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Overview of Psychotherapy Back to Basics 2008. Tin Ngo-Minh, MD PGY2 Psychiatry University of Ottawa. Objectives. Overview of psychotherapy Review of defense Mechanisms MCQ. Common Psychotherapies. Supportive Psychotherapy Conginitve behavioral Therapy - CBT

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Overview of psychotherapy back to basics 2008

Overview of PsychotherapyBack to Basics 2008

Tin Ngo-Minh, MD

PGY2 Psychiatry

University of Ottawa


Objectives
Objectives

  • Overview of psychotherapy

  • Review of defense Mechanisms

  • MCQ


Common psychotherapies
Common Psychotherapies

  • Supportive Psychotherapy

  • Conginitve behavioral Therapy - CBT

  • Interpersonal Psychotherapy - IPT

  • Dynamic Psychotherapy

  • Other Psychotherapies

    • Behavioral Therapy

    • Mindfulness-Based Cognitive Psychotherapy

    • Dialectical Behavior Therapy - DBT

    • Acceptance and Commitment Therapy - ACT


Therapeutic alliance
Therapeutic Alliance

  • Commitment in therapy

  • Better to disclose information

  • Pt feels valued as an individual

  • Development of a meaningful relationship

  • By trying to genuinely understand the patient, being empathic


Supportive psychotherapy
Supportive Psychotherapy

  • To maintain, restore and improve self-esteem, ego-function and adaptive skills

  • Self-esteem: praise, reassurance, encouragement, normalization

  • Ego-function: rationalization/reframing, advise/teaching, naming the problem, clarification, confrontation, interpretation

  • Adaptive skills: preventing anxiety, anticipatory guidance, problem solving


Cognitive behavioral therapy cbt a beck
Cognitive-Behavioral Therapy (CBT) (A. Beck)

  • People perceptions and automatic thoughts about situation influences their emotional and behavioral reactions

  • Depression: negatively biased judgements patient have of themselves (themselves, world and future – internal-global-stable)

  • Educative, collaborative and empirical approach - examination of distorded cognitions

  • Time limited (6-16 sessions)


Cbt goal
CBT goal

  • Teach patients how to respond to their dysfunctional thinking. Guide patients in evaluating the validity of their thoughts, seeking alternative explanations or perspectives, decatastrophizing, examining the utility of their thinking, getting distance from their thoughts through reflecting on advice they would give to others, and planning a course of action.


Cbt techniques
CBT Techniques

  • Socratic questioning, clarification, exploration, use of specific examples, « downward arrow »

  • Problem solving, relaxation, graded task assignement, graded exposure, activity monitoring (M + P), scheduling, behavipral activation, psychoeducation, guided discovery, dysfunctiuonal thought record, behavioral experiements, weighting advantages and disadvantages, coping cards, imagery work, response prevention

  • Homework, weekly visits (6-12 sessions x 1hr)



Interpersonal psychotherapy ipt sullivan
Interpersonal Psychotherapy – IPT(Sullivan)

  • Focus on interpersonal relationship

    • Improve maladapted communication skills

    • Change expectations in relationship

    • Discrepencies between support and its needs during time of crisis

  • Symptom reduction Here and Now

  • Based on attachment theory

  • Teach skills, problem solving, to continue to build new relationships and releave the distress

  • Indication: anxiety – depression

  • Time limited (12-20 sessions)


Ipt techniques
IPT - Techniques

  • Analysis of communication pattern

    • Convey their needs more clearly and effectively

      • Ex: explore a conflict: reactions – consequences

    • Transference in therapy

    • Feedback – role paying

    • How ask for help

    • Explore the perception of the other


Ipt area of expertise
IPT – Area of expertise

  • Grief and loss

    • Resolution of grief – description (good/bad) of the lost person

    • Facilitate mourning, new or change in interpersonal relationship, seek support

  • Interpersonal dispute

    • Better communicate attachment needs

  • Role transition

    • Give up old role


Dynamic psychotherapy
Dynamic Psychotherapy

  • Change ingrained pattern of interpersonal relatedness and personality style

    • Learn a more flexible and independant manner of interacting

  • Object relation theory

    • image of self and other evolve out of human interaction

  • Therapist as a participant-obsever

  • Transference (repetion of past conflict into therapeutic relationship)


Dynamic psychotherapy assumptions
Dynamic Psychotherapy - Assumptions

  • Maladaptive relationship patterns are learned from the past

  • Dysfunctional patterns are reenacted in vivo in the therapy

    • Therapist, through a new emotional experience (experiencial learning) – attempt to alter the dysfunctional interactive style

    • Invitation for metacommunication (what’s happening between therapist and patient) – highlight dysfunctional reenactment


  • Assessment of maladaptive pattern

    • Thoughts, feeling, perception and behaviors of the patient of an interpersonal nature

    • Expectation of other’s reactions

    • Behavior of other people and interpretation

    • Patient’s behaviours and attitudes toward the self – how the person treat himself



Behavioral therapy skinner
Behavioral therapy(Skinner)

  • Little attention in gaining insight

  • Time limited therapy

  • Anxiety management skills

    • Relaxation/breating

    • Structured problem solving

    • Behavioral rehearsal

  • Exposure therapy

    • Phobias, OCD, PTSD


Mindfulness based cognitive therapy mbct kabat zinn segal
Mindfulness-based Cognitive Therapy (MBCT)(Kabat-Zinn, Segal)

  • Mindfulness is a meditative practice from Buddhism, which aims to help people identify their thoughts, moment by moment, but without passing judgement on the thoughts.

  • “We can respond to situations with choice rather than reacting automatically”

  • Little emphasis on changing the content of thoughts (unlike CBT)

  • Body scan - meditation


Dialectical behavior therapy dbt linehan
Dialectical Behavior Therapy (DBT)(Linehan)

  • For borderline patients

  • Behavioral principle to promote change and mindfulness to promote acceptance

  • Extreme behaviors and emotions: Learn a middle ground

  • Mix of individual and structured group therapy

    • 1) enhance patient motivation

    • 2) enhance patient capabilities

    • 3) ensure that new capabilities generalize to the patient’s natural environment


Dbt goal
DBT - Goal

The goal is to bring out the opposites, both in therapy and the client’s life, and to provide conditions for synthesis. Strategies include extensive use of stories, metaphor, and paradox; the therapeutic use of ambiguity; viewing therapy, and indeed all of reality, as constant change; cognitive challenging and restructuring techniques; and reinforcement for use of intuitive, nonrational knowledge bases.


Acceptance and commitment therapy act hayes
Acceptance andCommitment Therapy (ACT)(Hayes)

  • ACT attempts to teach clients to accept, rather than control or eliminate, private experiences (i.e., negative emotions, thoughts, memories)

  • "self-as-context“ Here and Now — the you that is always there observing and experiencing and yet distinct from one's thoughts, feelings, sensations, and memories.

  • Acceptance, defusion, being present, a transcendent sense of self, values, and committed action.



  • Splitting

  • Dissociation

  • Intellectualization

  • Rationalization

  • Reaction Formation

  • Repression

  • Altruism

  • Humor

  • Identification

  • Introjection

  • Sublimation

  • Suppression

  • Denial

  • Distortion

  • Delusional Projection

  • Fantasy

  • Projection

  • Somatization

  • Acting out

  • Idealization

  • Displacement

  • Dissociation

  • Isolation



A 42-year-old man has just been informed that he has poorly differentiated small cell carcinoma of the lung. When asked if he understands the serious nature of his illness, the patient proceeds to tell his physician how excited he is about renovating his home. This patient is exhibiting

  • A. denial

  • B. displacement

  • C. projection

  • D. rationalization

  • E. reaction formation

  • F. sublimation


A 55-year-old male begins group therapy. After the first session, he befriends one of the other clients, and begins telling her how extraordinarily intelligent and talented the facilitator is. At the next session, he and the facilitator disagree. After the session, he tells his fellow group member that the facilitator is utterly incompetent and that they should sue for malpractice. This is an example of

  • displacement

  • fixation

  • reaction formation

  • regression

  • splitting


A 17-year-old girl loses her best friend in an automobile accident. After the death, she starts writing for hours daily in her diary. This would most likely be an example of which of the following defense mechanisms?

A. Identification

B. Projection

C. Rationalization

D. Regression

E. Sublimation


A 27-year-old swimmer who feels insecure about her athletic abilities harshly criticizes her teammates' techniques. Which of the following ego defense mechanisms is she displaying?

  • Displacement

  • Projection

  • Reaction formation

  • Repression

  • Sublimation


There is a classic zoo story about a cage with three monkeys in it. The largest monkey steals the middle-sized monkey's banana. The middle-sized monkey then screams with rage, hits the smallest monkey on the head, and then steals his banana. The middle-sized monkey is using which of the following mechanisms of defense?

A. Displacement

B. Projection

C. Reaction formation

D. Regression

E. Repression


Good luck on the exam

Good luck on the Exam! in it. The largest monkey steals the middle-sized monkey's banana. The middle-sized monkey then screams with rage, hits the smallest monkey on the head, and then steals his banana. The middle-sized monkey is using which of the following mechanisms of defense?


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