PSYCHIATRY > Psychotherapy > Flashcards

Psychotherapy Flashcards

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1
Q

define psychotherapy

A

the systematic use of a relationship between a patient and a therapist - as opposed to physical and social methods - to produce changes in feelings, cognition and behaviour

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2
Q

what are the 6 common characteristics of all psychotherapies

A
  • An intense confiding relationship with a helpful person (the therapeutic alliance or therapeutic relationship lies at the heart of all psychotherapeutic approaches)
  • A rationale containing an explanation of the patient’s distress
  • The provision of new information about the nature and origins of the patient’s problems and the ways of dealing with them
  • The development of hope in the patient that they will be helped
  • Opportunities to experience success during treatment, enabling an increased sense of mastery
  • The facilitation of emotional arousal
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3
Q

what are the 4 forms of psychotherapy available in the NHS

A
  1. psychodynamic psychotherapy
  2. CBT
  3. IPT
  4. family/systemic therapies
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4
Q

what theory does psychodynamic pyschotherapy develop from

A

Freud’s approach to psychoanalysis

Freud believed that unacceptable thoughts from early childhood are repressed in the unconscious mind but continue to influence our feelings, thoughts, emotions and behaviour. These repressed feelings often surface in adulthood as conflicts, depression, etc or in dreams and/or creative activities. These unconscious aspects are explored in the therapy through the intervention of the analyst, confronting the patient’s pathological defences, wishes and guilt

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5
Q

how does psychodynamic psychotherapy differ from classical psychoanalysis

A
  • less frequent (x1 or x2 weekly)
  • shorter session (~50 mins)
  • brief or long term
  • more focused (aiming for circumscribed character and behaviour change)
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6
Q

what does psychodynamic psychotherapy aim to address

A
  • centres on evolution of conscious understanding by interpreting what the patient does and says during a therapy session and through the inter-subjectivity of the therapeutic relationship
  • addresses issues of transference and psychological defence mechanisms
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7
Q

explain the structure of psychodynamic psychotherapy

A
  • unstructured: patient is encouraged to talk about childhood relationships with parents and other significant people, the primary focus being to reveal the unconscious content of a patient’s psyche in an effort to alleviate psychic tension
  • therapist takes a position of benign neutrality
  • talk about what is happening in life atm, what has happened in th epast and how the past can affect your current feelings and behaviour

A trained therapist will have had their own personal therapy in order that they are more aware of the emotional issues that they (as compared with the patient) bring into the therapeutic relationship

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8
Q

what theories is CBT based on

A

learning theory
- conditioning and operant learning
- usually involves exposure to reduce avoidance and permit habituation

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9
Q

from whose work was cognitive therapy developed and what was it initially aimed at

A

Aaron Beck 1960s
- management of depression

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10
Q

what are the key structural features and aims of CBT

A
  • directly addresses the role of dysfunctional thoughts and beliefs in producing and maintaining undesirable emotional states and behaviours
  • structured
  • problem oriented
  • time limited ~ 6-15 weekly session for 1 hr
  • active - complete hwk
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11
Q

describe the features of IPT

A
  • time-limited weekly therapy for depressed patients
  • uses link between onset of depressive symptoms and current interpersonal problems as a focus for treatment
  • does not dwell on enduring aspects of personality but addresses current relationships

utilisation of IPT has expanded from depression to other disorders, including eating disorders

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12
Q

what are the key features of family/systemic therapies

A
  • roots in anthropology and cybernetics
  • target the system that generates the problematic behaviour.
  • classically seen in a family unit, where each family member is viewed as a component of the system, and the patient’s problem is generated (and maintained) by the system’s malfunctioning
  • techniques of suggestion, or emphasising the positive value of symptoms for the whole family, as methods of bringing about change to the family system
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13
Q

in what settings is family therapy most commonly used

A

intervention for children
- also used in eating disorders (particularly with younger anorexic patients)
- as an adjunctive treatment in schizophrenia

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14
Q

what features make a patient suitable for psychotherapy

A

specific disorders respond better to specific therapeutic approaches but does not mean the individual is suitable for therapy
- verbalise problrms
- psychologically minded
- take some degree of responsibility for resolution of difficulties

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15
Q

which patients are not suitable for psychotherapy

A
  • psychosis
  • serious dependence on illegal drugs
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16
Q

what is the difference between psychotherapy and counselling

A
  • counselling offers non-judgemental support and encourages the person to clarify and prioritise current problems and to find solutions; does not usually explore the therapeutic relationship
  • counselling tends to help people overcome immediate crises (for example job losses, bereavement or relationship problems), whereas psychotherapy helps people with more long-standing problems of a serious nature
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17
Q

what is dialectical behaviour therapy

A

skills based therapy that was devised in response to idea that standard CBT approaches weren’t as effective for people experiencing emotional dysregulation and chronic suicidality

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18
Q

what is involved in DBT

A

combination of group and individual sessions
- can take between 6-12 months to complete

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19
Q

describe the modules of DBT

A
  • distress tolerance
  • emotional regulation
  • interpersonal effectiveness
  • periods of minfulness work to allow grounding and skill consolidation before moving on to next module
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20
Q

what is the pupose of distress tolerance

A

to increase an individual’s capacity to bear periods of intense emotional activation without the use of “unskilful behaviour” (this can include things such as deliberate self-harm, substance use and binge eating as a form of distracting from emotional pain).

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21
Q

what is the aim of emotional regulation work

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A
  • seeks to address emotion in a more neutral way, with a focus on naming distinct emotional experiences rather than categorising them as either “good” or “bad”
  • the work encourages a reflective rather than reactive approach, challenging the notion that emotions have to be frightening or overwhelming experiences resulting from unavoidable external stressors, and instead returning some sense of control to the individual
22
Q

what is the aim of interpersonal effectiveness work

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A
  • considers how individuals might work on enriching their lives by developing mutually rewarding relationships with others
  • a focus on developing skills in assertiveness and negotiation, allowing individuals to find a suitable balance between advocating for their own needs whilst also validating the needs of others, putting healthy boundaries in place to delineate the self from the other
23
Q

what is the most effective techique used for therapy in OCD

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A

exposure and response prevention

24
Q

IPT is a NICE recommended treatment for…

25
what is a family therapy an effective approach for
prevention of relapse of schizophrenia in patients whose families show high expressed emotion
26
what does IAPT stand for and what is it
**Improving Access to Psychological Therapies** - established in England in 2008 to provide more evidence-based talking therapies in primary care
27
what is reaction formation
a psychological defense mechanism where someone unconsciously behaves in an exaggerated way that is the opposite of their true feelings or desires to cope with anxiety or internal conflict ## Footnote an individual might act overly aggressive to hide underlying insecurities, or become excessively kind to someone they secretly dislike
28
what is psychoanalysis
the investigation of the mind, a systematised body of knowledge about human behaviour, and a method of treatment of psychological or emotional illness
29
what is the aim of psychoanalysis
provide a setting where unconscious patterns can be brought into awareness with a view to changing them - The patient’s relationship with the analyst is an important influence upon the patient’s unconscious ways of behaving and, in itself, becomes a central area of focus, highlighting the patient’s patterns within the relationship in the immediacy of the sessions
30
what is freudian psychoanalysis
- specific type of psychoanalysis in which the person undergoing psychoanalysis verbalises thoughts through methods such as free association, fantasy, and dreams - the analyst interprets them for the client to create insight for the resolution of issues and problems in the client’s life
31
what are unhelpful thinking styles
when people are depressed or anxious they start to think about things in extreme/unhelpfulw ays - the reflect habitual, repetitive and consistent thought patterns that occur during times of anxiety or depression so everyday situaions are misinterpreted
32
give some examples of unhelpful thinking styles
- They **overlook their strengths**, become very selfcritical and have a bias against themselves, thinking that they cannot tackle difficulties - They **unhelpfully dwell on past, current or future problems**; they put a negative slant on things, using a negative mental filter that focuses only on their difficulties and failures - They have a **gloomy view of the future** and get things out of proportion; they make negative predictions about how things will work out and jump to the very worst conclusion (catastrophise) that things have gone or will go very badly wrong - They **mind-read and second-guess that others think badly of them**, rarely checking whether this is true - They **unfairly feel responsible if things do not turn out well** (bearing all responsibility) and take things to heart
33
what does the 5 areas model focus on
1. life situation, relationships and practical problems 2. altered thinking 3. altered emotions (also called mood or feelings) 4. altered physical feelings/symptoms 5. altered behaviour or activity levels.
34
what are the 3 typs of therapy according to definitional framework for psychological therapies
* Type A – psychological treatment as an integral part of mental health care * Type B – eclectic psychological therapy & counselling * Type C – formal psychotherapies
35
what are the 3 parts of the human psyche in freud's psychoanalytic theory
* id * ego * superego
36
what is the nature, function and principle of the id
* **Nature**: The most basic and primitive part of the personality, present from birth. * **Function**: Driven by instincts, such as sexual and aggressive urges, and seeks immediate pleasure and gratification without regard for consequences. * **Principle**: Operates on the pleasure principle.
37
what is the nature, function and principle of the ego
* **Nature**: The rational and realistic part of the personality, developing from the id. * **Function**: The mediator that balances the id's impulsive demands with the moral constraints of the superego and the realities of the external world. * **Principle**: Operates on the reality principle, ensuring impulses are satisfied in socially acceptable and realistic ways
38
what is the nature, function and principle of the superego
* **Nature**: The moral component of personality that develops around age five through internalized societal and parental values. * **Function**: Acts as a moral compass, striving for ideal behavior and, when these standards are not met, inducing feelings of guilt or shame through self-criticism. * **Principle**: Operates on the morality principle.
39
give an example of the interaction and conflict between id, ego and superego
The ego constantly works to find a balance between the impulsive id and the judgmental superego, often employing defense mechanisms to alleviate the anxiety caused by internal conflict - If the id makes you want to take a cookie without permission, the superego might say it's wrong, and the ego would find a realistic solution, such as waiting until after dinner
40
give 6 examples of defence mechanisms
41
define transference
**unconscious** transfer of feelings and attitudes from the past into the therapist * ‘Seeing things through the eyes of the past’
42
define counter transference
All the feelings the therapist has in relation to the patient * How does the patient make you feel? * Why is this important ?
43
give 4 ways in which CBT works in anxiety
* Reduce avoidance * Cease safety-seeking behaviours * EXPOSURE (leads to habituation) * Test (and consequently change) beliefs (by real-life experiments)
44
catastrophising
cognitive distortion characterised by exaggerating the severity of a situation and expecting worst possible outcome, even with limited or no evidence - leads to overestimation of negative consequences and heightened anxiety and distress
45
learned helplessness
a phenomenon where an individual, after repeatedly experiecning a negative, uncontrollable situation, stops trying to change or escape even if there is opportunity to - have learned to believe they have no control or power over circumstances = passive behaviour and reduced sense of self-efficacy
46
fortune telling
cognitive distortion where an individual predicts negative future events without evidence, often focusing on the worst-case scenario and assuming it's inevitable
47
negative reinforcement
strengthens a desired behaviour by removing an unpleasant or aversive stimulus after behaviour occurs, making the behaviour more liekly to happen e.g. child makes bed (behaviour) to stop being told off by parent (Aversive stimulus) ## Footnote the difference between this and punishment is that reinforcement increases a behaviour whilsst punishment decreases it
48
mind reading
an unhelpful pattern of thought where someone jumps to negative conclusions about what others are thinking or intending, without any factual basis - e.g. employee might assume coworkers are silenttly judging them for being late
49
cognitive schema
a mental framework that organises information and past experiences allowing for faster processing and prediction of new situations e.g. 'dog schema' might include characterisitcs like four legs and hairy
50
all or nothing
aka black and white thinking - a cognitive distortion where a person sees the world and themselves in absolute terms, with no middle ground or shades of gray - rigid mindset involves an inability to integrate positive and negative qualities into a balanced perspective, leading to extremes like total success or complete failure (extreme dichotomies), and often uses words like "always" or "never" - narrow perspective
51
splitting
a psychological defense mechanism where a person divides people, objects, or ideas into absolute "all-good" or "all-bad" categories, failing to integrate positive and negative qualities into a realistic whole - helps manage intense, conflicting emotions by avoiding the anxiety of ambivalence, though it can hinder relationships and a balanced view of self and others - common symptom in borderline personality disorder (BPD) but can also appear in narcissistic personality disorder and other mental health conditions
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