Psychotherapies Flashcards
What is psychotherapy?
Systematic use of a relationship between a pt and a therapist- as opposed to physical & social methods- to produce changes in feelings, cognition & behaviour.
State some common characteristics of all psychotherapies
- An intense confiding relationship with a helpful person
- A rationale containing an explanation of the pt’s distress
- Provision of new information about nature & origins of pt’s problems and the ways of dealing with them
- Development of hope in the pt that they will be helped
- Opportunities to experience success during treatment
- Facilitation of emotional arousal
Only some psychotherapies involve active collabortion between pt & therapist; true or false?
False; all psychotherapies involve active collaboration between pt & therapist
Which type of pt’s make best candidates for psychotherapy?
*HINT: 3 things they must be able to do
- Able to verbalise their problems
- Psychologically minded: able to see that psychological processes could contribute to their problems
- Well-motivated: take some degree of responsibility for the resolution of their problems
State some examples of pschyotherapies
- Cognitive behavioural therapy (CBT)
- Psychodynamic psychotherapy
- Interpersonal therapy (IPT)
- Eye movement desensitation & reprocessing (EMDR)
- Dialectical behavioural therapy (DBT)
State the two most commonly used forms of psychotherapy
- Cognitive behavioural therapy (CBT)
- Psychodynamic psychotherapy
*NOTE: there are many other psychotherapies derived from these
The choice of psychotherapy depends on various factors; state some
- Illness
- Patient factors
- Preference
- Background history
- Family
- What they have tried before
- Local availability
- Practitioner experience
Explain how CBT works
Cognitive behavioural therapy (CBT) is a type of talking treatment which is based on the fundamental principle that what you think affects how you feel emotionally and physically and alters behavoiur.
It combines cognitive therapy (examining the things you think) and behaviour therapy (examining the things you do).
Aim of CBT is to help people identify and challenge negative thoughts or behaviours- this helps them to break the cycle and allow people to better control their thoughts, emotion, bodily sensations and behaviours. Also teaches people coping strategies.
For example:
- In depression pt may view themselves negativley so misinterpret others perception of them (thinking they too think negatively of them). This makes them feel sad and anxious. Stop doing activities they enjoy. Feel more low in mood and view themselves more negatively.
- In depression pt may have anhedonia and lack of energy so stop doing activities they enjoyed, this exacerbates the feelings of depression and anxiety.
Image demonstrates the thought proces that CBT targets
CBT can be delivered in a variety of formats; state some examples
- Self-help via books/workbooks
- Computer programmes (including online)
- Groups
- Individual
What is the average number of CBT sessions prescribed? (give a range)
6-20
State some indications for CBT
- Mild-moderate depression
- Bipolar affective disorder
- Anxiety disorders (phobias, GAD, OCD, panic, PTSD, BDD)
- Eating disorders
- Substance misuse disorders
- Sexual dysfunction
- Schizophrenia
Can also be used for chronic medical conditions e.g. fibromyalgia, chronic fatigue syndrome, fibromyalgia
The five areas approach is a model of assessment and management that uses CBT; what is the 5 areas approach?
Idea that you should gather information on each of the five areas to figure how it is all interlinked. This can help both the pt understand themselves better and you understand them. Once you better understand them it can aid your management e.g. if pt has significant life, relationship etc problems then it’s unlikely that just medication will work. It is based on the model of CBD.
Five areas:
- Environment (life situation, relationships, practical problems)
- Altered thinking
- Altered emotions/mood
- Altered physical feelings/symptoms
- Altered behaviours/activities
Explain how psychodynamic psychotherapy works
Psychodynamic therapy is based on the idea there are unconscious thoughts and emotions that drive behavior. These unconscious thoughts & emotions are due to past experiences- be this relationships, unresovled conflicts or childhood experiences. If a person has maladaptive/unhealthy thoughts, feelings & behaviours, becoming aware of the unconscious thoughts & emotions that are causing those can help them change them.
One of main techniques used is transferance.
One of the key aspects of psychodynamic therapy is transference and co-transference. Describe each of these
To understand transference & counter transference think of two people sat in a room. One person triggers the unconscious of the other person resulting in emotional and behaviour responses; these responses are based on previous experiences which have formed our unconscious.
Transference: unconscious transfer of feelings & attitudes from the patient’s past into the therapist (therapist triggers the unconscious of the pt)
Counter transference: unconscious transfer of feelings & attitudes from the therapist’s past into the patient (patient triggers the unconscious of the therapist)
An example: therapist presents themselves in a particular way and this triggers the patients unconscious because the therapist is presenting themselves in a similar way to pt’s abusive father. Pt becomes anxious, withdrawn, scared and thinks negatively of themselves.
*NOTE: if counter-transference occurs it makes it difficult to understand and treat the patients problem hence therapists must have psychodynamic therapy themselves so that they are aware of things that may trigger an emotional or behavioural response in themselves.
How often are psychodynamic therapy sessions?
How long do pts attend psychodynamic therapy for?
How is it delivered?
- Usually 1 50 minute session per week (but may be more)
- Over a period of months (possibly years)
It is an intense form of psychotherapy with long duration.
Delivered in person either individually or in groups
State some indications for psychodynamic therapy
- Personality disorders
- Depression
- Eating disorders
- Some anxiety disorders e.g. social anxiety disorder
- Recurrent & chronic relationship difficulties
What is the difference between psychoanalysis and psychotherapy?
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Psychoanalysis is not available on NHS.
Explain how systematic/family therapy works
Attempts to correct impaired communication and dysfunctional relationships as a means of helping the entire family- including the pt with the disorder. Each family member works together with the others to better understand their group dynamic and how their individual actions affect each other and the family unit as a whole.
State some indications for systematic/family therapy
- Most commonly used as an intervention for children
- Eating disorders
- Schizophrenia (*remember expressed emotion theory)
Explain how interpersonal therapy works
Interpersonal therapy (IPT) primarily focuses on how relationships affect us, and alternatively, how our mental health issues can affect our relationships. Helps people to develop good communication& healthy relationships.
Has some overlap with CBT and psychodynamic therapy and mostly deals with 4 interpersonal problems (grief at loss of relationships, role disputes within relationships, managing changes in relationships & interpersonal deficits) which may causing difficulty in initiating or maintaining relationships.
State some indications for interpersonal therapy
- Depression
- Eating disorders
NOTE: works for eating disorders by helping individual to see themselves in a positive light so they don’t rely soley on weight & body size to evaluate themselves
Explain how eye movement desensitisation & reprocessing works
- Aims to help pts access and process traumatic memories with the goal of emotionally resolving them
- Involves pt recalling emotionally traumatic event whilst focusing on external stimulus e.g. therapist moving their finger
State the main indication for EMDR
PTSD
Explain how dialectical behaviour therapy (DBT) works
Based on CBT but designed specifically for people who feel emotions very intensely. Aims to help people:
- Understand and accept their feelings
- Learn coping strategies (e.g. alternatives to self harm)
- Make positive changes to their life by changing unhelpful ways of thinking and behaving
State some indications for DBT
Primarily used for borderline personality disorder.
Some evidence it works for:
- Self harm
- Depression
For each of the following discuss what kind of psychotherapies would be appropriate:
- Adverse life eents
- Depression
- PTSD
- Schizophrenia
- Eating disorders
- Anxiety disorders
- Substance misuse
- Borderline personality disorder
*NOTE: counselling & psychotherapy not same- slightly different. Question phrased for ease.
Psychoeducation is vitally important and should be offered to everyone; what is psychoeducation?
Psychoeducation should cover 4 things… state these
Giving people/signposting people to information about their mental illness in order to help them understand and cope with their illness.
Should ensure pt is informed about:
- Name & nature of disease
- Likely causes
- What health services can do to help them
- What they can do to help themselves
What is counselling?
Counselling is a way of relieving distress. Counsellor offers non-judgmental support; this may be through simply listening or helping pt to prioritise problems and identify solutions.
Discuss the difference between counselling & psychotherapy
Counselling tends to help people overcome immediate crises (for example job losses, bereavement or relationship problems)
Whereas psychotherapy helps people with more long-standing problems of a serious nature to develop new ways of thinking, feeling & behaving to prevent further illness
State some indications for counselling
- Adjustment disorder
- Normal bereavement
- Trauma (e.g. miscarriage, rape)
- Prior to decision making e.g. genetic testing
Numerous behavioural therapies exist; describe the following behavioural therapies:
- Relaxation training
- Systematic desensitisation
- Flooding
- Exposure & response prevention (ERP)
- Behavioural activation
What kind of behavioural therapy is this an example of?
Systematic desensitisation
What does IAPT stand for?
What is it?
- Improving Access to Psychological Therapies
- Established in England in 2008 to provide more evidence based talking therapies in primary care
Why do pts in some forms of therapy often get worse before they get better?
- Therapy may bring back unpleasant memories, thoughts or feelings
- Therapy may bring problems to forefront of mind
- Therapy may start to break down our defence mechanisms
- Pt may realise they have more than one problem and it becomes overwhelming
State some examples of common defence mechanisms recognised in the psychodynamic therapy
In psychodynamic theory, a psychological defense mechanism is a technique that is used by a person’s ego to protect them against potential anxieties
