Psychotherapy

Question 1

what is the collaborative relationship ? what is it also known as ? what are the essential characteristics ?

Answer 1

1. a relationship which the individual may use for their own personal growth
2. therapeutic alliance
3. essential characteristics
   - unconditional positive regard
   - empathy
   - congruence

Question 2

how talking therapies work ?

Answer 2

1. collaborative treatment based on relationship between individual and therapist
2. help people understand why they feel as they do
   - reflect with the person (patient) about how past and present life events have affected their relationship styles and patterns of thinking and how these might affect their current mental state
3. use the patient/ therapist relationship as a tool (modelling good communicaiton, setting boudaries, exploring how emotions felt towards the therapist might reflect those in other relationships (anger) teaching skills (problem-solving, communication)
4. the therapist can support the person to change the way they interact and perceive the world, to come to terms with past stresses and cope more effectively

Question 3

types of psychotherapy ?

Answer 3

1. supportive psychotherapy
2. cognitive behavioural therapy (CBT)
3. Psychodynamic psychotherapy
4. cognitive analytic psychotherapy
5. mentalisation therapy
6. Dialetical behavioural therapy (DBT)
7. interpersonal therapy
8. Eye movement desensitization and reprocessing therapy (EMDR)
9. compassion focused therapy

Question 4

Discuss supportive Psychotherapy / counselling

Answer 4

• usually unstructured
• duration varies - often 6-10 sessions
• key points; establishing rapport, reflective listening, facilitating emotional expression, reflection, reassurance
• non-directive problem solving; adjustment disorders, stress, bereavement, mild depression and anxiety, alcohol counselling

Question 5

what is the vicious cycle of anxiety ?

Answer 5

1. thoughts - e.g ‘something terrible will happen and i will not be able to cope’
2. feelings - of apprehension (anxiety or fear something bad or unpleasant will happe), tension, fearfulness
3. physical symptoms
   - tachycardia
   - palpitations
   - flushing
   - dry mouth
   - diarrhea
   - urinary frequency
   - sweating
   - fatigue
   - pain
   - stiffness
   - tremor
   - chest tightness

Question 6

what are common cognitive errors

Answer 6

1. jumping to conclusions
2. filtering out the positive - selective abstraction
3. catastrophizing
4. mind reading
5. fortune telling

Question 7

discuss cognitive behavioural therapy

Answer 7

1. structured focus on what person wants to change
2. explicit - gives person clear strategies
3. focuses on present
4. Duration: time limited 6-12 sessions
5. cognitive: identify automatic negative thoughts and core beliefs
6. behavioural graded exposure
7. homework: observing thoughts and emotions, activity scheduling
8. antecedents behaviour consequences: depression, anxiety, eating disorders, personality disorders, psychotic disorders

Question 8

what is the relationship that forms the basis of cognitive behavioural therapy ?

Answer 8

relationship between feelings, thoughts, and behaviour
- at the center of this is a persons core beliefs on oneself, others, future

Question 9

cognitive component of CBT example

Answer 9

example: im unlovable - jumping to conclusions - anxiety and avoidance

• core negative belief: ‘im unlovable’
• automatic thoughts: ‘ they won’t want me there’ - ‘there is no point going out tonight’ - ‘they will find me boring’ - ‘ she cant mean it when she says something nice about me’
• feelings - anxious - fearful - upset ‘im no good’ ‘im boring’
• action - ‘there is no point going out’ - stop answering the phone, make excuses, avoid friends, act unfriendly when meet again
• longer term - depressed, lonely, withdraw socially, uncomfortable in the group, avoid all contacts

Question 10

discuss behavioural component of CBT

Answer 10

1. Based on;
   - learning theory (change in the behaviour of an organism that is a result of prior experience)
   - Operant conditioning: positive reinforcement or withholding reinforcement (negative reinforcement)
2. Avoiding feared items, places or actions increases anxiety. Challenge this avoidance, the anxiety will rise but then eventually decrease (habituation)

Question 11

techniques in behavioural therapy ?

Answer 11

1. graded exposure
   - graded exposure to a hierarchy of anxiety provoking situations - systemic desensitization - spider phobia
2. Flooding
   - the person is rapidly exposed to the anxiety-provoking stimulus
3. reciprocal inhibition
   - couples the desensitization with a response incompatible with the symptom - relaxation training, mindfulness, calming strategies.
   - example: habit reversal - become aware of habit (avoidance, fear, tension) and develop a competing response (relaxation, calming breathing, mindfulness)
4. Behavioural activation
   - activity scheduling to encourage people to approach the activity they avoid - travel, shopping
5. Behavioural Management therapy - ABC - deconstructing
   - A= antecedents (build up)
   - B = Behaviour (habits)
   - C = consequences (impact)

Question 12

discuss psychoanalysis

Answer 12

• unstructured
• duration - often years
• the unconscious
• free association, dreams, parapraxis (a slip of the tongue or pen, forgetfulness, misplacement of objects, or other error thought to reveal unconscious wishes or attitude)
• transference - patient to therapist
• counter-transference: therapist to patient

Question 13

discuss psychodynamic therapies

Answer 13

• derived from psychoanalysis (freud) but also incorporates the teachings of jung, adler etc
• explores effects of childhood experiences and outside world, including current life problems on the individual
• no detailed examination of the unconsciousness
• free association, transference and counterference
• needs to be modified and adapted for public psychiatric service - CAT

Question 14

discuss cognitive analytic psychotherapy

Answer 14

• a form of psychodynamic psychotherapy
• developed by Anthony Ryle
• Weekly appointments over 16-24 sessions
• focuses on relationship patterns

Question 15

discuss family therapy

Answer 15

• aims to improve the interfamilial relationships
• can be used for treatment of mental illness/ disorder of one person within the family e.g anorexia nervosa, childhood behavioural issues

Question 16

define dialectical

Answer 16

• means trying to understand how two things that seem opposite could both be true
• e.g accepting yourself and changing your behaviour might feel contradictory. But DBT teaches that its possible for you to achieve both of these goals together

Question 17

overview of dialectical behavioural therapy (DBT)

Answer 17

• developed by Marsha Linehan
• addresses the dialetic
• aims to create a life worth living
• intensive group and individual work
• 1 year+

Question 18

discuss EMDR and what does it stand for ?

Answer 18

1. eye movement desensitization and reprocessing therapy
2. what it entails
   - memory-based form of psychotherapy that uses rhythmic eye movements to evoke images and sensory details related to traumatic events
   - the eye movement aids in reprocessing trauma, enabling clients to update the way their brain stores traumatic information
   - while focusing on a target image/ snapshot of an event, the individual is guided to move their eyes
   - fast acting therapy: duration of this therapy depends on the depth and complexity of the trauma being addressed

Question 19

other therapies ?

Answer 19

1. compassion focused therapy
2. distress tolerance
3. interpersonal therapy (IPT)
   - structured
   - time limited
   - specific goals: depression, grief, relationships, transitions
4. therapeutic communities
   - addiction-Cuan Mhuire

Question 20

what is the general concept of interpersonal therapy (IPT) ?

Answer 20

focuses on relieving symptoms by improving interpersonal functioning.
- it addresses current problems and relationships rather than childhood or development issues.
- therapists are active, non-neutral, supportive and hopeful, and they offer options for change

Question 21

4 domains of interpersonal therapy?

Answer 21

1. grief
2. interpersonal role disputes
3. role transitions
4. interpersonal deficits

Question 22

original meaning of dialectic

Answer 22

• dialetic, also known as the dialectical method, refers originally to dialogue between people holding different points of view about a subject but wishing to arrive at the truth through reasoned argumentation. dialectic resembles debate, but the concept excludes subjective elements such as emotional appeal and rhetoric
• Hegelianism refigured “dialectic” to no longer refer to a literal dialogue. Instead, the term takes on the specialized meaning of development by way of overcoming internal contraindications

Question 23

DBT therapy - wikipedia

Answer 23

• designed to help people increase their emotional and cognitive regulation by learning about triggers that lead to reactive states and by helping to assess which coping skills to apply in the sequence of events, thoughts, feelings, and behaviours to help avoid undesired reactions

Question 24

4 modules of DBT ?

Answer 24

1. mindfullness
   - helps individuals accept and tolerate the powerful emotions they may feel when challenging their habits or exposing themselves to upsetting situations
   - wihtin DBT it is the capacity to pay attention, nonjudgmentally, to the present moment: about the living moment, experiencing ones emotion and senses fully, yet with perspective
   - relies on the principle of acceptance: rely on the patients ability to view situations with no judgment, and to accept situations and their accompanying empotions
2. Distress tolerance
   - means learning to bear emotional discomfort skillfully, without restorting to maladaptive reactions. Healthier coping behaviours are learned, including intentional self-distraction, self-soothing, and radical acceptance
3. Emotion regulation
   - emotional regulation skills are based on the theory that intense emotions are a conditioned response to troublesome experiences, the conditioned stimulus, and therefore, are required to alter the patients conditioned response
   - 4 modules: understanding and naming emotions, changing unwanted emotions, reducing vulnerability, and managing extreme conditions
4. Interpersonal effectiveness
   - the 3 interpersonal skills focused on in the DBT include self-respect, treating others “with care, interest, validation, and respect” and assertiveness
   - the dialetic involved in healthy relationships involves balancing the needs of others with the needs of the self, while maintaining one’s self respect

Question 25

What disorders is DBT used for?

Answer 25

1. Borderline personality disorder 2. Depression 3. Complex post-traumatic stress disorder (CPTSD)