Transcript Psychotherapy - GEOCITIES.ws

Dr. Muhammad Najib Mohamad Alwi
Jabatan Psikiatri, PPSP
USM
http://clik.to/drnajib
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© Dr Najib Y2K2
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Talking Therapy?
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Terms that you’ve probably heard before:
Counseling
 “Talking Therapy”
 “Psychoanalysis”
 Supportive Therapy
 Psychotherapy
 Etc.
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Definition of Psychotherapy
Strupp (1978)
“ An Interpersonal process designed to bring
about modifications of feelings, cognitions,
attitudes and behaviour which have
proved troublesome to the person seeking
help from a trained professional ”
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Definition of Psychotherapy
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Other definitions:
The development of a trusting relationship,
which allows free communication and leads to
understanding, integration and acceptance of
self
 The treatment of emotional, behavioural or
personality problems by psychological means
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CHARACTERISTICS OF ALL
PSYCHOTHERAPIES
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Intense, emotionally charged, confiding r/ship with a
helping person
A rationale which contains an explanation of the patient’s
distress and of the methods for its release
Provision of new information about the nature and
origins of the problems and of ways of dealing with them
Hope in the patient that he can expect help from the
therapy
An opportunity for experiences of success during the
course of therapy and a consequent enhancement of the
sense of mastery
The facilitation of emotional arousal in the patient
(Jerome Frank, 1971)
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BROAD CHARACTERISTICS
OF PSYCHOTHERAPIES:
The presence of a therapist-patient
relationship
 The interpersonal context of the
psychotherapies
 Conducted according to a model that
guides the therapist’s actions
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Counseling and Psychotherapy
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Similarities:
Counseling under broad definition can also
be defined as psychotherapy
 Counseling uses some form of
psychological model e.g. Roger’s Client
Centred Therapy
 Both provide some form of support to the
patients
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Differences: Counseling vs
Psychotherapy
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Counseling
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Offers non-judgemental
support, encourages
clarification of current
problems & help clients
find solutions.
Usually short-term (1 – 3
sessions)
Counselors are often not
psychotherapeutically
trained and seldom
requires supervision
Often done at primary
care settings / schools
etc.
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Psychotherapy
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Psychotherapy is
supportive but may not
directly help to solve
problems.
Usually longer-term (12
sessions or more)
Needs to undergo special
training and supervision
Often conducted in
secondary or tertiary
centres only
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Psychotherapies
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Thus, broadly speaking, the broad definition of
psychotherapy can encompass a large number
of interventions
Kazdin (1986) identified > 400 different therapies
that can be classified as psychotherapy
Differing levels:
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Informal: between friends, relatives, self-help groups
Formal: supportive, dynamic, behavioural etc.
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THE PSYCHOTHERAPY MATRIX
Theory
Technique
Mode
Setting
Timing
Level
Psychoanalytic Interpretive Individual
General
practice
Very brief
Self-help
Behavioural
Directive
Outpatient
Brief
Cognitive
Expressive Couple
Day hospital
Systemic
Supportive
Inpatient
Humanistic
Paradoxical
Group
Family
Level 1:
Counselling
Level 2:
Time-limited
Non-specialist
Level 3:
Indefinite
Specialist
>1/week
weekly
< 1/week
Major Classes of
Psychotherapies
Psychodynamic Psychotherapy
 Behavioural and Cognitive-Behavioural
Psychotherapy
 Interpersonal Psychotherapy
 Supportive and experiential psychotherapies
 Group therapies
 Family therapies: Systemic / Strategic /
Structural
 Existential Psychotherapy etc…..
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Aims of Psychotherapy
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Psychodynamic Tx: to change habitual patterns
of thinking, feeling and behaviour which may
include specific symptoms
Behaviour Tx: to reduce symptoms by changing
specific behaviours
Cognitive Tx: to reduce symptoms by changing
thoughts which maintain specific symptoms
Interpersonal Tx: to help patient identify and find
solutions to current life problems
Family Tx: to see if and how the problem of the
identified patient is maintained by the needs of
the family
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Major Classes of
Psychotherapies
Psychodynamic Psychotherapy
 Behavioural and Cognitive-Behavioural
Psychotherapy
 Interpersonal Psychotherapy
 Supportive and experiential psychotherapies
 Group therapies
 Family therapies: Systemic / Strategic /
Structural
 Existential Psychotherapy etc…..
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What Is It?
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(Psycho-)Dynamic Psychotherapy:
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Is concerned with the way in which a person’s mental
representation of self and the world may lead to
inappropriate behaviour in present personal and working
relationships
This approach seeks a personal meaning for the patient’s
symptoms in terms of his or her past and present life
Aim:
–
To help the patient by increasing understanding of his
thoughts, feelings and behaviour
 Thus, it is sometimes called ‘exploratory’ or ‘insight
directed’ therapy
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Psychodynamic Psychotherapy
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Main classification:
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Long-term:
 Frequency:
>2 times per week
 Duration: 1-5 years (or more!)
 “psychoanalysis”
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“Brief”:
 Frequency:
usually 1/week
 Duration: around 3-9 months
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Psychodynamic Psychotherapy
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“Brief” Dynamic Psychotherapy
Usually up to 20 sessions
 Suitable for patients who has had adequate
psychological health and adjustment, and who
has a specific symptom or problem with a
definable onset.
 At least 8 different variants
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Who Needs It?
Dynamic Psychotherapy is demanding
on patient and not everyone can benefit
from it
 Diagnostic conditions where dynamic
psychotherapy may be sought:
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Depression
Anxiety disorder
Personality disorder
Eating disorder
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Suitability for
therapy:
Recognizes problem as psychological
Responsible for his own situation
Curiosity or psychological mindedness
Motivation to understand and change
attitudes and behaviour
 Flexible and has problem solving ability
 Capacity to relate to another person
 Good childhood interpersonal relationship
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What Happens In Therapy?
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Patient sits facing about 120o away from the
therapist
Setting of clear rules and boundaries
Average 50 minutes sessions
No set agenda
Patient talks on what comes through their
mind
Therapist would give comments /
interpretations when appropriate
Therapeutic alliance / free association /
ending
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Overview of Concepts
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Working alliance: agreement between patient
and therapist that they will work together on the
patient’s emotional or psychological problems
Transference: transferring of feelings which
belong to a relationship from the past into the
present relationship
Countertransference: feelings elicited in the
therapist by the patient’s behaviour and
communications.
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Triangle of Feeling
DEFENCE
ANXIETY
HIDDEN FEELING / IMPULSE
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Triangle of Person
Others (current, recent past)
O
O/T link
P
Parent / sibling
(distant past)
Transference
(here and now)
T
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References
Individual Psychotherapy and the Science
of Psychodynamics (2nd Edition). David H.
Malan. Butterworth Heinemann, 1999.
 Dynamic Psychotherapy Explained.
Patricia Hughes. Radcliffe Medical Press,
1999
 This presentation is available on my
website: clik.to/drnajib
 Come and see me!
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