Psychological Therapies

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Psychological Therapies
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Psychotherapy is

• essentially a conversation which involves
  listening to and talking with those in trouble
  with the aim of helping them understand and
  resolve their predicament. - Brown and Pedder.
• an interpersonal process designed to bring
  about a modification of feelings, cognitions,
  attitudes and behaviour which have proven
  troublesome to the person seeking help. Hans
  Strupp
• the art of alleviating personal difficulties
  through the agency of words and a personal,
  professional relationship. - Anthony Storr

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Who does psychotherapy?

• (All mental health workers)CounsellorsClinica
  l /Counselling PsychologistsAdult
  PsychotherapistsChild Psychotherapists
• Medical Psychotherapists
• Forensic Psychotherapists

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Setting

• GP surgeriesOut-patient PCMHT, CMHT,
  Psychologyand Psychotherapy departments
  In-patient Day HospitalAt home of
  patientPrison (Grendon Underwood)

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System

• Individual
• Couple
• Group
• Family
• Organisation

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Four Main Groupings of Psychotherapy

• 1. Psychoanalytic/Psychodynamic2. Behavioural/C
  ognitive-Behavioural3. Humanistic Movement
• 4. Integrative Therapies

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Common Features of Psychotherapies(Jerome Frank)

• 1. An intense, emotionally charged relationship
  with a person or group.2. A rationale or myth
  explaining the distress and methods of dealing
  with it.3. Provision of new information about
  the future, the source of the problem and
  possible alternatives which hold a hope of
  relief.4. Non-specific methods of boosting
  self-esteem.5. Provision of success
  experiences.6. Facilitation of emotional
  arousal.7. Takes place in a locale designated as
  a place of healing

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Common types of therapy

• Cognitive Behavioural TherapyPsychodynamic
  psychotherapyCognitive Analytic
  TherapyPsychodynamic Interpersonal
  TherapySystemic/Family TherapyGroup analytic
  therapyPsychodramaCounselling

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Other types of therapy

• Specific family interventions with schizophrenia
  patients
• Supportive Therapy
• Therapeutic CommunitiesDialectical Behavioural
  TherapyGestalt TherapySolution Focused
  TherapyTransactional Analysis

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Classifications of psychotherapy (NHSE, 1996)

• Type A Psychological treatment as an integral
  component of Mental Health care. Refers to the
  psychotherapeutic skills required by all mental
  health and social care professionals.Type
  B Eclectic Psychological therapy and
  Counselling.Refers to the psychotherapeutic
  skills needed by a broadly trained mental
  health/social care professional (nurse,
  occupational therapist, social worker, clinical
  psychologist or psychiatrist with a special
  interest in psychotherapy who treats patients but
  does not act in a senior consultative or training
  capacity.Type C Formal Psychotherapies Refers
  to the specialist therapeutic skills required by
  a professional working for the majority of
  his/her time in the speciality ie. Consultant
  Psychotherapist level with a significant
  responsibility for teaching and supervising
  others.

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Problems with evidence base in psychological
treatments

• RCTs hard to do in psychotherapy (mainly done in
  CBT)
• But no/little evidence does not mean ineffective
  treatments
• Hard to study and follow up long term, complex
  interventions
• Patients choose (cf randomisation)
• Therapist factors may be most important
• Researcher allegiance effects
• How to measure global changes to personality (cf
  symptoms)
• Who funds psychotherapy studies?

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Available evidence for efficacy in specific
conditions (Roth and Fonagy, 1996)

• Depression Cognitive Behaviour Therapy (CBT),
  Intepersonal Therapy (IPT), Psychodynamic
  psychotherapy (PDP)Anxiety CBT, Applied
  relaxationPhobias Cognitive therapy (CT),
  Exposure therapyPanic CBT, Panic control
  therapyAlcoholism Behavioural treatments,
  social skills training, motivational
  interviewingSchizophrenia Family intervention
  programmes, CBTAnorexia CT, Eclectic
  therapy, Family therapy (younger)

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Available evidence for efficacy in specific
conditions (Roth and Fonagy, 1996)

• Bulimia CT, IPTPsychosomatic Psychodynamic
  Interpersonal therapy (PIT)Personalitydisorders
  Dialectical Behaviour Therapy (DBT),
• PDP Day hosp, ?Cognitive Analytic Therapy
  (CAT), ?Therapeutic Communities
  (TCs)OCD Exposure and response
  preventionPTSD Stress inoculation with CT and
  exposureSex dysfunctions Behavioural and CBT

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Why is psychotherapy important?

• Consumer choice
• Efficacy (equivalent to antidepressants)
• Cost effective
• Reduces relapse
• Additive effects to medication (SZ FT)
• Few side effects
• Works with treatment resistant cases
• Government investment over next 5 years