Transcript PSYCHOTHERAPY

Jose Pons Madera, Ph.D.
Director - Psy.D. Program
Ponce School of Medicine
Tel 844-5209
Objectives For Conferences I & II
• Define psychotherapy and to explore its mechanisms of
action.
• Identify the main psychotherapeutic approaches
• Recognize the conditions for which psychotherapeutic
interventions are indicated or appropriate
• Explore Short Term techniques especially Crisis
Intervention
• Familiarize with Psychoanalytically oriented
psychotherapies
• Understand the components of Cognitive and Cognitive
Behavioral Therapies
• List some of the psychotherapeutic techniques utilized
for a selected group of mental health conditions.
Caso # 1 – Tita de CESCO
• Quién es el/la paciente
• ¿Es esto una intervención
psicoterapeútica?
• ¿Que se debe hacer con Tita? ¿Con la
Mamá?
• ¿Quien más debe estar en la intervención
si se ofrece alguna?
• ¿Que es psicoterapia?
DEFINITION
A special relationship between two or
more persons, one or some of whom
(the patient/s) seek help with
problems of daily living or with
symptoms that interfere with their
functioning and quality of life, and the
other (the therapist) is a professional
that utilizes the relationship between
both as well as other specialized
psychological techniques, to help him
or them confront their difficulties.
Analysis of Definition
• Persons Involved
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Individuals
couples
families
groups
• Patient’s difficulties
– Symptoms
– Diff w/ daily living
– Diminished satisfaction
w/ self or life
The Psychotherapeutic Process
5 X 3 Model
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THE INTERVIEW
Introduction
Opening
Body
Closing
Termination
THE THERAPY PROCESS
• Initial Phase
• Middle Phase (Working
Through)
• Termination
Types of Psychotherapy
Crisis Intervention
Short-Term (Focused)
Supportive Psychotherapy
Long-Term (Reconstructive)
Conditions for which Psychotherapy
Might be Indicated
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Adjustment Disorders: all types
DSM-IV V codes
Interpersonal Difficulties & Personality Disorders
Depresive Disorders
Anxiety Disorders: GAD, Panic, OCD, Phobias.
PTSD: with or without dissociation
Addiction disorders
Behavioral Problems w/ children & adolescents
Eating and elimination disorders
Somatoform Disorders
Curative Factors
• Primary Curative Factors: Insight, Behavior
Change, Relationship
• Factor most correlated w/ positive therapy
outcome = EXPECTATION
• What Patients get from Psychotherapy:
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Emotional Corrective Experiences
Improved Self Esteem
Higher Sense of Control
Better Relationships
Higher Levels of Adaptation
Main Types of
Psychotherapeutic
Modalities
Main Theoretical Concepts
Process & Techniques
Case # 2 – Maria
From Junior High School
• ¿What is happening to María?
• ¿Is this a crisis situation?
• ¿What kind of intervention is needed to
help her?
• ¿What goals should the treatment
attempt to reach?
• ¿What type of techniques should be
utilized to help her?
CRISIS INTERVENTION
• A strong emotional/behavioral reaction to an external
situation or to internal conflicts which alters a person’s
capacity to cope with life’s circumstances and affects
their psychological stability.
– Two types of Crisis
• Situational
• Developmental
• Psychological Characteristics of Persons in Crisis
– Psychological “Tunnel” vision
• diminished range of options
– Pesimism with impaired Problem Solving abilities
– Lack of energy and of direction
– Psychological regression to stages of helplessness
CRISIS INTERVENTION
• Role of the Therapist
– Understanding of where the pt is and what his/her
perception of the situation is. Provide support and
reassurance
– Opening of perceptual focus and of the capacity to
generate alternatives
– Help pt adapt to unchangable circumstances or to
change those circumstances that may by changed.
• Goal of Crisis Intervention
– Restoration to previous levels of functioning
Psychoanalytic Therapies
I. Theory:
A. View of Mind
B. Core Issues:
– intrapsychic conflict & psychosexual
fixations
– focus on past experiences/emotions
II. Process:
– Therapeutic Alliance
– Resistance
– Denial & Defense Mech
III. Technique:
– Free Association, Dream Interpretation,
Interpretation, analysis of transference
IV. Indications
- Neurotic conflicts
Cognitive Therapies
• Theory: Cognitive Psychology
• Precursor: Karen Horney
• Pioneers: A.T. Beck, A. Ellis
• Process & Techniques
– Irrational Beliefs
– Thinking Distortions
• Initial Use: Depression &
Adjustment Problems
• Current Use:
– Depresion, anxiety and many
conditions including Personality
Disorders
Behavior Modification
• Theory:
– Learning Theories:Operant,Visceral, and
Cognitive (Motor, Visceral, Social).
• Process:
– Operational Defn of problem
– Identification of contingencies
• S-R-Rr o R> Rr
– Identification of reinforcers
– development of treatment process
– monitoring of Beh & Conditioning
Variables
• Techniques:
– Contingency Management
• Discriminative S & Rr
– Time Out, S control, Self Rr
– Desensitization
– Modeling Techniques
Humanistic Approach
• Theory: Phenomenology &
Existentialism
– Rogers: Client Centered
– Frankl: Existential
• Process
– Reliance on Relationship to
achieve meaning or congruence
– Perception of internal & external
world
– Self Actualization
– Choices & Being in the World
Cognitive Behavioral Therapy
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Integration of Cognitive w/ Beh. Mod
Newer forms integrate Humanistic Approaches
Most researched apporach - Empirically Validated Tech.
Cost-effective and most Managed Care friendly
Most Techniques developed
Multiple Modalities/Approaches:
– Arnold Lazarus: Multimodal Therapy
– Michenbaum: Self Verbalization Technique & multiple
conditions
– Others
• Newer CBT Modalities:
– Dialectical Behavior Therapy - DBT
– Eye Movement Desentization & Reprocessing - EMDR
CBT Techniques
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All Behavior Modification Techniques
All Cognitive Techniques
Relaxation Techniques
Social Skills Training
Problem Solving
Imaginary & visualization techniques (including Gestalt)
Somatic techniques: exercises & other Wellness
approaches.
• Clinical Health techniques
• Family & couples therapies
• Child therapy
Other Psychotherapeutic Modalities
• Family/Couples Therapy
& Systemic
Interventions
• Group Therapy
• Play Therapy
• Ecological Therapy
• Psychoeducational
• Art Therapy
• Dance Therapy
Empirically Validated
Interventions For Frequently
Encountered Conditions
From Randomized Clinical Trials to
Single Case Studies
Conditions & Interventions
• Depression: CBT & SSRI (T-I)
• ADHD: BT (contingency management), Psychoed for
family & school, CBT for child, Stimulants.
• Addiction Disorders: Detox (First), Residential, family,
CBT/Dynamic or AA, NA or other. CBT for social skills and
problem solving
• Anxiety Disorders - Panic: BM - progressive exposure
& development of coping skills W/ CBT for psychoeducation about
anxiety & its management
• Obsessive Compulsive Disorder: CBT w/ exposure
and response-ritual prevention w/ SSRI
Conditions & Interventions
• Conduct Disorder: Parent Management Training w/ FT,
Problem solving w/ other CBT techniques as needed. School
consultation.
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Trauma & PTSD: supportive, psychodynamic or EMDR.
Borderline Personality Disorder: DBT
GAD: psychodynamic, CBT w/ benzodiazepines.
Personality Disorders: Psychodynamic or CBT