Table 17-1 Psychoanalysis

1. Goal Patient selection criteria Resolution of symptoms and major reworking of personality structures related to childhood conflicts No psychotic potential Able to use understanding High ego strength Able to experience and observe intense emotional states Psychiatric problem derived from childhood conflicts Table 17-1 Psychoanalysis

2. Techniques Duration Focus on fantasies and the transference Free association Couch Interpretation of defenses and transference Frequent meetings Neutrality of the analyst 3-6 years Table 17-1 Psychoanalysis

3. Goal Patient selection criteria Understanding conflict area and particular defense mechanisms used More “here and now” than psychoanalysis Similar to psychoanalysis Also includes personality disorders with psychotic potential (Borderline, Narcissistic) Some major depressions and schizophrenia may be helped when combined with medication during periods of remission for the treatment of psychosocial features Table 17-2 Psychoanalytic Oriented Psychotherapy

4. Techniques Duration Face to face-sitting up Free association Interpretation and clarification Some supportive techniques Medication as adjunct Months to years Table 17-2 Psychoanalysis

5. Goal Patient selection criteria Clarify and resolve focal area of conflict that interferes with current functioning High ego strength High motivation Can identify local issue Can form strong interpersonal relationships, including with therapist, in a brief time Good response to trial interpretations Table 17-3Brief Psychodynamic Psychotherapy

6. Techniques Duration Face to face Interpretation of defenses and transference Setting of time limit at start of therapy Focus on patient reactions to limited duration of treatment 12-40 sessions; usually 20 sessions or less Table 17-3Brief Psychodynamic Psychotherapy

7. Goal Patient selection criteria Identify and alter cognitive distortions Unipolar, nonpsychotic depressed outpatients Contraindications include delusions, hallucinations, severe depression, severe cognitive impairment, ongoing substance abuse, enmeshed family system Table 17-4Cognitive Psychotherapy

8. Techniques Duration Behavioral assignments Reading material Taught to recognize negatively biased automatic thoughts Identify patients’ schemas, beliefs, attitudes Time limited: 15-25 sessions Table 17-4Cognitive Psychotherapy

9. Goal Patient selection criteria Maintain or reestablish best level of functioning Very healthy individuals exposed to stressful life circumstances (e.g., Adjustment Disorder) Individual with serious illness, ego deficits, e.g., Schizophrenia, Major Depression (psychotic) Individuals with medical illness Table 17-5Supportive Psychotherapy

10. Techniques Duration Available, predictable therapist No/limited interpretation of transference Support intellectualization Therapist acts as a guide/mentor Medication frequently used Supportive techniques: suggestion, reinforcement, advice, teaching, reality testing, cognitive restructuring, reassurance Active stance Discuss alternative behaviors, social/interpersonal skills Brief (days-weeks) to very long term (years) Table 17-5Supportive Psychotherapy

11. Goal Patient selection criteria Eliminate involuntary disruptive behavior patterns and substitute appropriate behaviors Habit modification Targeted symptom Phobias Some psychophysiological responses: headache, migraine, hypertension, Raynaud’s phenomena Sexual dysfunction Table 17-6 Behavioral Therapy (Behavioral Modification)

12. Techniques Duration Systemic desensitization Implosion therapy and flooding Aversive therapy Biofeedback Usually time limited Table 17-6Behavioral Therapy (Behavioral Modification)