PsychotherapyPsychotherapy

MUDr. Jan HankaMUDr. Jan Hanka3.LF UK, PCP3.LF UK, PCP

20132013

PsychotherapyPsychotherapy

• Definition• History• Basic principles of therapeutic work• Main branches of psychotherapy• Forms of psychotherapeutic care• Psychotherapy in treatment of specific

mental disorders

PsychotherapyPsychotherapy

What is it?What is it?

Treatment mediated by psychological methods

Used to treat mental disorders, psychological problems, relationship problems. In psychotherapy

Client’s emotions and behavior change in the course of therapy. It should also contribute to

personal development.

PsychotPsychothheraperapyyEffective factorsEffective factors

• support, restoration of morale, providing information, providing a rationale

• therapeutic relationship, listening, group dynamics

• Advice and guidance, suggestion

• Confrontation with one’s problems, release of emotions

• Learning new ways to cope + social skills

PsychotPsychothheraerapypyHistorHistoryy

• shamen, medicine men, herbalists (magic, suggestion)

• religion (meditation, confession, exorcism, moral therapy)

Psychotherapy Psychotherapy in medicine (the beginning)in medicine (the beginning)

• Hypnosis for Hysteria – Franz Mesmer in 1774`

• End of 19th century (Salpetriere hospital Paris - JM Charcot, Hippolyte Bernheim in Nancy)

• Paul Dubois, Switzerland 1904 - rational discussion about symptoms + persuasion (“The psychic treatment of nervous disorders”)

• Freud (1900 Traumdeutung, 1904 Zur Psychopathologie des Alltagslebens, 1905 Drei Abhandlungen zur Sexualtheorie, 1910 Über Psychoanalyse)

• 1910-1920: A Adler (individual pst), CG Jung (analytic pst), JL Moreno (group pst)

Basic princilpes of Basic princilpes of psychotherapypsychotherapy

• Goal-oriented, planned (contract, method, number of sessions, price)

• Expertise (training, supervision, specialization, continuous education)

• Decision to carefully listen to each other (therapeutic relationship)

• Empathy (therapist’s personality)

Various therapeutic approachesVarious therapeutic approaches

Based on the methods used:•Psychoanalytical•Interpersonal•Sugestive•Racional•Empathic•Abreaction•Training based

Basic schools of psychotherapyBasic schools of psychotherapy

• Analytic schools (psychoanalysis, neo-analytic therapists…)

• Dynamic and interpersonal

• Humanistic (Rogerian, Gestalt, logotherapy)

• Cognitive-behavioral therapy

Psychoanalysis Psychoanalysis Sigmund Freud Sigmund Freud (1856- Příbor, +1939)(1856- Příbor, +1939)

• Consciousness-unconsciousness-preconsciousness (conflicts produce symptoms)

• Complex (Oidipos, Elektra)• Drives: Eros / Thanatos

• Psychosexual development: oral phase (1st y.), anal phase (2nd + 3rd y.), phallic phase (4th+ 5th y.), latent phase, genital (since approx. 11th y.)

• Transferrence - countertransferrence• Free associations• Ego-defensive mechanisms: denial,

projection, racionalization, passive aggresion, conversion, compensation, regression, withdrawal (mature mechanisms: humility, mindfulness, acceptance, gratitude, altruism, tolerance, mercy, forgiveness, anticipation, humour)

Psychoanalysis Psychoanalysis (cont.)(cont.)

Carl Gustav JUNGCarl Gustav JUNG• Complex (unconscious set

of memories, thoughts, experiences, emotions- around one topic)

• Dealing with complexes: ignorance, identification, projection, confrontation

• introversion- extraversion• Archetypes (Self, Shadow,

Anima, Animus, Mother, Child, Hero..)

• Collective unconsciousness

• Symbolic language of dreams

Dynamic and interpersonal Dynamic and interpersonal psychotherapypsychotherapy

• Karen Horney (early childhood trauma: feeling insignificant/helpless/threatened. Strategies of compensation: striving for affection, power, submissivness)

• Harry S. Sullivan (focus on relationships: Everyday social encounters + therapeutic relationship)

• disorders originate in disturbed relationships

• Dynamic group therapy (today)

HypnosisHypnosis• State of increased

suggestbility + dependence + altered state of mind

• Franz Mesmer (1734-1815)

• Milton H. Erickson (1901-1980)

• Induction – hypnotic phenomena – posthypnotic suggestions

• Stage-fright, pain, smoking cessation, psychosomatic illness

Humanistic therapyHumanistic therapyGestalt therapyGestalt therapy

• Fritz (Frederick) Perls• Here and now princple• Relationsip „me and you“• Awareness of own’s

emotions• Responsbility ofr own’s

thoughts, emotions, actions (can’t = don’t want)

Humanistic therapyHumanistic therapyRogerian therapy Rogerian therapy (C Rogers, 1902-1987)(C Rogers, 1902-1987)

• Talking therap- is not interpreted or guided

• Empathy, congruence, reflexion

• Therapist as an authentic person

• What I am x what I want to be

• Unconditioned acceptance by the therapist

Transpersonal psychotherapyTranspersonal psychotherapy

- Stanislav Grof (*1931): unusual experiences, religious practice of ingenuous tribes, altered states of consciousness, near death experiencei

- psychospiritual crisis

- LSD psychotherapy

- Holotropic breathwork

Cognitive - Cognitive - behavioralbehavioral therapy therapy HansHans Eysenck (pic.) J Wholpe, BF SkinnerEysenck (pic.) J Wholpe, BF Skinner (skinner box)(skinner box)

• Scientific method• Theory of learning,

conditioning (classical/operant)• Desensibilisation (feared

stimulus is connected to relaxation, humour..)

• Exposure (face the feared stimulus with pevention of avoidant/safety-seeking behavior)

• Habituation (ignore a stimulus which does not bring serious consequences)

• Flooding• Relaxation training• Aversive therapy

Cognitive – behavioral tgerapyCognitive – behavioral tgerapy

Cognitive therapyCognitive therapy

• Aaron Beck (*1921)• BDI, BAI, BHS, BSS• Psychotherapy of depression• Automatic negative thoughts• Cognitive errors (exaggeration,

over-generalization, selective abstraction, negative forecasting, personalisation, labeling, mind-reading, “musturbation”, all or nothing)

Cognitive – behavioral tgerapyCognitive – behavioral tgerapy

Cognitive therapyCognitive therapy• Albert Ellis• R-ET• A B C system• „we are not worried

by events, but by our interpretations of events”

Cognitive therapyCognitive therapybasic vocabularybasic vocabulary

• Cognitive events- thoughts (rational x automatis/intrusive)

• Cognitive processes- way of thinking (possible cognitive errors)

• Cognitive schemas: core beliefs and dysfunctional scripts

self / others / the world

power / acceptance / performance

Methods of CBTMethods of CBT• BiofeedbackBiofeedback (headache/low back

pain, hypertension, training of controlled breathing and relaxation, ADHD theta:beta, incontinentia) -feedback on physiological functions

(EEG, HRV,..) used in learning how to control them by our will

  • Assertivness training1. express feelings openly2. engagae in conversation3. speek in front of others4.  ask a favor5. Refuse to yield to presure

Anger management

Psychotherapy- formsPsychotherapy- forms

• Individual (1:1) x Couple x Family x Group x Therapeutic community

• Counseling (in schools, in media / online, specialized counselors)

• Crisis intervention (loss, change, conflict, trauma)

Group psychotherapyGroup psychotherapy

• Since WW II., started in England (1940)

• Currently most prevalent form

• Groups closed x open

• Dynamic schools of psychotherapy

• Group analyis

• Group CBT

• Self-help groups (AA)

Therapeutic factors in Therapeutic factors in groupgroup therapytherapy

• Group cohesion• Socialization• Altruism• Imitation• Interpersonal learning• Recapitulation of the family group• Feedback, confrontation

Criteria of psychological healthCriteria of psychological health (Ellis, Dryden, 1987)(Ellis, Dryden, 1987)

• Self-interest• Social interest• Self-direction• High frustration tolerance• Flexibility• Acceptance of uncertainty• Commitment to creative pursuits• Scientific thinking• Self-acceptance• Risk-taking• Long-ange hedonism • Non-utopianism• Self-responsibility for own emotional disturbance

Psychotherapy in treatment of Psychotherapy in treatment of specific mental disordersspecific mental disorders

Example: Agoraphobia with panic disorder (CBT approach)

(Psychiatric examination) + Self-monitoring

Setting the rules for therapy

Formulation of the problem

Setting goals

Behavioral assessment (ABC, vicious circle of anxiety)

Functional assessment (consequences, secondary gains, maintaining factors)

Education

Relaxation trainin

Interoceptive exposure (to a panic attack)

Gradual exposure to agoraphobic situations (restricting safety-seeking behaviour: “crutches”)

Schematherapy

Relationship poblems solving

Long-term goals

DiscussionDiscussion

hanka@pcp.lf3.cuni.cz