Transcript Základy psychoterapie Osnova

Psychotherapy
MUDr. Jan Hanka
3.LF UK, PCP
2013
Psychotherapy
•
•
•
•
•
•
Definition
History
Basic principles of therapeutic work
Main branches of psychotherapy
Forms of psychotherapeutic care
Psychotherapy in treatment of specific
mental disorders
Psychotherapy
What is it?
Treatment mediated by psychological methods
Used to treat mental disorders, psychological
problems, relationship problems. In psychotherapy
Client’s emotions and behavior change in the
course of therapy. It should also contribute to
personal development.
Psychotherapy
Effective factors
•
support, restoration of morale, providing information,
providing a rationale
•
therapeutic relationship, listening, group dynamics
•
Advice and guidance, suggestion
• Confrontation with one’s problems, release of emotions
• Learning new ways to cope + social skills
Psychotherapy
History
• shamen, medicine men,
herbalists (magic, suggestion)
• religion (meditation, confession,
exorcism, moral therapy)
Psychotherapy
in medicine (the beginning)
• Hypnosis for Hysteria – Franz Mesmer in 1774`
• End of 19th century (Salpetriere hospital Paris - JM
Charcot, Hippolyte Bernheim in Nancy)
• Paul Dubois, Switzerland 1904 - rational discussion about
symptoms + persuasion (“The psychic treatment of nervous
disorders”)
• Freud (1900 Traumdeutung, 1904 Zur Psychopathologie des
Alltagslebens, 1905 Drei Abhandlungen zur Sexualtheorie,
1910 Über Psychoanalyse)
• 1910-1920: A Adler (individual pst), CG Jung (analytic
Basic princilpes of
psychotherapy
• Goal-oriented, planned (contract, method, number of
sessions, price)
• Expertise (training, supervision, specialization, continuous
education)
• Decision to carefully listen to each other
(therapeutic relationship)
• Empathy (therapist’s personality)
Various therapeutic approaches
•
•
•
•
•
•
•
Based on the methods used:
Psychoanalytical
Interpersonal
Sugestive
Racional
Empathic
Abreaction
Training based
Basic schools of psychotherapy
• Analytic schools (psychoanalysis, neoanalytic therapists…)
• Dynamic and interpersonal
• Humanistic (Rogerian, Gestalt,
logotherapy)
• Cognitive-behavioral therapy
Psychoanalysis
Sigmund Freud (1856- Příbor, +1939)
• Consciousness-unconsciousnesspreconsciousness (conflicts produce symptoms)
• Complex (Oidipos, Elektra)
• Drives: Eros / Thanatos
• Psychosexual development: oral phase (1st
y.), anal phase (2nd + 3rd y.), phallic phase (4th+
5th y.), latent phase, genital (since approx. 11th
y.)
• Transferrence - countertransferrence
• Free associations
• Ego-defensive mechanisms: denial,
projection, racionalization, passive
aggresion, conversion,
compensation, regression,
withdrawal (mature mechanisms:
humility, mindfulness, acceptance,
gratitude, altruism, tolerance, mercy,
forgiveness, anticipation, humour)
Psychoanalysis (cont.)
Carl Gustav JUNG
• Complex (unconscious set
of memories, thoughts,
experiences, emotionsaround one topic)
• Dealing with complexes:
ignorance, identification, projection,
confrontation
• introversion- extraversion
• Archetypes (Self, Shadow,
Anima, Animus, Mother, Child,
Hero..)
• Collective
unconsciousness
• Symbolic language of
dreams
Dynamic and interpersonal
psychotherapy
• Karen Horney (early childhood trauma: feeling
insignificant/helpless/threatened. Strategies of
compensation: striving for affection, power,
submissivness)
• Harry S. Sullivan (focus on relationships:
Everyday social encounters + therapeutic relationship)
• disorders originate in disturbed
relationships
• Dynamic group therapy (today)
Hypnosis
• State of increased
suggestbility + dependence
+ altered state of mind
• Franz Mesmer (1734-1815)
• Milton H. Erickson (1901-1980)
• Induction – hypnotic
phenomena – posthypnotic
suggestions
• Stage-fright, pain, smoking
cessation, psychosomatic
illness
Humanistic therapy
Gestalt therapy
•
•
•
•
Fritz (Frederick) Perls
Here and now princple
Relationsip „me and you“
Awareness of own’s
emotions
• Responsbility ofr own’s
thoughts, emotions,
actions (can’t = don’t want)
Humanistic therapy
Rogerian therapy (C Rogers, 1902-1987)
• Talking therap- is not
interpreted or guided
• Empathy,
congruence, reflexion
• Therapist as an
authentic person
• What I am x what I
want to be
• Unconditioned
acceptance by the
therapist
Transpersonal psychotherapy
- Stanislav Grof (*1931):
unusual experiences,
religious practice of
ingenuous tribes, altered
states of consciousness,
near death experiencei
- psychospiritual crisis
- LSD psychotherapy
- Holotropic breathwork
Cognitive - behavioral therapy
Hans Eysenck (pic.) J Wholpe, BF Skinner (skinner box)
• Scientific method
• Theory of learning,
conditioning (classical/operant)
• Desensibilisation (feared
stimulus is connected to
relaxation, humour..)
• Exposure (face the feared
stimulus with pevention of
avoidant/safety-seeking
behavior)
• Habituation (ignore a stimulus
which does not bring serious
consequences)
• Flooding
• Relaxation training
• Aversive therapy
Cognitive – behavioral tgerapy
Cognitive therapy
•
•
•
•
•
Aaron Beck (*1921)
BDI, BAI, BHS, BSS
Psychotherapy of depression
Automatic negative thoughts
Cognitive errors (exaggeration,
over-generalization, selective
abstraction, negative forecasting,
personalisation, labeling, mindreading, “musturbation”, all or
nothing)
Cognitive – behavioral tgerapy
Cognitive therapy
•
•
•
•
Albert Ellis
R-ET
A B C system
„we are not worried
by events, but by our
interpretations of
events”
Cognitive therapy
basic vocabulary
• Cognitive events- thoughts (rational x
automatis/intrusive)
• Cognitive processes- way of thinking
(possible cognitive errors)
• Cognitive schemas: core beliefs and
dysfunctional scripts
self / others / the world
power / acceptance / performance
Methods of CBT
• Biofeedback (headache/low back
pain,
hypertension,
training
of
controlled breathing and relaxation,
ADHD theta:beta, incontinentia)
-feedback on physiological functions
(EEG, HRV,..) used in learning
how to control them by our will
• Assertivness training
1. express feelings openly
2. engagae in conversation
3. speek in front of others
4. ask a favor
5. Refuse to yield to presure
Anger management
Psychotherapy- forms
• Individual (1:1) x Couple x Family x Group x
Therapeutic community
• Counseling (in schools, in media / online,
specialized counselors)
• Crisis intervention (loss, change, conflict,
trauma)
Group psychotherapy
•
•
•
•
•
•
•
Since WW II., started in England (1940)
Currently most prevalent form
Groups closed x open
Dynamic schools of psychotherapy
Group analyis
Group CBT
Self-help groups (AA)
Therapeutic factors in group
therapy
•
•
•
•
•
•
•
Group cohesion
Socialization
Altruism
Imitation
Interpersonal learning
Recapitulation of the family group
Feedback, confrontation
Criteria of psychological health
(Ellis, Dryden, 1987)
•
•
•
•
•
•
•
•
•
•
•
•
•
Self-interest
Social interest
Self-direction
High frustration tolerance
Flexibility
Acceptance of uncertainty
Commitment to creative pursuits
Scientific thinking
Self-acceptance
Risk-taking
Long-ange hedonism
Non-utopianism
Self-responsibility for own emotional disturbance
Psychotherapy in treatment of
specific mental disorders
Example: Agoraphobia with panic disorder (CBT approach)
(Psychiatric examination) + Self-monitoring
Setting the rules for therapy
Formulation of the problem
Setting goals
Behavioral assessment (ABC, vicious circle of anxiety)
Functional assessment (consequences, secondary gains, maintaining factors)
Education
Relaxation trainin
Interoceptive exposure (to a panic attack)
Gradual exposure to agoraphobic situations (restricting safety-seeking
behaviour: “crutches”)
Schematherapy
Relationship poblems solving
Long-term goals
Discussion
[email protected]