Psychological Therapies

Question 1

Family Therapy

Answer 1

• Form of psychological counselling that can help family members resolve existing conflict, and improve communications within the family unit
• Goals:
  
  • Resolving disputes
  • Improving communication
  • Psychoeducation
  • Recognising precipitating stressors
  • Recognising relapse signatures
  • Creating an improved home environment without blame on any family member
• Different types including structural, systemic and strategic

Question 2

Dialetical Behavioural Therapy

Answer 2

• Sessions move between both individual and group-based
• Principles of DBT:
  
  • Tolerance of distress:
    
    • Distress tolerance - Alternatives to dealing with a crisis with destructive self-harming behaviours
    • Interpersonal effectiveness- How to ask for things but say no whilst still maintaining important relationships
    • Mindfulness- Helps an individual to focus attention to life in the present
    • Emotion regulation- Skills to help an individual have more control of their emotions

Question 3

Dialetical Behavioural Therapy - Why Used For EUPD

Answer 3

• Small stressors can affect a patient with borderline personality disorder quite significantly
• Patients with borderline personality disorder often grew up in an environment where their emotions were not acknowledged by those around them
• This leads to a cycle of intense emotions on a regular basis, often in response to relatively minor triggers, whilst feeling guilty for having these emotions
  
  • Stressor –> strong emotions –> exaggerated behavioural response –> guilt –> stressor
• The term dialectics comes from a philosophical point that things are rarely black and white and that it is important to find the balance between opposite positions.
• People with borderline personality disorder often face a conflict between experiencing intense emotions and reacting to the way in which others respond to this reaction, leading to a feeling of guilt.

Question 4

What is CBT

Answer 4

• Check understanding
• Form of psychological therapy.
• It looks at specific issues in the present and aims to identify and challenge negative cognitions and behaviours that maintain negative emotional state.
• Thoughts - emotions - behaviours - physical sensations all linked (diagram)
• E.G. if we feel low we may not feel like we have the energy to do things we enjoy - which would actually improve our mood.
• Sessions are interactive - will be given homework to work on between sessions.
• Normally about an hour and on a weekly basis.
• # of sessions limited but flexible - on average 12
• Signpost to further information.

Question 5

CBT - Indications

Answer 5

• Depression
• Anxiety
• Phobias including agoraphobia (Systematic Desensitisation)
• OCD (Exposure and response prevention)

Question 6

Systematic Desensitisation

Answer 6

• Systematic desensitisation is a behavioural therapy based on classical conditioning and shares many elements of the behavioural components of CBT
• Comprises of two parts: graded exposure and relaxation
• A structured hierarchy of anxiety-provoking situations will be developed with the patient and worked through from the least stressful to the most stressful situation.
• Systematic refers to the fact that a patient will be exposed to different circumstances than would usually feel uncomfortable with but in a structured and hierarchical manner.
• Desensitisation refers to the fact that you will be taught relaxation techniques like breathing exercises to help counter and control any anxiety felt during these scenarios.
  
  • Idea is that the body cannot be both anxious and relaxed at the same time
• Be reassuring and reiterate will be small and they will not be forced into situations that cause severe distress
• Structure:
  
  • Sessions will be weekly and last about an hour
  • Average number of sessions is usually 8-12 but can be different
  • Can be carried out at home e.g. for agoraphobia

Question 7

Transference Reaction - Definition

Answer 7

• Ask them about experience of therapy so far:
  
  • How long, how many sessions, what was the aim of therapy
  • Explore reasons for wanting to stop
• Explain how bringing negative feelings to the surface in therapy can initially make things feel worse before they feel better
• Ask about feelings towards therapist?
  
  • Does this echo similar feelings towards anyone else?
• Process by which a patient displaces onto their therapist a feeling which derives from a previous relationship - in this case a negative one.
  
  • Can make people want to stop therapy
• This can mould the way in which new relationships develop as it means problems from the past get replayed in current relationships.
• One of the goals of psychotherapy is to work with the therapist to tolerate these difficult feelings.
• Sometimes we get a strong emotional response to a person in the here and now, but it actually relates to a pattern of relationships that we learnt in our early life
• This means that problems in the past often get reported again in the present moment.

Question 8

Displacement Reaction - Definition

Answer 8

• This is an unconscious defence mechanism whereby emotions are felt unacceptable and expressed on another person or object.

Question 9

Interpersonal Therapy - Assess Suitability

Answer 9

• Low mood can be a response to difficulties in our relationships which can then further damage our relationships.
• Looking to establish:
  
  • Symptoms of depression
  • Key relationships
    
    • Any recent changes in those relationships
  • Any recent loss of role or grief?
  • Any interpersonal deficits present?
• What is the patients motivation to engage in IPT?
• Screen for suicidality/psychotic symptoms

Question 10

Exposure and Response Prevention

Answer 10

• Identify the problems the patient is dealing with.
• ERP = type of CBT which looks at how thoughts, feelings and behaviours impact each other.
• With the therapist you will make a list of things that induce anxiety and make you feel compelled to carry out a behaviour - from most to least
• You then start by deliberately exposing yourself to the least anxiety-provoking situation and stopping yourself from doing the behaviour that you usually would.
  
  • Your anxiety will initially increase but you’ll find it subsequerntly goes down.
  • The therapist will help you in learning ways of thinking about the situation to lessen your anxiety too
• Structure:
  
  • Usually hour long sessions every week - typically 8-12 sessions
• Offer signposting to further information

Question 11

Family Therapy for Schizophrenia - Structure and Length

Answer 11

• Hour long sessions, usually weekly
• NICE recommend duration of 3 months up to 1 year
• Minimum 10 sessions

Question 12

Cognitive Disortions

Answer 12

‘JAMMED with SLOP’

Jumping to conclusions
All-or-nothing thinking
Mental filters
Magnification/minimisation
Emotional reasoning
Discounting the positive

Should statements
Labelling
Overgeneralisation
Personalisation and blame