1. Psychological Approaches In Primary Care II (Bradford GP VTS
Dr Andrew R. Wilson

2. Objectives
Reflect on validation homework to embed and share successes and acknowledge and deal with some of the difficulties
Have sufficient understanding of the rationale therapies to facilitate referral for psychological interventions
Explore some ways of bringing focus and facilititating change when working with psychological problems in primary care.

3. Today Session Summary of previous session
Rationale therapies / therapist – presentations
Homework review (tying in some of the learning from summer school “counselling” subschool.
Tools for change
Summary and feedback

4. Review of Session I
Pairs Work

5. What works Review of Session I Empathy Genuiness Warmth
negotiation of Goals
Reflecting

6. What works Review of Session I
Repairing rupture in therapeutic relationship
If patient satisfied
Alliance
Cohesion between pt and therapist
Emotional expression
Changing view of self

7. What works broad classification
Review of Session I
What works broad classification
Validation
Goal orientation/change techniques

8. 2. Rationale therapies
Presentations

9. Homework Review Validation In Groups What worked well
What worked less well

10. 4. Tools for change Problem and goal lists
Cognitive continuum methods – breaking down global thinking
Behavioural Activation

11. Problem and Goal Lists Give Focus Breaks things up into smaller parts
Uses patients definition of problems
Collaborative
Problem and present orientated
Directional
Gives in time a sense of progress made

12. Sources for problem lists
Situational problems
Medical and traditional psychological problems
What other observe (family/doctors)
Effect of pt on others
?symptom/problem diaries

13. Patients may under report
Embarrassed/shame
Not be aware it is a problem
Believe problem to be insoluable
Overwhelmed
Not consider it a problem

14. Goals
Specific
Measurable
Acheiveable
Realistic
Time Limited

15. Challenging Global Thinking
Lots of forms of negative global thinking
Worksheets in 3’s

16. Common Thinking Errors
All or nothing/Black or White/Polarised Thinking
Overgeneralising
Mental filter/selective abstraction
Jumping to conclusions/catastrophising
Mind reading
Fortune telling
Magnifying or minimizing

17. Common Thinking Errors
Emotional Reasoning
Shoulds and must
Labelling
Personalising
Tunnel Vision
Disqualifying or discounting the positive

18. Cognitive Continuum Identify the global thinking “I’m a bad mum
Score it 0-100
Break up “I’m a bad mum “ into constituent parts and re score

19. Good Mother belief at beginning 50%
Patient 0 x100 Loving 0 x100 Warm and Fed 0 x100 Quality Time 0 x 100 Build their Self Esteem 0 x 100
Good Mother belief at end 70-80%

20. Behavioural Activation
Some behaviours result in positive mood changes
Evidence that scheduling activities can result in improvement in patients with anxiety and depression, independent of traditional medical interventions
Probably the main “treatment” effect of CBT