Therapy Flashcards
Maudsley model for anorexia
Phase 1
Focus on refeeding to reduce risk of death and health damage
Initial family meal with therapist. Parents asked to get child to eat one more mouthful than they want to
Therapist interrupt any parental structure that erode parental authority, inconsistency, relying on siblings
Review shopping
Systematic approach/therapy
It sees any social group as a “system”
Each and every person’s behaviour affects others
It looks for:conflict, coalitions, codependency, split
No objective truth, everyone’s interpretation affects their role in the system
Maudsley mode for anorexia
Phase 2
Negotiating a new relationship
Shift focus on refeeding to on family relationship
Negotiate to allow adolescent to have responsibility for eating
Peer relationship and sexuality explored in relationship to food
Maudsley model for anorexia
Phase 3
Adolescent issues and finish
Continue focus on adolescent social world
Counselling and psychotherapy
An interactive client beneficial relationship set up to approach a client issues. These issues can be social, cultural, and emotional. A client can be a person, or a family group, or an institution
Counselling psychology aims to work with clients to examine mental health issue and explore the underlying problems that may have caused them
Clinical psychology
Aims to reduce psychological distress and to enhance and promote psychological wellbeing
They deal with mental and physical health problems including anxiety, depression, addition
Carl Rogers therapy
Therapist (congruence)
Client (incongruence)
Unconditional positive regard
Empathic understanding of client’s internal world
Therapist use clarification and reflection
Historical perspective of therapy
- Freudian psychoanalysis (unconscious)
- Skinner behaviourism (conditioning)
- Rogers person-centred
- Cognitive therapy
- Beck CBT
3 different schools in NHS
- Psychoanalytic
- Systematic
- Cognitive behavioural
4: overall of these 3–person centered therapy
The Dodo effect
States that different therapies are all generally equally as effective and cannot be judged in the same way that medical treatment are
It is the therapeutic alliance that is the key to a successful therapy
More than just the content of a therapy is important when considering whether it will work
Key feature;
- therapist factor (how experienced the therapist are)
- therapy factor (how the boundary)
- client factor (what he believes)
== therapy efficacy ( it’s not about which school is better than other)
Evidence based practice
Theoretical research –> professional consensus –> clinical guideline + clinical judgement (at the time of therapy) = clinical practise
Practice based evidence = efficacy of use of a certain therapy
Who does therapy
Clinical psychology Counselling psychologist Psychiatrist Counsellor CBT therapist/ family therapist IAPT low intensity therapist Mental health workers Nurse therapist
Formulation in psychological therapy
Explanation of current difficulty accusing go specific psychological theory
- to help patient understand their difficulties in a psychological way
- to structure information in a theoretically guided way
- to provide a working hypothesis to guide psychological intervention
Psychoanalytic psychotherapy
Explore of the cause of distress by seeking to understand unconscious process that lead to internal conflict and anxiety
Target: Unconscious process & internal conflict –>anxiety
Therapist interpret client’s internal world in relation to past
Therapist as expert making interpretation on client’s situation
Need to be able to cope with anxiety
Behavioural therapy
Identification of problem behaviour and changing environment/ trigger to replace behaviour with healthier one
Has structured sessions
Target: problem behaviour
Therapy: learning theory and animal studies
Analyze problem behaviour and alter behaviour
Good for learning disabilities, depression substance misuse
Cognitive behaviour therapy
Identification of thinking patterns that keep problem behaviour going. Testing out new ways of thinking and behaviour to change these cycles
Targets: situation ->thoughts-> feelings-> behaviour
Theory: information processing model: change thinking to change feeling
Structure; structured session toward goals, behavioural experiment and skill learning
Views therapeutic relationship as test ground for new skills and behaviours
Client and therapist as collaborators working toward a common goal
Good for particular identifiable problem
Systematic therapy
Understand problem in a context and focus on shifting dynamics in relationships to improve problem
Target: observable interaction within a system
Theory; problem fundamentally interpersonal, not situated in person
Structure; reflecting teams, communication pattern
Looking from another perspective
Often more than one therapist
Person centred therapy
Humanists therapy focus on self-development, growth and responsibilities. They seek to help individual recognize their strength, creativity and choice in the “here and now”
Target; person growth rather than pathology
Theory; 3rd wave in psychology development. Emphasis in subjective meaning
Structure: helping people to fulfil their own inherent “self-actualizing tendencies”
See the client as the driving force for change
Good for working toward better quality of life
-dementia
3rd wave cognitive Behavioural therapy
Target: thinking process vs thought content (how they think rather than what they think)
Theory: 3rd major development in CBT
Structure; focus on relationship with thoughts vs arguing with content.
Use or exercise, de-centring, mindfulness
Good for working toward better quality of life ( not specific problem focus)
Psychodynamic therapy
Allows the client to explore why a difficulty might have developed
Cultural formation approach in acute psychiatry
The difference from exciting DSM IV CF
Capture cultural identity in different way
For all ethnic group, not exclusively for minority ethnic group
A clinical interactive use of the CF, narratives from CF interview are circulated both to patient and carers, to the clinical team; and developed further as well as integrated into clinical care
Evidence of CF
1)cultural formation interviews have some clinical efficacy: improved both assessment and rapport with patients
2) complexity of setting, sample size
3) did not improve outcome or patient satisfaction score
What is cultural formulation in acute psychiatry ?
An approach that involve a sustained and continuing cultural dialogue between patient and clinician
A method that seeks to enhance therapeutic engagement and enrich clinical assessment for patients of all cultural backgrounds
Aimed at eliciting a structured narrative account of suffering, deploying the metaphor of “culture”
Allows patient an opportunity to systematically narrate their suffering in their own cultural vocabulary
Enable clinician to reflect how their own cultural identity might influence engagement, assessment, diagnosis and treatment
Actualize patient’s concept of culture, not clinician’s assumption of culture
Requires innovation in individual settings to be determined by local context, problem, and desired outcome
Cultural formulation is NOT
Not a technical fix
Does not yield a score or generate psychometric score
Not a one off interview that can solve the problem of “culture”
Not a diagnostic instrument it a standardized interview to be cloned
Does not replace a diagnosis and treatment plan, but enhances it
Not for exclusive use with Black and Minority Ethnic patient
Self management
Self-management program can be self guided or supported by a clinician
People are encouraged to become experts in their own recovery in self management program
Self management can be delivered in person, or through written or online material
Self management program often aim to teach problem solving skills
Techniques in mindfulness based therapy are based upon a type of;
Meditation.
Ethics and clinical care
1) non-maleficence (doing no harm)
2) autonomy (respecting patients’ right to make decision)
3) beneficence (making sure that we act in the patient’ best interest)
4) justice (being fair in decision about which patients receive which treatment)
Communication technique
Active listening
Mirroring
Reflecting back
-mirroring the words, paraphrasing
Mental state examination (MSE)
A&B=appearance and behaviour S=speech M= mood T=thought P=perception C=cognition I=insight
History -what to include
Medical history Family history of mental/physical health problem Current living condition Substance use Family background Recent trauma Educational background Criminal record History and current risk of self harm Coping strategy Expectation and goal of the treatment
Diagnosis vs formulation
Diagnosis: specific disorder label
Formulation; individual based
Why does this person has this particular problem at this particular time (specific)
Helps trailor intervention to specific individual
Behavioural intervention
Active scheduling Behavioural activation Problem solving training Assertiveness training Sleepy hygiene Graded exposure
Cognitive intervention
Identifying cognition
Distraction/attention retraining
Identifying cognitive bias
Reappraising negative automatic thoughts and images
Developing new perspective
Testing negative automatic thought and images
Modifying unhelpful rule and core beliefs
Cognitive bias
Black & white thinking Catastrophisation Over-generalization Jumping to conclusions Emotional reasoning Mind reading (assuming you know what other are thinking)
Physical intervention
Relaxation training Controlled breathing Physical activity/exercise Sleep intervention Medication
Protocol for CBT 6-12 sessions
Session 1-3
- assessment, formulation, treatment plan
- begin activity scheduling
- increase physical activity
- address bad sleeping pattern
Session 4-6
- continue monitoring activity scheduling
- explore and challenge NAT using thoughts record
Session 7-9
- identify and explore cognitive bias
- identify and challenge unhelpful rules
- behavioural experiment
Session 10-12
- identify and challenge core beliefs
- relapse prevention
What is self-management
The individual plays a central role in managing their own care: they become an expert in their own recovery
Develop skills like problem solving, decision making, taking goal oriented action which can be learnt
Less reliant on information-given than psycho-education
Common components of mental health self management
Recovery principle Illness psychoeducation Wellness maintenance strategies Relapse prevention and crisis planning Accessing resource and support Medication management and psychoeducation Goal setting
Peer support in mental health
A peer is someone who is or was receiving mental health service and self identifies as such
Peer support is social/emotional support mutually offered and provided by people with mental health problem to bring about desired change
A system of giving and receiving help founded on respect, shared responsibilities and mutual agreement of what is helpful
Types of peer support
Informal peer support
Mutual peer support
Intentional peer support
Peer mental health workers
Potential benefit of self management
Can be assessed any time, any where
Free
No waiting list
Self-generated idea -increased likelihood of service user complying
Independent of medication -no risk of dependency
Empowerment-taking ownership of techniques and methods
Similarity of condition and expediency-increase empathy
Shared knowledge of receiving service and medication
Level playing field -professional patient boundary diminished
Trust built through self-disclosure
Possibility for promoting culture-change within service
Setting up a peer-supported, self management program
Funding arrangement Employment arrangement >interview process >recruitment check >type of employment Management and support. >line management >supervision >relationship with CRT Providing the intervention consistently >training >session logs
Balanced care model
Mixture of service type including hospital beds and spectrum of others
Service close to home, mobile big static
Intervention for disabilities and symptoms
Treatment specifics to diagnosis and needs
Service are coordinated
Service reflect priorities of service users, family and friends
Balanced care -steps
Step 1) primary care with specialist support (lower resourced counties and regions)
Step 2) general mental health service (middle income)
England in 1950-1990
Step 3) generalized/specialized mental health service (high resource)
England in 2000-
IAPT (improving access to psychological therapy)
IAPT-stepped care (mainly CBT)
Nearly 1 million per year is treated
Practitioners: one year post-gras certificate, low intensity CBT role
Current state of acute mental health care service
Acute wards - lack of beds
Crisis team -lack of continuity of care
Crisis house-popular but not clear if it’s an alternative to hospital
Day hospitals/ recovery centre -old fashion and seen as institutional
Secondary mental health service
Community mental health team
Early intervention Psychosis team Teams for people with severe non psychotic illness Personality disorder team Assertive outreach Rehabilitation Perinatal (before after childbirth) Liaison -in general hospital Forensic For kids and LD
Mental health nurse
Predominantly profession in face to face care in secondary care
Clinical nurse therapist: specialist training in a therapy
Ascended practitioner: manage own caseloads, make complex decision, deliver treatment
Academic nurse: engage in teaching
Social worker
Generic mental health work (care coordination) with focus on social and families, and on the law.
Occupational therapist
Work to assess and improving physical & social functioning across range of sessions and care coordinator
