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Psychological Therapies
Psychotherapy is:
“…essentially a conversation which involves listening to
and talking with those in trouble with the aim of
helping them understand and resolve their
predicament.” - Brown and Pedder.
“…an interpersonal process designed to bring about a
modification of feelings, cognitions, attitudes and
behaviour which have proven troublesome to the
person seeking help.” Hans Strupp
“…the art of alleviating personal difficulties through the
agency of words and a personal, professional
relationship”. - Anthony Storr
Who does psychotherapy?
(All mental health workers)
Counsellors
Clinical /Counselling Psychologists
Adult Psychotherapists
Child Psychotherapists
Medical Psychotherapists
Forensic Psychotherapists
Setting
GP surgeries
Out-patient – PCMHT, CMHT, Psychology
and Psychotherapy departments
In-patient
Day Hospital
At home of patient
Prison (Grendon Underwood)
System
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Individual
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Couple
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Group
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Family
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Organisation
Four Main Groupings of Psychotherapy
1. Psychoanalytic/Psychodynamic
2. Behavioural/Cognitive-Behavioural
3. Humanistic Movement
4. Integrative Therapies
Common Features of Psychotherapies
(Jerome Frank)
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An intense, emotionally charged relationship with a
person or group.
A rationale or myth explaining the distress and
methods of dealing with it.
Provision of new information about the future, the
source of the problem and possible alternatives
which hold a hope of relief.
Non-specific methods of boosting self-esteem.
Provision of success experiences.
Facilitation of emotional arousal.
Takes place in a locale designated as a place of
healing
Common types of therapy:
Cognitive Behavioural Therapy
Psychodynamic psychotherapy
Cognitive Analytic Therapy
Psychodynamic Interpersonal Therapy
Systemic/Family Therapy
Group analytic therapy
Psychodrama
Counselling
Other types of therapy
Specific family interventions with schizophrenia patients
Supportive Therapy
Therapeutic Communities
Dialectical Behavioural Therapy
Gestalt Therapy
Solution Focused Therapy
Transactional Analysis
Classifications of psychotherapy (NHSE, 1996)
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Type A
Psychological treatment as an integral component of
Mental Health care. Refers to the psychotherapeutic skills required
by all mental health and social care professionals.
Type B
Eclectic Psychological therapy and Counselling.
Refers to the psychotherapeutic skills needed by a broadly trained
mental health/social care professional (nurse, occupational
therapist, social worker, clinical psychologist or psychiatrist with a
special interest in psychotherapy who treats patients but does not
act in a senior consultative or training capacity.
Type C
Formal Psychotherapies: Refers to the specialist
therapeutic skills required by a professional working for the majority
of his/her time in the speciality ie. Consultant Psychotherapist level
with a significant responsibility for teaching and supervising others.
Problems with evidence base in psychological
treatments
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RCTs hard to do in psychotherapy (mainly done in CBT)
But no/little evidence does not mean ineffective
treatments
Hard to study and follow up long term, complex
interventions
Patients choose (cf randomisation)
Therapist factors may be most important
Researcher allegiance effects
How to measure global changes to personality (cf
symptoms)
Who funds psychotherapy studies?
Available evidence for efficacy in specific
conditions (Roth and Fonagy, 1996):
Depression
Cognitive Behaviour Therapy (CBT),
Intepersonal Therapy (IPT), Psychodynamic
psychotherapy (PDP)
Anxiety
CBT, Applied relaxation
Phobias
Cognitive therapy (CT), Exposure therapy
Panic
CBT, Panic control therapy
Alcoholism
Behavioural treatments, social skills
training, motivational interviewing
Schizophrenia
Family intervention programmes,
CBT
Anorexia
CT, Eclectic therapy, Family therapy (younger)
Available evidence for efficacy in specific
conditions (Roth and Fonagy, 1996)
Bulimia
CT, IPT
Psychosomatic
Psychodynamic Interpersonal therapy (PIT)
Personality
disorders
Dialectical Behaviour Therapy (DBT),
PDP Day hosp, ?Cognitive Analytic Therapy
(CAT), ?Therapeutic Communities (TCs)
OCD
Exposure and response prevention
PTSD
Stress inoculation with CT and exposure
Sex dysfunctions
Behavioural and CBT
Why is psychotherapy important?
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Consumer choice
Efficacy (equivalent to antidepressants)
Cost effective
Reduces relapse
Additive effects to medication (SZ + FT)
Few side effects
Works with treatment resistant cases
Government investment over next 5 years