M.

Faisal Idrus

Psychotherapy

Includes those means by which a

therapist attemps to provide new
interpersonal experience for another
human being
These experiences are designed to
enhance one ability to manage
subjective disstress

Psychotherapy

It can not alter the problem of world in

which patient lives
But it can enhance self acceptance,
empower the patient to make life
changes and help patient to cope with
enviroment more effectively

Definition

Psychotherapy is an interpersonal, relational

intervention used by trained psychotherapists
to aid clients in problems of living. This usually
includes increasing individual sense of wellbeing and reducing subjective discomforting
experience. Psychotherapists employ a range
of techniques based on experiential
relationship building, dialogue, communication
and behavior change and that are designed to
improve the mental health of a client or
patient, or to improve group relationships
(such as in a family).

Classification of
Psychotherapy

according to who is involved in the

treatment
an individual
a group
a couple
a family therapy

Classification of
Psychotherapy

according to the content and

methods used
analytic
interpersonal
cognitive,behavioral, cognitive behavioral
All psychotherapies are aimed at
changing aspects of the patient

Characteristics common for

all psychotherapies

Based on interpersonal relationship

used verbal communication between
two or more people as healing
element
specific expertise on the part of the
therapist in using communication
and relationshop in healing way

Characteristics common for

all psychotherapies

based on rationale or conceptual

structure that is used to understand
the patient problem
use of the specific procedure in the
relationship that is linked to rationale
structure relationship
expectation of improvement

Behavior therapy

Aim : change the behavior.

derived from British empiricism,
Pavlov studies of conditioning,
research on stimulus response
relationship conducted by behaviorists
(such as Skinner, Wolpe, Eysenck.)

Behavior Psychotherapy

Assumptions of psychopathology

People learn their problems

Problems occur naturally through a learning process :
Classical conditioning

e.g phobias

Operant conditioning

e.g. , Substance abuse, personality disorders

This learning is NOT direct instruction

Typically natural and can even be passive
Problems are sustained largely through escape and
avoidance of aversive event

Behavior Psychotherapy

Thoughts require a slightly modified analysis but

are still understood as both important and as
behaviors
The aviodance of thoughts can lead to more
problems in living
It is the avoidance that produces the problem, not
the thougts.
Interpersonal problems can be fundamental in
bringing about and sustaining ineffective behavior
(psychopathology)

Behavior Psychotherapy

Assumptions of curative factors

If problems are learned, new and more

effective behaviors can be learned as well
Real key is exposure and extinction
Keep in mind both classical and operant
conditioning
Techniques
Graduated exposure treatments
Flooding

Graduated Exposure
Treatment
Person gradually taken into the feared situation
or exposed to the fear stimulus or traumatic
memory until the anxiety subsides

Systemic desensitization

Use coounterconditioning
Extinction to reduce fear
Work through an anxiety hierarchy of situations that lead to
lead fearfull reactions.
Imagine fearfull situasitions while remaining relaxed
Also use in :
Cognitive processing therapies (CPT) for sexual assault.

Flooding

Person is taken directly into the feared

situation until the anxiety subsides :

Escape response is prevented completely

Pros and cons to this

When would you NOT use this

Just as effective as systematic desensitization for

phobias

Behavior therapy

work with objective, observable

phenomena, referred to as behavior,
including physical activities (drinking,
eating, talking, completing a serial
sequential activities that lead to habit
formations and social interaction)

Behavioral techniques

do not necessarily help the patient to

understand his motivations and
emotions (but some od Bs believes
that the change of patients behavior
may lead to changes in how patient
think and feels)
symptoms : phobias, obsessions,
eating, sexual disorders, general
anxiety, mild depression, alcohol abuse

The forms of behavioral

therapy

Work on what the patient does

relaxation training
systematic desensitization
flooding

Relaxation training

used to teach patient to control over

their bodies
to achieve voluntary control over
their feeling of tension
to achieve relaxation ( they are
instructed to move through the
muscle groups of the body and make
them tense and relaxed)

Systematic
desensitization

Teaching how to reduce or control the

fear elicited by specific stimuli
trainig to reduce tense and anxious
response to feared stimuli ,fe therapist
may asked the agoraphobic patient to
imagine to visist the shopping mall
where the patient typicaly develops
panic, the patient is ecourage to use
relaxation techniques to diminished
panic and place it under voluntary
control

Flooding

aim : to extinguish anxiety produced by

feared stimuli

how : placing the patients in continuous

contact with the stimulus and helping
them learn that stimulus does not lead to
any feared consequences

Cognitive therapy

cognitive structures or schemata

shape the way people react and adapt
to a variety of situations that they
encounter in their lives

Cognitive therapy

aim : to abolish negative thoughts

which allow symptoms to persist
(our moods and feelings are influenced
by our thoughts and the psychological
disturbances are caused by habitual
errors in thinking. By correcting these
distorted ways of thinking, therapist
restructure patients views of
themselves)

Cognitive therapy

The three major cognitive patterns

observed in depression (by Beck)
- a negative view of oneself
- a negative interpretation of
experience
- a negative view of future

Cognitive therapy

treatment of depression
the schema that lead to negative
interpretations
the goal : to indentify and restructure
those negative schemata (that shape
p.perception)

Individual psychotherapy

Covers broad range of

psychotherapeutic techniques which
are usually done individually - single
therapist working with single patient

Psychoanalysis

Originally developed by S.Freud ( a

systemic theory to describe the structure
and operations of the human psyche)
reorganization of character structure with
emphasis on self understanding and
correction of development lags

Psychoanalysis

basic concept includes stages of

psychosexual development (oral, anal,
phallic)
the structures of conscious and
uncoscoius thougts (primary versus
secondary process thinking)
the structures of drive and motivation
(id, ego, superego)

Psychoanalysis

Assumptions of curative factors in

psychoanalytic theory
Curative process is resolution of the
unconscious tension
Need to free up the psychic energy being spent
on defences
Techniques :
Free association

Patient relaxes and freely expresses whatever comes

to mind

Dream analysis

Determine latent content of dreams

Psychodynamic
psychotherapy

concepts are embodied in

psychoanalytic theory (it does not
involve rigidly defined techniques that
charakterized classical psychoanalysis)

Psychodynamic
psychotherapy

based on idea of self exploration and

self understanding open up the
possibilities for change in personality
and behaviour
treatment of : personality disorder,
sexual dysfunction, somatoform ,
anxiety disorders, mild depression

Types of psychodynamic
psychotherapy

psychoanalysis
exploratory psychotherapy - aims at
understanding motivations and
uncousious forces (focus on current
life)

Types of psychodynamic
psychotherapy

supportive psychotherapy - lessening

of anxiety through reassurance,
advice, modifications of social factor (it
helps patients to get through difficult
situations), it is incorporated into any
of the other types os PT
short term psychotherapy

Insight oriented
psychotherapy

based on psychodynamic concept

focused on interpersonal relationship
- here and now situation
the patient are encouraged to achieve
an intellectual understanding of the
mainspring of their behavior that will
assist in changing it as needed

Interpersonal therapy

based on idea that mental illness may

reflect and be expressed in problems
with relationship
emphasizes working on improving
interpersonal realtionship during the
process of psychotherapy

References

Waldinger RJ: Psychiatry for medical

student, Washington DC : American
Psychiatric Press, 1997
Collier JAB, Longmore JM, Harvey JH :
Oxford handbook of clinical specialties,
Oxford, 1998