Psychotherapy

Question 1

What disorders use psychotherapy as a primary treatment?

Why does it work with these disorders?

Answer 1

1. PTSD
2. Adjustment disorder
3. Personality disorder
4. social phobia
5. GAD [dysthymia]
6. panic disorder

These are pretty specific problems and drugs impact EVERY serotonin or dopamine receptor of the brain. If the problem is global, drugs are better, but if it is specific, we want to use psychotherapy

Question 2

What disorders use psychotherapy effectively in conjunction with drugs?

Answer 2

OCD
MDD

Adjuvant in bipolar and schizophrenia

Question 3

What are the 2 main categories of psychotherapy?

How do they differ?

Answer 3

1. directive therapies - aim at the symptoms and the therapist gives instructions to reduce or change the problem [and believes the whole personality will benefit from the decreased anxiety and increased self-confidence]
   - cognitive behavioral therapy
   - interpersonal therapy [family, couples, group]
2. Evocative (expressive) fosters the growth of the the whole person with the idea that the underlying structures of personality change and thus symptoms will secondarily respond.
   - psychotherapy, psychoanalytic

Question 4

What are the 5 common features of all psychotherapy?

Answer 4

1. atmosphere of safety and acceptance
2. working together on a shared problem [therapeutic alliance] –>decrease alienation and shame about their problem
3. belief in the expertise of the therapist due to patient and doc sharing conceptual schema about the patients distress
4. inspire hope and expectation of relief
5. opportunity for new learning experiences

Question 5

How do psychoanalysis and psychoanalytic psychotherapy differ in terms of frequency and patient/doctor interaction?

Answer 5

Psychanalysis- 3 to 5 times/week with patient lying on the couch

Psychoanalytic psychotherapy - 1 to 2 times/week or less with patient sitting up and facing the doctor

Question 6

What 3 factors make psychotherapy psychoanalytic?

Answer 6

1. attention to the unconscious meaning of the patients thoughts and actions
2. interest in the influence of childhood development and trauma on the present
3. examination of the patterns of relationship that develop btwn the patient and the therapist

Question 7

What is the patients task in psychoanalytic therapy?

How is this achieved?

Answer 7

The task is to say everything they can without conscious censorship to hopefully arrive at INSIGHT where the patient understands what he is actually feeling and thinking

Patient on the couch allows relaxation and freedom from seeing the therapists rxn
It also allows the therapist to relax and have free-floating attention

Question 8

What are the insights that psycholanalytic patients come to ?

Answer 8

They start to see the drives like aggression and sexual desire that result in socially unacceptable wishes.
They see repetitive patterns [repetition compulsion] where they see themselves in ways that aren’t always flattering and easy to accept.

The realizations are slow, gradual and repetitive but once insight is found the patient can make the most of the difficulty.

Question 9

What are the boundaries established with psychoanalysis?

Answer 9

Atmosphere:

1. time of the session, how long it will last
2. quiet uninterrupted setting

Relationship to therapist:

1. lack of contact outside of the session
2. lack of physical contact

Question 10

What are the 2 main things therapists listen for during psychoanalysis because it means the patient is in the vicinity of a disturbing idea?

Answer 10

1. where the patient gets “stuck” –resistance

2. where the patient avoids

Question 11

What is transference and countertransference?

Answer 11

Transference is the patients perception and experiences that cause them to make assumptions and projections about the therapist that originated in the patients past.

Countertransference is when the doctor has experiences from her past that are created in reverse where she is the one in control of it [worry the patient hates her and thinks she isn’t good enough because she felt unloved as a child and unable to live up to expectation]

Question 12

What are the 4 factors that actually support change in a patient undergoing psychotherapy?

Answer 12

1. modeling and identification - therapist is flexible, tolerant, thoughtful and accepting of feelings
2. difficult things are brought to the surface and the patient learns to feel and bear emotion
3. transference allows new ways to resolve old conflicts
4. therapist makes new connections, points out themes, anxieties, conflicts, fantasies to help patient gain insight [cognitive and emotional]

Question 13

What changes are seen with psychoanalysis over the course of:

1. weeks
2. months
3. years

Answer 13

1. subjective state and painful feelings improve
2. changes in behavior as the therapy clarifies maladaptive defensive patterns
3. change in the psychic organization of the patient

Question 14

What is the purpose of behavior therapy? cognitive therapy?

Answer 14

Behavior therapy is aimed to directly influence an observable behavior in a predictable way
Cognitive therapy is intended to identify maladaptive and unreasonable ideas that adversely affect mood and behavior.

CBT is closer to a medical model of emphasizing an observable problem and measurable, quantifiable outcome

Question 15

What 4 disorders are behavior therapy useful in treating?

What are the 3 steps?

Answer 15

Used for

1. specific phobia
2. social phobia
3. OCD
4. difficulty with assertion

It uses systematic desensitization where

1. patient learns relaxation training
   - yoga, meditation, medical hypnosis
   - biofeedback uses physio monitoring of muscle tension, skin conductance, HR
2. create a hierarchy of anxiety provoking ideas, scenes behaviors
3. patient is guided through each step of the hierarchy pairing the anxiety with new skills of relaxation

Question 16

What is flooding?

Answer 16

a technique used far less than systematic desensitization where the patient experiences immersion in the most severe of the anxiety provoking stimuli and is left there until they feel calm and mastery

Question 17

What is positive reinforcement?

Which disorder is it frequently used in?

Answer 17

behavioral technique based on operant conditioning where the patient is rewarded for the desired behavior.

It is used in schizophrenia, substance abuse

Question 18

What is aversion therapy?

When is it used?

Answer 18

Undesired behaviors are punished [opposite of positive reinforcement]
It is controversial but is sometimes used in patients with treatment-resistant impulsive behavior with limited mental capacities [autism, ID]

Question 19

In what 3 situations does cognitive therapy tend to be used?

How many visits does this therapy tend to be?

Answer 19

Depression, OCD, Social phobia
It is a short term therapy [<25 sessions] that are highly structured.

It is based on the assumption that dysfunctional ideas are the root of the patients difficulties

Question 20

Describe the process of cognitive therapy.

Answer 20

1. the therapist helps the patient identify automatic thoughts that are distorted ideas
2. test the automatic thoughts and help the patient review faulty logic, recalculate unrealistic estimates of risk, foster flexible thinking
3. this exposes underlying maladaptive assumptions and the patient can see a pattern that was not visible to them before
4. these are broken down and replaced with more realistic and useful views

Question 21

Describe the types of group therapy. What are the 4 main benefits of group therapy?

Answer 21

Group therapy can be evocative [psychoanalytic, existential], directive [behavior, dialectal, pseudo-education] or supportive [grief]
They mirror the individual therapies of the same type but with the benefits of:

1. engaging patients in treatment
2. chance to help others [several perspectives/more heads are better than one]
3. decreasing stigma and isolation
4. validation that others have similar problems

Question 22

What are the 3 different theoretical models for family therapy?

Answer 22

1. Family System Therapy- degree of enmeshment vs. autonomy of each family member and analysis of triangles [conflicts of love and closeness are managed by excluding one from the triangle]
2. General systems Model - uncover internal rules of the family and the roles each person has
3. Psychodynamic model - unconscious patterns of anxiety and defense rooted in the past

Question 23

Current research in cognitive psychology supports unconscious mental life providing evidence that what 4 things all occur beneath our conscious awareness?

Answer 23

motivation
distorted cognition
affects
defenses

Question 24

How does the distinction between procedural [implicit] and declarative [explicit] memory explicate our understanding of unconscious mental life?

Answer 24

Declarative memories are conscious awareness of what we know and is undeveloped in a baby’s first few years. It depends on development of hippocampus

Procedural memory remains intact with hippocampal ablation. New procedural memory can be formed with the patient being consciously unaware that he had learned it

Question 25

What part of memory are attachment paradigms? What areas of the brain are involved?

Answer 25

Attachment is established as procedural or implicit memory and involves amygdala, striatum, neocortex

Question 26

What parts of the brain are involved in:

1. depression
2. social phobia
3. OCD

Answer 26

1. dorsolateral prefrontal cortex
2. amygdala
3. caudate