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Transcript
October 2011 PSYCHOTHERAPY OVERVIEW INTRODUCTION TO HARVEST HEALTHCARE Experience. Education. Excellence. Harvest is a leading full-service behavioral health provider, specializing in the delivery of progressive and innovative consultative behavioral health services for patients and residents residing in skilled nursing, rehabilitation, and assisted living facilities. Our multidisciplinary team of highly skilled professionals work together to offer a broad menu of services including but not limited to 24-hour prescriber oncall services and hospitalization support, comprehensive cognitive assessments, documentation review, OBRA compliance support and customized educational programs designed for the individual needs of your facility. OBJECTIVES This presentation on psychotherapy was developed for the continuing education of healthcare providers. At the conclusion of this presentation, participants will have a basic understanding of psychotherapy. Mental health professionals should be consulted for management of patients with are in need of psychotherapy. PSYCHOTHERAPY Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group. The problems addressed are psychological in nature and of no specific kind or degree, but rather depend the specialty of the practitioner. In the state of CT, in order to be a licensed psychotherapist one must have a masters degree or a higher level of education. PSYCHOTHERAPY Psychotherapy aims to increase the individual's sense of his own well-being. Psychotherapists employ a range of techniques based on experiential relationship building, dialogue, communication and behavior change that are designed to improve the mental health of a client or patient, or to improve group relationships (such as in a family). Psychotherapy can be helpful in treating most mental health problems, including: Anxiety disorders, such as obsessive-compulsive disorder (OCD), phobias, panic disorder, and post-traumatic stress disorder (PTSD) Mood disorders, such as depression and bipolar disorder Addictions, such as alcoholism, drug dependence or compulsive gambling Eating disorders, such as anorexia and bulimia Personality disorders, such as borderline personality disorder or antisocial personality disorder Schizophrenia and other disorders that cause detachment from reality (psychotic disorders) Dementia and other cognitive impairments. USES FOR PSYCHOTHERAPY Not everyone who benefits from psychotherapy is diagnosed with a mental illness. Psychotherapy can help with a number of life's stresses and conflicts that can affect anyone. For example, it may help: Resolve conflicts with your partner or someone else in your life Relieve anxiety or stress due to work or other situations Cope with major life changes, such as divorce, the death of a loved one or the loss of a job Learn to manage unhealthy reactions such as road rage or passive-aggressive behavior Come to terms with a chronic or serious physical health problem such as diabetes, cancer or chronic pain Recover from physical or sexual abuse or witnessing violence Cope with sexual problems, whether they're due to a physical or psychological cause Sleep better, if you have trouble getting to sleep or staying asleep (insomnia) PSYCHOTHERAPY & MEDICATION Psychotherapy can be as or more effective than medications such as antidepressants in some cases of mild to moderate depression. However, depending on the specific diagnosis, psychotherapy alone may not be enough to ease the symptoms. Proper evaluation by medical and behavioral health professionals is essential. Medications or other treatments may be needed in addition, in fact the combination of medication and psychotherapy is often stated as the most effective approach to significant depression, anxiety and other mental disorders. RISK OF PSYCHOTHERAPY In general, there's little risk in psychotherapy. Because it can explore painful feelings and experiences, though, it may cause one to feel emotionally uncomfortable at times and may temporarily increase negative feelings in order to reach improved emotional well-being. Some forms of psychotherapy, such as exposure therapy, may require a person to confront situations they would rather avoid — such as airplanes if one has a fear of flying. This can lead to temporary stress or anxiety. But the coping skills learned should help later on to manage and conquer negative feelings and fears. FORMS OF PSYCHOTHERAPY Most forms of psychotherapy use spoken conversation. Some also use various other forms of communication such as the written word, artwork, drama, narrative story or music. Psychotherapy with children and their parents often involves play, dramatization (i.e. role-play), and drawing, with a co-constructed narrative from these non-verbal and displaced modes of interacting. Psychotherapy occurs within a structured encounter between a trained therapist and client(s). Purposeful, theoretically based psychotherapy began in the 19th century with psychoanalysis; since then, scores of other approaches have been developed and continue to be created. SYSTEMS The different types of psychotherapy are referred to as systems. There are many systems of psychotherapy including: Psychoanalytic Behavior Cognitive behavioral Psychodynamic Existential Humanistic Brief Systemic Transpersonal Body psychotherapy EXPECTATIONS OF PSYCHOTHERAPY Psychotherapy often includes techniques to increase awareness and the capacity for self observation, change behavior and cognition, and develop insight and empathy. A desired result enable other choices of thought, feeling or action; to increase the sense of well-being and to better manage subjective discomfort or distress. Perception of reality is hopefully improved. Grieving might be enhanced temporarily in an effort to decrease risk of long term depression. Psychotherapy can improve medication response where such medication is also needed. EXPECTATIONS OF PSYCHOTHERAPY Psychotherapy can be provided on a one-to-one basis, in group therapy, conjointly with couples and with entire families. It can occur face to face (individual), over the telephone, or, much less commonly, the Internet. Its time frame may be a matter of weeks or many years. Therapy may address specific forms of diagnosable mental illness, or everyday problems in managing or maintaining interpersonal relationships or meeting personal goals. TECHNIQUES Psychotherapists use a range of techniques to influence or support the client to adapt or change in the direction the client has chosen. These can be based on clear thinking about their options; experiential relationship building; dialogue, communication and adoption of behavior change strategies. COGNITIVE BEHAVIORAL THERAPY Cognitive behavioral therapy refers to a range of techniques which focus on the construction and re-construction of people's cognitions, emotions and behaviors. Generally in CBT, the therapist, through a wide array of modalities, helps clients assess, recognize and deal with problematic and dysfunctional ways of thinking, emoting and behaving. BEHAVIOR THERAPY Behavior therapy focuses on modifying overt behavior and helping clients to achieve goals. This approach is built on the principles of learning theory including operant and respondent conditioning, which makes up the area of applied behavior analysis or behavior modification. This approach includes acceptance and commitment therapy, functional analytic psychotherapy, and dialectical behavior therapy. Sometimes it is integrated with cognitive therapy to make cognitive behavior therapy. INTERPERSONAL PSYCHOTHERAPY Interpersonal psychotherapy (IPT) is a time-limited psychotherapy that focuses on the interpersonal context and on building interpersonal skills. IPT is based on the belief that interpersonal factors may contribute heavily to psychological problems. It is commonly distinguished from other forms of therapy in its emphasis on interpersonal processes rather than intrapsychic processes. IPT aims to change a person's interpersonal behavior by fostering adaptation to current interpersonal roles and situations. EFFECTIVENESS OF PSYCHOTHERAPY Psychotherapy is indeed effective, The type of treatment is not a factor, The theoretical bases of the techniques used, and the strictness of adherence to those techniques are both not factors, The therapist's strength of belief in the efficacy of the technique is a factor, The personality of the therapist is a significant factor, The alliance between the patient(s) and the therapist (meaning affectionate and trusting feelings toward the therapist, motivation and collaboration of the client, and empathic response of the therapist) is a key factor. PSYCHOTHERAPY IN LONG TERM CARE FACILITIES Psychotherapy can be used in LTC facilities to address depression, anxiety, grief and loss among other issues which are based in developing insight and or problem solving. Psychotherapy can be key in determining the unmet needs or triggers that cause disruptive behaviors in cognitively impaired people. Psychotherapy can also play an important role in cognitive rehabilitation. Psychotherapy can identify and change negative environmental influences co THOUGHT PROVOKING QUESTIONS What conditions can psychotherapy treat? How can you make a referral for psychotherapy? Is a person ever too old for psychotherapy? Does psychotherapy work with medications?