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
Who does psychotherapy? (All mental health workers) Counsellors Clinical /Counselling Psychologists Adult Psychotherapists Child Psychotherapists Medical Psychotherapists Forensic Psychotherapists
Setting GP surgeries Out-patient – PCMHT, CMHT, Psychology and Psychotherapy departments In-patient Day Hospital At home of patient Prison (Grendon Underwood)
System Individual Couple Group Family Organisation
Four Main Groupings of Psychotherapy 1.Psychoanalytic/Psychodynamic 2.Behavioural/Cognitive-Behavioural 3.Humanistic Movement 4.Integrative Therapies
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
Common types of therapy: Cognitive Behavioural Therapy Psychodynamic psychotherapy Cognitive Analytic Therapy Psychodynamic Interpersonal Therapy Systemic/Family Therapy Group analytic therapy Psychodrama Counselling
Other types of therapy Specific family interventions with schizophrenia patients Supportive Therapy Therapeutic Communities Dialectical Behavioural Therapy Gestalt Therapy Solution Focused Therapy Transactional Analysis
Classifications of psychotherapy (NHSE, 1996) Type APsychological treatment as an integral component of Mental Health care. Refers to the psychotherapeutic skills required by all mental health and social care professionals. Type BEclectic 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 CFormal 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.
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?
Available evidence for efficacy in specific conditions (Roth and Fonagy, 1996): DepressionCognitive Behaviour Therapy (CBT), Intepersonal Therapy (IPT), Psychodynamic psychotherapy (PDP) AnxietyCBT, Applied relaxation PhobiasCognitive therapy (CT), Exposure therapy PanicCBT, Panic control therapy AlcoholismBehavioural treatments, social skills training, motivational interviewing SchizophreniaFamily intervention programmes, CBT AnorexiaCT, Eclectic therapy, Family therapy (younger)
Available evidence for efficacy in specific conditions (Roth and Fonagy, 1996) BulimiaCT, IPT PsychosomaticPsychodynamic Interpersonal therapy (PIT) Personality disordersDialectical Behaviour Therapy (DBT), PDP Day hosp, ?Cognitive Analytic Therapy (CAT), ?Therapeutic Communities (TCs) OCDExposure and response prevention PTSDStress inoculation with CT and exposure Sex dysfunctions Behavioural and CBT
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