M. Faisal Idrus

Psychotherapy

Includes those means by which a therapist attemps to provide new interpersonal experience for another human being

These experiences are designed to enhance one ability to manage subjective disstress

Psychotherapy

It can not alter the problem of world in which patient lives

But it can enhance self acceptance, empower the patient to make life changes and help patient to cope with enviroment more effectively

Definition Psychotherapy is an interpersonal, relational

intervention used by trained psychotherapists to aid clients in problems of living. This usually includes increasing individual sense of well-being and reducing subjective discomforting experience. Psychotherapists employ a range of techniques based on experiential relationship building, dialogue, communication and behavior change and that are designed to improve the mental health of a client or patient, or to improve group relationships (such as in a family).

Classification of Psychotherapy according to who is involved in the

treatment an individual a group a couple a family therapy

Classification of Psychotherapy according to the content and

methods used analytic interpersonal cognitive,behavioral, cognitive -

behavioral All psychotherapies are aimed at

changing aspects of the patient

Characteristics common for all psychotherapies Based on interpersonal relationship used verbal communication between

two or more people as healing element

specific expertise on the part of the therapist in using communication and relationshop in healing way

Characteristics common for all psychotherapies based on rationale or conceptual

structure that is used to understand the patient problem

use of the specific procedure in the relationship that is linked to rationale

structure relationship expectation of improvement

Behavior therapy

Aim : change the behavior. derived from British empiricism,

Pavlov ś studies of conditioning, research on stimulus response relationship conducted by behaviorists (such as Skinner, Wolpe, Eysenck.)

Behavior Psychotherapy Assumptions of psychopathology People learn their problems Problems occur naturally through a learning process : Classical conditioning e.g phobias Operant conditioning e.g. , Substance abuse, personality disorders This learning is NOT direct instruction Typically natural and can even be passive Problems are sustained largely through escape and

avoidance of aversive event

Behavior Psychotherapy Thoughts require a slightly modified analysis but

are still understood as both important and as behaviors

The aviodance of thoughts can lead to more problems in living

It is the avoidance that produces the problem, not the thougts.

Interpersonal problems can be fundamental in bringing about and sustaining ineffective behavior (psychopathology)

Behavior Psychotherapy

Assumptions of curative factors If problems are learned, new and more

effective behaviors can be learned as well Real key is exposure and extinction Keep in mind both classical and operant

conditioning Techniques Graduated exposure treatments Flooding

Graduated Exposure Treatment Person gradually taken into the feared situation

or exposed to the fear stimulus or traumatic memory until the anxiety subsides

Systemic desensitization Use coounterconditioning Extinction to reduce fear Work through an “anxiety hierarchy” of situations that lead to

lead fearfull reactions. Imagine fearfull situasitions while remaining relaxed Also use in : Cognitive processing therapies (CPT) for sexual assault.

Flooding Person is taken directly into the feared

situation until the anxiety subsides : Escape response is prevented completely Pros and cons to this

When would you NOT use this

Just as effective as systematic desensitization for phobias

Behavior therapy work with objective, observable

phenomena, referred to as behavior, including physical activities (drinking, eating, talking, completing a serial sequential activities that lead to habit formations and social interaction)

Behavioral techniques do not necessarily help the patient to

understand his motivations and emotions (but some od Bs believes that the change of patient´s behavior may lead to changes in how patient think and feels)

symptoms : phobias, obsessions, eating, sexual disorders, general anxiety, mild depression, alcohol abuse

The forms of behavioral therapy

Work on what the patient does relaxation training systematic desensitization flooding

Relaxation training

used to teach patient to control over their bodies

to achieve voluntary control over their feeling of tension

to achieve relaxation ( they are instructed to move through the muscle groups of the body and make them tense and relaxed)

Systematic desensitization Teaching how to reduce or control the

fear elicited by specific stimuli „trainig“ to reduce tense and anxious

response to feared stimuli ,fe therapist may asked the agoraphobic patient to imagine to visist the shopping mall where the patient typicaly develops panic, the patient is ecourage to use relaxation techniques to diminished panic and place it under voluntary control

Flooding aim : to extinguish anxiety produced by

feared stimuli

how : placing the patients in continuous contact with the stimulus and helping them learn that stimulus does not lead to any feared consequences

Cognitive therapy cognitive structures or schemata

shape the way people react and adapt to a variety of situations that they encounter in their lives

Cognitive therapy aim : to abolish negative thoughts

which allow symptoms to persist (our moods and feelings are influenced

by our thoughts and the psychological disturbances are caused by habitual errors in thinking. By correcting these distorted ways of thinking, therapist restructure patients views of themselves)

Cognitive therapy

The three major cognitive patterns observed in depression (by Beck)

- a negative view of oneself

- a negative interpretation of experience

- a negative view of future

Cognitive therapy treatment of depression the schema that lead to negative

interpretations the goal : to indentify and restructure

those negative schemata (that shape p.perception)

Individual psychotherapy

Covers broad range of psychotherapeutic techniques which are usually done individually - single therapist working with single patient

Psychoanalysis Originally developed by S.Freud ( a

systemic theory to describe the structure and operations of the human psyche)

reorganization of character structure with emphasis on self understanding and correction of development lags

Psychoanalysis basic concept includes stages of psychosexual development (oral, anal,

phallic) the structures of conscious and

uncoscoius thougts (primary versus secondary process thinking)

the structures of drive and motivation (id, ego, superego)

Psychoanalysis Assumptions of curative factors in

psychoanalytic theory Curative process is resolution of the

unconscious tension Need to free up the psychic energy being spent

on defences Techniques : Free association Patient relaxes and freely expresses whatever comes

to mind Dream analysis Determine latent content of dreams

Psychodynamic psychotherapy

concepts are embodied in psychoanalytic theory (it does not involve rigidly defined techniques that charakterized classical psychoanalysis)

Psychodynamic psychotherapy based on idea of self exploration and

self understanding open up the possibilities for change in personality and behaviour

treatment of : personality disorder, sexual dysfunction, somatoform , anxiety disorders, mild depression

Types of psychodynamic psychotherapy

psychoanalysis exploratory psychotherapy - aims at

understanding motivations and uncousious forces (focus on current life)

Types of psychodynamic psychotherapy

supportive psychotherapy - lessening of anxiety through reassurance, advice, modifications of social factor (it helps patients to get through difficult situations), it is incorporated into any of the other types os PT

short term psychotherapy

Insight oriented psychotherapy based on psychodynamic concept focused on interpersonal relationship

- here and now situation the patient are encouraged to achieve

an intellectual understanding of the mainspring of their behavior that will assist in changing it as needed

Interpersonal therapy

based on idea that mental illness may reflect and be expressed in problems with relationship

emphasizes working on improving interpersonal realtionship during the process of psychotherapy

References

Waldinger RJ: Psychiatry for medical student, Washington DC : American Psychiatric Press, 1997

Collier JAB, Longmore JM, Harvey JH : Oxford handbook of clinical specialties, Oxford, 1998