Flashcards in CM: Psychotherapy Deck (18):
What is psychotherapy?
treatments involving talking relationship between patient and therapist
use verbal and non-verbal communication to ameliorate distress and provoke change
What are indications for psychotherapy?
problems with love or work
coping with illness or loss
primary treatment for anxiety, dysthymia, PTSD, personality disorders, eating disorders, etc
adjunctive treatment for schizo and bipolar
combo w meds for depression and OCD
What are the advantages and disadvantages of psychotherapy?
advantages: extremely precise, less side effects
disadvantages: expensive, time consuming, emotionally draining and disturbing
What is the convergence of neurobiology and psychotherapy?
all psychological events have neurobiologic correlates - meds and psychotherapy both impact the same brain
meds decrease pain and allow therapy to occur, therapy makes one less reluctant to take meds
epigenetics can be mechanism for psychotherapy induced changes
What are common factors of psychotherapies?
aim to reverse pt's demoralization and shame, decrease alienation
atmosphere of safety and acceptance
sense of hope based on shared understanding - not alone w problem = therapeutic alliance
idea of therapist's expertise
What are important boundaries in psychotherapy?
regular meeting and location, clarity of roles and compensation
rationale - making it safe and non-exploitive
some variability depending on therapy type, but always present
What are directive vs. evocative psychotherapies?
directive - focus on symptoms, provide instructions to change them (Cognitive behavioral therapy)
evocative - aim to uncover underlying problems and foster growth (psychoanalytic psychotherapy)
What are the major types of psychotherapy?
psychoanalysis and psychoanalytic psychotherapy
cognitive behavioral therapy
family or couples therapy
What is cognitive behavioral therapy?
focus on observable symptoms and definable, measurable complaints
suited for manualization, easy to study
behavioral therapy techniques involve systematic desensitization, flooding, positive reinforcement, aversion therapy
What is systematic desensitization?
constructing hierarchy of anxiety
gradual desensitization of stimulus
What conditions have strong evidence for either cognitive or behavioral therapy?
cognitive - mild to moderate depression, social phobia
behavioral - simple phobias, OCD, panic disorder, social phobias
What are some common errors of thinking that cognitive therapy can address?
all or none thinking, discounting the positive, over generalization, over personalization
What are psychoanalysis and psychoanalytic psychotherapy?
psychoanalysis - 3-5x/wk, pt lying down
psychoanalytic psychotherapy - 1-2x/wk, sitting up, principles of psychoanalysis but also supportive
effective for complicated grief, adjustment problems, relationship conflicts, anxiety/panic, depression, trauma, personality disorders, etc
What are the core features of psychoanalytic treatments?
unstructured: free association and resistance (disconnects, get stuck around sensitive subjects)
unconscious meanings of thoughts and actions
influence of child dev and past trauma on present patterns
use of relationship w therapist - transference and countertransference
What is group psychotherapy?
range from evocative to directive to strictly supportive
crucial to inpatient psychiatric treatment
decreases isolation, provides validation, opportunities for altruism, multiple perspectives, feeling part of something bigger
What is family therapy?
usually a designated pt - individual symptoms are evidence of family pathology
focus on patterns across multiple generations
Bowen family systems theory - emotional triangles and excluding members
general systems model - focus on uncovering assigned roles (nurturer, scapegoat, rebel, victim, etc)
Why is psychotherapy prescribed?
brain is designed to be soothed by attachment and comforted by presence of another person