Psychological therapy and medication are not exclusive to each other and in fact are often used in conjunction.
Common elements to all styles of Psychotherapy
An effort to produce psychological and/or behavioral change
A relationship between a client seeking change/help and a provider facilitating change/offering help
The use of verbal communication
Goals of therapy vary with the patient’s needs and the style of the therapist
used to treat diagnosed mental disorders
used to promote personal growth and self awareness
used to improve interpersonal relationships
trying to promote a more adequate relationship with society
Major Categories of Psychological Therapy
Individual
- one on one client with therapist. Expressive psychodynamic model most often used
Group
- clients seen in a group. Help clients understand interpersonal relationships; cost effective
Family
- treats psychological problems within the context of the whole family
Cognitive-Behavioral
- a newer approach that leads to the use of different techniques
There are probably 100-200 different "brands" of psychotherapy
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Supportive Therapy
- aimed at symptom relief and/or specific behavioral changes. Relies on suggestion, advice, and educating by a therapist. The client-therapist relationship is important but not explored. Deals primarily with current life situation rather than the past. Helps clients with a "life crisis" or an acute illnesses. Termination of therapy is spread out over months/years. Frequently used by non-psychiatrist physicians as well as clergy, counselors, etc.
Very often used with patients newly discharged from a psychiatric hospitalization.
Expressive Dynamic Psychotherapy
- a.k.a. analytically oriented or insight therapy. The aim is to relieve symptoms and change behaviors through insights into their unconscious mechanisms. Exploration of the childhood roots of adult problems is undertaken based on the premise that insight into early conflicts will help relieve adult distress. The use of transference is used in this type of therapy. Used primarily with neuroses, mild depressions, anxiety disorders, and character problems. The length of treatment is months/years, usually 1-2 times’s per week face to face meetings with client. The beginning of the relationship is spent building trust. Termination is optimally when client feels they have met their goals for treatment and the client can do the work on their own.
Transference
- the repetition of past impulses, feelings, and attitudes projected onto the therapist. (e.g. the client acts towards the therapist like they used to with their parents. This can be examined and worked with.)
Psychoanalysis
- aims include symptom relief, behavioral change, and resolution of character problems through insight into unconscious mechanisms. Explorations of free association, fantasies, dreams, and the past are utilized. Therapist out of the client’s line of sight. Client-therapist relationship is heavily analyzed. There are several schools (Freud most common but also Jung, Klein, and more). Time and money as well as a strong ego are required.
Frequent visits (3-4/week) for a long time (3-5 years of treatment) limits utilization.
Effectiveness of Psychotherapy
Therapy has a procedural code. HMO’s have studied its cost effectiveness.
For mild to moderate depression therapy works as well as drugs (although it takes longer) and has less relapse risk.
Drug and therapy combo probably the best for mild to moderate depression.
80% of 600 independent studies demonstrated that psychotherapy leads to improvement.
65-75% of patients receiving psychotherapy improve significantly vs. on 20-30% of controls.
Methodological problems make studying psychoanalysis extremely difficult, so supportive therapy has been studied to a greater extent.
No difference in effectiveness have been demonstrated for different types of therapies suggesting that common elements are factors why psychotherapy works.
Common factors include:
the doctor-patient relationship, the patient has someone who will listen to them, and the opportunity for the patient to express difficult feelings in a safe environment.
Behavioral Medicine
use of psychotherapy when treating medical conditions (e.g. counseling for a COPD patient)
How does one begin?
try to understand more about the patient’s problem. Look at the patient’s coping mechanisms, self assessment ability, social relationships, and the therapist-client interactions.
set a CONTRACT. An agreement on the patient’s goals and expectations of treatment.