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11. Psychotherapy.pptPsychotherapyPsychotherapy
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- 2. . Outline • Definition andPurpose of psychotherapy • Therapeutic Relationship • Types of psychotherapy
- 3. . Definition and purposeof psychotherapy • Psychotherapy is an interpersonal treatment based on psychological principles • Psychotherapy is a form of treatment for problems of an emotional nature – a trained person deliberately establishes a professional relationship with a patient
- 4. Con… For the purposeof • Removing, modifying, or retarding existing symptoms • Mediating/intervening disturbed patterns of behavior • Promoting positive personality growth and development
- 5. . In all psychotherapies •Learn to identify and change behaviors or thoughts that adversely affect life • Explore and improve relationships • Find better ways to cope and solve problems • Learn to set realistic goals
- 6. . To achieve thegoals • Some therapies focus on changing current behavior patterns • Others emphasize understanding past issues • Some therapies combine changing behaviors with understanding motivation Can be – Short-term - with few meetings – Over years - with many sessions
- 7. . Changes in brainactivity observed following psychotherapy e.g. • Increased blood flow in the right basal ganglia • Increase in posterior cingulate activity • Metabolic activity increases in hippocampus
- 8. . Therapeutic Relationship Trust/ Bond-between therapist and patient/client • Listening • Non Judgmental • Empathy • Self disclosure • Congruence
- 9. . Con… • Relationship betweena healthcare professional and a patient(a working alliance between patient and therapist) • It is the means by which the professional hopes to engage with, and effect change in a patient. • An emotionally safe setting where the patient can feel accepted, supported, un-criticized The therapeutic relationship is more important than the type of psychotherapy
- 10. . • Confidentiality isintegral to therapeutic relationship (except with safety issues) • Empathy is the inner experience of sharing in and comprehending the momentary psychological state of another person
- 11. . What happens inthe therapy room? • Education about problem/disorder e.g. anxiety, OCD, Depression; crisis; grief etc. • Working on emotion, thoughts, feelings and beliefs • Open up - wounds, deep secrets, weaknesses, shame, guilt - without being judged - all these brought to awareness
- 12. Con… • Confronted/challenged andwilling to take a new path • Case conceptualization: what causes it, what is maintaining it; strength and weakness; what do you want to do with this? • Coping skills • Treatment plan
- 13. Forms of psychotherapy •Psychodynamic therapy • Brief psychodynamic therapy • Behavioral therapy • Cognitive behavioral therapy • Interpersonal therapy • Dialectical behavior therapy • Family therapy • Couples therapy • Supportive therapy • Group therapy
- 14. . Basic types • Psychoanalytic/Psychodynamicpsychotherapy • Cognitive and behavioral psychotherapies • Interpersonal psychotherapy • Motivational enhancement therapy
- 15. . Major Types ofPsychotherapy A.Behavioral: learned behaviors are conditioned responses. B.Cognitive Behavioral: learned behaviors and emotions are caused by one's thoughts. C.Interpersonal: interpersonal difficulties lead to psychological problems D.Psychodynamic/psychoanalytic: behaviors are the result of unconscious, irrational drives E.Motivational therapy: encourage patients to change maladaptive behaviors.
- 16. . Formats of Psychotherapy •Individual • Couple • Family • Groups- individuals or peers (similar issues)
- 17. . Individual therapy • Mostcommonly practiced format of psychotherapy • A confidential interaction between patient and provider. • Permits maximal disclosure without fear of others listening Couple therapy (marital therapy) • Allows two partners to overcome relationship difficulties • Issues addressed - include sexual relations and parenting, relationship distress, etc
- 18. Family therapy • Familymembers are seen together in treatment, • Focus on the family system and its ability to help both family problems and individual psychopathology • Correcting distorted communications and impaired relationships Group therapy • Supportive networks for people who have similar difficulties • Cognitive, psychodynamic, and supportive techniques - used in patients with a substance use disorder, or in a chronic or life- threatening condition- diabetes or cancer
- 19. A. Behavioral Therapy •Maladaptive behaviors as the source of psychological distress • Attempts to improve quality of life by altering and modifying these. • Works best for specific behavioral symptoms – e.g. Phobias and compulsions.
- 20. Con… 1. It isdirective: the therapist actively treats the client using methods based on learning principles. 2. The goal of therapy is behavioral change, not personality reconstruction. 3. Behavior therapy is generally shorter than other forms of therapy. 4. Interventions are condition-specific: there is no common therapeutic goal
- 21. . Types of BehavioralTherapy a) Systemic desensitization: helpful for phobic disorders b) Flooding/Implosion- in vivo or imaginary c) Aversion therapy – painful stimulus d) Exposure and response prevention- OCD e) Cognitive behavioral therapy (CBT)
- 22. B.Cognitive behavioral therapy(CBT) • Cognition is the major determinant of how we feel and act. – Incorporated faulty thinking leads to emotional and behavioral disturbances • Therapy is primarily oriented toward cognition and behavior • It stresses the role of thinking, deciding, questioning, and doing, and re-deciding. • Learning new way of thinking and acquiring more effective way of coping
- 23. The cognitive model Situation Corebelief Thoughts Feelings Behaviors
- 24. . COGNITIVE DISTORTIONS • All-or-nothingthinking - absolutistic thinking : ‘If I don’t succeed in this task, I am an absolute failure. I am either the best teacher, or I am nothing . . .’ • Overgeneralization - Drawing a general (negative) conclusion on the basis of a single incident: ‘That’s it – I always fail at this sort of thing . . . I can’t do it!’ • Personalization - Interpreting events as personal affronts or obstacles: ‘Why do they always pick on ME . . .? That’s how it always feels, even when I’m not to blame.’
- 25. Con … • Arbitraryinference - Drawing a conclusion without sufficient evidence to support it: ‘They don’t like me . . . I could tell from the moment we met . . .’ • Selective abstraction - Focusing on an insignificant detail taken out of context: ‘I thought my lecture went well. But that student who left early may have been unhappy with it. Perhaps the others were as well but didn’t show it . . .’ • Magnification/minimisation - faulty evaluation of relative significance of particular events. e.g. Magnification (“It is horrible if I don’t do this well”)
- 26. . • Therapist helpsthe patient identify and correct distorted, maladaptive beliefs • Techniques: • identify cognitive distortions • test automatic thoughts • identify maladaptive assumptions
- 30. What problems canCBT help with? • Anxiety and Panic Attacks • Phobias (agoraphobia, social phobia) • Depression • Obsessive-Compulsive Disorder • Eating problems • Sexual and relationship problems • Child and adolescent problems • General Health problems
- 31. Con… • Habit problems(e.g. tics) • Anger • Drug or Alcohol problems • Schizophrenia spectrum • Problems associated with a learning disability • Bipolar Disorder • PTSD • Sleep Disorders • Chronic pain
- 32. . C . Interpersonalpsychotherapy • It is presumed that current or recent interpersonal events. • Experiences are important and meaningful at face value and may cause distress regardless of the patient's early history, personality, or vulnerabilities. • Assumes connection between onset symptoms and interpersonal context in which the symptoms occur.
- 33. . • It islargely about helping patients "fix the problem," which includes their emotional feelings about the current problem. • It is not aimed at unconscious or characterological problems.
- 34. . The problem areascan be classified as • Stressful life events • Role transitions • Grief - bereavement • Role disputes
- 35. . Goals • Reduce symptomsby improving social functioning • Help clients to: • Repair or build supports • Improve communication • Resolve interpersonal problems
- 36. Con… IPT techniques • Linkssymptoms to social context • Conduct “interpersonal inventories” • Attend to details of communication • Help clients work through present-focused problems of bereavement, social-role transitions and disputes
- 37. Psychoanalytical Therapy •Focus onunconscious as it emerges in treatment relationship •To make the unconscious conscious •To assist clients in relieving earlier experiences and work through repressed conflicts D . Psychoanalytic/Psychodynamic psychotherapy
- 38. Con… • Insight byinterpretation of unconscious conflict • Most rigorous: 3-5 times/week, lasts years, expensive • Patient lies on couch, analyst unseen to eliminate visual cues • Must be stable, highly motivated, verbal, psychologically minded and be able to tolerate stress • Transference /counter transference / resistance
- 39. . Psychodynamic psychotherapy • Alsocalled “expressive” and “insight-oriented” • Based on modified psychoanalytic formulations • Primarily relies on developing patient insight • Based upon the idea that childhood experiences, past unresolved conflicts, and previous relationships significantly influence an individual’s current situation in life
- 40. Con… • Psychodynamic psychotherapyuncovers the unconscious patterns of interpersonal relationships, conflicts, and desires with the goal of improved functioning. • Brief, no couch, less focus on transference
Editor's Notes
- #1 Also Known as Talk therapy Counseling Psychosocial therapy Simply- “Therapy
- #7 The “basal ganglia” refers to a group of subcortical nuclei responsible primarily for motor control, as well as other roles such as motor learning, executive functions and behaviors, and emotions. The cingulate gyrus helps regulate emotions and pain hippocampus plays a vital role in regulating learning, memory encoding, memory consolidation, and spatial navigation
- #8 Self-disclosure can be a means of building rapport with clients, which is essential to the counseling relationship. Counselors often choose to disclose about themselves and their lives to aid in the development of trust that is necessary for counseling to be effective.
- #9 Predicts treatment compliance, and outcome across a range of patient diagnoses and treatment settings
- #11 Changing behavior, new beginning ; Corrective experience learning to be honest to oneself; facing fears learning to identify and express painful emotions frustration and distress tolerance
- #15 Supportive psychotherapy (or counseling ) eg, to help individuals cope with illness, deal with a crisis or transient problem, and maintain optimism or hope Techniques -emphasize communication of interest and empathy include guidance on available services, advice, respect, praise, and/or encouragement. Eclectic or integrative psychotherapy draw concepts and techniques from a variety of different types of therapy, including psychodynamic, cognitive, and behavioral approaches
- #16 No single preferred format Combination of therapies – possible Some problems respond better or worse to different formats, e.g. individual vs. couple
- #18 Psychodynamic therapy focuses on the psychological roots of emotional suffering
- #21 Modeling - Social learning Shaping - Positive reinforcement Systemic desensitization - Repeated exposure to the feared object or situation in the absence of any negative consequences should lead to a reduction of anxiety through the process of extinction. Systematic desensitisation involves gradual exposure to the object you fear, but with flooding you are completely exposed to it, all at once. It's like going directly to the end of the stimulus hierarchy and skipping all the stages in between.
- #22 CBT also includes education relaxation exercises coping skills training stress management assertiveness training - The purpose of assertiveness training is to teach persons appropriate strategies for identifying and acting on their desires, needs, and opinions while remaining respectful of others. This form of training is tailored to the needs of specific participants and the situations they find particularly challenging.
- #24 All or none-for example if a person fails to be promoted to the post they desperately wanted, they believe they will never be promoted and that their career is in ruins. Mental filtering/ selective perception -You pick out a single negative detail and dwell on it exclusively, while ignoring all the rest, so that your vision of all reality becomes darkened.
- #28 Questions to identify automatic thoughts What was going through your mind just then? What do you think you were thinking about? What did the situation mean to you (or mean about you)?
- #33 The IPT therapist takes an initial inventory of past experiences and considers interpersonal patterns to gain a deeper understanding of current problems. The term "characterologically difficult patients" designates a loosely defined group of patients who are neither grossly neurotic nor psychotic. They share a hab- itually maladaptive and unsatisfying way of perceiving, experiencing and responding to their inner stimuli and outer environment
- #34 Role transitions refer to the psychological and, if relevant, physical movements between positions within or between social systems, including disengagement from one role (role exit) and engagement in another role (role entry). Role disputes (e.g., in marriage) Interpersonal deficits (lack of social support)
- #37 Analyst neutral Goal: structural reorganization of personality Techniques: interpretation, clarification, working through, dream interpretation Exploration of the unconscious drive is done by free association and dream analysis The processes of transference, countertransference and resistance Free Association - A person freely shares any thought, word, or feeling that comes to mind with the therapist. Dream Analysis - Interpreting the content of dreams to reveal underlying motivations or symbolic meaning.
- #39 Symptoms are byproduct of unconscious patterns that begin in childhood. Couch not used Less focus on transference and dynamics Interpretation, encouragement to elaborate, affirmation and empathy important 1 – 2 sessions/week; open-ended duration Limited goals