Treatment, stages,Treatment, stages,Dr. Ali farah AhmedDr. Ali farah Ahmed

Opening stageOpening stage

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

Establishing a good relationshipEstablishing a good relationship

Therapist must not expect to be trusted Therapist must not expect to be trusted right away because pt. usually enters right away because pt. usually enters treatment emotionally demoralised, treatment emotionally demoralised, bruised, worried and fearful.bruised, worried and fearful.

So the combat between pt. and therapist So the combat between pt. and therapist may take time.may take time.

Pts. May test the therapist before the trust Pts. May test the therapist before the trust them.them.

Teaching how psychotherapy Teaching how psychotherapy worksworks

The easiest way to do so is to let pt. know by The easiest way to do so is to let pt. know by doing: doing: Therapist must let pt. get comfortable and tell why he Therapist must let pt. get comfortable and tell why he

came, who sends him,…etccame, who sends him,…etc Some times therapists get right with the pt. into the Some times therapists get right with the pt. into the

problem if they are acquainted with him.problem if they are acquainted with him. In either case therapist must be sure that he hears In either case therapist must be sure that he hears

the story from the beginning with interest not only in the story from the beginning with interest not only in the facts but in the pt’s feelings at the time of the the facts but in the pt’s feelings at the time of the problem or other peoples’ feelings as they become problem or other peoples’ feelings as they become involved.involved.

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

The mechanisms of therapy are rapidly learned:The mechanisms of therapy are rapidly learned: Firm appointments: usually 45-50 minutes per Firm appointments: usually 45-50 minutes per

session. session. The necessity of being on time and ending on time.The necessity of being on time and ending on time. The agreement that nothing of the pt’s life must be The agreement that nothing of the pt’s life must be

hold backhold back Agreement that no important changes in pt’s life Agreement that no important changes in pt’s life

would be made without discussing them in the would be made without discussing them in the therapy.therapy.

The understanding that everything the pt. The understanding that everything the pt. does or say may be of therapeutic value.does or say may be of therapeutic value.

The fact that all pts’ resist therapy in one way The fact that all pts’ resist therapy in one way or another and that effective treatment or another and that effective treatment involves identifying and eliminating these involves identifying and eliminating these forms of resistance gradually.forms of resistance gradually.

Forms of resistanceForms of resistance

Pt routinely coming late.Pt routinely coming late. Pt. being hostile.Pt. being hostile. Pt. coming when he wants not when Pt. coming when he wants not when

expected.expected. Pt. forgetting appointment.Pt. forgetting appointment. Pt. being too sick to come.Pt. being too sick to come. Pt. fighting into health.Pt. fighting into health.

Pt. filling the session with friend’s Pt. filling the session with friend’s problems. problems.

Pt. requesting hypnosis.Pt. requesting hypnosis. Pt. asking for reading assignments.Pt. asking for reading assignments. Pt. spending time of session in discussing Pt. spending time of session in discussing

readingsreadings

Resistance must be treated by uncovering Resistance must be treated by uncovering them until they melt away by:them until they melt away by: Identifying their origin,Identifying their origin, Pointing them out whenever they occur.Pointing them out whenever they occur.

Pt. will give them up one by onePt. will give them up one by one

The communist error that a therapist can The communist error that a therapist can do is to take too mush:do is to take too mush: Pt must be let to say the first words and the Pt must be let to say the first words and the

last words, in-between pt. must be kept last words, in-between pt. must be kept talking as long as he seems going well.talking as long as he seems going well.

Therapist must not say something because it Therapist must not say something because it is true, instead he must keep himself out of it. is true, instead he must keep himself out of it.

Taking history, case studyTaking history, case study

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

Middle stageMiddle stage

The tasks of this stage overlap with the The tasks of this stage overlap with the tasks of the previous stage.tasks of the previous stage.

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

Certain aspects of treatment apply to all Certain aspects of treatment apply to all pts.: the professional attitude of the pts.: the professional attitude of the therapist, nonjudgmental interest and therapist, nonjudgmental interest and authority are gradually valued pt. and he authority are gradually valued pt. and he would ventilate. would ventilate.

Also the pt’s personal objectivity increases Also the pt’s personal objectivity increases as he recount his history and as the as he recount his history and as the therapist maintain nonjudgmental atittudes therapist maintain nonjudgmental atittudes in a serious effort to understand.in a serious effort to understand.

Specific treatment is unique to each pt. it is not Specific treatment is unique to each pt. it is not important here to distinguish between treatment important here to distinguish between treatment which is primary supportive and that which is which is primary supportive and that which is analytic. analytic.

Supportive symptomatic treatment aims at Supportive symptomatic treatment aims at Reinforcing existing personality structure and Reinforcing existing personality structure and defence mechanisms.defence mechanisms.

Insight therapy aims at discovering roots of the Insight therapy aims at discovering roots of the disorder and hence the basic changes in disorder and hence the basic changes in symptoms, attitudes, reaction patterns and life symptoms, attitudes, reaction patterns and life adjustment.adjustment.

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

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

Ending stageEnding stage

This stage overlaps with the middle stage This stage overlaps with the middle stage and begins when therapy continues for and begins when therapy continues for several weeks or months.several weeks or months.

It may start when there is an indication It may start when there is an indication that some personality changes have been that some personality changes have been achieved in the direction of maturation and achieved in the direction of maturation and growth.growth.

Some symptoms disappear quickly in therapy Some symptoms disappear quickly in therapy but others return quickly if causative factors but others return quickly if causative factors reassert themselves e.g headaches, anxieties, reassert themselves e.g headaches, anxieties, impotence.impotence.

Other symptoms are not responsive to treatment Other symptoms are not responsive to treatment e.g depressive and obsessive e.g depressive and obsessive

Still other symptoms may become so fixed that Still other symptoms may become so fixed that they become part of personality so the gaol of they become part of personality so the gaol of treatment is to cope with them, e.g alcoholismtreatment is to cope with them, e.g alcoholism