CHAPTER 22 CHAPTER 22 Psychological Psychological

TreatmentTreatmentZhong-Lin Tan Ph.D. M.M.Zhong-Lin Tan Ph.D. M.M.

Hangzhou Mental Health CenterHangzhou Mental Health CenterDepartment of psychiatry, School of MeDepartment of psychiatry, School of Me

dicine Hangzhou Normal Universitydicine Hangzhou Normal Universityzlintan@yahoo.com.cn zlintan@yahoo.com.cn

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AimAim

Grasp classification of Grasp classification of psychological treatmentspsychological treatments

Be familiar with different Be familiar with different counseling approachescounseling approaches

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PrefacePreface

Psychological treatment isPsychological treatment is not not given in given in isolation, often combined with isolation, often combined with medication. Appropriate ways of doing medication. Appropriate ways of doing this are considered in the chapters this are considered in the chapters concerned with the relevant disorders.concerned with the relevant disorders.

This chapter contains advice on the This chapter contains advice on the generalgeneral value of various treatments. value of various treatments.

Although outline descriptions of Although outline descriptions of technique are given in several places, technique are given in several places, supervised experiencesupervised experience is essential before is essential before any of these treatments can be used with any of these treatments can be used with patients.patients.

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Psychological treatments Psychological treatments considered in this chapterconsidered in this chapter

CounselingCounseling Crisis interventionCrisis intervention Supportive Supportive

psychotherapypsychotherapy CBTCBT Individual dynamic Individual dynamic

psychotherapiespsychotherapies Historical Historical

treatmentstreatments Meditation and Meditation and

traditional healingtraditional healing

Small-group Small-group psychotherapypsychotherapy

Large-group Large-group psychotherapypsychotherapy

Psychotherapy Psychotherapy with coupleswith couples

Family therapyFamily therapy Psychotherapy Psychotherapy

for children and for children and older peopleolder people

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How psychological How psychological treatments developedtreatments developed

Hypnosis and free association:1895,1Hypnosis and free association:1895,1923923

Classical dynamic psychotherapyClassical dynamic psychotherapy The neo-Freudians:1930sThe neo-Freudians:1930s

Object relation theoryObject relation theory Attachment theoryAttachment theory Interpersonal therapyInterpersonal therapy

Behaviour therapy:1920sBehaviour therapy:1920s Cognitive therapy:Cognitive therapy: Cognitive-behaviour therapyCognitive-behaviour therapy

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Classification of Classification of psychological treatmentspsychological treatments

TechniqueTechnique EclecticEclectic PsychodynamicPsychodynamic Cognitive behavioralCognitive behavioral other: systems theoryother: systems theory

Number of patients Number of patients Individual therapyIndividual therapy Couple therapyCouple therapy Family therapyFamily therapy Small and large group therapySmall and large group therapy

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Common factors in Common factors in psychological treatmentpsychological treatment

I.I. Therapeutic relationshipTherapeutic relationshipII.II. ListeningListeningIII.III. Release of emotionRelease of emotionIV.IV. Restoration of moraleRestoration of moraleV.V. Providing informationProviding informationVI.VI. Providing a rationaleProviding a rationaleVII.VII. Advice and guidanceAdvice and guidanceVIII.VIII. SuggestionSuggestion

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Counselling and crisis intervenCounselling and crisis interventiontion

CounsellingCounselling Counselling incorporates the non-specifCounselling incorporates the non-specif

ic factors shared by all kinds of psychotic factors shared by all kinds of psychotherapyherapy

Crisis interventionCrisis intervention Helps patients cope with a crisis in their Helps patients cope with a crisis in their

lives, and to learn effective ways of dealilives, and to learn effective ways of dealing with future difficulties.ng with future difficulties.

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Counselling 1Counselling 1 Approaches to counsellingApproaches to counselling

Problem-solving counsellingProblem-solving counselling Interpersonal counsellingInterpersonal counselling

Loss, interpersonal disputes, role transitionLoss, interpersonal disputes, role transitions, and interpersonal deficits.s, and interpersonal deficits.

Psychodynamic counsellingPsychodynamic counselling

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Counselling 2Counselling 2 Counselling for specific purposesCounselling for specific purposes

DebriefingDebriefing Relationship problemsRelationship problems Late effects of traumaLate effects of trauma RisksRisks StudentsStudents In primary careIn primary care

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Crisis intervention 1Crisis intervention 1 Problems leading to crisisProblems leading to crisis

Loss problemsLoss problems Role changesRole changes Relationship problemsRelationship problems Conflict problemsConflict problems

Indications:Indications: well-motivated people with stabel personawell-motivated people with stabel persona

lities who are facing major but transitory lities who are facing major but transitory difficulties.difficulties.

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Crisis intervention 2: Crisis intervention 2: methodsmethods

Stage Ⅰ: Stage Ⅰ: reduce arousal; reduce arousal; focus on current problems; focus on current problems; encourage self-helpencourage self-help

StageⅡ: StageⅡ: assess problems; assess problems; consider solutions; consider solutions; test solutionstest solutions

StageⅢ: StageⅢ: consider future coping methodsconsider future coping methods

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Supportive Supportive psychotherapypsychotherapy

Table22.3Table22.3

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Interpersonal Interpersonal psychotherapypsychotherapy

Interpersonal problems under Interpersonal problems under four headingsfour headings

1.1. Bereavement and other lossBereavement and other loss

2.2. Role disputes Role disputes

3.3. Role transitionsRole transitions

4.4. Interpersonal deficits such as Interpersonal deficits such as lonelinessloneliness

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Cognitive behaviour therapCognitive behaviour therapy 1y 1

General features: 8 typesGeneral features: 8 types

AssessmentAssessment Topics to be considedTopics to be consided Source of information for the assessmenSource of information for the assessmen

tt The formulationThe formulation

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Cognitive behaviour therapCognitive behaviour therapy 2y 2

Behavioural techniques: 16 types ; reBehavioural techniques: 16 types ; relaxation training, exposure, desensitilaxation training, exposure, desensitization, flooding, exposure in everydazation, flooding, exposure in everyday practice, exposure with response py practice, exposure with response prevention……revention……

Cognitive techniquesCognitive techniques

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CBT for different mental CBT for different mental disordersdisorders

I.I. Anxiety disordersAnxiety disordersII.II. Panic disorderPanic disorderIII.III. Post-traumatic stress disorder (PTSPost-traumatic stress disorder (PTS

D)D)IV.IV. Depressive disordersDepressive disordersV.V. HypochondriasisHypochondriasisVI.VI. SchizophrenisSchizophrenisVII.VII. Personality disorderPersonality disorderVIII.VIII. Dialectic behaviour therapy for borDialectic behaviour therapy for bor

derline personality disorderderline personality disorder

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Individual dynamic Individual dynamic psychotherapiespsychotherapies

Brief insight-oriented Brief insight-oriented psychotherapypsychotherapy

Cognitive-analytical therapyCognitive-analytical therapy Psychodynamic interpersonal Psychodynamic interpersonal

therapytherapy Long-term individual dynamic Long-term individual dynamic

psychotherapypsychotherapy

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Treatment in groupsTreatment in groups

Small group psychotherapySmall group psychotherapy Types of small group Types of small group

psychotherapypsychotherapy Therapeutic groupsTherapeutic groups Large-group therapyLarge-group therapy

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Treatment in groupsTreatment in groups

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Psychotherapy with couples Psychotherapy with couples and familiesand families

Couple therapyCouple therapy PsychodynamicPsychodynamic Systems approachesSystems approaches Cognitive behviouralCognitive behvioural Behavioural-systemsBehavioural-systems

Family therapyFamily therapy Psychodynamic family therapyPsychodynamic family therapy Structural family therapyStructural family therapy Systemic family therapySystemic family therapy Eclectic family therapyEclectic family therapy

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Psychotherapy for Psychotherapy for childrenchildren

Play therapyPlay therapy

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Psychotherapy for older Psychotherapy for older peoplepeople

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Other psychological Other psychological treatmentstreatments

HypnosisHypnosis Autogenic trainingAutogenic training AbreactionAbreaction MeditationMeditation

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Ethical problems in Ethical problems in psychological treatmentpsychological treatment

AutonomyAutonomy ConfidentialityConfidentiality ExploitationExploitation

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