CHAPTER 22 Psychological Treatment Zhong-Lin Tan Ph.D. M.M. Hangzhou Mental Health Center Department of psychiatry, School of Medicine Hangzhou Normal University

2 Aim Grasp classification of psychological treatments Grasp classification of psychological treatments Be familiar with different counseling approaches Be familiar with different counseling approaches

3 Preface Psychological treatment is not given in isolation, often combined with medication. Appropriate ways of doing this are considered in the chapters concerned with the relevant disorders. Psychological treatment is not given in isolation, often combined with medication. Appropriate ways of doing this are considered in the chapters concerned with the relevant disorders. This chapter contains advice on the general value of various treatments. This chapter contains advice on the general value of various treatments. Although outline descriptions of technique are given in several places, supervised experience is essential before any of these treatments can be used with patients. Although outline descriptions of technique are given in several places, supervised experience is essential before any of these treatments can be used with patients.

4 Psychological treatments considered in this chapter Counseling Counseling Crisis intervention Crisis intervention Supportive psychotherapy Supportive psychotherapy CBT CBT Individual dynamic psychotherapies Individual dynamic psychotherapies Historical treatments Historical treatments Meditation and traditional healing Meditation and traditional healing Small-group psychotherapy Large-group psychotherapy Psychotherapy with couples Family therapy Psychotherapy for children and older people

5 How psychological treatments developed Hypnosis and free association:1895,1923 Hypnosis and free association:1895,1923 Classical dynamic psychotherapy Classical dynamic psychotherapy The neo-Freudians:1930s The neo-Freudians:1930s Object relation theory Object relation theory Attachment theory Attachment theory Interpersonal therapy Interpersonal therapy Behaviour therapy:1920s Behaviour therapy:1920s Cognitive therapy: Cognitive therapy: Cognitive-behaviour therapy Cognitive-behaviour therapy

6 Classification of psychological treatments Technique Technique Eclectic Eclectic Psychodynamic Psychodynamic Cognitive behavioral Cognitive behavioral other: systems theory other: systems theory Number of patients Number of patients Individual therapy Individual therapy Couple therapy Couple therapy Family therapy Family therapy Small and large group therapy Small and large group therapy

7 Common factors in psychological treatment I. Therapeutic relationship II. Listening III. Release of emotion IV. Restoration of morale V. Providing information VI. Providing a rationale VII. Advice and guidance VIII. Suggestion

8 Counselling and crisis intervention Counselling Counselling Counselling incorporates the non-specific factors shared by all kinds of psychotherapy Counselling incorporates the non-specific factors shared by all kinds of psychotherapy Crisis intervention Crisis intervention Helps patients cope with a crisis in their lives, and to learn effective ways of dealing with future difficulties. Helps patients cope with a crisis in their lives, and to learn effective ways of dealing with future difficulties.

9 Counselling 1 Approaches to counselling Approaches to counselling Problem-solving counselling Problem-solving counselling Interpersonal counselling Interpersonal counselling Loss, interpersonal disputes, role transitions, and interpersonal deficits. Loss, interpersonal disputes, role transitions, and interpersonal deficits. Psychodynamic counselling Psychodynamic counselling

10 Counselling 2 Counselling for specific purposes Counselling for specific purposes Debriefing Debriefing Relationship problems Relationship problems Late effects of trauma Late effects of trauma Risks Risks Students Students In primary care In primary care

11 Crisis intervention 1 Problems leading to crisis Problems leading to crisis Loss problems Loss problems Role changes Role changes Relationship problems Relationship problems Conflict problems Conflict problems Indications: Indications: well-motivated people with stabel personalities who are facing major but transitory difficulties. well-motivated people with stabel personalities who are facing major but transitory difficulties.

12 Crisis intervention 2: methods Stage Ⅰ : Stage Ⅰ : reduce arousal; reduce arousal; focus on current problems; focus on current problems; encourage self-help encourage self-help Stage Ⅱ : Stage Ⅱ : assess problems; assess problems; consider solutions; consider solutions; test solutions test solutions Stage Ⅲ : Stage Ⅲ : consider future coping methods consider future coping methods

13 Supportive psychotherapy Table22.3 Table22.3

14 Interpersonal psychotherapy Interpersonal problems under four headings Interpersonal problems under four headings 1. Bereavement and other loss 2. Role disputes 3. Role transitions 4. Interpersonal deficits such as loneliness

15 Cognitive behaviour therapy 1 General features: 8 types General features: 8 types Assessment Assessment Topics to be consided Topics to be consided Source of information for the assessment Source of information for the assessment The formulation The formulation

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17 Cognitive behaviour therapy 2 Behavioural techniques: 16 types ; relaxation training, exposure, desensitization, flooding, exposure in everyday practice, exposure with response prevention …… Behavioural techniques: 16 types ; relaxation training, exposure, desensitization, flooding, exposure in everyday practice, exposure with response prevention …… Cognitive techniques Cognitive techniques

18 CBT for different mental disorders I. Anxiety disorders II. Panic disorder III. Post-traumatic stress disorder (PTSD) IV. Depressive disorders V. Hypochondriasis VI. Schizophrenis VII. Personality disorder VIII. Dialectic behaviour therapy for borderline personality disorder

19 Individual dynamic psychotherapies Brief insight-oriented psychotherapy Brief insight-oriented psychotherapy Cognitive-analytical therapy Cognitive-analytical therapy Psychodynamic interpersonal therapy Psychodynamic interpersonal therapy Long-term individual dynamic psychotherapy Long-term individual dynamic psychotherapy

20 Treatment in groups Small group psychotherapy Small group psychotherapy Types of small group psychotherapy Types of small group psychotherapy Therapeutic groups Therapeutic groups Large-group therapy Large-group therapy

21 Treatment in groups

22 Psychotherapy with couples and families Couple therapy Couple therapy Psychodynamic Psychodynamic Systems approaches Systems approaches Cognitive behvioural Cognitive behvioural Behavioural-systems Behavioural-systems Family therapy Family therapy Psychodynamic family therapy Psychodynamic family therapy Structural family therapy Structural family therapy Systemic family therapy Systemic family therapy Eclectic family therapy Eclectic family therapy

23 Psychotherapy for children Play therapy Play therapy

24 Psychotherapy for older people

25 Other psychological treatments Hypnosis Hypnosis Autogenic training Autogenic training Abreaction Abreaction Meditation Meditation

26 Ethical problems in psychological treatment Autonomy Autonomy Confidentiality Confidentiality Exploitation Exploitation

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