Counselling and Psycho Therapy

8/8/2019 Counselling and Psycho Therapy

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Counselling and

Psycho therapy

Dr D.PD WijesingheConsultant Psychiatrist

NIMH -ANGODA


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Psychotherapy Is an one form of therapy used to treat

mental illness / problems

Often combined with medication

It includes all forms counseling,

psychological treatments & CBT

Some books exclude- Counseling & CBT


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..Psychotherapy history Old as Medicine

Buddhist stories

Greece

Wedamahaththaya

Village leader Priests


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History of modern psychological

treatments Hypnosis-19TH centaury Anton Mesmer

Animal Magnatism

James Braid Hypnosis

Burnheim use of suggestibility to treathysteria

Jean Martin Charcot only hystericals canbe hypnotized


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History Psychotherapy Persuasion- Alternative to hypnosis

Symptoms and problems are explained

and discussed without increasing

suggestibility


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..History

..FREUD Visited France to study hypnosis.

Initially became interested but

abandoned later

FREE ASSOCIATION

Used in Psychoanalysis & Dynamic

Psychotherapy


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History

Alfred Adler Left Freud rejected libido theory

Social factors are important

INDIVIDUAL ANALYSIS

Focused on current problems


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History

Carl Jung Inner world of fantasy

Dreams

Artistic presentation

COLLECTIVE UNCONCIOUSNESS

ARCHIETYPES

HAS COME TO CEYLON and visited SRIDALADA MALIGAWA


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Neo- Freudian Developed in USA

Did not accept Freud's libido theory

Family and Social factors

Karen Horney

Erich FrommHenry Stack Sullivan


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Object Relation School Melanie Klein in 1930 enlarged Freuds

theory about early infant development

Play interpretation in children

OBJECT love , hatred to it


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Attachment theory John Bowlby

Chimpanzee experiments

Secure attachments

Insecure attachments


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Classification Individual

Couple

Family Small and Large Groups

Counselling

Moderately complex

Complex


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Common Factors in Psychological

treatments Therapeutic relationship

Listening

Release of Emotions Restoration of Morale

Providing information

Providing rationale

Advice and Guidance

Suggestions


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TRANSFERENCE

COUNTER- TRANSEFERENCE


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COUNSELLING In everyday usage, Counselling = Giving advice

But it is wider concerning - EMOTIONS and

KNOWLRDGE Involve common factors

Relationship is very important

Client-Centred Approach

Replacing by Structured and FocusedProcedures


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Approaches to Counselling Problem-solving Counselling- stressful circumstances,

life problems exacerbating or maintaining a disorder Identify and list problems / practical course of action/

select one problem and try/ review results / chooseanother

Interpersonal Counselling Klerman Loss /interpersonal disputes/ role transitions/ inter personaldeficits Using problems solving

Psychodynamic Counselling- Past experience for curentbehaviour/ unconscious process / object relation theory/patients reactions to counseller gives informations Problem solving methods Used in students health cen.


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Counselling for specific purpose To relive acute distress-Emotional release /Coping

/Debriefing

Relationship problems- talk constructively about

problems /each to understand view, needs, feeling ofother/ identify positive aspect of relationship

Grief Counselling- working through stages of grief/emotional release, expression of anger/ informationabout normal course / engage in final act /advice aboutpractical problems of living without

Late effect of trauma- cognitive / Psychodynamic- careful

About risks genetic , STD


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CRISIS INTERVENTION Break- up relationship Natural disasters

Help to cope up- to deal effectively future difficulties

Four stages ( Caplan)

1. Emotional arousal with effort to solve

2. Fail Grater arousal disorganization opbehaviour

3. Trials of alternative ways of coping

4. Exhaustion and decompensation

Limit the reaction to first stage if passed , avoid forthstage


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.Crisis intervention Problems leading to crisis

1. Loss problem

2. Role changes

3. Relationship problems

4. Conflicts


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Crisis intervention methods Start soon as possible

Brief few sessions

Collaborative patient fully, family members , friends Interpersonal / problem solving / grater emphasis on

reducing arousal

Focus on current problem

Reassurance emotional release

Anxiolytic drugs may be required

Arrangements may need for other helps- care of children


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SUPPORTIVE PSYCHOTHERAPY

Used to relieve distress or to help to cope

with difficulties when Problem solving

approaches are unlikely to succeed

Chronic mental physical illness / Dying

patient


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.Supportive psychotherapy Therapeutic relationship Used to sustain pt / Dependence avoid

or limit

Listening should feel that have attention and sympathy andconcerns are taken seriously

Emotional release early stages only Information and advice important, accurate but timed slowly

gradually

Encouraging hope- important , but not premature unrealisticreassurance, Prognosis give a range including most optimistic ,encourage to build on remaining assert and opportunities

Persuasion some time need the doctor to persuade patientSupportive therapy is not always by health professionals SELF HELP

GROUPS


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C.B.T Cognition= thinking ; beliefs; assumptions;

ideas; attitutes; knowledge; memory

All psychiatric disorders have cognitive /

behaviour components

Behaviour therapy / Cognitive

therapy>>>


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C.B.T Behavioural technique

PROVOKING FACTORS- e.g. in Phobias

MAINTAING FACTORS-

Avoidance

Consequencesincreased attention


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C.B.T

Cognitive Disturbed thinking

1. Intrusive thoughts (automatic thoughts)

provoke emotional reactions (anxiety

& depression)

Dysfunctional beliefs ( Dysfunctional

assumptions)- determined the way in

which a situation is perceived


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Maintaining of Dysfunctional beliefs

Attend Selectively

Think illogically Over- generalization

Selective Abstraction

Personalization

Safety behaviour


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General features of C.B.T Patient is an active partner

Attention to provoking and maintaining factors Keep daily records >>> ABC approach

Treatment as experiments

Homework assignments

Highly structured

Monitoring progress Checking daily records-Rating scales

Treatment manuals


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Patients record- Behavioural

experiment Agoraphobic Date/ time ;Situation- Shopping in a crowded supermarket

My prediction I shall panic and feel dizzy , Unless I tense mystomach muscle and breathe deeply

Experiment- When anxious , do not tense or breath deeply

Out come- I did panic quite badly. I felt dizzy but less so than usual.I did not faint

What I learnt- I did not faint even I had a severe panic and I didnothing to prevent fainting. I seem to be wrong in thinking I shallfaint when ever I panic. Also tensing muscle and deep breathingmay not be having the effect I supposed. My therapist could be right

in thinking deep breathing may makes me more dizzy. What I could do next- Repeat the experiment next time when I go for

shopping.


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Source of information

Self monitoring

Observed during treatments

Special interview Laddering questions

why? Why? Why? Aei? Aei?


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Cognitive technique

Distraction attending something else/

mental arithmetic/ thought stopping

Neutralizing- rehearsing a reassuring

response / prompt card

Challenging

Reassessing pie chart


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CBT for

Depression

Anxiety disorders

Bulimia

Personality disorders

? Psychotic illness


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.. CBT .>>> Behaviour

Relaxation

Exposure

Systematic (gradual) desensitization Flooding

Exposure and response prevention

Thought stopping

Habituation EMDR

Behaviour therapy for nocturnal enurisis

Counselling and Psycho Therapy

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