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Psychological Therapies

Psychological Therapies. Psychotherapy is:. “…essentially a conversation which involves listening to and talking with those in trouble with the aim of helping them understand and resolve their predicament.” - Brown and Pedder.

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Psychological Therapies

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  1. Psychological Therapies

  2. Psychotherapy is: “…essentially a conversation which involves listening to and talking with those in trouble with the aim of helping them understand and resolve their predicament.” - Brown and Pedder. “…an interpersonal process designed to bring about a modification of feelings, cognitions, attitudes and behaviour which have proven troublesome to the person seeking help.” Hans Strupp “…the art of alleviating personal difficulties through the agency of words and a personal, professional relationship”. - Anthony Storr

  3. Who does psychotherapy? (All mental health workers)CounsellorsClinical /Counselling PsychologistsAdult PsychotherapistsChild Psychotherapists Medical Psychotherapists Forensic Psychotherapists

  4. Setting GP surgeriesOut-patient – PCMHT, CMHT, Psychologyand Psychotherapy departments In-patient Day HospitalAt home of patientPrison (Grendon Underwood)

  5. System • Individual • Couple • Group • Family • Organisation

  6. Four Main Groupings of Psychotherapy 1. Psychoanalytic/Psychodynamic2. Behavioural/Cognitive-Behavioural3. Humanistic Movement 4. Integrative Therapies

  7. Common Features of Psychotherapies(Jerome Frank) 1. An intense, emotionally charged relationship with a person or group.2. A rationale or myth explaining the distress and methods of dealing with it.3. Provision of new information about the future, the source of the problem and possible alternatives which hold a hope of relief.4. Non-specific methods of boosting self-esteem.5. Provision of success experiences.6. Facilitation of emotional arousal.7. Takes place in a locale designated as a place of healing

  8. Common types of therapy: Cognitive Behavioural TherapyPsychodynamic psychotherapyCognitive Analytic TherapyPsychodynamic Interpersonal TherapySystemic/Family TherapyGroup analytic therapyPsychodramaCounselling

  9. Other types of therapy Specific family interventions with schizophrenia patients Supportive Therapy Therapeutic CommunitiesDialectical Behavioural TherapyGestalt TherapySolution Focused TherapyTransactional Analysis

  10. Classifications of psychotherapy (NHSE, 1996) • Type A Psychological treatment as an integral component of Mental Health care. Refers to the psychotherapeutic skills required by all mental health and social care professionals.Type B Eclectic Psychological therapy and Counselling.Refers to the psychotherapeutic skills needed by a broadly trained mental health/social care professional (nurse, occupational therapist, social worker, clinical psychologist or psychiatrist with a special interest in psychotherapy who treats patients but does not act in a senior consultative or training capacity.Type C Formal Psychotherapies: Refers to the specialist therapeutic skills required by a professional working for the majority of his/her time in the speciality ie. Consultant Psychotherapist level with a significant responsibility for teaching and supervising others.

  11. Problems with evidence base in psychological treatments • RCTs hard to do in psychotherapy (mainly done in CBT) • But no/little evidence does not mean ineffective treatments • Hard to study and follow up long term, complex interventions • Patients choose (cf randomisation) • Therapist factors may be most important • Researcher allegiance effects • How to measure global changes to personality (cf symptoms) • Who funds psychotherapy studies?

  12. Available evidence for efficacy in specific conditions (Roth and Fonagy, 1996): Depression Cognitive Behaviour Therapy (CBT), Intepersonal Therapy (IPT), Psychodynamic psychotherapy (PDP)Anxiety CBT, Applied relaxationPhobias Cognitive therapy (CT), Exposure therapyPanic CBT, Panic control therapyAlcoholism Behavioural treatments, social skills training, motivational interviewingSchizophrenia Family intervention programmes, CBTAnorexia CT, Eclectic therapy, Family therapy (younger)

  13. Available evidence for efficacy in specific conditions (Roth and Fonagy, 1996) Bulimia CT, IPTPsychosomatic Psychodynamic Interpersonal therapy (PIT)Personalitydisorders Dialectical Behaviour Therapy (DBT), PDP Day hosp, ?Cognitive Analytic Therapy (CAT), ?Therapeutic Communities (TCs)OCD Exposure and response preventionPTSD Stress inoculation with CT and exposureSex dysfunctions Behavioural and CBT

  14. Why is psychotherapy important? • Consumer choice • Efficacy (equivalent to antidepressants) • Cost effective • Reduces relapse • Additive effects to medication (SZ + FT) • Few side effects • Works with treatment resistant cases • Government investment over next 5 years

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