psychological therapies dr chris williams todays objectives. you will: gain an overview of the range...
TRANSCRIPT
Psychological therapiesPsychological therapiesDr Chris WilliamsDr Chris Williams
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.
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?
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?
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.
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
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.
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
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
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
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
Life Situation, relationship and Practical Problems
Altered Thinking
Altered Feelings Altered Physical Symptoms
Altered Behaviour
The Five Areas Assessment ModelThe Five Areas Assessment Model
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
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
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 ++
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.
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
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
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
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.
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.
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.
Psychodynamic psychotherapyPsychodynamic psychotherapy
Freud was a major figure in 20th Century thought.
Neurologist.Outlined three theories to account for
mental processes.Topographical, structural, developmental.
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.
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
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.
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
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!
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.
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
Psychodynamic PsychotherapyPsychodynamic Psychotherapy
Working alliance
Transference: how the patient reacts to you
Counter-transference: how we react to the patient
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).
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”
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).
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.
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.
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?
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?
Any questionsAny questions
The EndThe End
Next week:Self-help and PsychotherapyProblem solving approachesCBT- focus on reduced activity and
identifying extreme and unhelpful thoughts