CLINICAL Psychology MGR. RENATA JARDIN COURSE: 5-6/12/2020 CLINICAL PSYCHOLOGY aim of course BASIC ORIENTATION IN PSYCHOLOGICAL TERMINOLOGY. PRACTICAL APPLICATION OF KNOWLEDGE . GROUP WORK AND CLINICAL CASES. COURSE REQUIREMENTS PRESENTATION FINAL ESSAY AND EXAM - group presentation – 12min time limit - individual assignment - 3-5 members - chose one of the suggested topics from Health or Clinical psychology and elaborate a presentation - choose one famous person or literary person and develop analysis of his mental issues, diagnostic hypothesis and therapeutic plan - present some examples or studies on the topic - requirements: minimum 3 pages, maximum 5 pages - deadline: one hour before last lesson DAY 1: 5/12/2020 – Program TIMETABLE: Morning: 9:00 to 10:30, 15min break, 10:45 to 12:00 Noon break: 12:00 to 13:00 Afternoon: 13:00 to 14:30, 15min break, 14:45 to 16:15, 15min break, 16:30 to 18:00 TOPICS ➢What is clinical psychology? ➢Abnormal Behaviour versus normal behaviour, assessment ➢Diagnosis and Classification of Psychological Problems according to the DSM IV ➢Introduction into therapeutic intervention ➢Psychotherapy: General Issues; Psychoanalytic; Client-Centered; Gestalt, Behavioural; Cognitive; Contemplative (Mindfulness), Community; Group/Family. What is clinical psychology? ➢- empiric (research based) approach towards the psyche ➢- includes psychological assessment, evaluation of disorders ➢- differential diagnostic in cooperation with other health professionals ➢ applying of scientific knowledge for relieving, healing and preventing mental health issues ➢Rules differ from country to country Normal versus abnormal - before defining anormality, we must define the sense of “normality” - normality is culturally defined - normality is conditioned by family culture AS A THERAPIST/CLINICAL PSYCHOLOGIST YOU MUST HAVE A NOTION OF NORMALITY AND UNDERSTAND THE NOTION OF NORMALITY OF THE PATIENT! E.g. abused, traumatized, tortured patients do not necessarily know what is normal! TOPIC: abnormal behaviour DEFINING WHAT IS NORMAL PERCEPTION OF NORMALITY ➢ DEPENDANT ON HISTORICAL PERIOD ➢ POWERFUL TOOL FOR MANIPULATION ➢ EDUCATION OF CHILDREN, GENDER ROLES, ACCEPTED BEHAVIOUR IN COUPLES ➢ SADIC, PSYCHOPATHIC, NARCISSTIC PERVERT PERSONALITIES USE IT EFFECTIVELY TO MANIPULATE ➢ DEPENDANT ON SOCIETAL EVENTS – CURRENT SOCIAL REPRESENTATIONS, CORONAVIRUS PERFECT EXAMPLE ➢ DOUBTS ABOUT THE TRUTH OF ONE´S PERCEPTION OF NORMALITY CAN LEAD TO MENTAL HEALTH ISSUES BREAKOUT ROOM BRAINSTORM DEFINE WHO IS NORMAL? - As a clinical psychologist you see a patient for the first time https://www.youtube.com/watch?v=prUFZIc gZiQ WHAT WILL YOU BE LOOKING FOR? HOW CAN YOU SAY THAT THIS PERSON IS ACTING “ABNORMALLY? HOW CAN YOU DISTINGUISH BETWEEN NORMAL AND ABNORMAL? TOPIC: abnormal behavior CLASSIFICATION OF ABNORMAL BEHAVIOUR CRITERIA FOR CLINICAL INTERVIEW DEVIATION FROM: ❖ SUFFERING ❖ STATISTICAL NORMS ❖ SOCIETAL NORMS ❖ BEHAVIOURS THAT ARE DESTRUCTIVE/CONTRAPRODUCTIVE ❖ MALADAPTATION TO LIFE, CHALLENGES, SITUATIONS ❖ IRATIONALITY, DELUSIONAL COMMUNICATION ❖ PERSONAL DISTRESS, MENTAL DISORDER ❖ UNPREDICTABILITY – PUTTING MYSELF OR OTHERS IN DANGER TOPIC: abnormal behaviour WHAT DOES THAT MEAN? - notions of a hypothesis of continuity - mental pathology is not that different from normal functioning - the difference is the quantity and length ➢ long-lasting ➢ consequences on “normal” life ➢ insomnia, loss of weight, pathologic thoughts, suicidal thoughts, break of social relations TOPIC: abnormal behavior - notions of a hypothesis of dysfunctionalism - discontinuity does not mean that it cannot be repaired - change of state continuity of humour, mood, social relations, interactions ➢ maniac - depression, bi-polar mood, hyperactivity, positivism WE ONLY HAVE HYPOTHESIS OF ABNORMAL BEHAVIOUR AND HIS FREQUENCY What we own: ➢ possible risk factors ➢ genetic factors ➢ factors of probability THEY ARE NOT THE SAME!!! ABNORMAL BEHAVIOUR - we start to speak about disorders, psychopathology BUT * in order to remain “mentally healthy” one must go crazy sometimes * in order to function and perform well, one must sometimes feel stress, anxiety * in order to protect oneself from danger, one must feel fear * in order to live in a fulfilled way one must experience extreme happiness * to be grateful for what you have in life you must know depression to some extent PSYCHOPATHOLOGY 200 YEARS behind medicine - trying to find an internationally recognized way of qualification ➢ DSM V used mainly in USA but also in France ➢ MKN 10 used in Europe and also CZ WHAT IS THE AIM? ▪ regroup and describe what we observe – symptoms ▪ a minimum, group of symptoms that are typical and could indicate a certain diagnosis PSYCHOPATHOLOGY •Psychiatrists, clinical psychologists, therapists etc. can communicate internationally in a standardized way and classify by using: •Categories – distinguishes between types of phenomena that differ in a clearly defined way •Dimensions – defines to which extent a person is expressing a certain symptom What does “differential diagnosis” mean? • supposes a comparison of other psychopathologies and tries to eliminate those in a logical and argumented matter form the “most probable” to the “most unlikely” diagnosis. • start to eliminate and distinguish between “psychotic” and “neurotic” elements • GAIN AS MUCH INFORMATION AS POSSIBLE • clinical interview is not a therapeutic interview!!! • ANAMNESIS: what does an anamnesis must contain? Basic information: name, age, marital status, sex, race, occupation, previous admissions, family composition PATIENT ANAMNESIS Reason for consultation/referral: actual symptoms, problems, recurrent, new? Own perception, opinion of other professionals. History and severity of present symptoms/disorder: dvlp of symptoms, behavioural changes, life impact, length of duration, perception of intensity (scale, comparison to other life events). Psychiatric and medical history: family history, genetic and organic factors, treatment history in the family Maping of family history and nature of relations Reconstruction of patients history: birth, school, education, social relations, work DURING THE INTERVIEW OBSERVATION OF PATIENT, NON VERBAL COMMUNICATION, PHYSICAL BEHAVIOUR, POSTURE, TICKS, HINTS FOR ANXIETY, DISSOCIATION… What else to keep in mind? Specification of severity The specifications can only be applied when the criteria of evaluation of the particular disorder are fulfilled: ❖ mild ❖ intermediate ❖ severe ❖ partial remission ❖ complete remission STAGES OF MENTAL ILLNESS 1 • Good constitution, functionality, hobbies, normal life • Characteristic traits of personality Period of health Premorbid symptoms • Before the actual apparition of the disease • Certain psychosomatic factors appear • We cannot define whether it is a mental illness • Onset of mental illness with specific traits among non specific traits • Differentiation between psychotic and neurotic symptoms and neurovegetative symptoms Prodromal stage STAGES OF MENTAL ILLNESS 2 • Specific traits are dominant and provide the possibility to confirm diagnosis – specific therapy • Manic or depressive episodes manifest, hallucinatory symptoms Manifestation of mental illness Symptom fading • The symptoms are starting to become less intensive and the non specific symptoms are dominant again • The premorbid personality is coming back • Specific symptoms have disappeared • The therapy has shown it´s effect • Non specific symptoms (tiredness, weakness) • Sociability regained Reconvalescence and normal health Causes of mental disorder What are the main causes of psychological disorders? Main causes still unknown Main factors that can influence their development: ❖chemical imbalances in the brain – neurotransmitters or hormones ❖childhood experiences ❖Genetic and organic factors ❖prenatal exposures, and stress but also nutrition BRAINSTORM BREAKOUT ROOMS WHAT DO YOU KNOW ABOUT PSYCHOSIS AND NEUROSIS? https://www.youtube.com/watch?v=s8cIjhBPPiY PSYCHOSIS AND NEUROSIS Lit: the catastrophes of perception, René Thom CATASTOPHY OF SUBORDINATION/CONFORMISM/FOLDING - to obey to societal rules is necessary NEUROSIS: simple catastrophe, the person can be “unfolded”, a mark of the folding or the scrunch will remain, even after therapy. It is not a traumatism, no severe interruption of continuity. Very common, person is mostly aware of the symptoms!!! PSYCHOSIS AND NEUROSIS The nature of the “catastrophe” must be determined. The line between severe neurosis and psychosis can be very vague. PSYCHOSIS: torn apart, ripped up. The cracks, fissure have conducted to loss of continuity, separation, dissociation, destruction. Destructive elements are present, defences are gone, emotions and representations do not collide. The therapeutic work is not only unfolding issues but exploring puzzle pieces and fixing them back together. What can be neurotic? ➢- mild functional neuro-psychical disorders with specific clinical phenomena - anxiety, obsession, certain types of depression ➢- causing factors: biological factors, socio-psychic climate, economic factors, cultural factors or climate factors (SAD) ➢- In Cultural psychology: the neurotic east coast (USA) ➢- genetic, organic factors less dominant ➢- functionality is affected but not thought, language, communication ➢- PERSONALITY IS NOT AFFECTED, CONTACT WITH REALITY MAINTAINED What can be psychotic? ➢ loss of relation to reality ➢ hallucinations, audio, visual, internal ➢ difficult to treat but not impossible ➢ unawareness of my own actions, feelings, behaviours ➢ impression that others are strange, I am okay ➢ prevalence of organic or genetic factors ➢ PERSONALITY IS AFFECTED, PERSON CAN SEEM FUNCTIONAL Psychotic and neurotic disorders In clinical practice it can be difficult to distinguish neurosis and psychosis in some cases. Strict clinical methodology and evaluation is necessary!!! ➢ which types of tests do you know? ➢ MMPI ➢ PANSS, SANS ➢ ROR, TAT ➢ complementary: Hamilton anxiety/depression scale, Columbia Suicide severity rating scale Classification of disorders from neurosis/psychosis view – clin case Anxiety disorders - Phobia - OCD - PTSD - Stress, panic Eating disorders - bulimia or anorexia Affective disorders - Postpartum depression - Unipolar/bipolar depression - SAD NEUROSIS Psychotic disorders - paranoia - schizophrenia - manic depression Personality disorders PSYCHOSIS TOPIC: Diagnosis and classification of psychologic problems BASIC CATEGORIES 1. Disorders diagnosed in childhood or adolescence 7. Anxiety disorders 8. Somatoform disorders 9. Dissociative disorders 2. Delirium, dementia, amnesia, cognitive disorders 10. Disorders of sexual identity 3. Mental disorders due to general medical states 11. Eating disorders, Sleeping disorders 4. Mental disorders linked to substance abuse 12. Personality disorders 5. Schizophrenia and psychotic disorders 13. Adaptation disorders 6. Mood disorders 14. Other disorders worth clinical examination 1. Disorders diagnosed in childhood or adolescence MENTAL RETARDATION From light, medium, severe to profound LEARNING DISABILITIES Reading disorder – dyslexia Calculation disorder – dyscalculia Writing disorder – dysgraphia Learning disorder – dyspraxia COMMUNICATION DISORDER Expressive disorder, phonologic disorder, stuttering, communication disorder 1. Disorders diagnosed in childhood or adolescence PERVASIVE DEVELOPMENTAL DISORDERS - Asperger syndrome autism disorder atypic autism disorder the Rett syndrome disintegrative childhood disorder invasive developmental disorder TICS - Gilles de la Tourette - motor or vocal tics - transitory tics 1. Disorders diagnosed in childhood or adolescence ATTENTION DEFICIT DISORDERS OR DISTURBING BEHAVIOUR - ADHD, ADD (no hyperactivity) conduct disorder ODD (oppositional) oppositional behaviour with provocation disturbing behaviour NS DISORDERS RELATED TO SHPINCTER CONTROL - enuresis, encopresis OTHER: attachment anxiety, selective mutism, stereotypical movements (automutilation) ADHD 6 SYMPTOMS that have to prevail for at least 6month: - Inattention (does not pay attention to details, cannot stay focused - hyperactivity, physical and mental - cannot get his job done, stick to the instructions, gets distracted - difficulties to get organized - jumping from one to the other - impulsivity (emotional, social in class) CLINICAL CASE - ADHD among adults also exists - LET´S DO A CLINICAL CASE AND THEN BRAINSTORM ABOUT IT A word on attachment Theory developed by John Bowlby and Mary Ainsworth. - supposes that for a healthy development, emotional stability and being able to create healthy relationships a stable attachment to a care figure (ideally the mother) is primordial. https://www.youtube.com/watch?v=WjOow WxOXCg 2. Delirium, dementia, amnesia, cognitive disorders Delirium: due to medical condition, intoxication or detoxication, NS. Change of conscience, cognitive functioning, disorganized language, memory deficit, can last several hours, leave come back. Dementia: Alzheimer type, Parkinson, Huntington after stroke, other medical conditions, substance abuse. Deficit of cognitive functions, change of memory (cannot remember or cannot memorize), alteration of language, motricity, change of executive functions, cannot recognize objects, faces, change of behaviour. Amnesia: alteration of memory (cannot remember anything or only puzzlepieces of the past), incapacity to learn new information. Transitory or chronic. Other cognitive troubles: Alzheimer versus Parkinson 3. Mental disorders due to general medical states - Catatonic disorder due to…(not due to mental disease) (immobility, negativity, strange movements, echolalia, echopraxia) - modification of personality due to… - mental disorder due to… Specifications: - lability, disinhibition, aggressivity, apathy, paranoia, combined, non specified 4. Mental disorders linked to substance abuse ALCOHOL - dependency (…), abuse, intoxication, detoxication, delirium, dementia, amnesia, anxiety, sexual dysfunction, sleeping troubles, psychotic symptoms, mood swings. Let´s define dependency: unadapted substance use that leads to alteration of functions, clinically significant suffering, presence of 3 or more symptoms: 1. 2. 3. 4. 5. tolerance (the need of higher and higher doses of the substance to obtain the desired effect). withdrawal symptoms when substance is not used permanent present desire to lower the consumption of the substance social, professional activities affected by substance use longterm, excessive use of substance 4. Mental disorders linked to substance abuse Other substances: “I take ONLY cocaine” the sexy drug - amphetamines: euphoria, extreme emotions, hypervigilance, sensitivity or anger, tension - caffeine: nervousness, excitation, insomnia - cannabis: alteration of coordination, euphoria or anxiety, slow down of time, alteration of judgement - cocaine: tachycardie, hyperawakeness, psychomotor agitation, convulsions - hallucinogens: depersonalization, derealisation, illusions, hallucinations -opiates: somnolence, coma, alteration of memory, attention, behaviour https://www.youtube.com/watch?v=vxI7PTVRf hQ 5. Schizophrenia and psychotic disorders - very serious mental condition, abnormal behaviour, affects emotions and cognition, lack of motivation and engagement in social interaction. IS NOT MULTIPLE OR SPLIT PERSONALITY POSITIVE SYMPTOMS hallucinations (auditory, visual, sensory) delusional or disorganized thinking agitated behaviour TYPES NEGATIVE SYMPTOMS apathy, flat effect, robotic speech lack of emotion, anhedonia lack of social engagement - paranoid disorganized (hebephrenic) catatonic undifferentiated 5. SCHIZOPRHENIA and psychotic disorders What is it CATATONIC SCHIZOPHRENIA https://www.youtube.com/watch?v=yhwbkB3iYM https://www.youtube.com/watch?v=IehtMYl OuIk - look for negative or positive symptoms while watching these videos PARANOID SCHIZOPHRENIA https://www.youtube.com/watch?v=PcMJ98 sNZOk Differential diagnosis schizophrenia of Other psychotic disorders SCHIZOPHRENIFORM DISORDER – takes at least 1month but less than 6 SCHIZO-AFFECTIVE DISORDER – maniac or depressive episode, delusions present for at least 2weeks DELUSIONAL DISORDER – delusions without alteration of functioning BRIEF PSYCHOSIS EPISODE (DISORDER) – due to life stress, disapears usually MOOD DISORDER WITH PSYCHOSIS PSYCHOTIC DISORDER DUE TO SUBSTANCE ABUSE OR MEDICAL CONDITION 6. Mood disorders DEPRESSION - major depressive disorder isolated episode recurrent depression Dysthemia/anhedonia differential diagnostic must be done carefully!!! - exclude schizo-affective disorder, schizophrenia, delusional disorder - track for maniac, hypomaniac or mixted episodes BRAINSTORM ON DEPRESSION - DEPRESSION IS ON THE RISE – WHY? ◦ Find actual health data about depression ◦ What could be the causes for the rise? ◦ Factors? ◦ Could it be that it is “overdiagnosed”? ◦ In which cases and how come? ◦ WHEN CAN WE ACTUALLY DIAGNOSE DEPRESSION? DEPRESSION CLINICAL DATA SPECIFICATIONS: - mild, average, severe, with or without psychotic characteristics - isolated, chronical - catatonic, melancholic, atypic, post partum Differential diagnostic: adolescent, instable feelings hormonal changes (taking the pill), menopausal changes CRITERIA OF EVALUATION: - frequency of depressive humour (episode at least 2weeks, major one year or more) - feelings of guilt (unjustified) - low selfesteem - basic needs altered to which extent? - presence of suicidal thoughts - evaluate depression and reactive depression (reaction to some life event) Bipolar disorder - at least one affective episode (maniac or depressive) has already been diagnosed in the past - mainly diagnosed during the age of 20 to 30 but can also be present among children attention to periods of unstable hormons! SEVERAL FACTORS CAN BE THE CAUSE - family events, infectious diseases, post partum start, hereditary, metabolism 7. Anxiety disorders - panic disorder panic with or without agoraphobia specific phobias OCD PTSD generalized anxiety disorder GAD intense stress anxiety due to… Types of phobia SIGNIFICANT PHOBIAS FOR COMPLEX PSYCHOTHERAPY - fear fear fear fear fear fear of of of of of of commitment abandonment separation loss death social interaction/people 8. Somatoform disorders - main criteria are repeated expressions of physical symptoms and the need (excessive) for physical examination, consultation with specialists – examinations reveal negative - physical symptoms are present but cannot explain the patient´s distress - start of symptoms can be related to a life situation or conflict – patient refuses to accept psychological cause of problems ◦ DIFFERENTIAL DIAGNOSTIC: histrionic personality, schizophrenia, GAD, depressive episode TRANSFER OF NEUROTIC SYMPTOMS INTO SOMATIC SYMPTOMS – beginning of 19th century, Freud ◦ Somatisation disorder ◦ Hypochondriac disorder ◦ Fear of physical dysmorphia – preoccupation by a self defined physical default 9. Dissociative disorders DISSOCIATIVE DISORDERS DISSOCIATIVE AMNESIA DISSOCIATIVE FUGUE DEPERSONALIZATION DISSOCIATIVE IDENTITY DISORDER Loss of memory of a traumatic event Loss of identity, escape to another reality Feeling of being detached Two or more distinct personalities 9. Dissociative disorders MAIN CHARACTERISTIC: FACTORS: - partial or total absence of normal integration between memories of the past, consciousness of identity, actual emotions and capability to control ones body - can occur promptly with no trigger - can last for several weeks, rarely years - previously referred to as hysteria (Charcot, Freud, Breuer) - psychogenic origin - traumatic life events, toxic or unfunctional relationships EMOTIONS: - lack of self-realization and attention - unresolved family issues, relations 10. Disorders of sexual identity SEXUAL DYSFUNCTIONS - diminution of sexual desire - aversion towards sexuality - excitation, erection disorder - orgasm disorder – man/woman - praecox erection - dyspareunia, vaginism - sexual disorder due to general medical condition PARAPHILIA, PARAPHILIC DISORDERS ❑Exhibitionism ❑Fetichism ❑Paedophilia ❑Masochism/sadism ❑Voyeurism ❑frotteurism MIND LEGAL ASPECTS OF OBTAINED INFORMATION IN THERAPY DISORDERS OF SEXUAL IDENTITY SEXUAL IDENTITY DISORDER Intense and persistent identification with the other sex or the desire to obtain cultural benefits attributed to the other gender. ◦ Among children ◦ Among adolescents GENDER DYSPHORIA ◦ Discomfort and unhappiness of one´s gender 11. Eating disorders, sleeping disorders EATING DISORDERS Anorexia nervosa Bulimia nervosa Binge eating disorder (others, non classified in DSM: Pica (eating non alimentary substances) Rumination (swallowing, regurgitating, chewing again) Avoidant food intake CAUSES: ➢personality traits such as impulsivity, perfectionism, neuroticism ➢https://www.youtube.com/watch?v=QqNI9aRUb3k - Diana 11. Eating disorders, sleeping disorders FIRST DEGREE SLEEPING DISORDERS DYSSOMNIAS - primary insomnia – difficulty falling asleep - primary hypersomnia – more than 8-10h - narcolepsia – excessive daytime sleepiness - sleeping disorder due to respiratory factors - sleeping disorder due to cardiac factors PARASOMNIA - nightmares - night terrors - somnambulia - parasomnia NS 3 CATEGORIES of personality disorder Paranoid, distrustful nature, doubts loyalty, easily offended GROUP A – BIZARRE AND EXCENTRIC ❑paranoic personalities ❑ schizoid personalities ❑ schizotypal personalities - Defense mecanisms applied : imagination, projection. Way of thinking shows psychotic traits, vulnerability and stress cause cognitive desorganisation Negative symptoms of schizophrenia Schizotypal, distorted reality, odd ideas, eccentric, unusual experiences, superstition, religiosity Schizoid, socially withdrawn, uninterested in others, solitary, unaffected by praise or criticism 3 CATEGORIES of personality disorder GROUP B – DRAMATIC, UNPREDICTABLE AND EMOTIVE ❑ histrionic personalities ❑ narcistic personalities ❑ antisocial personalities ❑ border line personalities - Defense mecanisms applied: denial, dissociation, clivage, acting out. Mood swings, dramatization, instability, emotivity. GROUP C – ANXIOUS, FEARFUL ❑ DEPENDANT PERSONALITY ❑ AVOIDANT PERSONALITY ❑ OCD - Defense mecanisms: withdrawal dominant, isolation, avoidance, passive aggressivity, hypochondric, anxiety, mood swings, doubtful 12. Personality disorders – breakout rooms OCD https://www.youtube.com/watch?v=_GT-qKTp9L0 Borderline https://www.youtube.com/watch?v=rZdjbLFPr5k Antisocial https://www.youtube.com/watch?v=y6VLuieUsDI Schizotypal, schizoid, schizophrenia https://www.youtube.com/watch?v=Nt9A8OTb-Is The triangle of our psychological functioning What is personality? Thoughts Behaviours Emotions 13. Adjustment disorders Adjustment DISORDER * with depression * depressive humour * with anxiety * with conduct disorder * with emotional disturbances Maladaptive reaction to life stress, acculturation, change of work/school within 3 month onset of the stressor. Subjective distress or emotional disturbance. •CLINICAL CASE: CHILDREN OF DIPLOMATS, EXPATS •Depending on culture, personality and coping mecanisms 14. Other disorders worth clinical examination - relational problems - neglect or abuse - simulation - professional problem - acculturation problems - problem connected with life period - religious issues - problems related to modern lifestyle (screen, workaholism, consumerism) Models of psychologic disorders BEHAVIORAL MODEL BIOMEDICINAL MODEL • First half of 19th century (Pinel, Tuke) moral model – punishment for bad behaviour. • CURRENTLY: learned disturbed behaviour – focus on restructuring the behaviour – thanks to +feedback (Pavlov). • Considers the person as sick, attributes a diagnosis related to a brain dysfunction. • Treatment consists of psychiatric medication, hospitalization. • Patriarchal approach – the doctor knows • REPLACE THE MORAL MODEL BIOPSYCHOSOCIAL MODEL • Introduced in the 1970ties (Engel) • Attributed mainly in psychosomatic diseases • Enriched by the dimensions of: • Psychological and social aspects in etiology and pathogenesis • Therapy, prevention and rehabilitation Models of psychologic disorders PSYCHOANALYTIC MODEL • Psychiatric disorder as a result of unconscious conflict • Uniqueness of disorder – INDIVIDUAL ETIOLOGY • Distinction from the parternalistic model INTERACTIVE FAMILY MODEL • Based on examination of the communication in the family of the patient • Supposed factor: defective family functions, where one individual is catalogued as psychologically ill • SYSTEMIC APPROACHES Other models • More recent • Social model • Conspirative model (Chromý) • Psychedelic modeltranspersonal psychology (Stanislav Grof) ROLE OF PSYCHOLOGIST * to be there * listen emphatically * give the support, understanding and encouragement that the person needs at a particular moment in his life or that he has lacked for a long time – substitute * play roles – saying * but also help to structure, sometimes the need to be directive! * you are not a friend but a expert in your field! Diagnostic interview versus Therapy Focused on gaining as much data and information as possible from the patient. Focused on letting the patient express, name, find his issues himself and consciously process emotions. ➢let patient explain what he is struggling with in his own words ➢ patient names and you act like a mirror ➢move on to directive questions that will guide you in your differential diagnostic ➢ help to analyse and concretise but stand away from interpretation ➢Establish diagnostic hypothesis and treatment plan – recommend cooperation with other specialists! ➢ give patient space to access his own unconscious information through cognitions or emotions BRAINSTORM – which therapies do you know? https://www.youtube.com/watch?v=M1iev0zph3o Psychoanalytic currents – 1 - Freud SIGMUND FREUD 1856-1939 - criticized but broadly used, repeated, cited, build upon - first structured approach towards mental illness, explanation of intrapsychic dynamics - ahead of his time where lobotomy was still considered a valid practice Psychoanalytic currents – 1 - Freud BASIC THEORY – first matter (Lit.: Freud, interpretation of dreams) - still plays an important role In psychotherapy, especially In trauma therapy, in projective METAPSYCHIC Unconscious - primary Tests (ROR, TAT) - capacity to reveal secondary mecanisms Preconscious - primary Conscious - secondary Psychoanalytic currents – 1 - Freud BASIC THEORY – second matter – the identities • SUPEREGO The id – reserve of pulsions The Super ego – parents, norms, societal constraints EGO ID The ego – myself, my personality, what I reveal in the real world Freud was persuaded that the super ego is represented by tension The father – contested by Melanie Klein In some theories you will find the distinction between the father and the mother super ego. Psychoanalytic currents – 1 - Freud BASIC THEORY – the defence mechanisms (later redefined by several authors, Peary) - extremely useful in everyday psychological practice to help the patient access deeper contents/ blocks and trauma - when the therapist is able to define and name the defence mechanism CAREFULLY and in the right time – this is actually the foundation of a good psychotherapy!!! - to be distinguished from dissociation! https://www.youtube.com/watch?v=9bHm8_kq3DA Psychoanalytic currents – 1 - Freud CODING AND THE FREUD DEFINITIONS : E (espace psychique, psychic space) E = (I, O, P) I: the pulsions, i1: sexual pulsion (Sexualtrieb), i2: life pulsion (Lebenstrieb), i3: the instinct of death (Todestrieb – from Greek mythology Thanatos), i4: the instinct of autoconservation (Selbsterhaltungstrieb), i5: the pulsion of power (Bemächtigungstrieb) – beginning of love stories (adolescence), i6: the pulsion of destruction (personality disorder), i7: pulsion of aggression, i8: the pulsion of cannibalism (still present in sexual practice), i9: the pulsion of knowledge, i10: the pulsion of the ego O: ontogenic forces, parents, siblings, religion, taboos, holding back, controlling oneself, forces of disgust and shame P: phylogenic forces, the interdiction of the incest, prescolarity and scolarity, police, justice, codes, norms, repressive economy The forces of “encrage”, socialization, should be applied in the family (ontogenic forces), if they are not the phylogenic forces must take the responsibility. Reference to psychosis and neurosis If rules are too much repressive, strict families, religious taboos, effort based education, forces cannot be sublimed. NEUROSIS – pulsions cannot be expressed, they are trapped -OCD - superobedience ……….ontogeneties …………. …………. SUBLIMATION If rules are not respected the phylogenetic forces must “frame” the individual. Psychosis, antisocial behavior: the stress tensions are not working, absence of “framing” can be dangerous! …….ontogeneties ………………………………… PULSIONS ………………. NO SUBLIMATION PULSIONS 1. Psychoanalytic currents: JUNG CARL GUSTAV JUNG (1875 – 1961) - swiss doctor and psychotherapist, founder of analytic psychotherapy - met with Freud in 1907 - enlarged the Freudian perspective with: ◦ Understanding psychology in relation to mythology, religion ◦ Art, symbols, archetypes ◦ Dreams and the connection to the unconscious ◦ Definition of the term of collective unconscious JUNGIAN THERAPY - PARTICULAR WAY OF THERAPY – psychodynamic and psychoanalytic but not only - helps the patient to understand his experience, feelings and dreams in the context of the Jungian theory - abstract, mythologic, philosophic theory - it implies the knowledge of this theory from both sides - Jung believed that all symptoms (anxiety, depression etc.) are linked to an issue of the ego – some message of the unconscious – not always the case (environmental, biological base too) JUNG VERSUS FREUD Jung broke with Freud about the theory of personality and the theory of the collective unconscious. Jung prepared the ground for the humanistic currents of psychology. They also differed in their concept of perception of the different parts of a personality: LIBIDO: for Freud psychic energy for sexual gratification, for JUNG a source that motivates certain behaviours. CONSCIOUSNESS: Freud: repressed desires, JUNG: repressed memories and our ancestral past. BEHAVIOUR: Freud: past experiences and trauma, JUNG past experiences in addition to future aspirations. EGO: Freud: the Ego is a mediator of the ID, Jung:how one sees oneself, selfregulation https://www.youtube.com/watch?v=dL0TvdiVN38 1. Psychoanalytic current: LACAN - French psychoanalytic - not that known in anglosaxon environment because of difficulty to translate his “neologismes” Jacques Lacan (1901-1981) - called “surrealistic psychoanalysis” inspired by artists (André Breton, Mallarmé) - was using automatic techniques that were supposed to enable immediate access to unconscious content MOST FAMOUS CONCEPTS: - the mirror phase - our own loneliness and nonunderstanding - his approach to love and partnership https://www.youtube.com/watch?v=5OnhOXq7m4w Lacan as a superstar 18:50 https://www.youtube.com/watch?v=byNaVrE0KrA 2. Client centred therapy : Rogers 1951 – Carl Rogers, Client centered therapy 1968 – Dunod, the development of a person CARL ROGERS (1902-1987) - psychotherapist that defended human value in alterity and the respect that it deserves - studied clincal psychopedagogics at NY University - therapist experience for over 30years CLIENT CENTERED THERAPY ELABORATION OF A THEORY OF - psychotherapy personality interpersonal relations the maxima functionality BASIS WHAT DOES EMPATIC ATTITUDE ACTUALLY MEAN? - dive into the subjective universe of the patient - learn the cognitive and emotional aspects of his experiencing of others - verbal and non verbal communication - empathic attitude of the therapist GIVE SPACE AND INSCITE TO THE GROWTH PROCESS. WHAT IS EMPATHY and what it is not? NOT - feeling for the patient - taking on the symptoms of the patient - IDENTIFICATION WITH THE PATIENT YES - therapeutic empathy takes place in the context of separation!!! - in the individuality of 2 individuals that communicate - I AM NOT THE OTHER AND THE OTHER IS NOT ME - learn to understand the patient´s reality from his perspective not from mine – in a sense of normality https://www.youtube.com/watch?v=iMi7uY83z-U – the power of listening - Rogers Principles of client centered therapy NON DIRECTIVITY - don´t show off – unlike the patriarchal perspective ATTITUDE OF POSITIVE UNCONDITIONAL UNDERSTANDING AND CONSIDERATION ❖ considering the other as capable ➢ absence of judgement ❖ therapist is just there to help him find his way ➢ absence of interventional directivity ❖ GOODWILLED NEUTRALITY ➢ THE MORE THE THERAPIST SEEMS COMPETENT, THE MORE THE PATIENT CANNOT ACTIVATE HIS COMPETENCE ➢Does not mean indifference!!! ❖ bring resources to consciousness ❖ enable to understand the origin of difficulties ❖ find capability to resolve them 5 imperatives of Rogers Attitude of receptivity, welcoming, like you welcome a guest –not initiative Focus on what the person has lived, experienced and not only on the facts – how you feel – we are not journalists Respect the person and show that you really care and consider, show that you respect his way of life and his “filter” Be interested in the person and not in the problem itself – the existential problem – the person not the pathology is the center Facilitate communication without making revelations. One should not listen to the patient in order to classify his speech into preestablished categories. HOW? - ECHO REFORMULTATION echo response, simple repetition can also come from the psychologist: is it hard? Yes it is hard for me… - ECHO REFLECTION reflect the communication of the patient retake his idea and reformulate in another way thinking with the client - REFORMULATION CLARIFICATION So if I understand you correctly?... It is not only something simple it is.... According to you? HOW? - RERORMULATION RESUME focuses on the essential that the client said and explains it to him – take notes supposes that you have captured the essential that the client wanted to say reformulates what is essential for the client himself SPACE FOR REVELATIONS ◦ PROPOSE TO THE CLIENT A REVELATION OF LATENT CONTENT ◦ SUPPOSED EXPLICATIONS OF TRUTH ABOUT HIS “UNCONSCIOUS MECANISMS” ◦ https://www.youtube.com/watch?v=r_yGBnZXFFA - Rogers ◦ https://www.youtube.com/watch?v=4wTVbzvBH0k – role play 3. Gestalt therapy USES REFORMULATION AS A RE-INVERSION OF THE RELATION FIGURE AND BACKGROUND - the white, image of a vase, the black – profile - the figure is detaching from the background APPEARING OF LATENT CONTENT https://www.youtube.com/watch?v=GBl14hIqDwc - explanation GESTALT THERAPY PRINCIPLES https://www.youtube.com/watch?v=yJHpnIKM7D4 – the empty chair technique 4. Cognitive -Behavioural therapy - CBT - type of psychotherapy that helps people learn how to identify and change destructive or disturbing thought patterns ◦ Overthinking ◦ Black and white thinking ◦ Catastrophizing ◦ Focusing on negative content ◦ Old, toxic believes ◦ TRIANGLE EMOTIONS, THOUGTHS, BEHAVIORS Old believes, challenges, new believes Old believes and situations Challenges New believes Other therapeutic interventions – when to use what - techniques of mindfulness - systemic therapy - couple therapy - group therapy - playtherapy - sandtray therapy - art therapy, clay therapy, dance therapy