Psychotherapy Flashcards
What are the indications for CBT?
Depression Anxiety disorders such as Generalised anxiety Disorder, Obsessive Compulsive Disorder, Post-traumatic Stress Disorder and Phobias Adjunct treatment for: Schizophrenia Bipolar Disorder
What re the steps for CBT?
Initial sessions: building therapeutic relationship, ABC model
Ongoing sessions: Weekly or fortnightly, last 50-60 minutes, HW between sessions
Identifying cognitive errors
Challenging cognitive errors: triggering event, automatic thought, behavioural responses
Behavioural experiments:
What are some common cognitive errors?
Arbitrary interference: (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
Magnification
Minimisation
Personalisation
Dichotomous thinking (If I do not get an “A” in class, that means I have failed)
How do we gain insight into the unconscious mind?
Dream analysis
Free association
Slips of the tongue
Transference and counter-transference
What is the psychodynamic triad?
Childhood events
Defence mechanisms
Current symptoms
What are mature defence 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
Sublimation: Channel potentially maladaptive impulses into socially acceptable behaviour (e.g. competitive sports channelling aggression)
Suppression
Affiliation: seek support from others
What are neurotic defence mechanisms?
Displacement: Transfer negative feelings about one person to another
Externalisation: blame others
Intellectualisation: 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 primitive defence mechanisms?
Denial
Autistic fantasy: day-dreaming to avoid reality
Passive-aggressive
Acting out
Splitting: black or white thinking
Projection: Falsely attribute unacceptable feelings to others
What is involved in psychoanalysis?
Quite rigorous
3-5 times/week
50-60 mins/session
Expensive and time-intensive
Patients need to be able to tolerate intensive self-reflection and not become dependent or impulsive
Focus is on developing insight through clarification and interpretation of unconscious conflict
Indicated for long-term personality difficulties
What is involved in psychodynamic therapy?
Also called insight oriented psychotherapy
1-2 sessions/week
50-60 mins/session
Can last 1-2 years but brief psychodynamic therapy only 14-20 sessions
Less focus on unconscious conflicts – more focus on defence mechanisms and link with current symptoms
Indicated in the treatment of personality disorders, certain cases of mood and anxiety disorders especially when co-morbid personality difficulties present
What is dialectical behavioural therapy (BDT)?
Recommended by NICE guidance for the treatment of emotionally unstable personality disorder
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
Lasts for a year and has 4 elements:
Individual therapy – weekly 1-1 therapy with a DBT therapist lasting about an hour
Skills training in groups – focussing 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 is problem solving therapy?
Provided mainly by primary-care based counsellors Involves step-wise approach 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
