Psychological therapies

Question 1

What are the main types of psychotherapy? Give an example of each.

Answer 1

Supportive therapies e.g. counselling and supportive psychotherapy

Psychodynamic therapies e.g. psychoanalysis and psychodynamic psychotherapy

Behaviourist therapies e.g. CBT, CAT

Newer therapies e.g

• EMDR
• Interpersonal therapy
• Family therapy

Physical therapy e.g. ECT

Question 2

What is the least intense level of psychotherapy?

Answer 2

Counselling /supportive psychotherapy

Question 3

Describe the principles of counselling. What does it work for?

Answer 3

• The sessions are unstructured but allow the patient to establish rapport, reflect and get reassurance
• It is a non-direct way of solving the problem –> works for stress, bereavement, adjustment disorder

Patients usually have about 6-10 sessions and it works well for mild disorders.

Question 4

What is the difference between counselling and CBT?

Answer 4

Both CBT and counselling are used to support patients with similar issues + they’re both forms of talking therapy used for short term work.

BUT:

• CBT aims to change a behaviour or thinking patterns
• Counselling aims to help the patient better understand themselves and find their own solutions to cope through listening, empathy, encouragement and challenge

Question 5

Where does psychodynamic therapy originate? What is the basis for it?

Answer 5

Based on work by Sigmund Freud - theorised that human behaviours are being determined by unconscious forces derived from primitive emotional needs

…so by looking at issues using psychoanalysis you can examine unresolved comflicts and symptoms that arise from past dysfunctional relationships

…which show up in life as bad behaviours

Usually 4/5 times a week and last 2-5 years

Question 6

What is transference and counterransference in psychodynamic therapy?

Answer 6

Transference - an unconscious redirection of feelings from one person to another (patient to therapist)

Counter-transference - when the therapist projects their own unresolved conflicts onto the client; therapist must recognise this and remain neutral. Can subjective, objective, positive or negative.

Question 7

How does psychodynamic therapy work?

Answer 7

The patient explores their subconscious by using free association (says whatever is on their mind)

The therapist interprets these statements to link the patient’s past experience with their current life and their relationship with the therapist. This uses 2 skills: transference and counter-transference

Question 8

What are the disadvantages of psychodynamic therapy?

Answer 8

• Long time needed for treatment to work
• Very intensive and expensive training
• Patients are left to work it out themselves
• Patients can become dependent

Question 9

What are the principles of behaviourist therapy?

Answer 9

Based on fact that psychiatry is about abnormal behaviours

These can be tackled in a structured way

Gives explicit strategies for the patient to imporve their thinking

It is time limited - ~6-12 sessions

Question 10

How would you explain CBT to a patient?

Answer 10

It is a type of talking therapy which is used to change the way you think, feel and behave about certain situations, reducing the symptoms you may be feeling.

Usually tasks are given between sessions to encourage thought-challenging and active monitoring of behaviour and thought patterns. You will be supported by a trained practitioner who reviews progress and outcomes.

NHS website:

• Based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle.
• Aims to help with overwhelming problems in a more positive way by breaking them down into smaller parts.
• Teaches how to change these negative patterns to improve the way you feel.
• Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past.

Question 11

How long is CBT usually continued for in a patient?

Answer 11

~12 weeks depending on the condition

Question 12

Describe group CBT.

Answer 12

Considered if low-intensity psychological intervention is declined

Should be delivered by 2 trained practitioners

Consists of 10-12 meetings of 8-10 participants

Question 13

What conditions can CBT be used for?

Answer 13

• bipolar disorder
• borderline personality disorder
• eating disorders – such as anorexia and bulimia
• obsessive compulsive disorder (OCD)
• panic disorder
• phobias
• post-traumatic stress disorder (PTSD)
• psychosis
• schizophrenia
• sleep problems – such as insomnia
• problems related to alcohol misuse

Question 14

How can CBT be delivered?

Answer 14

Individual -guided self-help based on CBT principles

One-to-one CBT (usually x2/week) with a therapist

Computerised CBT - if the patient prefers not to do it face to face

Question 15

What is Beck’s cognitive triad?

Answer 15

Negative views of

1. World
2. Self
3. Future

Question 16

Is CBT about ‘positive thinking’?

Answer 16

Yes but more about flexible and balanced thinking.

Question 17

What are the cognitive distorsions targetted in CBT?

Answer 17

1. All or nothing thinking
2. Magnification (catastrophising) and minimisation
3. Over generalising
4. Mental filter - only paying attention to some types of evidence
5. Disqualifying the positive
6. Personalisation - “this is my fault”
7. Jumping to conclusions (incl. ‘mind reading’ and ‘fortune telling’)
8. Emotional reasoning - assuming that because we feel a certain way what we think must be true
9. Labelling - to ourselves or other people
10. ‘Should’ and ‘must’ - makes you feel guilty or as if you ahve already failed

Question 18

What is the ABC approach in psychotherapy?

Answer 18

ABC Approach: identifies…

1. Antecedents,
2. Behaviour,
3. Consequences of behaviour.

This informs a management plan that is preferable to medicating behavioural problems, and may include:

• avoiding antecedents
• reinforcing positive behaviours
• preventing reinforcement of negative behaviours (e.g. using distraction techniques)
• helping people understand the consequence of their actions.
• NB: this is different from the ABC that preceded CBT:*
• ABC of CBT*
• A - activating event
• B - thoughts, attitudes, asumptions
• C - behaviour or emotion, cosequences

Question 19

What is EMDR and what is it used for?

Answer 19

Eye Movement Desensitization and Reprocessing (EMDR) - type of psychotherapy that allows patients to access past traumatic memories and emotionally resolve them.

Mainly used for PTSD

Usually 8 to 12 sessions.

Question 20

What should you waarn patients about regarding EMDR?

Answer 20

Can be distressing - makes patient relive their experiences and emotions

Question 21

How does EMDR work? What is DAS?

Answer 21

• Therapist first takes a history to establish traumatic memories + patients recall the disturbing events and the emotion they felt (e.g. sexual abuse and feeling powerless
• They then work together to create a positive belief about the event (“I am stronger now and so not powerless”)
• The therapist then activates both sides of the brain using Dual Activation Stimulation (DAS) by making they do eye movements –> brain reprocesses the upsetting memories by removing the old emotion and replacing it with the more positive, empowering emotion
• This means the memory is no longer experienced as a traumatic.

Question 22

What is interpersonal therapy?

Answer 22

Therapy with aims to improve social functioning and interpersonal skills. Based on identifying and addressing problems in relationships with others as these can make the depression worse or worsen with depression.

Question 23

What is interpersonal therapy used for?

Answer 23

Used for moderate to severe depression - better for those with later onset or longer duration of illness

16-20 sessions over 3-4 months with 2 sessions per week in the first 2-3 weeks

Question 24

What are the uses of family therapy?

Answer 24

• Schizophrenia - can reduce relapse rates. Involves communication skills training, education, problem-solving and expanding their social network
• Alcohol misuse - if children aged 10-17yrs present
• Depression in the elderly

CAMHS:

• Anorexia/bulimia nervosa (1st line in CAMHS)- involves whole family rather than just focusing on the patient. Most useful for children.
• Conduct disorder - problem solving
• Somatisation in a child

Question 25

What is the aim of motivational interviewing?

Answer 25

A form of counselling which aims to:

• empower the person to change by recognising the gap of where they are now and where they want to be
• enagage ambivalent patients who lack insight into their disorder or hold positive views of their illness e.g. anorexia nervosa

Based on supportive but challenging therapeutic relationship.

Question 26

What does group therapy involve?

Answer 26

Involves meeting and speaking with other people who have similar experiences

Question 27

What are the uses of group therapy?

Answer 27

1. PTSD
2. Depression in the elderly
3. Learning disability

Patients can share experiences and solutions to problems.

Question 28

Define psychoeducation.

Question 29

What conditions is psychoeducation useful in?

Answer 29

Most psychiatric disorders as they help the patient or carer understand symptoms, cope, encourage adherence to medication and participate in management.

Uses: somatisation, chronic pain, unexplained symptoms, ADHD, autism, anxiety, depression etc.

Question 30

What is transference-focused therapy? What condition is it used in?

Answer 30

EUPD

• Based on a theoretical process by which emotions are transferred from one person to another
• Therapist would verbally identify, or ask the person in therapy to identify, examples of their behavior that are happening immediately in the course of a therapy session
• Helps develop positive alternatives to destructive or potentially unhealthy behavior as it happens to help you build healthier relationships