Practice+of+Psychotherapy

=Reading= Andreason, 681-92 =goals= 1) understand the principles of cognitive-behavioral therapy (CBT) including thoguthdisortions, ognitive restructuring, ,and bhavioral activation 2) describe the cognitive-behavioral treatment of specific phobias, social phobia, an panic disorder 3) Undertand the key concepts of interpersonal therapy, including grief, role dispute, role tranition, and skill deficits 4) Recognize unique feeatures of psychodynamic psychotherapy 5) Define transferene and countertransference; recognize their operation in clinical settings

psychodynamics
anxiety disorders clinic much of what we do is focused on cognitive-behavioral therapy Start w/ CBT b/c several characteristics 1) signficiant, extended legacy of experimental spport for benefits it's quite common that some people respond well to placebo, or attn in office all have something in common: been shown to be more effective than placebo

Cognitie behavioral treatment take an exercise take a minute...produce and emotion.....how about guilt imagine had guiltmeter

whoever got a strong guilt reading would win the prize change how think..or how act almost all of us use these strategies all the time run into professor behavior change activites we all try to do trying to move emotions by changing habits

Focus for most patients is changing how they feel can't directly will changes in emotions behavior change, thought change are route

imagine had a lot of guilt 5 guilty phrases watch... ehave in a way suchthat if you stepped nto their life, you would feell depressed

Focus: distorted thinking not positive affirmations distortted thought---> truth find truth and devise plan of action for true problems problem solving therapy

'I am stupid...' 'just can't win'

distorted thought---> truth once find truth...often plan of action to adddress true trouble in the end, really about problem solving

'can we examine this thought'... current circumstances past experiences future possibilities behavioral tests

sorts of prsentaitons will present going to face these kinds of thoughts all thet ime respond....'well, that's not true!'

How do you spend your day?

Selective abstraction.... Depressed patines assume people are reacting negatively t them without evidence

all or nothing thinking depressed pts look at events in black and white categories....'that was a complete waste of time'

fortune telling...predict wont' be successful interferes with trouble solving

labelling: depressed patients apply negative terms to describe themselves..."I am a loser"

anhedonia I can't enjoy anything do not wait for motivation gain motivation through doing

Ican't accomplish anything re-establish self-care problem solving

Distorted thought--> Truth--> Action plan

anxiety disorders clinic exposure therapy for speicifc phobia behavioral activation cognitive restructuring 3rd: exposure

apprehension interferes with life //woman...afraid of bees didn't come out of house until november in spring...barricade self in house kids...backyard....no tie backdoor to car...illegally park cars... suspicion that a bee may be in the house.....call husband at work //

take advantage of...doing something you're afraid of long enough, and it gets dull //sing same song over and over in front of class//

measure anxiety social anxiety disorder direct to consumer campaign afraid of the scrutiny of other people fear of pubnlic speaing common fear more subtle or generalized fear of going to parties

one problem is that...unlike bees...can be very inconvenient afraid about meeting new people rules to exposure...easier to more difficult prolonged, end on good note

Social skills training psychotic disorders what to say, and what not to say?

social skills body positioning eye contact how ot intiate conversation, methods to maintain conversation, topics to avoid one thing that puts at risk...or is co-morbid

Cognitive therapy for social anxietyl.....'no one likes me', 'i am a loser' increase anxiety some people so afraid...attacks when leave house...................... stay home all the time not go cetain plcaes

panic disorder/agoraphobia aim is that people have sudden onset of fear need to get to place of safety

panic attacks...associated with inaccurate thinking "I am going to die" "I am going crazy" "I am having a heart atack" positive feedback loop need to teach counter irrational thinking with accurate thinking

feedback between worries...sympathetic response

cognitive behavioral therapy

I did skip one don't have any psychological techniques directly address.... anxiety, stress.....relaxation training,

IPT inerpsersonal therapy for depression initial development tool for treating depression treatment is in relative infancy comes fro smoenthing probably noticed......do track along with interpersonal troubles often connected with change in interpersonal life learn... whole range of causes of psych disorders many just begining to understand even things lie medical illnesses can case psych problems all psychotherapies an think...isn't depression caused by serotonin regualtion probelms? isn't schizophrenia genetic?

Gradually coming to find there ar emultiple causal fractors like many interventions, most successful don't necessarily target cause somewhere in the field of psychology, we've gotten hung up in the cause lets discoer the cause, then we'll be okay don't have any data to suggest that intervention isrelatied to cause don't hae to buy that interpersonal problems that cause depression addressing the problems can affect the depression

set aside whether directed at the cause or not arthritis....series of suggestiosn...some medical, some psychological, some physical think aboutpsychosocial interventions as adjunct choose a focus of treatment working from interpersonal phsychtoerhay format 'joe is depressed' lets look for some interpersonal hardships might be thinking... how do pick CBT vs IPT

interpersonal 'recon' 'interpersonal inventory' Is there trouble there did this trouble seem to connect with depression with this guy look for...temporally close onset of depression interpersonal hardships how often see nature of interaction how is it going? has there been a change? are there problems?

may take 3-4 sessions et good sense o f detailed character of person's relational life models are 12-20 weeks treatment weekly 1st half of treatment future sessions don't yield too much improvement mainenance phase short term review of thes atisfactory an nsatisfactory aspects of the relationship with specfic, detailed examples of both kinds of interactions

Why the pt would like to change the relationship, who thyenvision doing this

4 main proble areas:

Grief, Role dispute, Role Transitions, Deficits

Chances of major depression: ~20% Postpartum, postmenopausal someone close to you dies

male: job loss death in family retirement

Grief, role dispute, role transition, social deficit

Grief: develp a clearer, more complex, and more realistic picture of the relationship with the lost other about a dead body faciliate delayed mourning... assess the significance of the loss help re-establish interests & relationships

assess what is missing survior guilt, abandoment guilt reengage with living explore andfacilitate ways t become invovled agian

interpersonal role disputes non-reciprocal epectations about relationship with signfiicant other communication problems differences that ma or may bot be reconcilable focus if important in onset and perpetuation of the depression

pitch in with the kids not met --> trouble go to work not met--> trouble chores asking her about her life.... not met--> trouble affection...

fighting nature of communication outcome: changed expectation or change behavior, or accept that which cannot change, or dissolution

ROle Transition any transition that includes a role change often either an unwished for change or a transition from something known to something as yet undefin loss, deskilld fear of failure threatens esteem, sense of identity

evaluating and giving up old role mourning of old role expression of loss guilt, anger potential positive aspects of the new role developmetn of new attachments and supports; renew sense of bellonging, connection acquisition of new skills

also a focus in ineterpersonal focal problem areas....skill deficits ros some people, hae a fairly vacant social life mostly low-functioning socially lots of isolation Verbal communication training Non-verbal skills

Psychodynamic Therapy Dialectical Behavior Therapy...focus on personality disorders Postiive psychology eye movement desnesitisation training under the best circumstances, about 25% of pts will not respond, or will response will only be moderate

lots of people get extensive trainig psychodynamic treatment....

Present problems relate to past experiences feelings, thought, and relationship patterns reflect past experiences and relationshps many current issues relate to unconscious processes that are outside of a person's awareness

psychoanalysis vs psychodynamic therapy exploring past relationships will aid in gaining insight learn patterns of behaving, thinking, and feeling Many current issues relate to unconscious proesses that are outside f a person's awareness

relationship with therapist is meant to mirror osme of earlier relationships..play out interactions important constructs: mixed between id--instinctual urges--

Thie ID construct represents instictual urges....that seek self gratification superego cosntruct is created through socialization wherein taboos and values of societies guide pro-social behavior the ego is responsible for mediating between the two

defense mechanisms.... repression, denial repression: repress unwanted thoughts that are outside of a person's awareness denial how people distort current reality to fit current needs goal is longer-term...years explore past relationships, aim achieving insight relationship between therapist and patient is used to help gain this insight:


 * Transference** Patient responses towards the therapist influenced by others in patient's life including family of origin and current social network
 * Extreme liking, growing dislike, sexual attraction


 * Countertransferrence** Therapist reponses to the patient are influecned by others in the therapist's life including the family of origin and curren social netowrk
 * Extreme liking, growing dislike, sexual attraction