2. TYPES Mental Health Services Psychodynamic therapies Cognitive-behavioural therapies Humanistic, group and family therapies Biological treatments
3. Mental Health Services Multidisciplinary teams- more prevalent with the move away from institutionalised care and towards community-based services- Usually in community health facilities, grouping professionals from a range of specialties. E.g. Nurse + Psychiatrist + Social Worker + Clinical Psychologist = Team! Clinical Psychologists- much of the practice takes place in hospital/mental health facility- much of the work involves assessing the conditions and development of intervention strategies
5. Psychodynamic therapies Two key principles: role of insight and therapist-patient relationship. Insight – understanding of one’s own psychological processes- symptoms result from: maladaptive ways of viewing the self and relationships, unconscious conflicts, maladaptive ways of dealing with unpleasant emotions. Therapist-patient- patient must feel comfortable with the therapist (therapeutic alliance).- empathy more therapeutic than criticism
6. Psychodynamic techniques Free association:- therapist instructs the patient to say whatever comes to mind and censor nothing.- patient and therapist collaborate to solve the mystery of the symptoms Interpretation:- central element in psychodynamic technique is interpretation of conflicts, defences, etc. Analysis of transference:- transference refers to the process whereby people experience similar thoughts, feelings, fears, wishes and conflicts in new relationships as they did in past relationships.
7. Varieties of Psychodynamic Therapy Psychoanalysis – patient lies on the couch and the analyst sits behind. Patients usually undergo psychoanalysis three to five times a week for several years. Psychodynamic psychotherapy – face-to-face, more conversational, more goal directed due to limited time. One to three times a week.
8. Cognitive-behavioural therapies Basic principles: focus on the individual’s present behaviour and cognitions. Much more directive – assigning homework to change their thinking and behaviour. Starts with behavioural analysis – examining the stimuli or thoughts associated with a symptom. They then tailor procedures to address the issues. Classical conditioning techniques: - systematic desensitisation (used to treat anxiety-related disorders)- exposure techniques (response prevention is key)
9. Cognitive-behavioural therapies Operant conditioning – use of reinforcement and punishments. Participatory modeling – therapist models the behaviour and encourages the patient to participate in it. Skills training – therapist teaches behaviours necessary to accomplish goals, as in social skills or assertiveness training. Requires conscious awareness and practise until it becomes a routine.
10. Cognitive therapy Targets automatic thoughts, the things individuals spontaneously say to themselves and their assumptions. E.g. Ellis - REBT
11. Ellis’s Rational-Emotive Behaviour Therapy According to Ellis, what people think and say to themselves about a situation affects the way they respond. Proposed ABC theory of psychopathology. A = activating conditions; B = belief systems; C = emotional consequences REBT – focus on maximising their rational and minimising their irrational thinking.
12. Humanistic, group and family therapies Focus on the way each person consciously experiences the self, relationships and the world. Aim is to get in touch with their feelings, their ‘true selves’ and with a sense of meaning in life. E.g. Gestalt therapy and Client-centred therapy
13. Gestalt therapy Emphasises awareness of feelings. Developed in response to the belief that people had become too socialised – that thoughts, behaviours and feelings were controlled by social expectations. Focuses on ‘here and now’ rather than ‘then and there’ – avoids explanations of current difficulties as it leads people away from their emotions, not toward them. Common technique – empty-chair technique
14. Empty Chair Technique Therapist places an empty chair near the client and asks him/her to imagine that the person to whom he/she would like to express his feelings is in the chair. Theclient can then safely express their feelings by ‘talking’ with the person without consequences.
15. Group Therapies Multiple people meet together to work towards therapeutic goals. Typically 5-10 meet with a therapist on a regular basis, usually once a week for two hours. Benefits: presence of others who have made progress instills hope and discovers others with similar problems may relieve shame, anxiety and guilt. Variation: self-help groups- often has more people and is not guided by a professional.
16. Family Therapies Aim: to change maladaptive family interaction patterns. Focus is often on process as well as content – i.e transference reactions, sibling-like competitive relationship, accusations, etc is just as important as what the patient says. Therapist is relatively active and often assigns family tasks between sessions.
17. Biological Treatments Uses medication to restore the brain to as normal functioning as possible (pharmacotherapy). If medications are ineffective, clinicians may use electroconvulsive therapies (ECT) or in extreme cases, psychosurgery.
19. ECT and Psychosurgery ECT is currently used as a last resort in the treatment of severe depression (e.g. delusional depressions, with psychotic features). Psychosurgery is now primarily used for severe cases of obsessive-compulsive disorder.
20. Psychotherapy Integration The use of theory or technique from multiple therapeutic perspectives. Can be: Eclectic Psychotherapy Integrative Psychotherapy
21. Eclectic Psychotherapy Combination of techniques from different approaches to fit a particular case. E.g. Intensive, comprehensive treatment for schizophrenia combined education about the disorder, medication, weekly group therapy, family therapy and close monitoring of symptoms.
22. Integrative Psychotherapy Developing an approach based on theories that cut across theoretical lines. Difficult in practice – how to integrate theories of unconscious conflict with conditioning or cognitive distortions? E.g. A recovering anorexic finds weigh ins embarrassing. Her therapist agrees that if she maintains her weight for several weeks, he would stop asking to see her weight unless she obviously appeared to be losing again – behavioural (-ve reinforcement) + psychodynamic (anger at feeling controlled).
Notas do Editor
Multidiscinplinary teams are commonly used.Clinical Psychologists – Psychology can be thought of as both a field of study (the way the human mind works) and a profession (the application of the scientific principles underlying psychology). Clinical psychology is from the applied side of that scale. Can be defined as the branch of the profession associated with delivering psychological services in a health care setting.
Insight – therapeutic change requires that patients come to understand the internal workings of their mind and become “the captain of my own ship”.Means acquiring capacity to make conscious, rational choices as an adult about behaviour patterns, wises, fears and ways of regulating emotions that may have been forged in childhood.Psychodynamic clinicians often speak of ‘emotional insight’, stressing that knowing intellectually about one’s problems is not the same as really confronting intense feelings and fears.
Free association – no censoring – then patient and therapist collaborate to solve the mystery of the symptom, piecing together in what was both said and not said. (i.e. what the patient may be defending against).Interpretation – one patient repeatedly had affairs with married men. Associations led to her parent’s divorce. At one point, her mother refused to allow her to see her father, so the patient arranged secret meetings with him. The therapist wondered if the rage she felt toward her mother was not directed towards the wives of the men.Analysis of transference – e.g. one patient experienced his father as extremely critical and impossible to please. In therapy, the patient tended to interpret even neutral comments from the therapist as severe criticism and would then respond by doing things that would elicit criticism an hostility.
Systematic desensitisation – patient gradually confronts a phobic stimulus mentally while in a state that inhibits anxiety. E.g. a person who fears driving is taught relaxation techniques such as tensing and then relaxing muscle groups or breathing from the diaphragm. Then the therapist asks the patient to inmagine sitting behind the wheel of a non-moving car driving along an empty quiet street on a sunny day driving slong a busy street -- > driving on the same street at night Driving on busy highway in the rain driving on busy highway in rain at night.Exposure techniques – shows patients actual phobic stimulus.e.g. fear of flying affects 10-25% of population and can be treated with 90% success with either exposure or virtual exposure.In flooding, the patient confronts the phobic stimulus all at once – e.g. a woman who feared escalators rode the escalators in a large department store for hours until the symptom subsided.Graded exposure – like systematic desensitasation but with exposure.
Watching the therapist handle the phobic stimulus allows the patient to recognise that doing the phobia is safe (vicarious conditioning). It also alters self-efficacy expectancies.Skills training – Skills are a form of procedural knowledge and are typically carried out automatically.
The thereapist continually brings the patient’s illogical or self-defeating thoughts to the patient’s attention, showing them how they are causing problems, demonstrating their illogic and teaches alternative ways of thinking.
Empty chair technique – therapist places an empty chair near the client and asks him/her to imagine that the person to whom he/she would like to express his/her feeling (such as a dead parent) is in the chair. The client can then safely express his feelings by ‘talking’ with the person without consequences. A variant of this technique is the two-chair technique, in which the patient places two sides of a dilemma in two different chairs and expresses each side while sitting in the appropriate chair.
Self help groups: often has many more than the 5-10 participants in the therapist guided groups. Tends to flourish when a disease or disorder is stigmatising. One of the oldest and best known is AA, Weight Watchers, Gamblers Anonymous and groups for cancer patients or parents who have lost a child.
