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Psychological Psychological therapies therapies Dr Chris Williams Dr Chris Williams

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Page 1: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Psychological therapiesPsychological therapiesDr Chris WilliamsDr Chris Williams

Page 2: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Today’s objectives. You will:Today’s objectives. You will:

Gain an overview of the range of psychological therapies

Look at the four main models of psychological treatments used in the NHS.

Think about how a patient could be thought about in each of the models.

Page 3: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Task - at endTask - at end

Split into pairs.

How would you approach working with this depressed man in these four different types of therapy?– What would be different?– What would be similar?

Page 4: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Psychotherapy: Group Psychotherapy: Group discussiondiscussion

What goes through your mind when you think about the term “psychotherapy”?

Would you want it yourself?Would you tell others you were having/had received it?

How would this compare with say an antibiotic?

Page 5: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

PsychotherapyPsychotherapy

Is a blanket term for those treatments which offer psychological rather than physical or social interventions.

Those usually available on the NHS include CBT, Psychodynamic, Counselling, Family Therapy.

Page 6: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Key documentKey document

www.dh.give.uk and search for title

www.nice.org.uk – depression, anxiety, PTSD, self-harm, Eating disorders

SIGN has some materials

Page 7: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

The CBT modelThe CBT model

Aims to reduce symptoms by changing specific behaviours and thoughts which maintain specific symptoms.

Name associated with it is Professor Aaron Beck.

Page 8: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

CBT: a simple messageCBT: a simple message

What you think affects how you feelWhat you think affects how you feel

Thinking Feelings

Thinking Behaviour

What you think affects what you doWhat you think affects what you do

Page 9: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

The CBT modelThe CBT model

In anxiety and depression: Thinking changes characteristically:

extreme and unhelpful

e.g. worthlessness, guilt, incompetence, failure, hopelessness

Behaviour changes characteristically:

- reduced activity- avoidance

- unhelpful behaviours

Page 10: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

CBT treatmentCBT treatment

1). Alter unhelpful/extreme thinking Not the same as positive thinking Identify/test out extreme thoughts Balanced conclusion based on all the evidence

2). Alter unhelpful behaviours

Page 11: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Experiment:Experiment:(in pairs – 5 minutes)(in pairs – 5 minutes)

Q. If you talk to someone who is depressed/fed up, what do do they:– Feel emotionally– Feel physically– Say– Do/not do– What life situations do they often face?

– Use the language they would use

Feedback timeFeedback time

Page 12: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Life Situation, relationship and Practical Problems

Altered Thinking

Altered Feelings Altered Physical Symptoms

Altered Behaviour

The Five Areas Assessment ModelThe Five Areas Assessment Model

Page 13: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Life Situation, relationship and Practical Problems£2500 debt, arguments with husband

ThinkingI’m useless,

Everything’s wrong

FeelingsLow, anxious,

angry

Physical Sleep + appetite red. Weight loss

BehaviourArgue with

husband, stay in

A Five Areas Case Summary -1A Five Areas Case Summary -1

Page 14: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Unhelpful thinking styles - 1Unhelpful thinking styles - 1Unhelpful thinking style Typical thoughts

Bias against myself Overlook my strengths

Focus on my weaknesses

Downplay my achievements

My own worst critic

Putting a negative slant on things

(negative mental filter)

See things through dark tinted glasses

Put a negative slant on things

Having a negative view of the future

Jump to the very worst conclusions

Catastrophising

Make negative predictions about the future

Predict that things will go wrong

Page 15: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Unhelpful thinking styles - 2Unhelpful thinking styles - 2Unhelpful thinking style Typical thoughts

Mind-reading

Negative view of how others see me

Mind-read what others think of me

Assume that others don’t like me/judge me badly

Bearing all responsibility Take things to heart

Take the blame ++

Feel overly responsible

Make extreme statements/rules

Use the words “must”, “should”, “ought” and “always”/”never” a lot.

High standards ++

Page 16: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Task: (in pairs)Task: (in pairs)Q. What is your first thought?Q. What is your first thought?

Scenario: You travel to meet your friend at 10am, but they

don’t turn up.

You are giving a talk and you notice someone in the audience yawning.

You go to do some last minute photocopying - and the machine jams halfway through. It needs the engineer.

Page 17: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Key Point:Key Point:

These thinking styles are normal/everyday occurrences

In anxiety and depression they are:Experienced more frequently - unhelpful

thoughts “pop” into mind ++Harder to challenge and believed moreHelpful/balanced thoughts are crowded out

Page 18: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

The impact of extreme The impact of extreme thoughtsthoughts

What is unhelpful about extreme thoughts1. “There’s nothing I can do”2. “She hates me”3. “I won’t enjoy it”

Q: If I believed these thoughts, how would I feel?

Q: If I believed these thoughts, what would I do differently

Page 19: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

How does CBT work?How does CBT work?

Identifies – and then challenges extreme and unhelpful thoughts

Gathers evidence for and against the thought

Come up with a balanced conclusionOvercome reduced activity, avoidance and

unhelpful behaviours.More next session

Page 20: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Psychodynamic psychotherapyPsychodynamic psychotherapyExploratory approach to help the patient

develop insight into why they are distressed/ causing distress or suffering from symptoms.

Prominence given to the unconscious.Freud is the father of this approachLater developments by Jung, Adler, Klein,

Anna Freud, Winnicott - different schools.

Page 21: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Psychodynamic psychotherapyPsychodynamic psychotherapy

Much more of an emphasis on the past, particularly on childhood events

It emphasises the importance of mental representations of early life experiences in the present & the impact they have on current relationships.

Page 22: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Psychodynamic psychotherapyPsychodynamic psychotherapy

Exploratory and less directive.Must make links between past and present.Increase patient’s understanding that their

current patterns of relating to others have their origins in past (childhood).

Tends to last for longer time (can be years) although recent shorter therapy advocated.

Page 23: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Psychodynamic psychotherapyPsychodynamic psychotherapy

Freud was a major figure in 20th Century thought.

Neurologist.Outlined three theories to account for

mental processes.Topographical, structural, developmental.

Page 24: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Psychodynamic psychotherapyPsychodynamic psychotherapy

Topographical theory & unconscious mind.– Conscious and unconscious mind– Unconscious thoughts and feelings which

influence behaviour.– Thought may be unconscious because it is

consciously suppressed or unconsciously repressed.

Page 25: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Psychodynamic psychotherapyPsychodynamic psychotherapy

Structural Theory.– Mind can be conceptualised as having three

parts - the Superego, ego & id.

– Superego - what is thought of as conscience.– Ego - rational part of your mind.– Id - contains the instincts of sexuality &

aggression

Page 26: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Psychodynamic psychotherapyPsychodynamic psychotherapy

Developmental Model - series of stages.– Oral - first year.– Anal - 2nd, 3rd years.– Genital - 3-5th year– Theorised that problems occurred at these times

cause characteristic mental symptoms later on e.g. OCD and anal phase.

Page 27: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Psychodynamic psychotherapyPsychodynamic psychotherapy

Conflict - may also be conscious or unconscious.

E.g. Mrs B wants to have Mother to live with her - but postpones moves due to worsening back pain.

Unconscious conflict may lead to the development of symptoms

Page 28: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Psychodynamic PsychotherapyPsychodynamic Psychotherapy

Defence mechanisms - protects us from emotional distress by preventing the unconscious becoming conscious.

Can be on a spectrum from conscious to unconscious.

Everyone uses them - not necessarily pathological indeed we need them!

Page 29: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Psychodynamic PsychotherapyPsychodynamic Psychotherapy

Defence mechanisms - major one is repression.

E.g. choosing not to remember you have an exam next week.

Reaction formation, denial, rationalisation, projection.

Page 30: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Psychodynamic Psychotherapy: Psychodynamic Psychotherapy: what does it look like?what does it look like?

Can be individual or group. Uses therapeutic relationship as with all other

models of psychotherapy. But…uses the relationship to explore the

defences, conflicts, and the unconscious. Central to this is how the current relationship

reflects past relationships in the patient’s life – can also include interpretation of dreams

Lie/sit down e.g. on a couch or bed– long silences

Page 31: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Psychodynamic PsychotherapyPsychodynamic Psychotherapy

Working alliance

Transference: how the patient reacts to you

Counter-transference: how we react to the patient

Page 32: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

CounsellingCounselling

Aims to offer a supportive, non-directive relationship in which the patient can work out solutions to personal difficulties.

Not intended to make the patient confront their anxieties.

Really to strengthen existing coping strategies. Mild to moderate psychological problems Life crises & problem solving (HIV, Cancer,

bereavement in NHS).

Page 33: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

CounsellingCounselling

Most common approach.Common in general practice in the UK.Anyone can call themselves a ‘counsellor’.Common in voluntary sector.Focuses on warmth, empathy and

genuinenessAvoids providing “answers”

Page 34: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Family therapyFamily therapy

Aims to see if and how the problem of the identified patient is maintained by the needs of the family.

A number of schools (Systemic).

Page 35: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Family therapyFamily therapy Usually in NHS used for childhood problems

where one or more children in the family are showing emotional or behavioural difficulties..

Uses concept of the ‘System’: the system is set up to be self-maintaining and resists change (good or bad)

System says that lots of interactions within the family all causing the ‘picture’ in the individual.

Page 36: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Case exampleCase example

Cameron is 32 and is depressed. Already on medication from GP. Lives with his mother; he doesn’t work. Witnessed alcoholic father/ domestic abuse Now has panic attacks on leaving house Took an overdose of paracetamol. Upset that his sister is leaving for New Zealand.

Page 37: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Task – 5-10 minsTask – 5-10 mins

Split into pairs.

How would you approach working with this depressed man in these four different types of therapy?– What would be different?– What would be similar?

Page 38: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

FeedbackFeedback

Any thoughts?How would you approach working with this

depressed man in these four different types of therapy?– What would be different?– What would be similar?

Q. How easy is it to access psychotherapy in the UK?

Page 39: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

Any questionsAny questions

Page 40: Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main

The EndThe End

Next week:Self-help and PsychotherapyProblem solving approachesCBT- focus on reduced activity and

identifying extreme and unhelpful thoughts