Psychotherapy

1. Psychotherapy K. Kavindya M. Fernando JMJ 1

2. Psychotherapy • Individual psychotherapy • Supportive psychotherapy • Insight oriented psychotherapy • Behavioural modification • Systematic desensitization • Substitution • Hypnosis • Cognitive therapies • Social therapies JMJ 2

3. Supportive psychotherapy • Form a close alliance with the patient • Help pt to define current problem • Consider and implement possible problem solutions • “shore up” the current patient’s ego defenses JMJ 3

4. Supportive psychotherapy • Used for • Adjustment disorders • Acute emotional crisis • When a long lasting “cure” is not expected but improved functioning is hoped JMJ 4

5. Insight – oriented psychotherapy • Form an alliance with the patient • Recognize transference/countertransference feelings • Uncover unconscious wishes and defenses, • That have cause the patient to become maladaptive JMJ 5

6. Psychotherapy – Oxford text book JMJ 6

7. Psychoeducation • Education of patients (and their carers), • About their illness. • It is usual to inform the patient of • Name & nature of their illness • Likely cause of the illness, in their particular case • What health services can do to help them • What they can do to help themselves JMJ 7

8. Terminology • Transference • An intense relationship, between the patient and the doctor • Fraud’s theory • Patient transfers to the doctors feelings and thoughts that • originated in a close relationship during childhood • Positive transference – positive current feelings • Negative transference – negative current feelings JMJ 8

9. Terminology • Countertransference • Therapist develop strong positive or negative feelings • Because a particular patient reminds them, • Consciously or unconsciously, • Of a parent or another close figure in their life • May impair doctor-patient relationship JMJ 9

10. Formal psychological treatments • Problem solving treatment • Behavioural and cognitive therapies • Dynamic psychotherapy • Group treatment • Couple and family treatment JMJ 10

11. Problem solving treatment JMJ 11

12. Problem solving approach • Useful for patients with (main tx) • Adjustment disorders • Acute reaction to stress • Depression • Deliberate self harm • Help the patient to solve stressful problems, • To make changes in their lives JMJ 12

13. Used for problems requiring • A decision • (whether a pregnancy is to be terminated, or an unhappy marriage brought to an end) • Adjustment • New circumstances in life- diagnose to have a terminal illness • Change JMJ 13

14. Basic problem solving techniques • Define and list current problems • Choose a problem • List alternative solutions for this problem • Evaluate the alternative solutions & choose the best • Try to chosen course of action • Evaluate the results • Repeat until all the important problems have been resolved JMJ 14

15. Behavioural and Cognitive treatments Behavioural therapy JMJ 15

16. Behavioural therapy • Used to treat symptoms & abnormal behaviours • That persist • Because they cause distress to, • Patient and others JMJ 16

17. Commonly used techniques • Distraction • Relaxation training • Graded exposure • Response prevention • Thought stopping • Assertiveness training • Self-control techniques • Contingency management JMJ 17

18. Distraction • This can reduce the impact of, • Worrying thoughts & pre-occupations • Encourage the patient to focus attention on some external object, • Or mathematics (which needs full attention) • Cooking, cleaning or with friends will also distract the patient JMJ 18

19. Relaxation training • Used to reduce anxiety, • By lowering muscle tone & automatic arousal • Not effective to use alone • Essential procedures • Relaxing muscle groups one by one • Breathing slowly as in sleep • Clearing the mind of worrying thoughts by concentrating on a calming image JMJ 19

20. Relaxation training • 1st session last for 30 minutes • Subsequent sessions – 15 minutes • After about 6 sessions- have a rapid improvement JMJ 20

21. Graded exposure • Used mainly for phobic disorders • Usually achieved in real life(in vivo), • Can used in the patient’s imagination (in imagino) • Graded exposure = desensitization • Flooding – enter patient rapidly in to feared situations JMJ 21

22. Graded exposure 1. Determine in detail which situations are avoided 1. Rate them 2. Arrange these situations in order of the amount of anxiety that each provide 1. Hierarchy 2. No anxiety = 0/10 3. Treat relaxation training JMJ 22

23. Graded exposure 4. Persuade the patient to enter a situation at the bottom of the hierarchy 4. Monitor the anxiety regularly 5. Stay until anxiety is gone 6. Score = 0/10 5. Repeat with the next situation up in the hierarchy JMJ 23

24. Response prevention • Used for treat obsessional rituals JMJ 24

25. Thought stopping • Used to treat obsessional thoughts , • Occurring without obsessional rituals • A sudden, intrusive stimulus is used to interrupt thoughts • An mildly painful effect of snapping an elastic band worn around the wrist • Helping patient with distracting stimulus JMJ 25

26. Assertiveness training • Used in who are abnormally shy or socially awkward • Steps • Analyze the problem • Change roles to help patient understand the viewpoint of the other person in the situation • Demonstrate appropriate social behaviour • Practice within the session • Practice at social situations • Record the outcome JMJ 26

27. Self control techniques • Used to increase control over behaviour • Excessive eating or smoking • Self monitoring • Self reinforcement JMJ 27

28. Behavioural and Cognitive treatments Cognitive therapy Cognitive behavioural therapy JMJ 28

29. 4 stages of cognitive therapy • Identify maladaptive thinking • Asking pt to keep daily record of the thoughts • This record is know as – dysfunctional thought record • Challenge the maladaptive thinking • By correcting misunderstanding with accurate information, • & pointing out illogical ways of reasoning JMJ 29

30. 4 stages of cognitive therapy • Devise more realistic alternatives • Test out these alternatives JMJ 30

31. Cognitive Behavior Therapy • Therapist helps patients 1st to become aware of, • And then to modify, their maladaptive thinking & behaviour • Treatment is collaborative – pt is treated as active and expert partner in care • Patient will be given homework JMJ 31

32. Cognitive Behavior Therapy • Written instructions are used to instruct the patients • Record symptoms in a diary or dysfunctional thought record • Treatment takes from a graded series of tasks • Tasks and activities are presented as experiments • Behavioural experiments JMJ 32

33. CBT for anxiety management • Assessment of the problem • Relaxation • Techniques for changing anxiety-provoking cognitions • Exposure • Anxiety management • Time limited, focused intervention • Delivered within a stepped care model JMJ 33

34. CBT for panic disorder • Assessment of the problem • Relaxation • Techniques for changing anxiety-provoking cognitions • Exposure • In addition to above 4 steps --. 4 additional steps JMJ 34

35. CBT for panic disorder • In addition to above 4 steps --. 4 additional steps • The therapist explains – physical symptoms are part of normal response • Patient record – fearful thoughts that precede and accompany the panic attacks • Therapist demonstrates • Patient attempt to think in the new way JMJ 35

36. CBT for depressive disorder • Eliminate intrusive thoughts by distraction • Logical errors • Help to recognize those errors and make them correct (more realistic thoughts) • Maladaptive assumptions • Activity scheduling is another method JMJ 36

Psychotherapy

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