Psychotherapy

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Introduction

Psychotherapy is the interaction between a therapist and one or more patients which attempts to relieve suffering and psychological disability by inducing changes in patient's attitudes and behaviour (Frank and Frank, Persuasion and Healing).

 

Counselling is drawing on what people already have available to them; therapy is interventional. Psychotherapy is effective, but not in all patients. Different techniques work better than others for different conditions. Patients as well need to want to change.

 

There are many types of psychtherapy, differing from others in technique or theoretical framework. Therapists are drawn to one type or another based on exposure, training opportunities, personality style, belief system, etc. Types of psychotherapy include:

 

 

Common Tasks of Psychotherapy

Most therapies are efficacious.

• form a relationship
• trust in the therapist
• active listening
• clarify symptoms and problems
• inspire hope
• help patient to express and experience feelings
• taching new coping strategies
• alleviate the patient's sense of powerlessness and demoralization (important)
• encourage self-reflection

 

people often have mixed feelings about change

• desire to change things
• fear of change
• resentment of being told what to do

 

The Therapist

An essential part of psychotherapy is to have a positive relationship, which has:

• healthy boundaries
• awareness and tolerance of feelings in the room, both in the patient and the therapist
• a sense of how the patient's problems might be approached
• ability to inspire confidence

It is important to acknowledge feelings such as judgment and frustration (counter-transference).

 

 

Verbal interchange between two people, working on life problems in the hope of producing behavioural change.

They share:

• learning component
• corrective emotional experience: resolves negative schemas
• ventilatory component

Levine: schemas or cognitions are tapes we develop in our heads

the most important tapes to resolve are the self-esteem tape and the intimacy tape

negatively distorted tapes, or negative schemas or cognitions

tapes are often unconscious and can be

 

an acute problem requires supportive therapy, while a long term problem requires change therapy

supportive therapy should be time-limited; once it turns into chatting,

how many psychiatrists does it take to change a light bulb? one, but it has to want to change.

change therapy can be dangerous when patients are fragile

supportive

• normalizes problems
• coping strategies and potential environmental manipulation
• stays in the here and nwo; does not go into the past

 

Counselling Skills Education Program

U of T longitudinal program, 1/2 day for 15 weeks

Didactic teaching and practicum with interprofessional teams

live supervision and team approach in counselling: learner and therapist

ongoing feedback

increases competence and confidence in dealing with psycho-social issues

 

 

barclay L. JAMA 2009 - mindfulness and physical burnout