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Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main.

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Presentation on theme: "Psychological therapies Dr Chris Williams Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main."— Presentation transcript:


2 Psychological therapies Dr Chris Williams

3 Todays objectives. You will: Gain an overview of the range of psychological therapies Look at the four main models of psychological treatments used in the NHS. Think about how a patient could be thought about in each of the models.

4 Task - at end Split into pairs. How would you approach working with this depressed man in these four different types of therapy? – What would be different? – What would be similar?

5 Psychotherapy: Group discussion What goes through your mind when you think about the term psychotherapy? Would you want it yourself? Would you tell others you were having/had received it? How would this compare with say an antibiotic?

6 Psychotherapy Is a blanket term for those treatments which offer psychological rather than physical or social interventions. Those usually available on the NHS include CBT, Psychodynamic, Counselling, Family Therapy.

7 Key document and search for title – depression, anxiety, PTSD, self-harm, Eating disorders SIGN has some materials

8 The CBT model Aims to reduce symptoms by changing specific behaviours and thoughts which maintain specific symptoms. Name associated with it is Professor Aaron Beck.

9 CBT: a simple message What you think affects how you feel ThinkingFeelings ThinkingBehaviour What you think affects what you do

10 The CBT model In anxiety and depression: Thinking changes characteristically: extreme and unhelpful e.g. worthlessness, guilt, incompetence, failure, hopelessness Behaviour changes characteristically : - reduced activity - avoidance - unhelpful behaviours

11 CBT treatment 1). Alter unhelpful/extreme thinking Not the same as positive thinking Identify/test out extreme thoughts Balanced conclusion based on all the evidence 2). Alter unhelpful behaviours

12 Experiment: (in pairs – 5 minutes) Q. If you talk to someone who is depressed/fed up, what do do they: – Feel emotionally – Feel physically – Say – Do/not do – What life situations do they often face? – Use the language they would use Feedback time

13 Life Situation, relationship and Practical Problems Altered Thinking Altered FeelingsAltered Physical Symptoms Altered Behaviour The Five Areas Assessment Model

14 Life Situation, relationship and Practical Problems £2500 debt, arguments with husband Thinking Im useless, Everythings wrong Feelings Low, anxious, angry Physical Sleep + appetite red. Weight loss Behaviour Argue with husband, stay in A Five Areas Case Summary -1

15 Unhelpful thinking styles - 1 Unhelpful thinking styleTypical thoughts Bias against myselfOverlook my strengths Focus on my weaknesses Downplay my achievements My own worst critic Putting a negative slant on things (negative mental filter) See things through dark tinted glasses Put a negative slant on things Having a negative view of the future Jump to the very worst conclusions Catastrophising Make negative predictions about the future Predict that things will go wrong

16 Unhelpful thinking styles - 2 Unhelpful thinking styleTypical thoughts Mind-reading Negative view of how others see me Mind-read what others think of me Assume that others dont like me/judge me badly Bearing all responsibilityTake things to heart Take the blame ++ Feel overly responsible Make extreme statements/rules Use the words must,should, ought andalways/never a lot. High standards ++

17 Task: (in pairs) Q. What is your first thought? Scenario: You travel to meet your friend at 10am, but they dont turn up. You are giving a talk and you notice someone in the audience yawning. You go to do some last minute photocopying - and the machine jams halfway through. It needs the engineer.

18 Key Point: These thinking styles are normal/everyday occurrences In anxiety and depression they are: Experienced more frequently - unhelpful thoughts pop into mind ++ Harder to challenge and believed more Helpful/balanced thoughts are crowded out

19 The impact of extreme thoughts What is unhelpful about extreme thoughts 1. Theres nothing I can do 2. She hates me 3. I wont enjoy it Q: If I believed these thoughts, how would I feel? Q: If I believed these thoughts, what would I do differently

20 How does CBT work? Identifies – and then challenges extreme and unhelpful thoughts Gathers evidence for and against the thought Come up with a balanced conclusion Overcome reduced activity, avoidance and unhelpful behaviours. More next session

21 Psychodynamic psychotherapy Exploratory approach to help the patient develop insight into why they are distressed/ causing distress or suffering from symptoms. Prominence given to the unconscious. Freud is the father of this approach Later developments by Jung, Adler, Klein, Anna Freud, Winnicott - different schools.

22 Psychodynamic psychotherapy Much more of an emphasis on the past, particularly on childhood events It emphasises the importance of mental representations of early life experiences in the present & the impact they have on current relationships.

23 Psychodynamic psychotherapy Exploratory and less directive. Must make links between past and present. Increase patients understanding that their current patterns of relating to others have their origins in past (childhood). Tends to last for longer time (can be years) although recent shorter therapy advocated.

24 Psychodynamic psychotherapy Freud was a major figure in 20th Century thought. Neurologist. Outlined three theories to account for mental processes. Topographical, structural, developmental.

25 Psychodynamic psychotherapy Topographical theory & unconscious mind. – Conscious and unconscious mind – Unconscious thoughts and feelings which influence behaviour. – Thought may be unconscious because it is consciously suppressed or unconsciously repressed.

26 Psychodynamic psychotherapy Structural Theory. – Mind can be conceptualised as having three parts - the Superego, ego & id. – Superego - what is thought of as conscience. – Ego - rational part of your mind. – Id - contains the instincts of sexuality & aggression

27 Psychodynamic psychotherapy Developmental Model - series of stages. – Oral - first year. – Anal - 2nd, 3rd years. – Genital - 3-5th year – Theorised that problems occurred at these times cause characteristic mental symptoms later on e.g. OCD and anal phase.

28 Psychodynamic psychotherapy Conflict - may also be conscious or unconscious. E.g. Mrs B wants to have Mother to live with her - but postpones moves due to worsening back pain. Unconscious conflict may lead to the development of symptoms

29 Psychodynamic Psychotherapy Defence mechanisms - protects us from emotional distress by preventing the unconscious becoming conscious. Can be on a spectrum from conscious to unconscious. Everyone uses them - not necessarily pathological indeed we need them!

30 Psychodynamic Psychotherapy Defence mechanisms - major one is repression. E.g. choosing not to remember you have an exam next week. Reaction formation, denial, rationalisation, projection.

31 Psychodynamic Psychotherapy: what does it look like? Can be individual or group. Uses therapeutic relationship as with all other models of psychotherapy. But…uses the relationship to explore the defences, conflicts, and the unconscious. Central to this is how the current relationship reflects past relationships in the patients life – can also include interpretation of dreams Lie/sit down e.g. on a couch or bed– long silences

32 Psychodynamic Psychotherapy Working alliance Transference: how the patient reacts to you Counter-transference: how we react to the patient

33 Counselling Aims to offer a supportive, non-directive relationship in which the patient can work out solutions to personal difficulties. Not intended to make the patient confront their anxieties. Really to strengthen existing coping strategies. Mild to moderate psychological problems Life crises & problem solving (HIV, Cancer, bereavement in NHS).

34 Counselling Most common approach. Common in general practice in the UK. Anyone can call themselves a counsellor. Common in voluntary sector. Focuses on warmth, empathy and genuineness Avoids providing answers

35 Family therapy Aims to see if and how the problem of the identified patient is maintained by the needs of the family. A number of schools (Systemic).

36 Family therapy Usually in NHS used for childhood problems where one or more children in the family are showing emotional or behavioural difficulties.. Uses concept of the System: the system is set up to be self-maintaining and resists change (good or bad) System says that lots of interactions within the family all causing the picture in the individual.

37 Case example Cameron is 32 and is depressed. Already on medication from GP. Lives with his mother; he doesnt work. Witnessed alcoholic father/ domestic abuse Now has panic attacks on leaving house Took an overdose of paracetamol. Upset that his sister is leaving for New Zealand.

38 Task – 5-10 mins Split into pairs. How would you approach working with this depressed man in these four different types of therapy? – What would be different? – What would be similar?

39 Feedback Any thoughts? How would you approach working with this depressed man in these four different types of therapy? – What would be different? – What would be similar? Q. How easy is it to access psychotherapy in the UK?

40 Any questions

41 The End Next week: Self-help and Psychotherapy Problem solving approaches CBT- focus on reduced activity and identifying extreme and unhelpful thoughts

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