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Information on Psychotherapy


There are many different forms of Psychotherapy which can be applied to modify your thinking patterns, improve your condition and enhance your ability to cope effectively.

Psychotherapy refers to a group of therapies which are all 'talking' therapies, i.e. they involve verbal interchanges between the patient and the therapist. Education and support are also considered to be elements of psychotherapy.

Depending on the nature of your illness some therapies will be more effective than others.

A basic outline of the different therapies is listed alphabetically below:

Activity Scheduling:

Activity Scheduling is a very useful tool assisting in situations where motivation or loss of interest in pleasurable activities is a problem, as in depression.

Where there is a pattern of inactivity, teaching the patient how to stay active even when feeling down will reduce feelings of depression and speed recovery.

The aim is to teach patients to increase the range and frequency of routine and pleasurable activities in a structured and organised manner. This is designed to increase positive response in mood.

The patient needs to be aware that they have ceased doing things they need to do or enjoy doing because of feeling down. The patient also needs to understand the importance of doing these things as the less they do the worse they will feel and feeling worse makes them do less. This common reaction to depression can be modified with extremely beneficial outcomes for the patient in enhancement of mood and feelings of accomplishment.

Activity scheduling begins by identifying the things the person is doing now, and the things the person should be doing but is not doing.

The next step is identifying at least 10 things the person would like to be doing and used to enjoy ie. going out for coffee with a friend etc.

From this information a schedule is drawn up starting with the easiest activities scheduling one or two each week. Pleasurable activities are balanced with routine activities.

Important feedback from the patient includes rating the sense of pleasure and achievement from completing an activity. This forms part of discussions for future sessions and serves as a basis for implementing assistance if the patient is having difficulties completing assigned activities.

Anger Management Therapy:

Anger Management therapy provides techniques for better control of excessive or inappropriate anger. It assists the person to better manage or regulate their anger when facing conflict or stress.

Anger management does not eliminate anger but provides a means of control. This is done in a series of stages and provides the person with effective self coping statements and relaxation techniques which are easy to apply in confrontational situations.

Behaviour Modification:

Behavioural modification is used to:

(a) Increase or learn desirable or functional behaviours.
(b) Decrease a problem or dysfunctional behaviour.

It begins with behavioural analysis to identify behaviours to be altered, and the reasons behind the behaviours.

Exposure techniques are used for all anxiety disorders and phobias. It involves graded exposure to the object of anxiety over a period of time resulting in decreasing levels of fear.

Other techniques include desensitization involving exposure with relaxation techniques and cognitive coping self-statements to assist the person to overcome fear and anxiety.

Cognitive Behaviour Therapy:

Cognitive Behaviour Therapy (CBT) is a more recent and now more widely used therapy than psychoanalysis. The Therapist has a more active involvement as they endeavour to help the patient to recognise the negative and self-defeating beliefs which the patient has come to accept.

Cognitive Behaviour Therapy seeks to reverse these negative thinking patterns by providing the patient with alternative counteracting beliefs. This teaches patients how to control their symptoms and better manage their disorder. CBT has long term benefits as techniques learned can be applied in the future should a need develop.

This therapy has mostly been deployed in mild or moderate personality and mood disorders. It is used as the sole treatment for patients who's illness is not serious enough to require medication.

In recent times it has achieved some success for patients with more serious disorders either alone or when combined with medication therapy. Studies are currently being done to see if CBT can play a greater role in the treatment of these illnesses in the future.

How Cognitive Behaviour Therapy Works:

CBT is based on the idea that a person interprets or appraises a situation based on past experiences. This is a persons 'frame of reference'. This influences how a person thinks and feels about any given situation and because we all have different life experiences our individual frame of reference and how we interpret a situation will be different to someone else.

When a person is fearful of something the focus of their attention is selectively on what they fear - they are not focussed on the entire situation and this affects their ability to rationally evaluate the whole situation.

To explain the influence of how we think, feel and behave we use the ABC model developed by Ellis in 1975, where:-

(A) is the Activating Event
(B) is the Belief or reaction to the event, and
(C) is the Emotional Consequence of that belief.

The Activating Event causes the reaction and accompanying Belief and thoughts about the event which influences how we feel - Emotional Consequence of the thinking or reaction.

Our beliefs which flow on to our self-talk (what we say to ourselves), have a strong influence on how we feel.

The aim of cognitive therapy is to teach people how to modify their beliefs in order to change their emotional response.

Learning to challenge negative thoughts and substitute more rational beliefs leads to better emotional outcomes.

Negative automatic thoughts (NATS) - that is our automatic response to given situations or events can occur consciously or unconsciously. NATS are a powerful influence of behaviour and interpretation of events as they are strongly believed by the person.

At the commencement of therapy usually the patient will be given some simple 'homework' which involves monitoring their thoughts about particular events.

They will record on a form any situations that cause them distress including the date, what the situation was, how it made them feel, what their automatic thoughts about it were, and how much they believe those automatic thoughts.

This information will form the basis of following sessions where the therapist will discuss and analyse with the patient; the validity of the person's automatic thoughts, if those thoughts are rational or irrational.

Techniques for analysing automatic thoughts include generating 'evidence' for a particular thought. A patient may be asked to think about what is the evidence for or against the automatic thought being rational, or what is true or not true about the automatic thought or the situation. They may be asked to consider if there are any additional facts about the situation that they may have forgotten or not acknowledged.

From this evidence based information the next step is defining a more rational or reasonable interpretation of the thought/belief.

This may be achieved by considering the following questions:

What is a more helpful way of looking at the situation?
What could you tell yourself next time this thought occurs?
What advice would you give to someone else having this thought?
What would someone else say about this thought?

Obviously, this is a time consuming process and the above activities will be done over a number of sessions to achieve the desired outcomes.

Shifts in thinking do no happen immediately and this process will continue until a shift in thinking small or large occurs.

Communication Training:

Good communication skills are essential to good relationships with family and others.

Learning how to communicate what you are thinking effectively without causing major arguments is a skill we could all use at some stage.

Communication training will teach you how to:

1. Make clear, simple statements or questions.
2. Praise someone
3. Ask someone to do something.
4. Express negative feelings.
5. Listen to others.
6. Recognise when a negative reaction is not your fault.

Interpersonal Therapy:

Interpersonal therapy aims to provide people with depression with a means to identify and resolve issues with interpersonal relationships - family, partners and others that may be contributing to their depression.

It is also used for those experiencing difficulties adjusting to altered career or social role or other life transitions such as prolonged grief following loss.

Problem-Solving Skills Training:

Involves teaching the person a series of systematic steps to give a sense of control over difficulties encountered. These techniques can be applied to many different situations.

Problem solving is easy to learn and apply.

Summary of Steps in Problem Solving:

1. Clearly define the problem.
2. List all the possible solutions.
3. Evaluate advantages and disadvantages of each possibility.
4. Choose the best strategy or combination of strategies.
5. Plan how to implement the chosen strategies.
6. Implement the chosen course of action and review the outcome.

The therapist will work though each of the steps in detail with the patient to arrive at a thorough and workable solution for the patient to implement in stages if necessary.

Psychoanalysis:

Psycoanalysis is used in mild to moderate personality and mood disorders. The focus is on the early years of the patients life and finding events that even though the patient may have little or no memory of them, have contributed to the patients current thought processes and beliefs which may be an underlying cause of problems or distress. Psychoanalysis was developed by Sigmund Freud.

Psychoeducation:

Psychoeducation is the process of educating a person about all aspects of their illness including explaining the disorder, prevalence, treatments, symptoms, causes, long term outlook, pros and cons of treatments.

Psychoeducation has proven benefits to people suffering mental disorders in the adherance to treatment and improved outcomes.

The more people understand about what is happening to them the bettern prepared and more willing they are to participate in their own recovery.

Relaxation Therapy:

Relaxation therapy is generally implemented in conjunction with other therapies.

Relaxation strategies include a number of different techniques which may be delivered during therapy or be suitable for practice by the patient outside of therapy.

These strategies include:

1. Progressive Muscle Relaxation
2. Slow Breathing
3. Guided Imagery

Social Skills Training:

Social Skills training follows on from Communications training providing skills covering topics such as:

1. How to approach people in appropriate ways.
2. Conversation Skills
3. Co-operative behaviour
4. Assertiveness and relating to others.

These skills are usually taught over two or three sessions.


More detailed information on these can be accessed from our Helpful Links page under 'Treatments'.


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