assessing whether a patient will benefit from psychotherapy?
Efficacy of psychotherapy as a treatment for their disorder
Ability to talk about difficulties openly
Motivation to engage in psychological work
Ability to identify psychological factors that relate to their difficulties
Motivation to change their behaviour
Previous response to psychotherapy
What is CBT?
Cognitive behavioural therapy is structured, time limited and goal orientated
Emphasis is on current problems rather than considering the past
Homework is important, focus on relapse prevention
“Change the way you feel by changing the way you think”
- distressing emotions and behaviours are the result of cognitive errors or distortions
- cognitive distortions relate to self, world and future (Beck’s triad)
Cognitive methods used in CBT
1) ABC method
- identifying the ANTECEDENT, BEHAVIOUR and the CONSEQUENCES
- e.g. A = panic attack in the supermarket, B = avoiding going to the supermarket, C = increasing isolation and reinforcement of panic attack
2) Identifying negative automatic thoughts
- selective abstraction: focusing on one minor aspect of the bigger picture
- All-or nothing thinking: thinking of things in absolute terms
- Magnification/ minimalisation: faulty elevation of relative significance of particular events
- Catastrophic thinking: anticipating the worst possible outcome for a situation
- Overgeneralisation: if one thing has gone wrong, all others will as well
- Arbitrary interference: coming to a conclusion in the absence of any evidence to support it
3) Thought diary recognise connections between cognitions, emotions and behaviour
4) Examine evidence for and against negative automatic thoughts and substitute other more realistic interpretations
What behavioural methods are used as part of CBT?
Relaxation techniques
Systematic desensitisation - constructing a hierarchy of anxiety provoking situations and the patient is exposed to these situations in a graded manner
- can be in there imagination or real life (depends on availability of phobic object)
- patients gradually habituate to the anxiety they experience and the anxiety will eventually be easier to tolerate and subside
Activity scheduling
Indications for CBT
Depression (mild to moderate) Eating disorders Anxiety disorders OCD PTSD Chronic psychotic symptoms
Also reduces likelihood of subsequent relapse
What is psychodynamic psychotherapy?
Psychodynamic theories were developed by Freud, Jung, and Klein. Early childhood experiences are crucial in shaping the personality. Treatment involves discussing past experiences and how these have shaped the present situation
Unconscious conflicts are explored and the insight gained aims to change the patients maladaptive behaviour. Main goals of psychotherapy are symptom relief and personality modification through exploration of the unconscious. Therapies offered on an individual, group or residential community basis
What is transference and counter-transferance?
These are elements of psychodynamic psychotherapy
Transference is the patients attitudes and feelings towards the therapist. It is the projection onto the therapist of assumptions derived from a previous important relationship in the patient’s life (usually in childhood). Transference is a very important way for the patients difficulties to be understood as these relationship problems are re-enacted during therapy. Analysing and interpreting these is the basic of psychodynamic therapy
Counter transference is the therapists emotional response to the patient. If understood properly, it can allow the therapist to gain valuable insight into the way the patient relates to others
Defence mechanisms
Psychological strategies to protect people from emotional distress. Utilised unconsciously by everybody at some point to cope with stressful situations. Grouped into three categories: mature, neurotic and immature
Those with mature defences have better, more stable outcome
Analysing a patients defence strategies can be used as a tool in therapy
Examples of mature defence mechanisms
Altruism - meeting own needs by helping others
Humour - seeing the funny side of difficult situations
Sublimation - modifying unacceptable desires to make them acceptable
Neurotic defence mechanisms
Displacement - transfer of negative feelings to someone/ something else
Reaction formation - opposite reaction to hide true feelings
Isolation - exclusion of others to protect self
Repression - thoughts are prevented from being made conscious
Immature defence mechanisms
Splitting - people are either all good or all bad
Projection - internal issues are attributed to an external cause
Acting out - unacceptable behaviour in response to conflict, e.g. self harm
Passive aggression - anger becomes passive resistance to co-operate
Indications for psychodynamic therapy
Dissociative disorders, somatoform disorders, psychosexual disorders, certain personality disorders, chronic dysthymia, recurrent depression
What are the contraindications for psychodynamic therapy?
Antisocial personality disorders, acute psychotic disorders, dependence on drugs and alcohol, current depression with a high suicide risk
What is supportive psychotherapy?
Widely used term with various definitions. Commonly used to describe the psychological support given by mental health professionals to patients with chronic and disabling mental illness. Aim is to optimise the patients psychological and social functioning, helping them cope with the effects of their illness, increasing self esteem, self confidence, education about their condition and prevention of relapse
