Transcript Introduction to psychodynamic concepts

Assessing for Adult
Psychological Therapy
What suits whom ?
Howard Edmunds
[email protected]
Friday 23rd November 2012
Introductions
Name
Mode/ type of therapy you practice ?
BTC Therapies
• Counselling: Psychodynamic, Integrative,
Humanistic: J.S, K.W., P.S.,
• Individual Psychotherapy: Psychoanalytic
(E.C. D.O. H.E.) , Integrative (),
Psychosynthesis (C.B.), Humanistic (),
Gestalt ().
• Mindfulness Based Cognitive Therapy:
John Mitchell.
Step 4. / Secondary Care Psychological Therapies
Brighton Therapy Centre
• Group Cognitive Behavioural Therapy:
•
•
•
•
Mind Over Mood. ().
Individual C.B.T 12weeks- 1 yr: (Laura
Findlay, Jacquie Patterson, Sarah Arnold,
Maz Low)
Cognitive Analytic Therapy 6 months:
vacancy to be filled.
Eating Disorders pathway; individual and
‘pre therapy’ group: Laura Findlay.
S.T.E.P.P.S.: Lisa Davies.
• Art Psychotherapy: Michele Humphrey,
•
•
•
•
•
•
Nick May, Duncan Wardlaw
Psychodrama 2 yrs. Mel Bates
E.M.D.R. Michele Humphrey.
Systemic Family Therapy : Mike Lloyd.
Depression and Mood Swings Group. (
mentalization/ CBT/ Psychodynamic ). Jo
Laurens 30 months
Group Analytic Psychotherapy Howard
Edmunds
Individual Psycho-analytic Psychotherapy
E.C., D.O., D.M.,
Exclusion criteria for BTC
in midst of acute crisis – crisis support team /
acute admission/ C.P.N. ( Tier 4).
organic brain syndromes that affect ability to
communicate – medical treatments e.g. Donald
Wilson Unit St Richards.
significant risk to others – forensic services.(
Appendix 1)
actively using non-prescribed drugs to numb
feelings or manipulate thinking- drug rehab.
services.
Counselling: Psychodynamic, Integrative,
Humanistic: J.S, K.W., P.S.,
Psychotherapy: Analytic
Indicated for personality problems in several areas of life e.g.
work, family, self image. ‘ complex comorbidities that may be
present along with depression’ Nice Guidelines.
Long term – 1 year.
Broader goals; tackles underlying causes & gaps in emotional
development
Psychodynamic – drives and defences - uses past experiences
and their impact on present relationships.
Transference - refers to relationship with therapist & how
patient’s past can distort their perceptions in the present.
Focus on internal conflicts as well as strengths.
Patient must have some support / coping strategies for managing
distress in addition to therapy.
Psychotherapy: Integrative
Mindfulness Based Cognitive
Therapy: John Mitchell.
C.B.T. Anxiety & Depression Group
Disorders; affective, anxiety, personality.
10 week programme for patients with low self-esteem /
depression.
Focus: negative thoughts, assumptions & schemas/core
beliefs and how these affect mood and maintain
dysfunctional behavioural patterns. Emphasis on
understanding of the development of these but focus on
here and now.
Psycho-educational model with focus on developing
skills to make the difference in quality of life e.g. Self
awareness, capturing and reappraising negative
thoughts, alternatively letting go, behavioural activation,
aspects of mindfulness, recognition of strengths and
positive qualities. Practice through ‘homework’
Group benefits : “ Phew, I’m not the only one !”, peer
support, practice, learning from others.
C.B.T. Obsessive Compulsive
Disorders Group
Client who are able and willing to explore and talk in a
group about their OCD.
12 weeks therapy using specific OCD Model.
Focus: building own Exposure and Response Prevention
programme, plus distress tolerance.
Experiential model with focus on exploration of intrusive
unwanted thoughts and the consequences of these,
sharing experiences and supporting group members
through group experiments/ exposure.
Often based on a meta-cognitive and schema approach
to the maintenance of OCD.
Group benefits: reduce isolation; peer support.
Shame and Compassion Group
10 week closed group for those who have
experienced childhood sexual abuse.
Focus on acceptance, validation, safety,
trust, power, and esteem.
Exploration of the connection between
cognition, development of beliefs, emotion
and attachment.
Group benefits: ‘Having a voice’ peer
support and acceptance.
Eating Disorders
Anorexia nervosa
Bulimia
Individual C.B.T.
Can’t access group; low level ego strength, logistics.
N.I.C.E. ( 2002) guidelines; 100% of individuals with
schizophrenia who are experiencing persistent
psychotic symptoms should be offered CBT”.
Disorders: affective disorders, anxiety disorders,
personality disorders.
Usually short term – 12-24 weeks.
Focus on negative thoughts, assumptions &
schemas/core beliefs and how these affect mood.
Educational model with focus on skills eg. Self
awareness, reality testing, self help, changing thoughts.
Does not focus on transference; aims at positive
therapeutic alliance with client.
S.T.E.P.P.S.
Systems Training for Emotional Predictability and
Problem Solving.
Patients with personality disorders; ‘emotional intensity
disorder’; patients who lack internal ability to regulate
emotional intensity.
Developed in Iowa, 1995 Blum, St John & Pfohl ( 2002).
Stage 1. 20 week basic skills group, plus individual ‘
reinforcement’ sessions to support application of skills to
everyday life.
Stage 2. 1 year fortnightly group. ‘Stairways’.
Cognitive Behavioural Skills approach; emotion and
behaviour management skills.
Model; CBT, psychodynamic, systemic, attachment,
educational.
Skills: Self Awareness, emotional management &
behaviour management.
E.M.D.R. 'Eye Movement Desensitisation
and Reprocessing'.
Developed by Dr Francine Shapiro, in the 1980s (in Palo
Alto, USA).
Length: 12 – 25 weeks individual sessions. (up to a year
for complex cases) Patients who have experienced
trauma eg. war related, road traffic accidents, natural
disaster, workplace accidents, surgical trauma, assault.
Can also be used for childhood sexual and/or physical
abuse or neglect.
Focus on relief of PTSD symptoms by recounting
memory of trauma and ‘re-processing’ this. Eg flashbacks, changed core beliefs, hypervigilance.
EMDR
Model. Adaptive Information Processing. Sees brain as
processing information but where it can’t needs help.
Eg. Flash backs as unprocessed information which
subside during treatment.
Approach: Involves discussion of the salient aspects of
the trauma from which target images and cognitions are
generated. Therapist initiates Bilateral Stimulation (hand
movements, tones, taps or buzzers) to facilitate
processing and uses verbal/cognitive prompts where
necessary. Others aspects of the trauma(s) are also
processed e.g., physiological experience of trauma.
Cognitive Analytic Therapy
Time limited, focussed, integrative therapy. Forged
within the crucible of the British NHS (Tony Ryle).
16 sessions – ‘neurotic’ problems such as depression,
anxiety, eating disorder, bereavement.
24 sessions - personality disorders of all types,
developing reputation particularly for BPD.
Patient derived focus of ‘target problems’.
Collaborative therapy centered around a shared
‘reformulation letter’ describing ‘target problem
procedures’ inc ‘reciprocal roles’, ‘snags’ ‘traps’ and
‘dilemmas’. Diagrammatic formulation also.
Psychodynamic i.e. refers to past experiences and
works with transference relationship.
Behaviour Therapy.
Indicated for specific behavioural problems.
Medium term – 12 weeks to 1 year.
Agree specific behaviours to target.
Educational model – looks at chain analysis of
behaviours, thoughts and feelings leading to
problem behaviour. Teaches coping strategies.
O.C.D. – Springfield Hospital.
Eating Disorders – Maudsley Eating Disorders
Unit.
Systemic Family Therapy.
Family relationship problems.
Short/ medium term, with few weeks between
meetings.
One or two therapists work with family,
supported by consultation team observing via
one way mirror.
Focus on family as a system. Encourages
verbalisation, awareness of relationship
patterns, roles, paradoxical intervention (as
family unites to defeat therapists).
Drama Therapy
Psychodrama is a method of group psychotherapy.
Indicators: Relationship problems/ personality problems.
Helpful for those who can’t find words, are to vocal, use metaphors
or very visual in their communications.
Participants are encouraged to explore their problems and life
experiences in action. Group members play auxiliary roles.
Broad goals – tackles underlying causes & gaps in emotional
development.
Focus: early life and significant events and how these impact on
current relationships.
Ego training in action; highlights patterns of relating that emerge in
the drama & offers a chance to try out new ways of relating. – Role
Training
Patients require some support and coping strategies.
Time Limited – 2 years
Art Psychotherapy
“ Through the arts we can express and fulfill ourselves, and engage
with other people in ways that other forms of communication do not
offer.”
‘(Andy Burnham and David Lammy MPs Foreword to ‘A Prospectus for
Arts and Health’ Arts Council and
Department of Health 2007)
Art Psychotherapy’s aim is to offer to patients a way to express their
thoughts, feelings and experiences that does not rely solely on
verbal communication. This can be of benefit to those who find
expressing themselves verbally difficult or who use language as a
defence. Sessions are offered individually or in group.
Referrals are accepted for patients who are part of the CMHT or inpatients who it is felt would benefit from time using an arts medium
within the structure of a therapeutic relationship.
Patients need to have a desire to explore the issues that have
brought them into the service and feel able to cope with the space
between sessions as well as the process within.
Group Analytic Psychotherapy
Indicators: Relationship problems/ personality problems.
Borderline personality disorders – used in day hospitals combined with
CBT, OT and therapeutic community model.
Long term – 2-5 years average length of stay.
Broad goals – tackles underlying causes & gaps in emotional development.
Focus: early life and significant events and how these impact on current
relationships.
Ego training in action; highlights patterns of relating that emerge in the
group & offers chance to try out new ways of relating. e.g. asking for help,
giving & receiving feedback.
Multiple transferences; explores how patient relates to group as a whole,
conductor and other individuals in group.
In depth focus on interpersonal conflicts in group & negative feelings as well
as positives.
Patient must have some support/ coping strategies in addition to group.
References