This document discusses various types of psychotherapy including supportive psychotherapy, insight-oriented psychotherapy, behavioral therapies, cognitive therapies, and psychoeducation. Supportive psychotherapy aims to help patients cope with problems in the present through building rapport and considering problem solutions. Insight-oriented psychotherapy focuses on uncovering unconscious wishes and defenses that cause maladaptive behaviors. Behavioral therapies use techniques like relaxation training, graded exposure, and thought stopping to modify abnormal behaviors. Cognitive therapies identify and challenge maladaptive thinking patterns.
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
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4. Supportive psychotherapy
• Used for
• Adjustment disorders
• Acute emotional crisis
• When a long lasting “cure” is not expected but
improved functioning is hoped
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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
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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
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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
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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
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10. Formal psychological
treatments
• Problem solving treatment
• Behavioural and cognitive therapies
• Dynamic psychotherapy
• Group treatment
• Couple and family treatment
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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
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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
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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
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16. Behavioural therapy
• Used to treat symptoms & abnormal
behaviours
• That persist
• Because they cause distress to,
• Patient and others
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17. Commonly used techniques
• Distraction
• Relaxation training
• Graded exposure
• Response prevention
• Thought stopping
• Assertiveness training
• Self-control techniques
• Contingency management
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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
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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
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20. Relaxation training
• 1st session last for 30 minutes
• Subsequent sessions – 15 minutes
• After about 6 sessions- have a rapid
improvement
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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
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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
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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
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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
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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
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27. Self control techniques
• Used to increase control over behaviour
• Excessive eating or smoking
• Self monitoring
• Self reinforcement
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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
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30. 4 stages of cognitive therapy
• Devise more realistic alternatives
• Test out these alternatives
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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
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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
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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
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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
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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
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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
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