E2: PSYCHOTHERAPY

Psychotherapy

treatment given to mentally ill and emotionally disturbed people through psychological techniques

1934

Year wherein psychotherapy was introduced to psychiatric practice

Psychotherapy

used to refer to all psychological treatments

Psychotherapy

one of the most valuable inventions of the last hundred years

Wolberg

Defined psychotherapy as a form of treatment for problems of an emotional nature in which a trained person deliberately establishes a professional relationship with a patient with the objectives of:

• Removing or modifying existing symptoms

• Mediating disturbed patterns of behavior

• Promoting positive personality growth and development

Rotter

Defined psychotherapy as a a planned activity of the psychologist, the purpose of which is to accomplish changes in the individual that make his life adjustment potentially happier, more constructive, or both.

J.D Frank

Defined psychotherapy as a planned, emotionally charged, confiding interaction between a trained, socially sanctioned healer and a sufferer. Also said that it often includes helping the patient to accept and endure suffering as an inevitable aspect of life that can be used as an opportunity for personal growth

Fisher

Defined psychotherapy as a planned and systematic application of psychological facts and theories to the alleviation of large variety of human ailments and disturbances, particularly those of psychogenic origin 

J.D Page

defined psychotherapy as the treatment of mental disorders especially psychoneurosis by psychological techniques.

Psychotherapy

the systematic application of techniques derived from psychological principles, by trained and experienced professional therapists, for the purpose of helping psychologically troubled people

to rid the patients of symptoms which make his life a burden to him

The chief objective of psychotherapy

Counselling

An activity for working with relatively normal-functioning individuals who are experiencing developmental or adjustment problems

Counselling

This consists of whatever ethical activities a counselor undertakes in an effort to help the client engage in those types of behavior that will lead to a resolution of the client’s problems

Therapeutic Process

It consists of the interactions and communications that take place between patient and therapist during the regular meetings in therapy sessions, and includes all of the events that can be observed and recorded during therapy sessions.

Three phases

How many phases are there in the therapeutic process?

First Phase

• From first meeting until the signing of the contract

• Main Task: To assess the necessity of psychotherapy

• First psychotherapeutic interview

• Case conceptualization & Therapy Contract

Second Phase

• After signing the contact and until the beginning of the conclusion of the therapy

• The therapeutic work

• When no improvement is made at the early stages; case conceptualization must be recommenced and treatment must be adjusted

Third Phase

• The conclusion of the psychotherapy

• Begins after reaching the desired result or when the therapy is proved to be unsuccessful

• This is also preparation for the prevention of relapse

Objective Structured Clinical Examination

OSCE

Variables

Other than the quality of treatment provided, patient outcome is affected by ?

Evaluation of Standardized Role Plays

This evaluation is well-established in medical education

Competence

the possession of required skill, knowledge, qualification or capacity

Emotional Competence

therapist is aware of his emotional state while dealing with their clients.

Realistic and Clear

As a responsbility of the therapist, contracts involving the client should be ? and ?

Professional Intent

As a responsibility of the therapist to the client, therapy should be undertaken only with ?

Harm

As a responsibility of the therapist to the client, therapists take all reasonable steps to avoid ? to their clients as a result of the therapy

• supervision

• refer

As a responsibility of the therapist to the client, therapists should seek ? or ? the client in situations which are beyond their competence.

Effectiveness, resilience, and ability

As a responsibility of the therapist to self, they must maintain their own ?, ?, and ? to help clients,

• monitor

• depleted

As a responsibility of the therapist to self, they must ? their own personal functioning, and seek help or refrain from therapy when their personal resources are ?

• impaired

Therapists should not undertake therapy when their functioning is significantly ?

Informed Consent

This is extremely important as it ensures that a patient’s decision to take part in psychotherapy is informed, voluntary, and rational.

Therapeutic Contract

This should be a written document, which includes the responsibilities of the therapist and the client in a particular psychotherapy. 

• Time

• Duration

• Frequency of sessions

• Late to the session

• Cancellation

• Fees

• Emergency contact

• Termination

• Gifts

• Self-disclosure

• Homework assignments

• Documentation

• Recording

• Provision for revision

• No suicide contract

What’s included in the therapeutic contract?

Confidentiality

Maintaining this is the foundation of psychotherapy.

Confidentiality

This ethical requirement overlaps with the law

Nonsexual boundary crossing

This can enrich therapy, serve the treatment plan, and strengthen the therapist-client working relationship

Hippocrates

He promoted humane treatment in 400 BC

Philippe Pinel

• Reformed Paris mental hospitals

  • Removed restraints/chains

  • More humane treatment

• Patients got better

• Stressed “moral” understanding

• Developed individualized therapies based on diagnosis and life history

• Drugs: last resort

Dorothea Dix

• Reform of US System

• Moral-treatment movement

• Led to large, state-supported public asylums

1960s

Era where group therapy gained popularity and community mental health centers were established

1970s

Era when family therapy was introduced

Minfulness-Based Cognitive Therapy

MBCT

Psychodynamic Therapy

believes that the path to overcoming psychological problems is to develop insight into the unconscious that are assumed to underlie the problems

Psychodynamic Therapy

has its roots in Freud’s psychoanalytically oriented theory of personality

Psychodynamic

• means mind energy/mind in conflict

• the active forces within the personality that influence behavior, and the inner causes of behavior, specifically the unconscious conflict

Chronic problems are rooted in the unconscious mind and must be brought to light for catharsis to occur.

What’s the assumption in psychodynamic therapy?

Psychological Diagnostic Manual

PDM

PDM

This was an alternative or complement to the DSM which is deemed to be more useful in diagnosing and treating clients

2006

Year when PDM was released

Rorschach Inkblots

The test involves presenting 10 inkblot images and asking clients to describe what they see, while the therapist records and explores their interpretations.

Freudian Slip

Least formal and perhaps least applied technique

Free Association

The most important and most used tool in Psychodynamic therapy. It’s simple and often effective

Abreaction

this can be provoked by free association wherein repressed material, particularly painful experiences or conflicts, is brought back into consciousness

Dream Analysis

Highly subjective technique that is useful but not scientifically proven

• Brief

• Family

• Art/Music

Three types of psychodynamic therapy

Catharsis

releasing negative emotions such as anger, unacknowledged trauma, or fear.

Self-awareness

The client must have this to discover these unconscious patterns of thought and understanding of how these patterns came to be in order to deal with them.

Transference

the client reacts to the analyst based on unconscious childhood fantasies

Psychoanalysis

Assumes that humans are born with aggressive and sexual urges that are repressed during childhood development through the use of defense mechanisms

Neurosis

This was said to be a consequence of unresolved conflicts between the id, ego, and superego.

Carl Jung

• Agreed that insight was a key therapeutic goal but disagreed that insight usually involves unconscious conflicts about sex and aggression

  • Emphasized the collective unconscious

Alfred Adler

Believed that emotional conflicts are the results of perceptions

Melanie Klein

Disagreed with Freud and believed that primitive fantasies of loss and persecution

Harry Sullivan

Stressed the importance of interpersonal relationships in the formation of emotional problems

CBT

The therapist & client work together to identify the problems the client is facing to come up with strategies and solutions

CBT

Most popular and influential form of therapy of the last 50 years

CBT

• Not designed for lifelong participation

• Aims to help clients meet their goals in the near future

Cognitive Distortions

Also known as “logical errors” which is the result of clients misinterpretations of certain life situations

Aaron Beck

The first to practice CBT

Filtering

Cognitive distortion of Focusing on the negative and Ignoring the positive

Polarized Thinking

Cognitive distortion of all-or-nothing thinking wherein complexity is ignored

Control Fallacies

Cognitive distortion wherein one assumes only others to blame or assumes only self to blame

Fallacy of Fairness

Cognitive distortion wherein one assumes life should be fair

Overgeneralization

Cognitive distortion wherein one assumes a rule from one experience

Emotional Reasoning

Cognitive distortion wherein one thinks that “If I fell it, it must be true”

Fallacy of Change

Cognitive distortion wherein one expects others to change

“Shoulds”

Cognitive distortions whrein one holds tight to personal rules of behavior, plus judges self and others if rules broken

Catastrophizing

Cognitive distortion wherein one expects the worst-case scenario

Heaven’s Reward Fallacy

The cognitive distortion wherein one expects self-sacrifice to be rewarded

Always Being Right

The cognitive distortion wherein one thinks that being wrong is unacceptale or being right supersedes everything

Personalization

The cognitive distortion wherein one is always assuming self responsible

Jumping to Conclusion

The cognitive distortion wherein one has assumptions based on little evidence

Blaming

The cognitive distortion wherein one assumes everyone else is at fault

Global Labelling

The cognitive distortion wherein there is extreme generalization

Journalling

A way to gather one’s moods and thoughts which can help identify thought patterns and emotional tendencies, describe them, and change, adapt, or cope with them.

Unraveling Cognitive Distortions

a CBT technique wherein one become aware of the distortions

Cognitive Restructuring

a CBT Technique wherein how those distortions took root and why you came to believe them are explored, then challenged

Exposure and Response Prevention

CBT technique where exposing self to what elicits the compulsive behavior, but doing the best to refrain from behavior

Interoceptive Exposure

CBT tool that involves exposure to feared bodily sensations in order to elicit the response which help see that the symptoms of panic are not dangerous

Nightmre Exposure and Rescripting

CBT technique wherein nightmare is elicited, relevant emotions are brought up, desired emotion is identified, new image is developed

Play the Script Until the End

CBT technique which helps individuals with fear and anxiety by having them imagine the worst-case scenario. By mentally playing it out, they can realize that even the feared outcome is often manageable.

Progressive Muscle Relaxation

CBT technique that instructs you to relax one muscle group at a time until your whole body is in a state of relaxation

Relaxed Breathing

CBT technique that is bringing regularity and calm to your breath will allow you to approach your problems from a place of balance, facilitating more effective and rational decisions

Coping Styles Formulation Worksheet

CBT Worksheet wherein client lists the following:

• perceived problems,

• risk factors,
  triggers or events,

• coping strategies,

• effectiveness,

• advantages & disadvantages, and

• alternative actions.

ABC Functional Analysis

Helps the clients learn about self—what leads to specific behaviors and results from those behaviors

A: Antecedent,

B: Behaviors,

C: Consequences

Meaning of ABC in ABC Functional Analysis

Antecedent

Factors that led up to behavior

Behavior

Stands for B in ABC Functional Analysis which is usually potentially problematic

Consequences

Meaning of C in ABC Functional Analysis which is the result of the behavior

Case Formulation Worksheet

a CBT worksheet that contains the 4P’s