Session 5 Flashcards
(19 cards)
Communication: Give examples of good practice in communicating well with patients in situations where there may be barriers
See Groupwork
Describe the wide range of psychlogical therapies available and what are the different types?
- Methods/techniques derived from many different branches of psychology (experimental work on learning, remembering and thinking, developmental stages, motivation and skill acquisition)
- Give most weight to those founded, and evaluated, scientifically
Psychotherapeutic approaches:
Overwhelming number
Each approach may differ in concepts, research and use of language causing confusion – every psychotherapeutic approach carries its own lexicon
Various approaches themselves heterogeneous
Definitional framework for psychological therapies (Parry, 1996)
- Type A: psychological treatment as an integral part of mental health care e.g. what a community psychiatric nurse does (dishes out medication and spends time talking to patient), GP does a lot of this
- Type B: eclectic psychological therapy and counselling (drawn from lots of sources and theories)
- Type C: formal psychotherapies (structured by time e.g. appointment slots)
Explain more about Type C
Cognitive-behaviour therapy (CBT)
Psychoanalytic / psychodynamic therapies
Systemic and family therapy
Explain about psychoanalytic and psychodynamic therapies
Psychodynamic: (focal) id conflicts arising from early experience that are re-enacted in adult life
- Use the relationship with therapist to resolve these
- Tend to see patient weekly (more often) over a shorter period of months
Psychoanalytic – long term – allow unconscious conflicts to be re-enacted and interpreted in relationship with therapist
Psychoanalytic/psychodynamic therapies’ techniques:
- Aim to resolve the unconscious conflicts that underlie symptoms
- Therapy explores feelings, using experience of therapist and relationship (transference and counter-transference)
- Attempts to enhance insight of difficulties and help incorporate painful previous experiences
Psychoanalytic/ psychodynamic therapies are suitable for:
- Interpersonal difficulties and personality problems (overlap between problem and personality/character)
- Capacity to tolerate mental pain (having to thinking about previous memories, previous experiences)
- Interest in self-exploration (even finding out about things you’d rather not know)
Explain about systemic and family therapy
- Individuals, couples and/or families focus on relational context, address patterns of interaction and meaning
- Aim to facilitate resources within the system as a whole
Explain about Humanistic and Client-Centred Therapy
No universal definition
- Relies on general counselling skills (warmth, empathy, unconditional positive regard)
- Can help coping with immediate crises where there is already motivation and willingness to problem solve
Humanistic therapy is suitable for:
- Mild to moderate difficulties related to: life events (illness, loss); subclinical depression; mild anxiety / stress; marital/relationship difficulties
- Recent onset (< 1 year)
Which therapy do you choose?
- Where possible, refer to comprehensive treatment service with access to range of treatment types
- Referral dictated by BOTH problem (nature, chronicity, severity, complexity) & patient (‘psychological mindedness’, capacity to tolerate pain, preference for short/long term or focused/exploratory work)
What is the focus of CBT and the Cognitive Negative Triad?
Cognitive therapy rationale (focus of CBT):
- We are not passive recipients of stimuli
- We interpret the world via values, beliefs, expectations, attitudes
- We use such cognitions to make sense of the world
- Not situations that upset us (not the actual stimulus), but the view we take of them
- Changes of mood state are directly related to the way we make sense of events
Negative Cognitive Triad:
- Negative view of self
- Negative view of the world around
- Negative view of the future - feeds into hoplessness
Explain about schema and assumptions using examples
Core Belief (schema) =\> Basic Assumptions (conditional schemata) e.g. I am… =\> if…then…I should…or else… Core Beliefs (schemata)
- Love; I’m unlovable
- Ability; I’m incompetent
- Moral qualities; I’m evil
- Normality; I’m a freak
- General Worth; I’m worthless
Attitudes/assumptions/rules:
- I must be loved by everybody
- Either I am 100% successful or I am a total flop
- My value as a person depends on what others think of me
- I should always be a nice person
- If people disagree with me, it means I am no good
- I should be able to do everything: to ask for help is weak
What are common healing factors?
- An emotionally charged, confiding relationship with a helpful person
- A healing setting e.g. therapy room should feel safe
- A rationale or myth that explains symptoms and suggests a way forward
- A ritual or procedure requiring the active participation of the therapist and the patient
- Combating the patient’s sense of alienation (they’re not alone, they can be helped)
- Inspiring the patient’s expectation of help
- Providing new learning experiences
- Arousing emotions
- Enhancing a sense of mastery or self-efficacy
- Providing opportunities for practice
What is psychotherapy?
the systematic 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. THERAPY IS WORK
What is CBT?
CBT: pragmatic combination of concepts and techniques from CT (cognitive therapy) & BT (behavioural therapy – treats humans like a black box, putting them into a scenario to evoke and modify responses)
- Relieve symptoms by changing maladaptive thoughts, beliefs and behaviour
What are the Behavioural Therapy Techniques?
Graded exposure to feared situations
Activity scheduling (doing things helps break cycles of remuneration)
Reinforcement and reward
Role play/modelling
What are the Cognitive Therapy Techniques?
- Education (detailed explanation and discussion of cognitive model; what goes through your head during this situation? How do you respond?)
- Monitoring of thoughts, behaviours, feelings, contexts, to develop awareness of their inter-relationship
- Examining / challenging negative thoughts
- Behavioural experiments
- Cognitive rehearsal of coping with difficult situations (testing out hypotheses – is what happens really as catastrophic as you fear? Need for rapport between therapist and patient)
- Schema (core beliefs) work
Describe Beck’s Cognitive Model for Depression
- *Critical Incident e.g. failure, rejection, psychological trauma
- NATS: negative automatic thoughts
- Assumptions: rules/ideas that enable you to cope e.g. I need to please everyone in order to be loveable
What are the limitations of CBT?
- Findings of efficacy usually derived from homogeneous populations (extremely selective) with limited co-morbidity
- Delivered by expert practitioners (challenge for routine practice)
- Circumscribed benefits where problems complex and diffuse
Identify the mental health conditions that CBT is likely to be effective for
- Depression – particularly for milder depression, reduces risk of relapse, better than anti-depressants
- Anxiety states (phobias/OCD/GAD (Generalized Anxiety Disorder) / panic / PTSD / health anxiety - hypochondriac / BDD (body dysmorphic disorder). These orders can be extremely debilitating and also common
- Eating disorders – mainly effective for bulimia.
- Sexual dysfunction
- (Psychotic symptoms (delusions and hallucinations): as adjunctive treatment – not first line treatment, used as add on to anti-psychotic treatment)
What is the evidence of efficacy for Eating Disorders and Psychoses?
Evidence of efficacy: Eating Disorders
- Central dysfunctional statement ‘I must be thin’
- Yet anorexia resistant to cognitive behavioural approaches
- Clearer benefits for bulimia (50% patients reporting benefit), but specific cognitive mechanism unclear
Evidence of efficacy: Psychoses
- CBT premise to distract from symptoms and alter beliefs about abnormal perceptions
- Can be effective in reducing preoccupation with delusions and intensity of beliefs
- Less impact on negative symptoms (withdrawal, passivity)
- Increasingly deployed to facilitate family problem solving
Who is CBT suitable for?
- Patients keen to be active participants (may have to do daily homework, tasks in between weekly therapy sessions)
- Those who can engage collaboratively (keep diaries, complete homework tasks)
- Those who can accept a model emphasising thoughts/feelings
- Those who are able to articulate their problems and are practically seeking solutions rather than nebulous (hazy) wish to be happy (have specific goals they want to achieve
