According to the Concept of Psychotherapist

Psycho therapy

Definition: Non pharmacological treatment of psychiatric illness using psychotherapeutic techniques to ameliorate distress, abnormal patterns of relations or symptoms

Classification:

According to the concept of psychotherapist:

Psychoanalysis=psychodynamic

Cognitive therapy

Behaviour therapy

Person - centredtherapy

According to participants:

Individual therapy

Group therapy

Marital therapy

Family therapy

PSYCHOANALYTIC PSYCHOTHERAPY

Classical Psychoanalysis: It is based on the notion that early childhood experiences are internalized and, interacting with biological urges from within, form a dynamic unconscious that influences behaviours, thoughts, and feelings. Problems will be reduced through attaining insight.

1-IT is the first form of psychotherapy described by Sigmund Freud.

2-Only designed for patients suffering from symptomatic neuroses of a hysterical, obsessive-compulsive, or phobic nature

3- Only for young patients, generally those in their 20s and 30s.

4-Psychoanalysis as a therapeutic procedure, based on the notion of uncovering and reconstructing the patient’s past through re-creation of that past in the transference neurosis with the analyst

5- In formal psychoanalysis, the process is conducted four or five times a week in sessions that last either 45 or 50 minutes. The patient usually reclines on a couch while the analyst sits behind the couch out of the patient’s view. It takes long duration for years.

6-it consists of 3 phases:

1-opening phase: the patient narrates his story

2-The second, is characterized by the appearance of a transference neurosis

3-The third, or termination, phase of analysis requires that the patient mourn and give up infantile attachments to parental figures

N.B It is now considered archaic.

Post Freudian Psychoanalysis

1-No age restriction

2-The spectrum of patients included in addition to those in classical psychoanalysis highly perfectionist depressed individuals, some sexual disorders, certain personality disorders, including obsessive-compulsive, histrionic, avoidant, and narcissistic, selected patients at the upper end of the spectrum of borderline personality disorder, self-defeating personality disorder, and many cases of mixed personality disorder. In addition, many patients who may experience significant distress ,Having difficulties with intimacy, relatedness, and commitment; lack of assertiveness; avoidant tendencies; self-defeating behaviour; problems with authority; shyness; unresolved grief; or problems related to separation or rejection.

Characteristic of individuals

i-the patient is motivated to sacrifice the time and financial resources required for psychoanalysis.

ii- patients who enter analysis must have a genuine wish to understand themselves, rather than a desperate hunger for symptomatic relief.

iii-They must be able to withstand the frustration, anxiety, and other strong affects that emerge in analysis without fleeing or acting out their feelings in a self-destructive manner, have the ability to delay impulses and control affects

iv- reality testing and self/object differentiation.

v- mature superego development.

vi-pathological liars, morally corrupt, or who commit criminal acts are unsuitable for psychoanalytic treatment.

vii-At least averageintelligence is required for analytic work

viii- a capacity to verbalize internal experiences.

ix-patient can think abstractly and symbolically and use analogy

x-patient is not in a major crisis

xi-In the same geographical area

xii-no serious physical illness

xiii- history of unsuccessful previous treatments

Behaviour Therapy:

-Concept:Intrapersonal and interpersonal problems are seen as resulting from learning maladaptive inappropriate behaviour.

-No place for the unconscious conflicts.

-The aim is to modify behaviour getting rid of undesirable behaviour

Behavioural Techniques are:

1-Exposure

2-Relaxation technique

3-Assertiveness training

4-Response prevention

5-Thought stopping

6-Token economy

1-Exposure is mainly for phobic disorders

Exposing the patient to the phobic stimulus either in natural situation or in vitro (in the clinic e.g. to photos of the phobic stimulus). The exposure could be either sudden (flooding) or by gradual sensitization through a hierarchy of avoided situations.

The anxiety is reduced by relaxation training

N.B. It is contraindicated in heart diseases, and in those who have weak psychological adaptation.

2-Relaxation training:

i-Choose a good place

ii-Slow and deep breathing(inspiration =expiration=stop of breathing=three seconds)

iii-Learning to relax the group of muscles starting from the feet till the head by contraction followed by relaxation

iv-It is very helpful in anxiety and phobic disorders.

3-Assertiveness training:

i-It is ideal for people who are unable to express their feelings and thought directly to others.

ii-it is done through role modelling, desensitization, positive reinforcement

iii-It helps people to practice appropriate social behaviour in everyday life by expressing their true feelings and thoughts verbally and non-verbally.

4-Response prevention:

It is ideal for treatment of compulsion in obsessive compulsive disorder, e.g. the patient who has compulsive hand washing is prevented from washing his hands.

5-Thought stopping:

-It is used to treat obsessional thoughts, which involves stopping irrational beliefs before they begin to cause discomfort .

6-Token economy:

i-Repeated rewards of a desired behaviour encourage the patient to repeat the behaviour

ii-It is used with chronic schizophrenic patients to improve their social skills e.g . self hygiene,sharing in a social activity.

iii-It is used with children and mentally retarded.

Cognitive therapy

Concept:

i-Person’s behaviour is associated with it’s own cognitive process (way of thinking,expectations,attitudes and beliefs)

ii-Maladaptive cognitive processes are associated with behavioural and emotional problems.

iii-Correcting the maladaptive cognitive processes reduce’s patient’s problems

iv-the duration is15-20 sessions for twelve weeks

Process:

i-Identification of the maladaptive thinking.The commonest cognitive errors are either magnification or minimization of events,and overgeneralization

ii-Correction of misunderstandings is challenging the maladaptive thinking.

iii-Alternative ways of thinking are sought out and each is tested.

Cognitive behaviour therapy

Cognitive behaviour therapy alone is effective in mild and moderate depression

i-Combined treatment(drug +cognitive therapy) is superior to each type alone.

ii-It can be used also in panic disorders and phobic disorders.

Supportive therapy:

It is a systemic professional therapy that involves:

i-Building a good patient-doctor relationship

ii-Careful listening to the patient’ problems and concerns facilitating emotional ventilation and empathizing with the patient i.e sharing emotions with him.

iii-Instillation of hope and improving self esteem.

iv-Encouraging self help.

v-Inducing the cognition of acceptance the illness (إبتلاء من الله)as infliction from god and satisfactionor complianceرضا

vi-It is used to relieve distress during a short period of personal difficulty.

vii-It is used with those who have stressful life problems that cannot be resolved completely or a medical disease that cannot be treated.

Counselling:

It helps person to solve stressful problems through decision making

The counsellor’s role is not to provide ready solution to the client’s problem, instead he assists the client to choose a decision among different alternatives.

Using problem solving technique which involves 6 steps

1-identify the problem

2- List as many solutions as possible without any evaluation of them

3-discuss the pros and cons of each possible solution

4-select the best or most promising solution

5-plan how to carry out your chosen solution

6-try it out, review what happens and praise all efforts.Whether the chosen solution has worked completely or partially or not at all,praise yourself for the efforts and try again.

Counselling process requires empathy and unconditioned positive regard of the client.

Group therapy is a form of therapy where 6-10 patients with similar disorders or with different disorders meets regularly in the presence of the psychiatrist.

The therapeutic factors in group therapy are

-Group cohesion and support

-Acceptance and ventilation

Identification and universalization