Psychotherapy Flashcards
Define psychotherapy?
The systematic (i.e. built around a system/framework) use of a relationship between a patient and a therapist (as opposed to physical and social methods) to produce changes in feelings, cognition and behaviour
What specialist psychological therapies are offered on the NHS?
- CBT
- Psychodynamic therapy (rarely, mostly private)
- Systemic and family therapy (views mental health as coming from a group/system) -includes couples therapy.
Outline Freud’s topographical model?
The psyche is made up of 3 parts:
- The Conscious- containing our immediately visible thoughts and perceptions
- The Preconscious-containing the facets of our mind which are not at the forefront but are retrievable e.g. Memories and stored knowledge
- The Unconscious- parts of our psyche which are not obviously apparent or directly retrievable, and yet can influence our thoughts, perception and behaviour. Includes fears, irrational wishes, sexual desires, selfish needs etc…
The goal of Freud’s psychotherapy is to bring forth unconscious conflicts and urges so they may be confronted and resolved.
Describe the 3 aspects of Freud’s model of personality?
The ID: Animalistic, impulse driven urges e.g. for sex, food, violence.
The Ego: Rational part of the brain, works on reality principles
Super-Ego: Works on the morality principle.
According to Freud, how does the Ego protect itself from unpleasant thoughts?
- Repression
- Denial
- Projection
- Displacement
- Regression (acting child-like when facing stress)
- Sublimation (satisfying an impulse, but in a socially acceptable way)
Outline Bowlby’s two principle theories of attachment?
The Internal Working Model:
The first relationship provides the infant with an attachment template from which they will go on to model all future attachments.
The Continuity Hypothesis:
The attachment behaviours developed in the internal working model continue to follow the same template in the future
IMN describes internalised beliefs, CH describes how those internalised beliefs influence behaviour.
What does the research evidence suggest about Bowlby’s theories suggest?
Pros:
- Attachment, identity and emotions are increasingly seen as interlinked
- All are adversely affected by childhood abuse and neglect
Cons:
- Broad theory, in no way universal
What is ‘transference’ in the context of psytchotherapy?
The unconscious transfer/projection of feelings and attitudes from the past into the therapist.
E.g. when someone gets irritated or anxious with their therapist when discussing a difficult topic, transferring emotions they feel about the past onto the therapist.
N.B: Counter-transference is the feelings the therapist has in relation to his interactions with his patient.
How does psychodynamic psychotherapy understand mental illness?
The presenting problem is understood in the light of past experience (e.g. childhood trauma or deficiency) and the dynamics of the internal world (hence- psychodynamic).
For what is psychodynamic therapy used?
- Recurrent and Chronic inter-personal (i.e. relationship) difficulties
- Can be helpful in the management of personality disorders, depression, eating disorders, and some presentations of anxiety disorders.
Generally less useful than CBT, and with a weaker evidence base.
How does exposure therapy work?
- Expose person to thing that causes anxiety
- Make them not run away, stay with it
- With continued repetition of this process, eventually get to the point where initial anxiety is more manageable, and it goes away faster.
- ‘Extinguish learned coping mechanisms’
When can CBT be used?
- Depression (mild, non-psychotic)- both uni and bipolar
- most Anxiety disorders (phobias, OCD, GAD, panic, PTSD, health anxiety, BDD)
- Eating Disorder (especially bulimia)
- Sexual Dysfunction
- Some evidence for Sz and psychosis
- Insomnia
Emerging evidence for:
- Chronic Fatigue Syndrome
- IBS
- Fibromyalgia
- Chronic pain
Describe family therapy and when is it typically used?
- Therapy that aims to focus on the relational context, address patterns of interaction and meaning
- Aims to facilitate resources within the system as a whole
- Useful in couples and families
- Generally used in cases of child behavioural issues, eating disorders and depression however evidence suggests it is also highly effective in adults (especially with Sz)
Describe CBT?
- CBT is a psycho-social intervention which focuses on challenging and changing unhelpful cognitive distortions and behaviours
- Improving emotional regulation, and the development of personal coping strategies that target solving current problems
- Works on the idea that mentally unwell people fall into patterns of emotional states and reactionary behaviours which are unhelpful.
What are the main targets of CBT?
1) Cognitions. People with depression and anxiety exhibit certain patterns of thinking which are unhelpful and propagate their symptoms. Including:
- Overgeneralisation
- Personalisation
- All or Nothing Thinking
- Magnification and Minimisation (overemphasising the bad and underemphasising the good)…
CBT aims to address and correct these e.g. through challenging and testing them.
2) Behaviours. People with D/A tend to respond to their Cognitions with maladaptive Behaviours, including Compensatory Behaviours and Avoiding them all together. CBT aims to use exposure/response as well as other techniques to get the patient to recognise and hence avoid these behaviour types.
There is also an emphasis on:
- Altered Physical Symptoms
- Altered Emotional States
