PSYCHOTHERAPY = talking therapy
 Expressive = patient does most of talking (Psychodynamic psychotherapy)
 Directive = therapist does most of the talking (Behaviour therapy)
 CBT lies in between
Treatment of the psyche (the mind) by psychological means (talking)
 Past & present experiemces and relationships
 Relationship with therapist
o Transference – unconscious reenactment of early interpersonal patterns in
relationship with therapist
o Countertransference – therapist’s transference to patient i.e. BPD patients
o Resistance – elements in the patient which oppose treatment
WHAT TO USE WHEN?
ANXIETY DISORDER
Panic disorder = CBT
Agoraphobia = GE + CBT
OCD = GE + response prevention + CBT
PTSD = GE to memories/thoughs
Social and other phobias = GE + CBT
DEPRESSIVE DISORDERS
Non melancholic = CBT/ACT and Activity scheduling (behaviour therapy)
Relapse prevention of non melancholic = mindfulness based CBT
Bipolar = Psychoeducation + Supportive psychotherapy + Interpersonal and social rhythms
psychotherapy
SUBSTANCE ABUSE DISORDER = 12 step self help (AA) + CBT and ACT
Psychodynamic PT for some due to underlying issues
PERSONALITY
Borderline = DBT or ACT
Recurrent relationship problems = Psychodynamic psychotherapy
Complex trauma/Abuse = Psychodynamic psychotherapy/ACT
PSYCHOSIS = Family therapy + Psychoeducation
CBT/ACT for resistant symptoms
Case management
SITUATIONS
Loss = Grief therapy
Crisis = Crisis therapy
Relationships = Relationship therapy
Couples = Couple therapy
Role transitions/disputes = Interpersonal therapy
Skill deficient = role play + social skill train
EATING DISORDER = Maudsley FBT + CBT
Psychodynamic Psychotherapy = Part of unconscious and consciousness are in dynamic/moving flux
 Feelings -> Thoughts -> Behaviour
 Feeling come from unconscious impulses and drives developed during early childhood
before we can put words to experiences
 Therapy makes unconscious conscious and lessens associated emotional pain
Look at:
 Symptoms = go to the root
 Recent events
 Events in room = how they are responding
 Past events which formed personality
Involves = can be individual or group
 Free association
 Dreams
 Transference = feelings patient brings into the room
 Identifying psychological defences
Help patient improve insight; used in depression, anorexia nervosa and personality
Psychoanalysis (exploratory psychotherapy) = Developed by Feud, goal is self-revelation and insight
 Exploration of the meaning of early experiences and affect emotions/ behavior presently
 Relationship troubles from relationship with mother
 Time intensive
 Need to be able to think abstractly – intelligent, willing to change
 For individuals who can tolerate ambiguity in explorations of feelings and treatment
Supportive Psychotherapy = don’t go deep just listen, clarify and occasionally confront
 Goal is not insight but reduction of anxiety
 Strengthen healthy defense mechanisms to assist in day-to-day functioning
 Techniques include: enhancing self-esteem, clarification, confrontation, rationalization,
reframing, encouragement, rehearsal/anticipation, de-catastrophizing, allowing ”venting” of
frustrations
Interpersonal therapy = focus on role transition and role disputes
 Short-term treatment looking at relationship patterns and teaching coping mechanisms
 Good for depression, bipolar
 Focus on personal social roles and relationships to help deal with current problems
Defenses = a dead dog
 Denial = still put out dinner
 Repression = can’t remember dogs name
 Displacement = hard day at work so kick another dog
 Intellectualization = unemotionally describes detail of death
 Rationalization = Paul wants a dog but wife doesn’t. Paul adopts her reasoning
 Humor = jokes about dead dogs
 Projection = harry can’t run so makes dog run instead
 Reaction formation = Janine loves her old dog but says they should get ride of him when she
sees him – respond with exact opposite of feelings
 Acting out = kills dog because parents like sister
Behavior Therapy = do first, feel good after
 Direct patient to do sometime – aim to improve symptoms not underlying cause
 Exposure and relaxation training
Useful in ANXIETY/SUBSTANCE ABUSE
Modification of internal & external events which precipitate or maintain emotional distress
 Graded exposure
 Activity scheduling
 Systematic desensitization
 Flooding – confronting feared stimulus for prolonged periods
 Positive reinforcement
 Negative reinforcement
 Extinction – causing a behaviour to diminish by not rewarding it
 Punishment (aversion therapy)
Biofeedback = understand physiological functions – aim to manipulate
 For incontinence, stress, PTSD, GAD, migraine = conditions that have autonomic response
Cognitive Therapy= moods and feelings are influences by one’s thoughts
 Psychiatric disturbances are frequently caused by habitual errors in thinking
 Goal is to help patient become aware of automatic thoughts and correct assumptions with
a more balanced view
 Useful for depression, anxiety disorders, self-esteem problems
 Use of this therapy presupposes a significant level of functioning
 Utilises “thought journal” to determine when/where thoughts occur and what underlying
error in thinking may be
Cognitive Behaviour Therapy (CBT) = thoughts lead to behavior so change both – change thinking
 Short term approach for emotional, behavioural and psych disorders
 Combines cognitive & behaviour therapies to teach patient to weaken connections between
thinking patterns, habitual behaviours and mood/anxiety problems
Elements: education, relaxation exercises, coping skills training, stress management, assertiveness
Good Rx for depression/anxiety (mild – moderate); also eating disorders, medication conition
 NEED SELF-MOTIVATED INDIVIDUALS
Mindfulness Based Cognitive Therapy – depression, bipolar, PTSD, anxiety
 Don’t change your thinking, change relationship to thoughts and feeling
 Paying attention to own thoughts, defusing them and engaging with reality and curiosity
 **reduces rate of melancholic depression relapse
Acceptance and Commitment Therapy = Mindfulness without meditation
Motivational Interviewing = Identify and change maladaptive behaviors (Quit smoking)
 Match strategies implemented to ones’ readiness to change
 Derived from CBT & readiness-to-change models
Dialectical Behaviour Therapy
 Therapy that combines CBT technique with approaches from meditation
 Effective for borderline personality disorder
 4 types of skills: mindfulness, emotion regulation, interspersonal effectiveness and distress
tolerance
 Individual & group therapy settings
Group psychotherapy
 Goals: self-understanding, acceptance, social skills
 Creates a microcosm of society
Family Therapy = Family system considered more influential than individual
 Focuses on: here and now, reestablishing parental authority, strengthening normal
boundaries and rearranging alliances
Hypnosis = Looks for distortions in family systems
Case Management = monitor mental state, risk assessment, compliance and side effects
 Report back to treating team and mobilise help as needed
 Good for chronically and severely ill with social issues = Schizophrenia, bipolar, ABI
CATT = risk + mental illness
Social work = finances, accommodation, vocational