Psychotherapy Flashcards
What are some (relative) contraindications for brief psychodynamic therapy?
-Severe depression
-Acute psychosis
-substance abuse
-EUPD
(Marked acting out, serious suicide attempts)
What is a technique used in Moreno’s psychodrama?
Representational role reversal
What are some signs of Resistance in pychoanalysis?
- asking irrelevant questions
- fidgetting
- intellectualising events
- being late for appointments
What is a problem with hypnosis?
-sudden removal of symptoms by suggestion under hypnosis can lead to rebound anxiety and depression
What are Yalom’s therapeutic factors in group therapy?
Universality (removes group members sense of isolation)
Altruism (the experience of helping anther group member)
Instillation of hope (seeing other members who have progressed in therapy)
Imparting information (learning from others)
Corrective recapitulation of the primary family experience (therapists analysis of transference)
Development of socialising techniques (practicing social skills)
Imitative behaviour (using other members as models)
Cohesiveness (feeling part of the group)
Existential factors (taking responsibility)
Catharsis (relief from expressing emotion)
Interpersonal learning (using feedback from other members)
Self understanding (insight)
Who was the founder of group analysis who propounded the idea of a social matrix?
Foulkes
type of family therapy in which past experiences of a family are thought to be responsible for present conflicts
Psychodynamic family therapy
Transference is most intense when working with which of the following client group?
EUPD
What is Transference?
Transferenceis the phenomenon whereby we unconsciously transfer feelings and attitudes from a person or situation in the past on to a person or situation in the present.
Which factors increase Transference?
Borderline personality disorder
Anxiety
Frequent contact with key worker
Ways to effectively manage
Recognise the importance of the relationship to the patient
Maintaining professional boundaries and clear limits in treatment
Interpreting the transference
Being a reliable therapist (missing appointments and being unreliable will complicate the transference)
What is Countertransference?
Countertransferenceis the response that is elicited in the therapist by the patient’s unconscious transference communications.
A projected role may be very different from any aspect of his or her personality and the recipient is able to recognise that this perception of his or feelings or behaviour is a product of the patient’s mind.
However, a role may be congruent with an aspect of the therapist’s personality and he or she may unconsciously accept and collude with the projection
What is socratic questioning and which Psychotherapy is it used in?
Socratic questioning (sometimes referred to as the Socratic method) involves a disciplined and thoughtful dialogue
Cognitive therapy uses a technique called Socratic questioning to elicit false beliefs called negative automatic thoughts.
Dichotomous thinking
The tendency to see things as black and white rather than shades of grey
Personalisation
Incorrectly assuming that things happen due to us. Attributing external events to oneself when there is actually no causal relationship
Overgeneralisation
Coming to a general conclusion based on a single piece of evidence
Arbitrary inference
Drawing of an unjustified conclusion
Selective abstraction
Concentrating on the negative while ignoring the positives
Catastrophising
Expecting disaster from relatively trivial events
Filtering
Selecting out only negative aspects of a situation and leaving out the positive
Control Fallacies
Believing we are responsible for everything (internal control fallacy) or nothing (external control fallacy)
Fallacy of Fairness
Believing that life is fair
Blaming
Holding other responsible for our distress
Shoulds
Preconceived rules we believe (often incorrect) which makes us angry when others don’t obey them
Magnification
A tendency to exaggerate the importance of negative information or experiences, while trivialising or reducing the significance of positive information or experiences
Minimisation
An undervaluation of positive attributes
Emotional Reasoning
Believing what we feel must be true
Fallacy of Change
Expecting others to change just because it suits us
Global Labelling
Exaggerating and labelling behaviour (e.g. when you fail at something, saying ‘Im a loser’)
Always Being Right
When the need to be right dominates all other needs
Heaven’s Reward Fallacy
Expecting our sacrifices will pay off
Magical thinking
Incorrectly believing that our actions influences the outcomes
Which psychologist developed theories about group dynamics?
Bion
What did Bion believe about group dynamics?
He believed that groups had a collective unconscious that operated in a similar way to that of an individual
What were the two types of groups Bion distinguished between?
He made the distinction between two types of group. The first was theworking group, which was one that was working well and getting the job done.
The second was thebasic assumption groupwhich was acting out primitive fantasies and preventing things from getting done.
What are the three basic assumption groups?
Dependency.Here the group turns towards a leader to protect them from anxiety. An example of this is when a group of strangers get together for the first time, there can be an awkward silence before someone finally takes initiative and plays the role of leader.
Fight-flight.Here the group acts as if there is an enemy who must be attacked or avoided. The enemy can be either within the group or external. The group may at times pursue and defeat the perceived enemy but will soon create another one. An example of this would be the way doctors in different specialities become so damming of one another.
Pairing.Here the group acts as if the answer lies in the pairing of two of the members. This may be in the form of a friendly pairing or an extremely hostile one.
Which therapy is based on Otto Kernberg’s theory of borderline personality organisation?
Transference focused psychotherapy
What is Otto Kernberg’s theory of borderline personality organisation (BPO)?
BPO is a concept that includes borderline personality disorder but also other less severe personality disorders.
BPO is characterised by
- Identity diffusion (failure to integrate aspects of self)
- Primitive defences (splitting, and projective identification)
- Characteristic object relations
- Variable reality testing
The aim of therapy is to resolve issues in these four areas by means of interpretation of the transference
What is Cognitive Analytic Therapy (CAT)?
Cognitive Analytic Therapy (CAT) is a blend of psychodynamic and cognitive ideas.
A reparatory grid was used to identify the key aspects of psychodynamic psychotherapy that made it useful.
CAT is therefore an attempt to pick out the useful parts of psychotherapy and make it more efficient.
It is also an attempt to create a form of therapy that would lend itself to research.
How long does CAT usually last?
It is a brief focused therapy normally lasting between 16-24 sessions.
Who developed CAT?
Anthony Rhyle
What are Traps in CAT?
Negative assumptions generate acts and then confirm assumptions.
A trap is a flawed thinking pattern / coping strategy that serves to aggravate rather than help an underlying problem.
Traps are things we cannot escape from. Certain kinds of thinking and acting result in a vicious circle when, however hard we try, things seem to get worse instead of better. Trying to deal with feeling bad about ourselves, we think and act in ways that tend to confirm our badness.
For example, a person has low self esteem, to cope with this they try to please everyone around them, they are then taken advantage of and end up feeling pathetic and worse.
What are Dilemmas in CAT?
Dilemmas. Options for action are conceived in the form of polarised choices.
In a dilemma, a person incorrectly considers that there choice is restricted to opposite actions, neither of which is satisfactory.
For example, a young girl is ridiculed by her parents when she talks about her problems. She grows up to believe that when she has problems she has only two options, either bottle feelings up be ridiculed.
What are Snags in CAT?
Snags. Appropriate goals are abandoned if unacceptable to self or others.
Snags are thinking patterns that restrict our actions due to a perception that we will be unsuccessful or will harm someone.
For example, as a child a man was raised by a mother who had regular bouts of depression. He felt unable to take problems to her for fear of being a burden. This view and approach to difficulties persisted into adulthood as he was unable to find emotional support through his marriage.
How does CAT work with regards to procedures?
CAT identifies maladaptive, cognitive, emotional, and behavioural patterns which are referred to as procedures.
CAT takes a procedural sequence model. First the problem or issue is appraised. The options available to the client are then discussed and a plan of action is created. The plan is put into place. The consequences are then evaluated. The summary of the problem along with the plan is often put into a letter written by the therapist to the client.
What are reciprocal role procedures (RRPs) and which therapy are they associated with?
CAT
These are patterns observed about the way we relate to others. Imagine a client who has been brought up by a stern, dominating father whom he chose to rebel against, an example of an RRP could be the way the same client is dismissive of therapy because he sees the therapist as a demanding authority figure.
Once the RRPs have been defined they are visually presented using a sequential diagrammatic reformulation.
What is a sequential diagrammatic reformulation?
Diagrammatic representation of an RRP in CAT
Who developed CBT?
Aaron Beck
What’s the aim of CBT?
seeks to help the client overcome difficulties by identifying and changing dysfunctional thinking
Negative automatic thoughts (cognitive distortions)
Which therapy uses collaborative empiricism?
CBT - treatment is present focused and based on collaboration between client and therapist and on testing beliefs (collaborative empiricism).
Structural Family Therapy
What’s the main assumption in Structural Family therapy?
What constitutes a healthy family system?
What are Dysfunctional families marked by?
The main assumption is that the family’s structure is wrong.
It is one where there are clear boundaries and no coalition
Dysfunctional families are thought to be marked by impaired boundaries, inappropriate alignments, and power imbalances
What are some key terms in Structural Family Therapy?
subsystems, hierarchy, boundaries, alliances and coalitions
Who developed Structural Family Therapy?
developed by Salvador Minuchin
Strategic Family Therapy
What’s the main assumption in Strategic Family therapy?
What are Dysfunctional families marked by?
Strategic therapy claims that difficulties in families arise due to distorted hierarchies.
Dysfunctional families are believed to communicate in problematic repetitive patterns (vicious cycles) that kept them dysfunctional. These patterns arise as intended solutions by the family to some symptom. The intended solutions then became the problem because the family had either over or under responded to the symptom through their interactions
What are some key terms in Strategic Family therapy?
task setting, and goal setting
Who developed Strategic Family Therapy?
Jay Haley and Cloe Madanes
What other name is Systemic Family Therapy known by?
Milan Model
Systemic Family Therapy
What’s the main assumption in Systemic Family therapy?
How are the interviews conducted?
Milan-Systemic therapists see the family as a self-regulating system which controls itself according to rules formed over a period of time through a process of trial and error. They are interested in the rule-maintaining characteristics of communication and behaviours, and assume that the way to eliminate a symptom is to change the rules.
An interview consists almost entirely of questioning of the family by the therapist. Questioning is a recursive and circular process, with each question building upon the family’s response to previous questions. Emphasis is placed on exploring differences between family member’s behaviours, emotional responses and their beliefs at differing points in time.
What are some key terms in Systemic Therapy?
hypothesising, neutrality, positive connotation, paradox and counter-paradox, interventive questioning and the use of reflecting teams
Who developed the Systemic Family Therapy?
Mara Selvini-Palazolli
What does Transgenerational Family Therapy aim to understand?
Transgenerational family therapy aims to understand how families, across generations, develop patterns of behaving and responding to stress in ways that prevents health development and lead to problems.
Which 7 interlocking concepts make up Transgenerational Family Therapy theory?
Seven interlocking concepts make up the theory
scale of differentiation
nuclear family emotional system
family projection processes
multi-generational transmission processes
sibling position profiles
emotional cut-off
triangles
What is Solution Focused therapy?
emphasises solutions over problems. In fact, it sees the problem as being maintained by a focus on the problem to the exclusion of the solution behaviour which is already happening.
Solution focused therapy philosophy:
The central philosophy of the model could be stated as:
- If it ain’t broke, don’t fix it.
- Once you know what works, do more of it.
- If it doesn’t work, don’t do it again, do something different.
How does the interview process work in Solution Focused family therapy?
The therapist collaborates with the family through in-depth questioning to focus on the solutions already being used by the clients.
This is underpinned by a belief that people have the capacity to develop their own solutions, even if they are not using it.
Blame, shame and conflict are seen as issues which impede people from realising these solutions.
The therapist is non-interventionist.
Silences are tolerated when they arise in order to see what happens next.
The presumption here is that the more the therapist intervenes, the more he or she will impose their own understanding and interpretation onto the family.
The focus is on the present and the future.
How a problem has arisen is not important.
The emphasis the family places on the problem is accepted by the therapist as he or she is not interested in changing the family’s definition
Which defense mechanisms are seen in Borderline personality disorder?
Projection and splitting
Which defense mechanisms are seen in phobias?
Repression and displacement
Which defense mechanisms are seen in OCD?
Isolation, undoing, and reaction formation
Which defense mechanisms are seen narcissistic PD?
Projection and splitting
Which defense mechanisms are seen agoraphobia?
Displacement
What are the components of Freud’s Structural theory?
Freud proposed the existence of three separate areas:-
Id
The Id is the area that contains the instinctive drives. It operates underprimary process thinking, acts according to thepleasure principle, and is without a sense of time.
Ego
The ego attempts to modify the drives from the Id with external reality. It operates on thereality principle. It has aspects that are conscious, preconscious, and unconscious. It is home to the defenses mechanisms.
Super ego
The super ego constantly observes a person and acts as critical agency. Freud claimed it developed from internalised values of a child’s main carers. The ego ideal is part of the super ego and represents ideal attitudes and behaviour. It is useful to think of the super ego as the conscience.
What is IPT? Which condition is it most notably used for?
IPT is a time-limited, structured form of psychotherapy.
It is based heavily on the belief that interpersonal factors impact heavily on psychological problems.
It is used for many conditions but most notably for depression.
What does IPT aim to intervene?
IPT aims to intervene at the level of social functioning, it does not focus on personality. Patients social functioning problems are thought arise from one of four areas
Grief
Role transitions
Interpersonal deficits
Interpersonal disputes
What’s the usual course of IPT?
normally runs from 10-16 one hour sessions
What are the phases of IPT?
IPT moves though 3 defined phases.
Phase 1 - Identification of the problem, sessions 1-3
Phase 2 - Working on the target problem area
Phase 3 - Termination
Sessions 1-2 involve data collection and formulation.
An interpersonal inventory is taken which is a register of all the key relationships in the patient’s life.
The problem is then organised into one of the four categories above. The remaining sessions explore the formulation in more detail.
What’s an interpersonal inventory?
An interpersonal inventory is taken which is a register of all the key relationships in the patient’s life.
Who developed IPT?
Harry Stack Sullivan - theory
Klerman and Weissman - therapy
Is IPT more or less effective than CBT in depression + PD?
IPT has been found to be less effective than CBT in treating people with depression and comorbid personality disorders
What was the finding about IPT vs Imipramine vs CBT in depression?
equal efficacy
