Treatment, stages, Dr. Ali farah Ahmed

Opening stage  In this stage the therapist must:  Establish a good relationship with the pt.  Teach the pt. how psycho therapy works.  Take history. Case study.  Formulate a tentative workable diagnosis.

Establishing a good relationship  Therapist must not expect to be trusted right away because pt. usually enters treatment emotionally demoralised, bruised, worried and fearful.  So the combat between pt. and therapist may take time.  Pts. May test the therapist before the trust them.

Teaching how psychotherapy works  The easiest way to do so is to let pt. know by doing:  Therapist must let pt. get comfortable and tell why he came, who sends him,…etc  Some times therapists get right with the pt. into the problem if they are acquainted with him.  In either case therapist must be sure that he hears the story from the beginning with interest not only in the facts but in the pt’s feelings at the time of the problem or other peoples’ feelings as they become involved.

 In this way pt is taught to realize that feelings, attitudes, and emotional reactions form the important data with which both pt. and therapist work

 The mechanisms of therapy are rapidly learned:  Firm appointments: usually minutes per session.  The necessity of being on time and ending on time.  The agreement that nothing of the pt’s life must be hold back  Agreement that no important changes in pt’s life would be made without discussing them in the therapy.

 The understanding that everything the pt. does or say may be of therapeutic value.  The fact that all pts’ resist therapy in one way or another and that effective treatment involves identifying and eliminating these forms of resistance gradually.

Forms of resistance  Pt routinely coming late.  Pt. being hostile.  Pt. coming when he wants not when expected.  Pt. forgetting appointment.  Pt. being too sick to come.  Pt. fighting into health.

 Pt. filling the session with friend’s problems.  Pt. requesting hypnosis.  Pt. asking for reading assignments.  Pt. spending time of session in discussing readings

 Resistance must be treated by uncovering them until they melt away by:  Identifying their origin,  Pointing them out whenever they occur. Pt. will give them up one by one

 The communist error that a therapist can do is to take too mush:  Pt must be let to say the first words and the last words, in-between pt. must be kept talking as long as he seems going well.  Therapist must not say something because it is true, instead he must keep himself out of it.

Taking history, case study  This must be done as informal as possible; i.e letting the pt. fit the pieces in any order he likes: these pieces can be:  current problem  Family history,  Medical history,….  etc

Middle stage  The tasks of this stage overlap with the tasks of the previous stage.  The main task is to accomplish actual therapy: so here is the area of overlap: therapy may begin in the first stage and gradually fills in the hours of sessions until termination.

 Certain aspects of treatment apply to all pts.: the professional attitude of the therapist, nonjudgmental interest and authority are gradually valued pt. and he would ventilate.  Also the pt’s personal objectivity increases as he recount his history and as the therapist maintain nonjudgmental atittudes in a serious effort to understand.

 Specific treatment is unique to each pt. it is not important here to distinguish between treatment which is primary supportive and that which is analytic.  Supportive symptomatic treatment aims at Reinforcing existing personality structure and defence mechanisms.  Insight therapy aims at discovering roots of the disorder and hence the basic changes in symptoms, attitudes, reaction patterns and life adjustment.

 The choice between the therapies depends on the type of disorder, and on the characteristics of the pt, e.g in psychosis supportive therapy is largely used together with somatic therapy, while in psycho physiological disorders insight therapies are major

 Personality problems require long term and deep uncovering techniques while neurosis can be treated either by supportive or uncovering techniques, depending on the motivation, goals, and the personality of the pt.

Ending stage  This stage overlaps with the middle stage and begins when therapy continues for several weeks or months.  It may start when there is an indication that some personality changes have been achieved in the direction of maturation and growth.

 Some symptoms disappear quickly in therapy but others return quickly if causative factors reassert themselves e.g headaches, anxieties, impotence.  Other symptoms are not responsive to treatment e.g depressive and obsessive  Still other symptoms may become so fixed that they become part of personality so the gaol of treatment is to cope with them, e.g alcoholism