Psychotherapy

Psychotherapy works by helping people understand why they feel as they do. It uses a combination of reflecting about past events, learning new coping strategies and building a therapist-patient relationship.

– There are 3 main areas of psychological therapy, each with its advantages and disadvantages:

i) Supportive therapies

e.g. Counselling + Supportive Psychotherapy

This is the least intense level of psychotherapy which is used for mild depression and anxiety

– The sessions are unstructured but allow the patient to establish rapport, reflect and get reassurance

– It is a non-direct way of solving the problem –> works for stress, bereavement, adjustment disorder

– Patients usually have about 6-10 sessions and it works well for mild disorders.

ii) Psychodynamic therapies:

e. g. Psychoanalysis + Psychodynamic Psychotherapy

These therapies are based on the work from Sigmund Freud – he theorised that human behaviours are being determined by unconscious forces derived from primitive emotional needs

– Therefore, by looking at the condition using psychoanalysis, it allows patients to examine unresolved conflicts and symptoms that arise from past dysfunctional relationships which show up in life as bad behaviours

– Psychodynamic sessions are 4/5 times a week and can last up to 2- 5 years

Procedure:

– The patient explores their subconscious by using free association (says whatever is on their mind)

– The therapist interprets these statements to link the patient’s past experience with their current life and their relationship with the therapist. This uses 2 skills:

– Transference –> when the patient re-experiences strong emotions from early relationships with the therapist

– Counter-transference –> When the therapist experiences strong emotions towards the patient

Problems:

– Long time needed for treatment to work

– Very intensive and expensive training

– Patients are left to work it out themselves

– Patients can become dependent

iii) Behaviourist Therapies

These therapies originate from the view that psychiatry is about abnormal behaviours.

– To address this, it suggests you have to tackle these in a very structured, patient-centred approach

– It is explicit – gives the patient clear strategies to improve their thinking and make a tangible difference

– Time limited – usually lasts about 6-12 sessions

Cognitive Analytic Therapy (CAT)

This is a short time-limited therapy which provides inexpensive psychological treatment

– It looks at the ways an individual think and feels and the events and relationships underlying experiences.

– They key of this therapy is reflection after – therapist writes a goodbye letter and asks patient to respond

It focusses on 3 main principles:

– Reformulation Phase – this establishes where the patient’s psychological problems have developed from.

–  It then diagrams to see how effective their current coping strategies are in feeling with the current problem

– It then finds new and better ways of coping which are more relevant and suitable to their current lives.

iv) Newer Psychotherapies

EMDR

This is a type of psychotherapy that allows patients to access past traumatic memories and emotionally resolve them.

– It is mainly used for post-traumatic stress disorder (PTSD)

Interpersonal Therapy

This therapy is based on psychodynamic therapies and is used for moderate to severe depression.

– The patient explains who their close relationships are to the therapist who draws an interpersonal network

– This allows them to view the patient’s emotions in terms of their interpersonal network e.g. a close member may have died (causing grief)

– The rest of the session then involves work on how to cope and change their views of these events and transform their relationship into a positive on

Family Therapy

This believes that relationships between people and communications are more important than the individual

– The therapist asks questions and observes the family style of interacting with each other

– The therapist then will give feedback and encourage positive engagement.

– In this way, changing one thing can lead to the whole system changing

– It is especially beneficial for the treatment of children with eating disorders (and now used 1st line)

v) Physical Therapies

ECT

This is a treatment option which uses electrodes to induce a modified cerebral seizure in the brain

– This leads to massive amounts of neurotransmitter release, hormone secretion and a transient increase in blood brain barrier permeability.

– It is used to induce fast improvement after all other treatment options have failed

Uses: People with severe depression/refractory to medication, catatonia

Contraindications:

– Raised intracranial pressure (absolute)

– Stroke and MI (relative contraindication)