Psychoanalytic Psychotherapy:
In its purest form, two types of problems bring an individual
to a psychologist's office: Problems emerging from a patient's past
life (the patient's developmental trauma and experiences) and problems
which appear to arise from current internal and external stressors.
It is rarely, if ever, that this separation of problems is that pure.
In reality, current problems are superimposed on old and chronic problems
which the patient has carried for an extended period. The skilled
doctor is able to see the impact of the past upon the response to
present stressors. An initial means of conceiving of psychotherapy
is understanding that it is a means of creating a professional atmosphere
in which old feelings and fantasies can be brought to the surface
so that they may be studied, understood and resolved.
Psychotherapist
believe that the unconscious motives along with unresolved conflicts
lead to maladapted behavior. They believe that to develop
a normal personality, a person successful go through five
psychosexual stages:
- Oral
- Birth to 1 year: Sucking.
- Anal
- 1 to 3 years: Holding and releasing urine and feces.
- Phallic
- 3 to 6 years: Pleasure in genital stimulation.
- Latency
- 6 to 11 years: Sexual instincts develop.
- Genital
- Adolescence: Sexual impulses return.
Inadequate resolution
of any of these stages lead to flawed personality development.
Behavior therapy is a combination
of the systematic application of principles of learning theory to
to the analysis and treatment of behavior. It involves more than
principles of learning and conditioning, however, and uses the empirical
findings of social and experimental psychology. The emphasis is
placed upon the observable and confrontable and not inferred mental
states or constructs. The doctors seeks to relate problematic behaviors
(symptoms) to other observable physiological and environmental events.
This involves behavioral analysis of what is occurring (and has
occurred) and means of altering the behavior.
The
early development of behavior therapies occurred in the 1960s
and 1970s and at that time, this mode of psychological care was
defined as the systematic application of learning theory to the
analysis and treatment of behavioral disorders. This is too narrow
of a definition and today, behavior therapy draws not only
upon principles of learning theory and conditioning but upon empirical
findings from experimental and social psychology. The doctor relates
that patients and their disorders to to observable events from physiological
or environmental factors rather than inferring that they arise as
a result of unseen/unrecognized/unconscious conflicts or trauma.
Behavioral analysis, noting the events which lead to motor or verbal
behaviors, is used to assist the patient in understanding cause-effect
relationships and means of disrupting/discontinuing the maladaptive
or counterproductive behaviors. Behavior Therapies have a wide range
of application in phobic, maladaptive habit, and compulsive behaviors.
In
systematic desensitization, the patient can overcome maladaptive
anticipatory anxiety that is evoked by situations or objects by
approaching the feared situations gradually and in a psychophysiologic
state that inhibits the experience of anxiety. A variety of deep
muscle relaxation procedures induces a psychophysiological state
that counterconditions the anxiety response. A graded list or hierarchy
of anxiety-provoking scenes which are associated with the patient
fears is prepared. The patient then approaches the deconditioning
of anxiety by beginning, in fantasy (mental imagery), with the least
anxiety provoking scene and progressing up the hierarchy. The clinical
goal is for the patient to be able to vividly imagine the previously
most anxiety-evoking scene with equanimity. This capacity translates
to real life situations but is most successful when real life situations
are also used during the course of resolving each scene in the hierarchy.
Clinical Hypnosis is an attentive,
receptive, focal concentration while the individual has a concurrent
awareness but a constriction of peripheral events. It is very similar
to visual focus and peripheral vision. Those items in the center
are sharp, detailed and colorful while those in the periphery are
less noticeable. It is very similar to being so absorbed in that
which a person is reading that they enter the world of the book
and often fail to note things occurring around them. There are psychological,
sensory, and motor/behavioral changes during hypnosis. The individual
may have the ability to alter perceptions, dissociate from events
and have amnesia for part of the hypnotic experience. The patient
has the tendency to comply with the doctor, but this suggestibility
and willingness has limitations. EEG (electroencephalographic) studies
suggest that the brain is experiencing resting arousal and that
they are not asleep. Unfortunately, clinical hypnosis as
performed by your doctor can become confused with mythology and
stage performers who use similar approaches to entertain an audience.
See Hypnotherapy Pages
Group psychotherapy
is effective and appeals to many patients and doctors. The
same number of doctors can treat more patients, and it may be combined
with individual psychotherapy. In some countries, the group psychotherapeutic
approach has exceeded the individual approach. As the nuclear family
and religion has become diverse, and in some instances, fragmented,
the psychotherapy group may meet the strong need to belong, affiliate
and assist others. Many doctors see a group size of 8 to 10 patients
as optimal, but groups may vary in size from 3 to 15. Weekly or
twice monthly sessions of 1-2 (1½ most common) hours seems to be
the average. Groups of differing ("heterogenous") patient
needs may be helpful, but there are some group psychotherapy where
all share the same expressed need or disorder. In some instances
the group is thought of as a doctor who is expressed through other
group members: as each group member grows stronger, he/she provides
assistance in interpretation, insight and decision making to other
group members.
Clinical biofeedback instrumentation
provides information (data) to a patient about normally involuntary
physical processes that are below threshold (outside of awareness).
The patient, with these data, can adjust behavioral, cognitive (mental)
and affective (emotional) processes and learn to control these physical
processes. The term was first employed during WWII and the term
behavioral medicine was first utilized in 1973 to describe integration
of behavioral and biomedical sciences for the diagnosis, treatment,
rehabilitation and prevention of illness as well as promotion of
health. Not only can biobehavioral methods be effective in the management
of specific symptoms and rehabilitation, but these approaches are
often useful for patients who are resistant to other forms of treatment.
Dialectical
behaviour therapy (DBT)
is a longer term cognitive behavioural treatment devised for borderline
personality disorder which teaches patients skills for regulating
and accepting emotions and increasing interpersonal effectiveness.
Eclectic therapies Many NHS
therapists formulate the patient's difficulties using more than
one theoretical framework and choose a mix of techniques from more
than one therapy approach. The resulting therapy is pragmatic, tailored
to the individual. These generic therapies often emphasise important
non-specific factors (such as building the therapeutic alliance
and engendering hope). By their nature, they are more idiosyncratic
and difficult to standardise for the purposed of randomsied controlled
trials research.
Eye movement desensitisation
and reprocessing (EMDR) is a form of imaginal exposure treatment
for post-traumatic conditions where the traumatic event is recalled
whilst the client makes specific voluntary eye movements.
Focal psychodynamic therapy
identifies a central conflict arising from early experience
that is being re-enacted in adult life producing mental health problems.
It aims to resolve this through the vehicle of the relationship
with the therapist giving new opportunities for emotional assimilation
and insight. This form of therapy may be offered in a time-limited
format, with anxiety aroused by the ending of therapy being used
to illustrate how re-awakened feelings about earlier losses, separations
and disappointments may be experienced differently.
Psychopharmacotherapies
are based upon the realization that the brain is not chemically
responding in a functional fashion. This has to do with chemicals
within the brain and central nervous system called neurotransmitters
which must not only exist but exist in balance for thought, emotion
and behavior to have regulation. Vigorous research on these chemical
agents have existed since the mid 1950s. As a result of this
research, we better understand how the brain's function is regulated
and how best to assist those who suffer from dysregulation of these
neurotransmitters. Acetylcholine and norepinephrine were among the
first investigated followed by dopamine (dihydoxyphenylethylamine)
and indoleamine serotonin. Quantitatively, these are only minor
transmitters in the brian but they serve major roles in emotional
behavior. The anticonvulsants, neuroleptics, antidepressants and
anxiolytic agents are ever being refined. They are not addictive
agents although some patients become dependent upon the anti-anxiety
(anxiolytic agents) when they are not prescribed in an appropriate
schedule. Non-medical abuse of the anti-anxiety drugs is actually
uncommon. These anxiolytic agents were excessively prescribed in
the past, and some clinicians became hesitant to prescribe them.
Appropriately used, the drugs are both safe and beneficial. See
Psychopharmacology Pages
Marital and Sexual Psychotherapies
deal with not only environmental, situational and phase of
life problems which confront relationships but deal with concurrent
problems in communication and conflict. Problems that occur within
a relationship often emerge from interactional problems, the nature
of feedback which couples provide each other, the difficulties in
maintaining functional balance within the relationship, and the
struggles for power and control which emerge. While interactional
problems within a marital system may result in, and sometimes from,
sexual conflicts, these are not the sole causes, nor even necessarily
the primary causes. It is quite possible for a couple to have a
functional sexual relationship and a dysfunctional emotional relationship.
Relationship problems may emerge or worsen as a result of sexual
dysfunction. By the time the couple consults a doctors, it is questionable
as to whether sole resolution of the sexual problem, via medication
for example, will make the marriage again functional unless other
intervention (e.g. marital psychotherapy) is concurrently provided. See
Counselling Pages
Short-term dynamic psychotherapies
(STDP) work well for nonresistant patients whose resolution of problems
do not become steeped in long term transferential problems relating
to the doctor and for whom problems are significant but not overwhelmingly
complex. Such patients often have some beginning insight or awareness
of potential causes of their problems. Treatment begins with a comprehensive
diagnostic examination which determines whether the problems/disorder
can be appropriately treated by a particular psychotherapeutic technique.
The doctor also determines whether the patient has the strength
to confront the underlying causes for their problems and that there
is the potential for positive response to short term intervention.
As in psychoanalysis or psychoanalytic psychotherapies, STDP does
involve examination of of the means by which unconscious needs and
drives influence a patient's behavior and functional capacity.
Client-centered psychotherapy
arose during the period of 1938-1950 and broadened the scope
of patients treated by this approach in the 60s and 70s. The characteristics
that distinguished this form of patient care included the belief
that specific characteristics of the doctor were necessary and sufficient
for effective treatment; rejection of the medical/disease model
and focus upon the growth model of patient change; the immediate
(rather than emotionally distant) accessibility of the doctor; focus
upon the experiences of the patient; focus upon the patient's ability
to live within the moment; concern for personality change rather
than personality structure; and belief that the process applies
to all patients rather than a select group; application of all knowledge
of the impact of psychotherapy upon the interpersonal process. Many
patients reported significant gains after only brief treatment exposure
in contrast to the greater time period perceived required by other
modes of treatment.
Cognitive Behavioral Psychotherapy
is based upon a theory of psychopathology, set of psychotherapeutic
principles, and knowledge based upon empirical investigation.
It is based upon information-processing theory and social psychology.
Aside from being effective with a wide range of disorders, it appears
to enhance the impact of medications used to treat such disorders
and has appeal in that it is active, structured and time-limited.
Pain, phobias, and mood disorders as well as psychophysiologic (psychosomatic)
disorders have been treated successfully with this treatment approach.
Errors in our thinking leading to self-defeating assumptions, incorrect
interpretation of information, and lack of adequate problem solving
planning are believed to be at the heart of our problems. Treatment
assist the patient in identifying, testing the reality of, and correcting
dysfunctional beliefs underlying our thinking and to assist the
patient in modifying the thoughts and behaviors which emerge.
Relaxation Techniques in this
form of therapy the patient is helped to resolve stresses that can
contribute to the particular disorder. Breathing re-training and
other skills are taught in which the patient is actively involved
in developing skills that are useful for a lifetime. Can take time
to achieve results and treatment benefits are limited to active
use of the techniques.
Adlerian Therapy Adlerian
Therapy is a growth model. It stresses a positive view of
human nature and that we are in control of our own fate and not
a victim to it. We start at an early age in creating our own
unique style of life and that style stays relatively constant through
the remained of our life. That we are motivated by our setting
of goals, how we deal with the tasks we face in life,
and our social interest. The therapist will gather as much
family history as they can. They will use this data to help
set goals for the client and to get an idea of the clients' past
performance. This will help make certain the goal is not to
low or high, and that the client has the means to reach
it. The goal of Adlerian Therapy is to challenge and encourage
the clients' premises and goals. To encourage goals that are
useful socially and to help them feel equal. These goals maybe
from any component of life including, parenting skills,
marital skills, ending substance-abuse, and most
anything else. The therapist will focus on and examine the
clients' lifestyle and the therapist will try to form a mutual respect
and trust for each other. They will then mutually set goals
and the therapist will provided encouragement to the client in reaching
their goals. The therapist may also assign homework,
setup contracts between them and the client, and make suggestions
on how the client can reach their goals.
Existential Therapy Focuses
on freedom of choice in shaping one's own life. Teaches one
is responsible to shape his / her own life and a need for self-determination
and self-awareness. The uniqueness of each individual forms
his / her own unique personality, starting from infancy. Existential
therapy focuses on the present and on the future. The therapist
try's to help the client see they are free and to see the possibilities
for their future. They will challenge the client to recognize
that he / she themselves were responsible for the events in their
life. This type of therapy is well suited in helping the client
to make good choices or in dealing with life.
Gestalt Therapy Gestalt
therapy integrates the body and mind factors, by stressing
awareness and integration. Integration of behaving,
feelings, and thinking is the main goal in Gestalt therapy.
Client's are viewed as having the ability to recognize how earlier
life influences may have changed their life's. The client is is
made aware of personal responsibility, how to avoid problems,
to finish unfinished matters, to experience thing in a positive
light, and in the awareness of now. It is up to the
therapist to help lead the client to awareness of moment by moment
experiencing of life. Then to challenge the client to accept
the responsibility of taking care of themselves rather then excepting
others to do it. The therapist may use confrontation,
dream analysis, dialogue with polarities, or role playing
to reach their goals. This may include treatment of crisis
intervention, marital / family therapy, problem in children's
behavior, psychosomatic disorders, or the training
of mental health professionals.
Rational-emotive and Cognitive-behavioral
Therapy Rational-emotive therapy is a highly
action-oriented and deals with the client's cognitive and moral
state. This therapy stresses the clients ability of thinking
on their own and in their ability to change. The rational-emotive
therapist believes that we are born with the ability of rational
thinking but that my fall victim to irrational thinking. They
stress the clients ability to think, in making good judgments,
and in taking action. The therapist will use directed
therapy. The therapist believes that a neurosis is a result
of irrational behavior and irrational thinking. The Rational-emotive
and Cognitive-behavioral therapist believe the clients problems
are rooted in childhood and in their belief system, that was
formed in childhood. Therapy will include method is solving
and dealing with emotional or behavior problems. The therapist
will help the client to eliminate any self-defeating outlooks they
may have and to view life in a rational way. The therapist
will never have a personal relationship with the client. The
therapist will think of the client as a student and themselves as
the teacher.
Reality Therapy The
reality therapist teaches the client ways to control the world around
them and how to meet their personal needs. They believe
that the client can and will change their life for the better.
The reality therapist focuses on the what and the why of the clients
actions. They point out what the client doing and in
getting them to evaluate it. A behavioral or emotional problem
is a direct result of the clients believe and feelings about themselves.
The therapist will help the client evaluate their behaviors and
feelings, to challenge them to become more effective at meeting
their needs.
Transactional Analysis Transactional
analysis focus on the clients cognitive and behavior functioning.
The therapist helps the client evaluate their past decisions and
how those decisions affect their present life. They
believe self-defeating behavior and feelings can be overcome by
an awareness of them. The therapist believes that the clients
personality is made up of the parent, adult, and child.
They believe that it is important for the client to examine past
decisions to help their make new and better decisions.
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