Psychotherapy Flashcards
What is psychotherapy?
An umbrella term that includes a range of talking therapies.
Psychotherapy is defined as:
“A treatment by psychological means of problems of an emotional nature in which a trained person deliberately establishes a professional relationship with the patient with the object of:
-Removing, modifying or retarding existing symptoms
-Mediating disturbed patterns of behaviour
-Promoting personal growth and development*
What 4 characteristics do all talking therapies share?
- Non-judgemental, positive regard for patient where patient can feel safe and supported
- Building a therapeutic relationship between therapist and patient
- Confidentiality is integral to therapeutic relationship (except when safety concerns demand breach of confidentiality)
- Supervision of therapist (where they can discuss issues arising from the therapy sessions)
What is a key feature does psychotherapy need to work?
A degree of motivation to change and the ability to see a link between psychological factors and behavioural change - psychological mindedness
What is the basic premise of CBT?
You feel the way you think
Cognitive refers to mental processes like thinking
Behaviour refers to all the things we do - our actions
What are indications for CBT?
- Depression
- Anxiety disorders such as Generalised anxiety Disorder, Obsessive Compulsive Disorder, Post-traumatic Stress Disorder and Phobias
Can also be used as an adjunct treatment for:
- Schizophrenia
- Bipolar Disorder
What does the ABC stand for in CBT?
Antecedent (triggering event) -> Belief (thoughts, attitudes, beliefs triggered by event -> Consequences (emotions, behaviours, physiological changes
What are 4 sources of CBT?
* the main one
- In primary care (Integrated Access to Psychological Therapy - IAPT
- Computerised CBT (approved by NICE)
- Self-help books (available on prescription)
- Use of mobile phone apps such as Mood Gym
What are the initial sessions of CBT spent on?
The therapist explains the model and its rationale to ensure that the patient has a good understanding of the CBT model, including ABC analysis.
What are the ongoing sessions on CBT based on and how often?
- Sessions tend to take place weekly or fortnightly
- Sessions tend to last 50-60 minutes
- Patients are expected to complete homework between sessions
- Patients need to be able to write or otherwise record their thoughts, feelings and behaviours
- The focus is on challenging and correcting cognitive errors, and replacing maladaptive with more adaptive coping mechanisms
What are some cognitive errors that can be identified in CBT and some examples?
- Arbitrary inference My girlfriend is out, she might be enjoying herself with someone else.
Overgeneralisation
I missed the bus this morning. I am always late and I am so hopeless. - Selective abstraction
Although Tom said he likes me, he did say once that he did not like the dress I was wearing that day, which means Tom does not like me like how he says. - Magnification
If I do not submit this assignment today then the lecturer will think I am completely useless. - Minimisation
Lecturer said that “well done” only because she was in a good mood. - Personalisation
My team did not get a prize in the quiz. It’s all my fault – I am the one to blame. - Dichotomous thinking
If I do not get an “A” in class, that means I have failed.
What is the framework that a CBT therapist typically uses to challenge a cognitive error?
- The triggering event
- The automatic thought that follows (verbatim if possible)
- The feelings generated, and the intensity of those feelings
- The behavioural responses
- The cognitive errors involved
- Any challenges to those cognitive errors
What 9 things do you need to include when explaining CBT?
- Check prior knowledge/experience of CBT
- Explain why CBT is being considered (its effectiveness) to instil hope
- Explain the mechanism of action – relating specifically to the symptoms that your patient is experiencing. The hot cross bun diagram may help, as will the chart of cognitive errors
- Explain the process – number/time of sessions, location, need for homework
- Mention possible side effects (yes, therapy can have side effects too…) – such as increased agitation, restlessness etc.
- Explain whether medications need to continue concurrently
- Explain what might happen once therapy ends or if therapy is not successful
- Check understanding
- Signpost to self-help resource (e.g. Royal College of Psychiatrists’ leaflets)
What is psychodynamic psychotherapy?
According to psychodynamic theory, our feelings and behaviours are influenced by unconscious motives that are the result of early childhood experiences. Contrast this with CBT where feelings and behaviours are considered to derive from thoughts and core beliefs.
Not all of our childhood memories are accessible to us as we grow up. Freud postulated that delving into the unconscious mind could offer a window into one’s early childhood which in turn could help explain current feelings and behaviours (and indeed symptoms)
What 4 ways do we get a peek into our unconscious mind?
- Dream analysis
- Free association - patient speaks whatever comes to mind
- Slips of the tongue -
Freud suggested that these were not “accidents” – but the unconscious mind trying to make itself heard - Transference and counter-transference:
-In the process of establishing a therapeutic relationship, the therapist and the patient bring, unconsciously so, their own beliefs, values, previous experiences etc. to the interaction
-Analysis of this interaction then can offer another window into the unconscious.
-This unconscious redirection of one’s feelings from those towards significant others in one’s childhood to the therapist is called transference.
-The process of the therapist transposing his/her feelings that they may have held for significant others in their childhood to the patient is called counter-transference.
What is the main task of psychodynamic therapy?
Therapeutic relationship with the patient that helps draw links between the patient’s early childhood experiences (including early trauma), defense mechanisms and current symptoms
What is the psychodynamic triad?
Therapist/patient interaction in the centre of:
- Childhood events
- Defence mechanisms
- Current symptoms
What are defense mechanisms?
coping mechanisms that the individual develops to negotiate conflicts/traumas encountered in early childhood
What are 3 groups of defense mechanisms?
- Mature
- Neurotic
- Primitive
What are 6 types of mature defense mechanisms?
- Altruism
- Deal with stress or conflict through devotion to charitable endeavours to help others - Anticipation
- Anticipate possible adverse events and prepare for them - Humour
- Deal with stress by seeing the lighter side - Sublimation
- Channel potentially maladaptive impulses into socially acceptable behaviour (e.g. competitive sports channelling aggression) - Suppression
- Distract oneself (consciously) to avoid thinking about stressor - Affiliation
- Seek support from others
What are 5 types of neurotic defense mechanisms?
- Displacement
- Transfer negative feelings about one person to another - Externalization
- Blame others - Intellectualization
- Avoid painful emotions but getting stuck on details - Repression
- Dispel disturbing thoughts/feelings from consciousness (unconsciously) - Reaction formation
- Express the unconscious unacceptable impulse in the opposite – more acceptable form
What are 6 primitive defense mechanisms?
- Denial
- Refuse to acknowledge some aspect of reality - Autistic fantasy
- Day-dreaming to avoid reality - Passive-aggressive
- Expressing hostility without being openly aggressive - Acting out
- Engage in inappropriate behaviour without consideration of consequences - Splitting
- Black or white thinking - Projection
- Falsely attribute unacceptable feelings to others
How often does psychodynamic therapy occur and for how long?
1-2 sessions/week
50-60 mins/session
Can last 1-2 years but brief psychodynamic therapy only 14-20 sessions
What are the indications for psychodynamic therapy?
- Personality disorders
2. Certain cases of mood and anxiety disorders especially when co-morbid personality difficulties present
What is the focus of psychoanalysis?
On developing insight through clarification and interpretation of unconscious conflict
What is an indication of psychoanalysis?
Long-term personality difficulties
What is an indication of dialectical behavioural therapy (DBT)?
Emotionally unstable personality disorder
How does DBT help people with EUPD?
Help people manage difficult emotions by letting them experience, recognise and accept them. This model says that, with acceptance, people become more able to change damaging behaviours
How long does a course of DBT usually last for?
1 year
What are 4 elements of DBT?
- Individual therapy – weekly 1-1 therapy with a DBT therapist lasting about an hour
- Skills training in groups – focusing on developing practical skills (tolerating distress, managing personal relationship issues, mindfulness)
- Telephone crisis coaching – gives service receivers telephone contact with their therapist outside of therapy sessions
- Therapists’ consultation groups – members of the team of people providing DBT may meet together weekly to discuss issues that have come up in treatment sessions
What rationale is interpersonal therapy (ITP) based on?
That disorders such as depression can be explained as disorders arising from interpersonal relationship difficulties
What techniques do ITP use?
Using principles of active listening, empathy, facilitation of emotional expression in the context of inter-personal relationships, the patient is encouraged to reframe and rebuild their relationships
Who provides problem-solving therapy?
Primary-care based counsellors
What is the step-wise approach to problem solving therapy?
- Elicit practical problems
- Explain emotional symptoms
- Reassure
- Clarify the problem and collaboratively identify possible solutions
- Patient chooses most likely solution
- Review and repeat as necessary
What are the 6 aims of supportive therapy?
- Actively listen to patient’s concerns
- Develop therapeutic relationship
- Allow ventilation of emotions
- Identify and utilise patient’s strengths
- Promote self-management
- Involve and support carers
What are the aims of family therapy?
- Focuses on the “system” rather than the individual hence the focus on the family
- Allows multiple perspectives to emerge
What setting is family therapy usually used for?
Child and Adolescent Mental Health Services
