Treatment for Mental Disorder and Doctor Patient Relationship

Categories of psychotherapy

Psychodynamic and CBT

What is pscyhodynamic

Unstructured open ended dialogue focused on the Pt unconscious thoughts

What is CBT

Structured, focused talking with therapist controlling the interaction

In clinical practice how is psychodynamic different to CBT

CBT → Offers advice, therapist is the teacher

Psychodynamic → Neutral stance, no advice or help is offered

How is the psychotherapeutic relationship special

The interaction is confidential (unless law is broken), disclosure of material does not disrupt the bond (the Pt is able to admit things without the relationship terminating)

What is therapeutic alliance

Doctor patient contract that may be complicated by covert agenda = Pt unconscious and unspoken wish

Patient expectation

Doctor is competent, will do suitable examination and investigation, prescribe relevant treatment

Doctor expectation

Pt will generally do their best to comply with treatment

What happens when a mental boundary is broken or does not exist

Your own mental representation of self and object is projected onto others unconsciously

What is transference

Projection of feeling and attitude from the past onto a present situation unconscioiusly

How does a patient show transference

Enacted by the Pt showing inappropriate feelings that may dominate and impede work

How to deal with transference

Acknowledge and apologise, if needed explore why it is difficult for the patient

What factors increase transference

Vulnerable personality, anxiety about psychological safety, frequent contact with the same people

How to manage transference

Be reliable, set boundary, interpret and manage the unconscious feelings

What is countertransference

When the doctor acts out due to the Pt transference projection

How prevent counter transference

Reflect on the attitude to prevent a reaction