Psychological Treatment Flashcards
PSYCHOTHERAPY
What is psychotherapy?
A term covering the wide and disparate range of techniques used in an attempt to enhance psychological and emotional well-being.
PSYCHOTHERAPY
How do they vary?
Vary in terms of efficacy (how useful they are)
Scientific rigour (how well supported by evidence they are)
Can also be biased (it might work better for some groups compared to others)
PSYCHOTHERAPY
Who does psychotherapy?
Social workers, counsellors, nurses, GPs, Psychiatrists. It is not just done by psychologists.
PSYCHOTHERAPY
Where is it done?
Can be done in: Workplaces Support services Group/family settings Hospitals Schools Online/over the phone Practitioner rooms/surgeries.
What makes a good therapist?
Warmth & empathetic
Ability to develop good therapeutic alliance
Focus on the key issues
Able to align treatment approach with the person
Willing to get feedback from client, supervisor and colleagues
Keep up to date with research
Expected to behave in ethical manner.
What do we base therapeutic practice on?
The Science-practitioner model: which is an interrelationship between research and practitioners
What are the 5 psychotherapeutic perspectives?
Psychodynamic Humanistic-Existential Behavioural Cognitive Behavioural Biological
PSYCHODYNAMIC THERAPIES
What are psychodynamic therapies?
Found by Freud, based on the assumption that psychopathology develops when people remain unaware of their true motivations and fears
PSYCHODYNAMIC THERAPIES
What are the 2 key principles of it to work?
Insight: clients capacity to understand their own psychological processes
Therapist-Client Alliance: crucial in effective change to the disordered psychological processes.
PSYCHODYNAMIC THERAPIES
What are the 5 core beliefs of psychodynamic therapies?
- Behaviour is driven by unconscious wishes, impulses, drives and conflicts
- Meaningful explanation for abnormal behaviour
3- Issues are based on childhood experience.
4- Reliving of past emotional experiences is crucial.
5- Once the client understands, the issue often resolves itself.
PSYCHODYNAMIC THERAPIES
What is free association?
The first stage of psychoanalysis where the client is encouraged to give free rein on their thought and feelings with the intent to uncover unconscious material.
PSYCHODYNAMIC THERAPIES
What is Interpretation?
The second stage of psychoanalysis. The therapist points out to the patient, their defences and underlying meaning of their thoughts and behaviours.
PSYCHODYNAMIC THERAPIES
What is dream analysis?
The third stage of psychoanalysis. The therapist interprets dreams in the context of what is occurring in life for the person.
PSYCHODYNAMIC THERAPIES
What is resistance?
The 4th stage of psychoanalysis. Resistance to free association are thought to arise from unconscious control over sensitive areas.
PSYCHODYNAMIC THERAPIES
What is transference?
The 5th stage of psychoanalysis. The process by which people experience similar thoughts, feelings, fears, wishes and conflicts in new relationship as they did in previous relationships; they might transfer feelings and existing beliefs.
PSYCHODYNAMIC THERAPIES
What is working through?
The 6th stage of psychoanalysis. Where the therapist assist the person in processing the info and insights gained through therapy and involves continued identification of arising conflicts and resistance.
PSYCHODYNAMIC THERAPIES
What are the criticisms of the psychodynamic approach?
Sample bias - based on rich, intelligent and successful individuals (no variance)
Confirmation Bias- selecting information that supports claims and disregarding evidence that doesn’t.
Long term is expensive.
Do we really need insight to solve problems?
Lack of scientific rigour in some situations.
HUMANISTIC-EXISTENTIAL PSYCHOTHERAPY
What is it?
Similar to psychodynamic therapies, it requires the client to develop insight. It is the belief that human nature is inherently positive and good and that we all have the ability to reach our full potential. The aim is to help people get in touch with their true selves and with a sense of meaning of life.
HUMANISTIC-EXISTENTIAL PSYCHOTHERAPY
What is phenomenology?
The way each person consciously experiences the self, relationships and the world.
HUMANISTIC-EXISTENTIAL PSYCHOTHERAPY
What is Maslow’s Hierarchy of needs?
A hierarchy that starts at the basic human needs such as physiological needs, to the pinnacle of self actualisation.
HUMANISTIC-EXISTENTIAL PSYCHOTHERAPY
What is Person-Centred therapy?
Developed by Carl Rogers who rejected the notion of a disease model; meaning you should not be treating people as unwell. The core traits of the therapist include:
Authentic and genuine
Unconditional positive regard
Must relate to client with empathetic understanding.
HUMANISTIC-EXISTENTIAL PSYCHOTHERAPY
What are the assumptions of Person-Centred therapy?
- People can be understood only from the vantage point of their own perceptions and feelings.
- Healthy people are aware of their own behaviour.
- People are innately good and effective, they become ineffective only when faulty learning intervenes.
- Behaviour is purposive and goal directed.
- Therapists should not attempt to manipulate events for the individual. (the client needs to come to their own conclusion.
HUMANISTIC-EXISTENTIAL PSYCHOTHERAPY
What is Gestalt Therapy?
Dysfunction is caused by individuals surpassing experiences and traits that are anxiety inducing. Therefore we need to recognise and accept these to become integrated and whole.
Emphasis on therapy is accepting responsibility for own feelings and focussing on the here and now.
HUMANISTIC-EXISTENTIAL PSYCHOTHERAPY
What are the techniques used in Gestalt therapy?
Empty Chair technique: provides opportunity to talk to another without risk.
Two chair technique: outlines both sides of the story.
HUMANISTIC-EXISTENTIAL PSYCHOTHERAPY
What are the criticisms of Humanistic-Existential Therapy?
- Lack of scientific rigour in some situations
- Positive regard and empathy may not be necessary for effective counselling
- Efficacy is variable
- Cultural bias- some argue that is based on western individualistic values.
BEHAVIOURAL AND COGNITIVE-BEHAVIOURAL THERAPIES
How did they develop?
A result of the development of behaviourism and cognitive psych. Both have their scientific explorations rather than clinical practice.
BEHAVIOURAL AND COGNITIVE-BEHAVIOURAL THERAPIES
What are the basic principles?
- Short term therapy.
- Therapeutic focus is current behaviour/cognitions, not on the past experiences or inferred motives.
- Therapy commences with behavioural analysis.
- Therapy targets problematic behaviours, cognitions and emotional responses.
BEHAVIOURAL AND COGNITIVE-BEHAVIOURAL THERAPIES
What is the exposure technique?
Used to treat phobias and anxiety triggered responses; it involves confronting the client with the stimulus they fear. Techniques of exposure include:
Systematic desensitisation
Flooding techniques
Virtual reality exposure
BEHAVIOURAL AND COGNITIVE-BEHAVIOURAL THERAPIES
Describe anxiety decay and exposure.
The anxiety reactions decrease over time due to the energy needed to maintain. By preventing the capacity to leave a situation, the person experiences anxiety decay and is therefore reconditioned.
BEHAVIOURAL AND COGNITIVE-BEHAVIOURAL THERAPIES
Explain systematic desensitisation.
It is specifically aimed at alleviating maladaptive anxiety. It involves pairing relaxation with imagery of anxiety provoking scenes of stimuli.
It is not a linear process.
BEHAVIOURAL AND COGNITIVE-BEHAVIOURAL THERAPIES
Explain flooding.
Client is immediately exposed to feared experience. The therapist stops the person from engaging in their typical avoidance responses. It is quite an extreme form of exposure.
BEHAVIOURAL AND COGNITIVE-BEHAVIOURAL THERAPIES
Explain virtual reality
The client views computer generated images of the feared experience. It is proven to be helpful when it is difficult or expensive to recreate the feared stimuli.
BEHAVIOURAL AND COGNITIVE-BEHAVIOURAL THERAPIES
What is modelling?
Learning theory has influenced how clinical psychs. explain how disorders develop as well as developing new therapeutic approaches to treatment.
You demonstrate the behaviours that people want to learn.
BEHAVIOURAL AND COGNITIVE-BEHAVIOURAL THERAPIES
What is social skills training?
Emphasis on assisting clients with interpersonal/social problems.
Can be used to improve social interactions in people with schizophrenia, depression and autism. But it can not be considered to have ‘cured’ the disorder.
BEHAVIOURAL AND COGNITIVE-BEHAVIOURAL THERAPIES
What is assertion training?
Teaching people to respond to requests in an appropriate manner.
BEHAVIOURAL AND COGNITIVE-BEHAVIOURAL THERAPIES
What is behavioural rehearsal?
Therapist uses role-play to demonstrate and allow practice of behaviours
BEHAVIOURAL AND COGNITIVE-BEHAVIOURAL THERAPIES
Conditioning: Operant
Involves the use of a reward based system to counteract maladaptive behaviours, emotions or cognitions. Based on learning theories.
BEHAVIOURAL AND COGNITIVE-BEHAVIOURAL THERAPIES
Conditioning: Token Economy
Use star chart or similar to promote desired behaviour and discourage unwanted behaviour. It is often used with children but can also be used in an adult setting.
BEHAVIOURAL AND COGNITIVE-BEHAVIOURAL THERAPIES
Conditioning: Aversion Therapies
pairing of unpleasant stimuli with unwanted behaviour. Not commonly used but can still be useful in some situations.
It is a highly contentious technique as it used to be used in ‘treating’ homosexuality. It is now mainly just used for substance abuse and is only used when other things prove to be ineffective.
BEHAVIOURAL AND COGNITIVE-BEHAVIOURAL THERAPIES
What are the criticisms of behavioural therapy?
Some therapies require moderate-high level of motivation by the client.
Negative thoughts can be realistic
Insufficient consideration of personal relationships.
What is Group therapy?
It is not a type of therapy but it is a setting
Advantages include: Cost/time efficient Allows peer support Helps to normalise experience Better opportunities to practice skills Can be done online or in person
Disadvantages:
People may feel uncomfortable to share
May learn new maladaptive behaviours from others (e.g. eating disorders)
Lack of personalised treatment
What is family therapy?
It is group therapy but your family is the group.
What is strategic family therapy?
Designed to improve communication between family members, help them work together to solve problems etc.
What is structural family therapy?
The therapist interacts with and observes the family, and helps to change the way they interact.
What is Cognitive-Behavioural Therapy (CBT)?
Behavioural therapy focuses on increasing adaptive actions and behavioural responses. Change tends to be at a physiological/behavioural level. Cognitive behavioural extends on this and incorporates cognitive responses at a greater level.
What are the 3 key assumptions of CBT?
- Cognitions can be identified and measured.
- Cognitions underpin both adaptive and maladaptive psychological function.
- Through therapy and practice, maladaptive thought processes and behaviours can be changed into adaptive processes.
What is the CB model?
It is thought of as a cyclical process:
Trigger –> Unhelpful/maladaptive thoughts –> emotion –> unhelpful maladaptive behaviours –> trigger
What is Rational Emotive Therapy (RET)?
Emotional reactions are caused by internal sentences that people repeat to themselves. RET is designed to eliminate the incorrect beliefs of a disturbed person.
What is the ABC theory in RET?
a = Activating conditions (identify with rational analysis) b= belief systems (target with therapy) c= consequences (e.g. anxiety)
What is Beck’s Cognitive Therapy?
Was developed specifically for the treatment of depression. He believed that depression in particular was caused by the negative patterns in which individuals think about themselves, the world and the future.
It is now more broadly used.
What are biological treatments?
Psychological disorders can be a result of the organic pathology of the brain which can be a structural or chemical imbalance.
PHARMACOTHERAPY
What is it?
Drugs that act on specific brain functions; broadly includes any pharmaceutical agent that is able to cross the blood-brain barrier and exert a direct influence on CNS cellular function.
PHARMACOTHERAPY
How do they work?
they either:
1. increase neural transmission by ‘locking up’ receptor sites’
- Increase neural transmission by blocking reuptake.
- Increases neural transmission by blocking breakdown of neurotransmitters in syntactic vesicles.
PHARMACOTHERAPY
Common Meds.: Anti-anxiety medications.
Include Benzodiazepines, Busipirone, Beta Blockers
Potential side effects include drowsiness, dizziness, low BP. and some are addictive.
PHARMACOTHERAPY
Common Meds. : Antidepressants
Include Monoamine Oxidase inhibitors, cyclic antidepressants, SSRIs.
Potential side effects include nausea, headaches, increased appetite, sexual dysfunction and drowsiness.
PHARMACOTHERAPY
Common Meds: Mood stablisers
Used primarily to treat bipolar and related disorders they include mineral salts and anticonvulsant medications.
Potential side effects include weight gain, tremors, fatigue and digestive problems.
PHARMACOTHERAPY
Common Meds: Antipsychotic medications
A class of drugs used to treat Schizophrenia as well as other disorders involving episodes of psychoses. Include conventional anti-pyschotics and serotonin-dopamine antagonists. Potential side effects include drowsiness, rapid heart beat, weight gain. Older drugs caused tremors, terdive dyskinesia which can get worse with time.
PHARMACOTHERAPY
Common Meds: Psychostimulants
Used to treat attentional disorders such as ADHD and disorders such as narcolepsy, most work by increasing dopamine. Include Methylphenidate, amphetamine, atomexetine.
Potential side effects include decrease appetite, sleep disturbances, and headaches. Some have risk of addiction.
PHARMACOTHERAPY
What are the cautions of pharmacotherapy?
Often have side effects that are either short or long term.
Indvidual differences as people vary greatly in response to drugs depending on various factors.
Overprescription and poly therapy
PHARMACOTHERAPY
What are the misconceptions?
It is not always necessary to treat a biological disorder with drugs, non pharmaceutical therapies can alter neurobiology.
SURGICAL TREATMENTS
What is psychosurgery?
Involves the neurosurgical destruction of brain tissue to cure mental illness. Although it is now rare, it involves highly selective lesions to specific brain structures and only performed in extreme cases.
It still falls under biological treatments
SURGICAL TREATMENTS
What is capsulotomy?
Specific lesions to reduce the symptoms of severe medication resistant OCD.
SURGICAL TREATMENTS
What is Electroconvulsive Therapy (ECT)?
Involves the application of brief electrical current to the head of a person. The duration is sufficient enough to induce a seizure
It is currently used in cases of severe depression that are unresponsive to other therapies
SURGICAL TREATMENTS
What is Repetitive Trans-Magnetic Stimulation (rTMS)?
It is similar to and ECT except that a magnetic pulse is used instead of electrical charge. It is non-invasive and patient remains conscious.
Found to be effective for people with medication resistant MDD.
SURGICAL TREATMENTS
What is Deep Brain Stimulation (DBS)?
It is similar to a pacemaker but provides small electrical impulses to the brain.
It was initially used in Parkinson’s disease but is now also used for intractable OCD and MDD.
SURGICAL TREATMENTS
What are the cautions?
Can have serious side effects, some which could be life long.
Mechanisms of action remain unclear for ECT, DBS & rTMS ( we don’t know why they work)
Only appropriate where other measure have failed and person in continuing to experience significant and distressing levels of impairment.
What are the ethics in clinical practice?
Ethics are what is right about conduct, they are moral principles adopted by a group or individual to provide rules for the right conduct.
What are the principles for good practice?
Professional competence
Good and appropriate relationships with clients and colleagues
Observance of professional ethics.
What are the 3 general principles of the APS Code of Ethics?
- Respect for the rights and dignity of people and people
- Propriety (follow guidelines)
- Integrity (behaving appropriately)
Why do we need ethics?
To protect the client, clinician and profession.
