PSYCHOTHERAPY

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PSYCHOTHERAPY
Healthy Relations
relaxation
Self Act
tion
Healthy Self Esteem
on
Separa
Jose Pons Madera, Ph.D. Director - Psy.D.
Program Ponce School of Medicine Tel [phone]
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Objectives For Conferences I II

• Define psychotherapy and to explore its
  mechanisms of action.
• Identify the main psychotherapeutic approaches
• Recognize the conditions for which
  psychotherapeutic interventions are indicated or
  appropriate
• Explore Short Term techniques especially Crisis
  Intervention
• Familiarize with Psychoanalytically oriented
  psychotherapies
• Understand the components of Cognitive and
  Cognitive Behavioral Therapies
• List some of the psychotherapeutic techniques
  utilized for a selected group of mental health
  conditions.

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Caso 1 Tita de CESCO

• Quién es el/la paciente
• Es esto una intervención psicoterapeútica?
• Que se debe hacer con Tita? Con la Mamá?
• Quien más debe estar en la intervención si se
  ofrece alguna?
• Que es psicoterapia?

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DEFINITIONA special relationship between two or
more persons, one or some of whom (the patient/s)
seek help with problems of daily living or with
symptoms that interfere with their functioning
and quality of life, and the other (the
therapist) is a professional that utilizes the
relationship between both as well as other
specialized psychological techniques, to help him
or them confront their difficulties.
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Analysis of Definition

• Persons Involved
• Individuals
• couples
• families
• groups

• Patients difficulties
• Symptoms
• Diff w/ daily living
• Diminished satisfaction w/ self or life

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The Psychotherapeutic Process5 X 3 Model

• THE INTERVIEW
• Introduction
• Opening
• Body
• Closing
• Termination

• THE THERAPY PROCESS
• Initial Phase
• Middle Phase (Working Through)
• Termination

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Types of Psychotherapy

• Crisis Intervention
• Short-Term (Focused)
• Supportive Psychotherapy
• Long-Term (Reconstructive)

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Conditions for which Psychotherapy Might be
Indicated

• Adjustment Disorders all types
• DSM-IV V codes
• Interpersonal Difficulties Personality
  Disorders
• Depresive Disorders
• Anxiety Disorders GAD, Panic, OCD, Phobias.
• PTSD with or without dissociation
• Addiction disorders
• Behavioral Problems w/ children adolescents
• Eating and elimination disorders
• Somatoform Disorders

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Curative Factors

• Primary Curative Factors Insight, Behavior
  Change, Relationship
• Factor most correlated w/ positive therapy
  outcome EXPECTATION
• What Patients get from Psychotherapy
• Emotional Corrective Experiences
• Improved Self Esteem
• Higher Sense of Control
• Better Relationships
• Higher Levels of Adaptation

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Main Types of Psychotherapeutic Modalities

• Main Theoretical Concepts
• Process Techniques

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Case 2 Maria From Junior High School

• What is happening to María?
• Is this a crisis situation?
• What kind of intervention is needed to help her?
• What goals should the treatment attempt to
  reach?
• What type of techniques should be utilized to
  help her?

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CRISIS INTERVENTION

• A strong emotional/behavioral reaction to an
  external situation or to internal conflicts which
  alters a persons capacity to cope with lifes
  circumstances and affects their psychological
  stability.
• Two types of Crisis
• Situational
• Developmental
• Psychological Characteristics of Persons in
  Crisis
• Psychological Tunnel vision
• diminished range of options
• Pesimism with impaired Problem Solving abilities
• Lack of energy and of direction
• Psychological regression to stages of helplessness

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CRISIS INTERVENTION

• Role of the Therapist
• Understanding of where the pt is and what his/her
  perception of the situation is. Provide support
  and reassurance
• Opening of perceptual focus and of the capacity
  to generate alternatives
• Help pt adapt to unchangable circumstances or to
  change those circumstances that may by changed.
• Goal of Crisis Intervention
• Restoration to previous levels of functioning

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Psychoanalytic Therapies

• I. Theory
• A. View of Mind
• B. Core Issues
• intrapsychic conflict psychosexual fixations
• focus on past experiences/emotions
• II. Process
• Therapeutic Alliance
• Resistance
• Denial Defense Mech
• III. Technique
• Free Association, Dream Interpretation,
  Interpretation, analysis of transference
• IV. Indications - Neurotic conflicts

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Cognitive Therapies

• Theory Cognitive Psychology
• Precursor Karen Horney
• Pioneers A.T. Beck, A. Ellis
• Process Techniques
• Irrational Beliefs
• Thinking Distortions
• Initial Use Depression Adjustment Problems
• Current Use
• Depresion, anxiety and many conditions including
  Personality Disorders

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Behavior Modification

• Theory
• Learning TheoriesOperant,Visceral, and Cognitive
  (Motor, Visceral, Social).
• Process
• Operational Defn of problem
• Identification of contingencies
• S-R-Rr o Rgt Rr
• Identification of reinforcers
• development of treatment process
• monitoring of Beh Conditioning
• Variables
• Techniques
• Contingency Management
• Discriminative S Rr
• Time Out, S control, Self Rr
• Desensitization
• Modeling Techniques

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Humanistic Approach

• Theory Phenomenology Existentialism
• Rogers Client Centered
• Frankl Existential
• Process
• Reliance on Relationship to achieve meaning or
  congruence
• Perception of internal external world
• Self Actualization
• Choices Being in the World

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Cognitive Behavioral Therapy

• Integration of Cognitive w/ Beh. Mod
• Newer forms integrate Humanistic Approaches
• Most researched apporach - Empirically Validated
  Tech.
• Cost-effective and most Managed Care friendly
• Most Techniques developed
• Multiple Modalities/Approaches
• Arnold Lazarus Multimodal Therapy
• Michenbaum Self Verbalization Technique
  multiple conditions
• Others
• Newer CBT Modalities
• Dialectical Behavior Therapy - DBT
• Eye Movement Desentization Reprocessing - EMDR

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CBT Techniques

• All Behavior Modification Techniques
• All Cognitive Techniques
• Relaxation Techniques
• Social Skills Training
• Problem Solving
• Imaginary visualization techniques (including
  Gestalt)
• Somatic techniques exercises other Wellness
  approaches.
• Clinical Health techniques
• Family couples therapies
• Child therapy

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Other Psychotherapeutic Modalities

• Family/Couples Therapy Systemic Interventions
• Group Therapy
• Play Therapy
• Ecological Therapy
• Psychoeducational
• Art Therapy
• Dance Therapy

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Empirically Validated Interventions For
Frequently Encountered Conditions

• From Randomized Clinical Trials to Single Case
  Studies

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Conditions Interventions

• Depression CBT SSRI (T-I)
• ADHD BT (contingency management), Psychoed for
  family school, CBT for child, Stimulants.
• Addiction Disorders Detox (First), Residential,
  family, CBT/Dynamic or AA, NA or other. CBT for
  social skills and problem solving
• Anxiety Disorders - Panic BM - progressive
  exposure development of coping skills W/ CBT
  for psychoeducation about anxiety its
  management
• Obsessive Compulsive Disorder CBT w/ exposure
  and response-ritual prevention w/ SSRI

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Conditions Interventions

• Conduct Disorder Parent Management Training w/
  FT, Problem solving w/ other CBT techniques as
  needed. School consultation.
• Trauma PTSD supportive, psychodynamic or
  EMDR.
• Borderline Personality Disorder DBT
• GAD psychodynamic, CBT w/ benzodiazepines.
• Personality Disorders Psychodynamic or CBT