Psychotherapy 1.2 Flashcards
When were group methods developed?
Early 20th century
What led to the development of group methods?
Observations of beneficial group effects in TB patients
Who was the first major proponent to observe beneficial effect of groups?
JH Pratt
Who developed group methods?
T Burrow in the 1920s
What is the premise of group processes?
Behaviour and dynamics of the group cannot be derived from the individuals.
Once formed, groups develop their own way of existing.
What is group alliance?
Quality of relationships that develop between each member and the therapist.
What is group cohesion?
Group working together towards a common goal.
What is group coherence?
Group goes beyond cohesion and becomes self-evolving and able to work through conflicts.
What is positive identification?
Unconscious group mechanism in which a person incorporates the characteristics and qualities of the group.
What is catharsis?
Expression of ideas and conflicts is accompanied by an emotional response which produces a sense of relief.
How can group therapies be divided
According to degree of leadership
According to membership
According to mode of therapy
Which group therapies have high level of leader input and are highly specific
Structured groups for drug and alcohol misuse
Activity groups like OT
Which group therapies are highly specific but have low level of therapist activity
Problem-solving therapy
Psychoeducational groups
Which groups have low leadership level and low specificity of treatment goals
Support groups
Art therapy
Interpersonal therapy like Tavistock model analytic groups
What can groups be divided into according to mode of therapy?
Activity Support Problem-focused Psychodynamic Behavioural
What do analytic/dynamic groups involve?
Examination of the conscious and unconscious processes in the group including resistance, transference and countertransference
What did Bion describe?
Three basic states that a group goes into when it gets derailed
What are the three states described by Bion?
Dependency
Pairing
Fight-flight
What are the three states described by Bion known as?
Basic assumption
What is the 4th basic assumption introduced by Hopper?
Massification/aggregation
What happens in dependency?
Group members become dependent on one another
What happens in pairing?
Formation of a partnership in the group might bring forth new resolution
What is massification/aggregation?
Regid fusion of identities leads to loss of individuality or extensive withdrawal leads to loss of mutual dependence
What did Foulkes describe?
Group matrix; web of communications and relationships within a group
What did Foulkes divide the group matrix into?
Foundation matrix
Dynamic matrix
What is the foundation matrix?
Commonalities existing between strangers attributable to characteristics of human species
What is the foundation matrix a precondition of?
Later evolving dynamic of group matrix
What is the dynamic matrix?
Ever developing exchanges that occur between group members
Factors that influence a group matrix
Mirroring Exchange Free floating discussion Resonance Translation
What did Yalom cite?
11 curative factors responsible for change in groups
What are the 11 curative factors according to Yalom?
Instillation of hope Universality Imparting information Altruism Corrective recapitulation Socialisation techniques Imitative behaviour Interpersonal learning Group cohesiveness Catharsis Existential factors
Name some expressive therapies
Psychodrama
Art therapy
Music therapy
Support groups
Who created psychodrama?
Moreno
What happens in psychodrama?
Therapist acts as the director
Patient as protagonist
Another group member as someone significant in the patients life (auxiliary ego)
Soliloquey as a recital of thoughts and feelings
What is role reversal in psychodrama?
Exchange of patients role for role of significant person
What is ‘double’ in psychodrama?
Auxiliary ego acting as the patient
What is ‘multiple double’ in psychodrama?
Several egos acting as the patient
What is ‘mirror technique’ in psychodrama?
Auxiliary ego imitating the patient and speaking in the proxy
Most important component of music therapy?
Therapeutic alliance
Important aspects of cognitive behavioural groups?
Group cohesiveness
Task focus
Principles of therapeutic communities is based on what?
Henderson hospital model
Major components of therapeutic communities?
Communalism
Permissiveness
Democratisation
Reality confrontation
What is communalism?
Staff not separated from patients
Mutual helping and learning
What is permissiveness?
Tolerating each other and realising unpredictable behaviour can happen in the community
What is democratisation?
Shared decision making and joint running of the unit
What is reality confrontation?
Self-deception or distortions from reality are dealt with honestly and openly by all members
Who created interpersonal therapy?
Klerman & Weissman
Aim of interpersonal therapy?
Improvement of interpersonal functioning
How many sessions are involved in interpersonal therapy?
12-16
What is the patient seen as in interpersonal therapy?
The sick role
What is interpersonal therapy based on?
The idea that emotional problems are best understood by studying the interpersonal context in which they arise.
Focus of interpersonal therapy?
Current interpersonal relationships and their relationship to development of illness
Therapists stance in IPT
Advocate for patient
Areas of focus in IPT
Role transitions
Interpersonal disputes
Grief
Interpersonal deficits
Which disorders is IPT indicated for?
Mild to moderate depression
Bulimia
Who created DBT?
Marsha Linehan
Aim of DBT
Reduce self-harm in BPD
How does DBT address problems of patients with BPD?
Uses hierarchical fashion starting from self-harming behaviours, then therapy interfering behaviours and later behaviours reducing QoL.
Modes of DBT?
Group skills training
Individual therapy
Phone consultations
Consultation team
Key techniques of DBT
Distress tolerance
Interpersonal effectiveness
Core mindfulness
Emotion regulation skills
What happens in distress tolerance?
Accepting, finding meaning for and tolerating distress.
What is interpersonal effectiveness training?
Assertiveness and problem solving training
What is core mindfulness training?
Learning to monitor internal mental states
What is another approach used in DBT>
Validation - recognising distress and behaviours as legitimate and understandable but ultimately harmful
Who created cognitive analytic therapy?
Anthony Ryle
Which psychiatric disorders can CAT be used for?
Depression
Anxiety
PDs
Central concepts of CAT?
Procedural sequence model
Role-repertoires
What is procedural sequence model?
Attempt to understand aim-directed action.
What do aim-directed actions consist of?
Aim generation Environmental evaluation Plan formation action Evaluation Procedural revision
What patterns are seen in patients under the procedural sequence model?
Traps
Dilemmas
Snags
What are traps?
Negative assumptions that produce consequences which in turn reinforce assumptions.
What are dilemmas?
A person acts as though available actions are limited or polarised.
What are snags?
Appropriate roles or goals abandoned because others would oppose them or thought to be forbidden
What is restricted role repertoire?
Undue restriction in number/variety of procedural sequences may occur due to impoverished environment, childhood abuse etc.
These lead to neurotic difficulties.