1 © Dr Najib Y2K2 Dr. Muhammad Najib Mohamad Alwi Jabatan Psikiatri, PPSP USMhttp://clik.to/drnajib

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3 Talking Therapy? Terms that you’ve probably heard before: Terms that you’ve probably heard before: Counseling Counseling “Talking Therapy” “Talking Therapy” “Psychoanalysis” “Psychoanalysis” Supportive Therapy Supportive Therapy Psychotherapy Psychotherapy Etc. Etc.

4 Definition of Psychotherapy Strupp (1978) Strupp (1978) “ An Interpersonal process designed to bring about modifications of feelings, cognitions, attitudes and behaviour which have proved troublesome to the person seeking help from a trained professional ”

5 Definition of Psychotherapy Other definitions: Other definitions: The development of a trusting relationship, which allows free communication and leads to understanding, integration and acceptance of self The development of a trusting relationship, which allows free communication and leads to understanding, integration and acceptance of self The treatment of emotional, behavioural or personality problems by psychological means The treatment of emotional, behavioural or personality problems by psychological means

6 CHARACTERISTICS OF ALL PSYCHOTHERAPIES Intense, emotionally charged, confiding r/ship with a helping person Intense, emotionally charged, confiding r/ship with a helping person A rationale which contains an explanation of the patient’s distress and of the methods for its release A rationale which contains an explanation of the patient’s distress and of the methods for its release Provision of new information about the nature and origins of the problems and of ways of dealing with them Provision of new information about the nature and origins of the problems and of ways of dealing with them Hope in the patient that he can expect help from the therapy Hope in the patient that he can expect help from the therapy An opportunity for experiences of success during the course of therapy and a consequent enhancement of the sense of mastery An opportunity for experiences of success during the course of therapy and a consequent enhancement of the sense of mastery The facilitation of emotional arousal in the patient The facilitation of emotional arousal in the patient (Jerome Frank, 1971)

7 BROAD CHARACTERISTICS OF PSYCHOTHERAPIES: The presence of a therapist-patient relationship The presence of a therapist-patient relationship The interpersonal context of the psychotherapies The interpersonal context of the psychotherapies Conducted according to a model that guides the therapist’s actions Conducted according to a model that guides the therapist’s actions

8 Counseling and Psychotherapy Similarities: Similarities: Counseling under broad definition can also be defined as psychotherapy Counseling under broad definition can also be defined as psychotherapy Counseling uses some form of psychological model e.g. Roger’s Client Centred Therapy Counseling uses some form of psychological model e.g. Roger’s Client Centred Therapy Both provide some form of support to the patients Both provide some form of support to the patients

9 Differences: Counseling vs Psychotherapy Counseling Counseling Offers non-judgemental support, encourages clarification of current problems & help clients find solutions. Offers non-judgemental support, encourages clarification of current problems & help clients find solutions. Usually short-term (1 – 3 sessions) Usually short-term (1 – 3 sessions) Counselors are often not psychotherapeutically trained and seldom requires supervision Counselors are often not psychotherapeutically trained and seldom requires supervision Often done at primary care settings / schools etc. Often done at primary care settings / schools etc. Psychotherapy Psychotherapy Psychotherapy is supportive but may not directly help to solve problems. Usually longer-term (12 sessions or more) Needs to undergo special training and supervision Often conducted in secondary or tertiary centres only

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11 Psychotherapies Thus, broadly speaking, the broad definition of psychotherapy can encompass a large number of interventions Thus, broadly speaking, the broad definition of psychotherapy can encompass a large number of interventions Kazdin (1986) identified > 400 different therapies that can be classified as psychotherapy Kazdin (1986) identified > 400 different therapies that can be classified as psychotherapy Differing levels: Differing levels: Informal: between friends, relatives, self-help groups Informal: between friends, relatives, self-help groups Formal: supportive, dynamic, behavioural etc. Formal: supportive, dynamic, behavioural etc.

13 Major Classes of Psychotherapies Psychodynamic Psychotherapy Psychodynamic Psychotherapy Behavioural and Cognitive-Behavioural Psychotherapy Behavioural and Cognitive-Behavioural Psychotherapy Interpersonal Psychotherapy Interpersonal Psychotherapy Supportive and experiential psychotherapies Supportive and experiential psychotherapies Group therapies Group therapies Family therapies: Systemic / Strategic / Structural Family therapies: Systemic / Strategic / Structural Existential Psychotherapy etc….. Existential Psychotherapy etc…..

14 Aims of Psychotherapy Psychodynamic Tx: to change habitual patterns of thinking, feeling and behaviour which may include specific symptoms Psychodynamic Tx: to change habitual patterns of thinking, feeling and behaviour which may include specific symptoms Behaviour Tx: to reduce symptoms by changing specific behaviours Behaviour Tx: to reduce symptoms by changing specific behaviours Cognitive Tx: to reduce symptoms by changing thoughts which maintain specific symptoms Cognitive Tx: to reduce symptoms by changing thoughts which maintain specific symptoms Interpersonal Tx: to help patient identify and find solutions to current life problems Interpersonal Tx: to help patient identify and find solutions to current life problems Family Tx: to see if and how the problem of the identified patient is maintained by the needs of the family Family Tx: to see if and how the problem of the identified patient is maintained by the needs of the family

15 Major Classes of Psychotherapies Psychodynamic Psychotherapy Psychodynamic Psychotherapy Behavioural and Cognitive-Behavioural Psychotherapy Behavioural and Cognitive-Behavioural Psychotherapy Interpersonal Psychotherapy Interpersonal Psychotherapy Supportive and experiential psychotherapies Supportive and experiential psychotherapies Group therapies Group therapies Family therapies: Systemic / Strategic / Structural Family therapies: Systemic / Strategic / Structural Existential Psychotherapy etc….. Existential Psychotherapy etc…..

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17 What Is It? n (Psycho-)Dynamic Psychotherapy: – Is concerned with the way in which a person’s mental representation of self and the world may lead to inappropriate behaviour in present personal and working relationships – This approach seeks a personal meaning for the patient’s symptoms in terms of his or her past and present life n Aim: – To help the patient by increasing understanding of his thoughts, feelings and behaviour n Thus, it is sometimes called ‘exploratory’ or ‘insight directed’ therapy

18 Psychodynamic Psychotherapy Main classification: Main classification: Long-term: Long-term: Frequency: >2 times per week Frequency: >2 times per week Duration: 1-5 years (or more!) Duration: 1-5 years (or more!) “psychoanalysis” “psychoanalysis” “psychoanalysis” “Brief”: “Brief”: Frequency: usually 1/week Frequency: usually 1/week Duration: around 3-9 months Duration: around 3-9 months

Freud’s famous couch

20 Psychodynamic Psychotherapy “Brief” Dynamic Psychotherapy “Brief” Dynamic Psychotherapy Usually up to 20 sessions Usually up to 20 sessions Suitable for patients who has had adequate psychological health and adjustment, and who has a specific symptom or problem with a definable onset. Suitable for patients who has had adequate psychological health and adjustment, and who has a specific symptom or problem with a definable onset. At least 8 different variants At least 8 different variants

21 Who Needs It? n Dynamic Psychotherapy is demanding on patient and not everyone can benefit from it n Diagnostic conditions where dynamic psychotherapy may be sought: – Depression – Anxiety disorder – Personality disorder – Eating disorder

22  R  Recognizes problem as psychological  R  Responsible for his own situation  C  Curiosity or psychological mindedness  M  Motivation to understand and change attitudes and behaviour  F  Flexible and has problem solving ability  C  Capacity to relate to another person  G  Good childhood interpersonal relationship Suitability for therapy:

23 What Happens In Therapy? n Patient sits facing about 120 o away from the therapist n Setting of clear rules and boundaries n Average 50 minutes sessions n No set agenda n Patient talks on what comes through their mind n Therapist would give comments / interpretations when appropriate n Therapeutic alliance / free association / ending

24 Overview of Concepts Working alliance: agreement between patient and therapist that they will work together on the patient’s emotional or psychological problems Working alliance: agreement between patient and therapist that they will work together on the patient’s emotional or psychological problems Transference: transferring of feelings which belong to a relationship from the past into the present relationship Transference: transferring of feelings which belong to a relationship from the past into the present relationship Countertransference: feelings elicited in the therapist by the patient’s behaviour and communications. Countertransference: feelings elicited in the therapist by the patient’s behaviour and communications.

25 Triangle of Feeling DEFENCE ANXIETY HIDDEN FEELING / IMPULSE

26 Triangle of Person O Others (current, recent past) T Transference (here and now) P Parent / sibling (distant past) O/T link O/P link T/P link

27 References Individual Psychotherapy and the Science of Psychodynamics (2nd Edition). David H. Malan. Butterworth Heinemann, Dynamic Psychotherapy Explained. Patricia Hughes. Radcliffe Medical Press, 1999 This presentation is available on my website: clik.to/drnajib Come and see me!