Psychotherapy PDF

Psychotherapy Dr. Mohammed Ridha  Psychotherapy Definition: Psychotherapy refers to the variety of psychological interventions that share the goal of alleviating human problems and facilitating effective functioning in society  subtypes of psychotherapy: Psychoanalytic psychotherapy...

Psychotherapy Dr. Mohammed Ridha  Psychotherapy Definition: Psychotherapy refers to the variety of psychological interventions that share the goal of alleviating human problems and facilitating effective functioning in society  subtypes of psychotherapy: Psychoanalytic psychotherapy Brief psychodynamic therapy Cognitive Behavioral therapy Interpersonal therapy Family therapy Couples therapy Supportive therapy Group therapy  Psychoanalysis and Psychoanalytic Psychotherapy Psychoanalysis is virtually synonymous with the renowned name of its founding father, Sigmund Freud. It is also referred to as “classic” or “orthodox”. psychoanalysis A key assumption of Psychoanalytic therapies is that people’s current problems cannot be resolved successfully without a thorough understanding of their unconscious basis in early relationships with parents and siblings.  Aim The aim of Psychoanalytic therapy is to identify, bring to notice, and reprocess repressed conflicts from previous experiences which are being unconsciously enacted in current interpersonal interactions leading to maladaptive patterns of behavior ‫املعالج اهناه ميتدخل بالكالم مالت املريض فيكون‬ passive role brief psychodynamic‫ مثل ال‬active ‫وليس‬  Selection criteria Characteristics of patients who often do well with this form of therapy include those with: Psychological mindedness. ‫شخص واعي ومثقف يفهم طبيعة العالج‬ Motivation to get better. The ability to trust and collaborate with therapists.  Techniques MCQs ‫يحجي اي شي بباله‬ Free association (the patient is encouraged to speak whatever comes to his mind without inhibition or censorship ) Dream analysis (Interpretation of dreams is used to examine unconscious conflicts and impulses) Transference (emotion experienced by a patient towards the therapist which is based on experiences from previous relationships. )  Duration long-term (1-5 sessions/week for a number of years). Intermittent or brief (less than 6 months in duration or 6-40 sessions in total). sessions 20 ‫الباقي كله على‬  Any psychodynamic ‫= مشتقه من ال‬ psychoanalysis Brief Psychodynamic Therapy (BPT) ‫اقل وقت واقل تكلفه‬ Alexander and French listed the benefits of time limited therapy using psychodynamic principles. In this era of emphasis on optimal resource utilization and cost-benefit analysis for interventions brief therapies have regained popularity.  Aim aims to identify and reprocess repressed conflicts from previous experiences which are being unconsciously enacted in the current interpersonal interactions and thus causing maladaptive patterns of behavior. ‫يحاول يصلح االضطراب من العقل الالواعي لتحديد السبب والشروع بالعالج للسلوكيات الخاطئه‬  Selection criteria Psychologically minded. Highly motivated. trust‫نفسهه ال‬ Able to tolerate the temporary increase In anxiety or sadness that this type of therapy can evoked. ‫قادر على تحمل الزيادة املؤقتة في القلق أو الحزن‬.‫الذي يمكن أن يثيره هذا النوع من العالج‬  Duration The usual number of sessions in BPT varies from 12-40 and is usually completed in six Brief months, Given a shorter duration of therapy, the The therapist directed the session therapist has a more active role compared to long-term psychodynamic therapy, Clinical applications Panic disorder Phobias generalized anxiety disorder (GAD), post traumatic stress disorder (PTSD). Patients with depressive and eating disorders of mild-moderate severity  ‫‪Behavioral Therapy‬‬ ‫كل ما تاكل الخوفه وتتشجع وتسويهه كل ما الخوفه‬ ‫تقل وتنتهي مستقبال‬ ‫وكل ما تتجنب الخوفه كا ما الخوفه تزداد مستقبال‬  Behavioral Therapy Behavioral Therapy (BT) utilizes techniques derived from both Pavlov’s classical and Skinner’s operant conditioning. BT identifies maladaptive behaviors as the source of psychological distress and attempts to improve quality of life by altering and modifying these. BT works best for specific behavioral symptoms such as phobias and compulsions.  subtypes of BT MCQs. Systemic desensitization: is particularly helpful for phobic disorders In the initial phases, relaxation techniques including deep breathing and progressive muscle relaxation are taught and practiced. A hierarchy of anxiety-provoking stimuli is constructed with the help of the patient. For example, a person afraid of using an elevator would go through therapeutic steps of first imagining standing in front or riding the elevator, then on to seeing pictures of elevator, then going to a building with an elevator, standing in front of the elevator, and eventually taking the elevator General anxiety disorder = fear from the Vague (unknown)  Flooding/Implosion: This is based on the concept that escape or avoidance of an anxiety-causing situation (phobia) maintains the fear. Patients are exposed to anxiety provoking stimulus (not graded exposure) either in vivo (flooding) or imaginary (implosion) and not allowed to leave till their anxiety subsides (habituation). Compared to systemic desensitization, flooding leads to severe anxiety initially and may not be tolerated very well by some patients. This approach has proved to be particularly effective in the treatment of agoraphobia and obsessive-compulsive disorders ‫كبل يدخل بمكان بيه ناس هواي‬ ‫او باالوبسسز كبل يدوس الشغله الي متوقع انو بيه وساخه وهكذا‬  ‫ راح‬disulfiram ‫من ياخذ الكحول اطيه ماده مرافقه اله مثل‬ ‫تسوي عده اعراض شديده وعقابيه فراح يتركهن‬ ‫النفور‬ ‫العقاب‬ Aversion therapy: This is based on a "punishment model" and used to treat substance abuse disorders and paraphilias. A maladaptive behavior is combined with aversive (noxious) stimulus to decrease the repetition of maladaptive behavior. An example of this is an individual with alcohol dependence is given disulfiram. The next time this individual drinks alcohol, he will experience adverse effects such as nausea, vomiting, flushing and headache. Panic disorder = ‫يخاف انو يجيه الخوف‬ ‫فيصير كلش مضطرب‬ ‫الخوف االول هو من الخوف الثاني والخوف الثاني من خوفه من االعراض الكولنرجك الي حتصير‬  ‫ حتى من يتعرض للي عده وهواس منه يبقى بدون مسوي رد الفعل مالته‬OCD‫تفيد لل‬ Gold standard therapy for OCD #MCQs Exposure and response prevention: This is a key technique to treat Obsessive Compulsive Disorder (OCD). Patients are trained to refrain from performing rituals (compulsions) despite having increased anxiety stemming from obsessional thoughts, images or impulses (response prevention). For example, a patient whose obsessions involve fear of contamination is asked to touch various surfaces (exposure) but refrain from washing hands (response prevention). Over time, this helps to break the vicious cycle of compulsive acts in response to obsessions.  Token economy: This is commonly used in settings where children, adolescents, and patients with mental retardation are treated. Desired adaptive behaviors are reinforced with tokens such as stars or tickets. Tokens are accumulated and exchanged at the end of a specified time period for gifts such as snacks, toys, watching television, or playing video games. When maladaptive behaviors occur then there is a penalty with a certain number of tokens is taken away. What makes a behavior desired or maladaptive and the rewards/penalty associated with them are clearly communicated in advance to the patients. Hence this technique promotes acquisition of good behaviors and autonomy  ‫تقليد املعالج او اشخاص اخرين يشوفهم ديسوون شي ويتكافؤون عليه‬ ‫فهو يقلدهم حتى تتم مكافأتهم‬ Modeling: A patient initially observes a peer or a therapist perform a desired behavior that is positively reinforced. This is followed by the patient imitating the behavior to also get rewarded for this enactment. Observing the behavior of a model (either live or videotaped) has proved effective in reducing fears and teaching new skills. Watching videotapes of models enjoying a visit to the dentist or going through various hospital procedures has proved successful in helping both children and adults overcome their fears of such experiences  ‫السلوكيات مالته اله عالقه باالفكار مالتنه تجاه اشياء معينه مو بالكبت وتقسيمات فرويد للنفس البشريه‬ COGNITIVE THERAPY Cognitive therapy is a relatively short-term treatment (about 20 sessions) designed to get clients thinking about events in their life – including the symptoms of their disorder – in new ways. Developed in the 1960s by psychiatrist Aaron Beck, this therapy aims to change the negative thought processes and beliefs that lead to problematic behaviors.  this therapy aims to change the negative thought Beck’s cognitive therapy processes and beliefs that lead to problematic behaviors. Aaron Beck developed one of the most influential cognitive therapies to treat depression. Beck maintains that the depressed person’s negative view of self, the world and the future (the ‘cognitive triad’) results from the operation of maladaptive automatic thoughts – the spontaneously generated thoughts associated with specific moods or situations (e.g. ‘Everything I do turns out wrong’). In depression, these cognitive distortions can take many forms including dichotomous thinking (‘I’m either a success or a failure’), overgeneralization (‘Whatever I say just shows how stupid I am’), arbitrary inference (‘He glanced over my shoulder while talking to me. I’m a social failure’) and magnification (‘My mistake in answering the test question just shows that I’m an idiot who shouldn’t be at university’). ‫الحياه ابيض واسود لو اكون االول لو اني صفر‬ ‫وهذا النمط من التفكير يسبب مشاكل هوايه‬ ‫نخليه هو الي يتكشف خطا تفكيره وهو يصححه‬ ‫الن اذا بس كوكنتف معناه احنه نكله انو‬ ‫تفسيرك خطا وغالبا مو كلش يفيد الن الشخص‬ ‫يجرب وهو يفسر يال يقتنع‬ Whatever form the cognitive distortion takes, a primary goal in cognitive therapy is to help the client identify automatic thoughts and evaluate them. The therapist helps the client to do this by asking questions like, ‘What is the evidence for this idea?’, ‘Is there another way to look at the situation?’, ‘Are these facts, or your interpretation of the facts?’  Cognitive and ‫انجح الطرق‬ behavioral therapies These therapies stem from the belief that it is not what happens to people but how they think about what happen to them that upsets them. These thoughts can lead an individual to behavior based on a false premise. Cognitive-based therapy seeks to change patterns of negative thought. Behavior- based therapy aims to replace unhelpful behaviors with positive actions that then change underlying feelings. Many therapies take elements from both cognitive and behavioral theories. The therapist helps the client challenge automatic thoughts and practice new ways of reacting. Once the client can change their viewpoint, they can alter how Thought they feel and behave.  CBT, Cognitive Behavioral Therapy Psychiatric disorders are characterized by dysfunctional schemae and maladaptive thoughts (cognitive distortions) that lead to abnormal affect and maladaptive behavioral patterns that reinforce core beliefs managing anxiety disorders and has also been tailored to help patients with bipolar disorder, eating disorders, personality disorders, substance abuse disorders, and even psychotic disorders  ‫‪-‬مثال الدبرشن‬ ‫نطبق عليه الحلقه ادناه‬ ‫واحد يكول اني فاشل بسبب درجاتي هاي فكره‬ ‫السلوك ينعزل ويدخل بكآبه وهذا السلوك‬ ‫املشاعر كآبه‬ ‫هذا الثالوث اكدر اطبقه على اغلب الكيسات النفسيه‬ ‫هذا الثالوث مابيه اساس انما بيه ترابط‬ ‫يروح ويرجع لكل الفقرات‬  Aim ‫املعرفي هو انو اخليه واعي بانو الي ديسويه غلط‬ ‫والسلوكي ابدي اخليه يغير سلوكه وافكارهه ومشاعره‬ CBT aims to empower patients with the ability 1- 2- to become aware of and change these maladaptive core beliefs and cognitive distortions.  Duration The total number of hourly sessions varies from 5-20, with an average number being 12- Hrs 16. Patients with residual symptoms or recurrent illness may find "booster" sessions helpful to maintain response Clinical Applications: depressive and anxiety disorders Dysthymia effective for and in combination with medications for major depressive disorder, panic disorder OCD Generalized anxiety disorder modifying overvalued ideas seen in eating disorder symptom recognition relapse prevention medication adherence in psychotic illnesses and bipolar disorder.  Interpersonal Therapy Interpersonal psychotherapy (IPT) is a brief, time-limited therapy developed in the 1970s for the treatment of depression. This approach is based on the premise that depression is often closely intertwined with the patient’s interpersonal relationships. ‫ يعتمد‬.‫( هو عالج قصير محدود الوقت تم تطويره في السبعينيات لعالج االكتئاب‬IPT) ‫العالج النفسي بني األشخاص‬.‫هذا النهج على فرضية أن االكتئاب غالبا ما يتشابك بشكل وثيق مع العالقات الشخصية للمريض‬  Aim changing communication solving interpersonal problems to help improve interpersonal relationships to improve emotional well-being Duration Typically, IPT is time-limited and usually once- a-week, for 12 to 20 sessions ‫مرتني الى ثالثه باليوم‬  Selection criteria Outpatients ‫ والي‬unipolar‫يعالج فقط الدبرشن الي هو ال‬ Nonbipolar disorder ‫غير مرتبط بالسايكوسز‬ Nonpsychotic depressive disorder  Technique Developing the communication skills ‫اطمئنه للمريض وراهه اوضحله شنو راح نسوي‬ ‫وراهه احسن مهاراته وعالقاته وراهه اطيه دواء‬ Reassurance Clarification of feeling states Improvement of interpersonal communication Testing perceptions Development of interpersonal skills. Medication. ‫يدخلون العائله كله عمود املريض فيدخلون العائله كله بالعالج‬ ‫‪Family Therapy‬‬  ‫ ثربست واحد رجال واحد مره ويبدون يعلمون العائله عن اساليب العالقه العائليه الصحيحه‬2 ‫اجيب العائله كله ويه‬ ‫وراهه افهمهم انو اضطرابات الشخصيه الي واحد تاثر على الكل واشوفلهم فديوات عليهه وهكذا‬ Family Therapy In family therapy, the family meets regularly with one or two therapists (usually a male and a female). The therapist observes the interactions among family members and tries to help each member become aware of the way he or she relates to the others and how his or her actions may be contributing to the family’s problems. Sometimes videotape recordings are played back to make the family members aware of how they interact. family therapy – in which the entire family undergoes therapy together –can be considered specialized forms of group therapy.  Techniques ‫هاي بالخارج نشجعهم انو يعيشون مع بعض‬ Mutual accommodation is encouraged. This is a process in which family members work toward meeting each other’s needs. ‫نشجعهم حتى نسوي سستم للعائله‬ Normalizing boundaries between subsystems and reducing the likelihood of triangles is encouraged. Redefining “blame” (i.e., encouraging family members to reconsider their own responsibility or problems) is another important technique. ‫نشجعهم حتى ياخذون كل واحد ومسؤوليته‬  Clinical Applications Children with behavioral problems Families in conflict People with eating or substance use disorders Families of people with schizophrenia  Couples Therapy (CT) Couple or marital therapy is designed to psychologically modify the interaction of two people who are in conflict with each other over one parameter or a variety of parameters(social , ‫حل النزاع الي بني االزواج من‬ emotional, sexual or economic) ‫نكعدهم كبالنه سويه ونثقهم‬ Clinical Applications: To resolve conflicts, couples must confide in a therapist to safely explore sources of and possible solutions to problems or failings in the relationship.  Supportive Therapy (ST) Supportive psychotherapy is the most widely practiced form of individual psychotherapy today. Supportive therapy is aimed not at insight into problems, but rather at helping people, protected and supported during life crises (e.g., serious illness of loved one). For people with chronic mental illnesses, supportive therapy may be used over many years along with medication. ‫ بل إلى مساعدة الناس وحمايتهم ودعمهم خالل‬،‫ال يهدف العالج الداعم إلى التبصر في املشاكل‬ ‫ بالنسبة لألشخاص الذين يعانون من‬.(‫ املرض الخطير ألحبائهم‬،‫أزمات الحياة )على سبيل املثال‬.‫ يمكن استخدام العالج الداعم على مدى سنوات عديدة إلى جانب األدوية‬،‫أمراض عقلية مزمنة‬  ‫كل واحد يطرح تجربته بالعالج وهكذا‬ ‫املشاركه مهمه‬ ‫)‪GroupTherapy (GT‬‬  Group Therapy (GT) In group therapy, patients join together with others to share problems or concerns, to better understand themselves and others, and to learn from and with others. Group psychotherapy entails a small number of people (generally no more than eight or ten) who meet together regularly (most often weekly ) under the guidance of one (or sometimes two) therapists  Clinical Applications: they may be ‫ناس مشاكلهم مختلفه او متشابهه‬ homogeneous or heterogeneous depend on diagnosis for example of homogeneous groups include those patients attempting to lose weight, stop smoking &groups sharing same medical or psychiatric problem(AIDS , PTSD , substance use disorders)  self-help groups Groups that are conducted without a professional therapist – are increasing. Self-help groups are voluntary organizations of people who meet regularly to exchange information and support one another’s efforts to overcome a common problem. Alcoholics Anonymous is the best known of these groups Thank you