Psychotherapy has been proven to be generally effective; however, there is uncertainty as to why. The field is currently experiencing apparent turmoil in three areas: (a) theory development for psychotherapeutic effectiveness, (b) research design, and (c) treatment technique.
Individual psychotherapy involves regularly scheduled talks between the patient and a mental health professional such as a psychiatrist, psychologist, psychiatric social worker, or nurse. This usually includes increasing individual sense of well-being and reducing subjective discomforting experience. The sessions may focus on current or past problems, experiences, thoughts, feelings, or relationships.
Indications
Useful in two groups of patient:
1. Those experiencing stressful circumstances.
2. Those with chronic psychological problems or mental illness.
The centrality of relationship to healing and the subjective intuitive stance necessary in knowing another person is rooted in qualitative data and is dissonant with the outcome driven, quantitative philosophy of managed care and contemporary biomedical psychiatry. And, of course, all psychotherapy has a supportive component. Drug abuse counselors, for example, often favor challenge and confrontation over emotional support, but they too are "supportive" because a mental health professional treating a drug addict is often one of the few reliable and helpful people in the addict's life.
By sharing experiences with a trained empathic person – talking about their world with someone outside it – individuals with schizophrenia may gradually come to understand more about themselves and their problems. They can also learn to sort out the real from the unreal and distorted.
Aims
# to help them to achieve best adaptation possible
# to reinforce existing personality structure and defense mechanisms.
# does not aim to achieve any radical change in personality or defense mechanisms.
Technique
# Therapist adopts role of benevolent professional, fostering trust and positive expectations.
# Permits patient to relinquish all or some of his self-reliance.
# Dependent role sanctioned patient need not feel shame or embarrassment.
Strategies:
# explanation
# encouragement, reassurance
# permission for catharsis
# environmental manipulation.
This type of therapy can be brief in nature or longer term, depending on the needs of the individual client and available for those whose issues center around relationships with significant others in their lives. Psychotherapy can be short-term, with just a couple of sessions, or it can involve many sessions over several years. It can take place in individual, couples, family or group sessions. Sometimes psychotherapy is combined with other types of treatment, such as medication. Some withdrawing addicts are treated in residential chemical dependency programs that provide individual and group therapy, 12-step support groups, and other services, usually for a month to three months.
Supportive psychotherapy—the most widely practiced form of individual psychotherapy today—draws on a depth and breadth of skills to exercise the discipline effectively. Recognizing the importance of this therapy to the field, the Psychiatry Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME) mandated that competence in supportive psychotherapy is required of all psychiatry residents.
Supportive psychotherapy may be just a phase in the treatment of a person or it may be the total focus of treatment for an individual. Supportive psychotherapy is used during a phase of treatment when the person is having temporary, but severe difficulties in daily functioning such as an episode of severe depression, anxiety, mania, and so on. Perhaps most important, however, individual therapy is evaluated over a 3-year period—a duration consistent with clinical experience of the time required to effect functional improvement in schizophrenia.
supportive therapy is one of the most commonly practiced types of psychotherapy. It is a form of treatment in which therapist support is a core component. Gilbert & Ugelstad (1994) believe that the therapist’s primary role in supportive psychotherapy is to support and strengthen the individual’s potential for better and more mature ego functioning in both adaptational and developmental tasks.
It is important to distinguish between the supportive component of all psychotherapies and supportive psychotherapy as a specific mode of treatment for a particular group of patients (Holmes, 1995). Support is fundamental to all psychotherapies and is characterized by regularity, reliability and attentiveness of the therapist towards the patient.
Basic rules:
* Listen and say little. Avoid glib reassurance.
* Do not interrogate. Encourage patient to be at ease.
* Be empathic, accept patient non-judgmentally.
* Do not pronounce on general matters.
* Avoid authoritative directions over what patient should do.
* Avoid facile interpretations of behavior and motives.
* Keep own attitudes to oneself.
* Do not over identify with the patient (leads to excessive anxiety in therapist and impaired judgment).
* Define aims clearly and the nature of help offered.
* Set clear mutually agreed goals, frequency and duration of treatment.
* Review progress regularly.
* Respect confidentiality and avoid gossip.
Development of excessive dependency
It is the main complication. Liable to occur when therapist dominates and permits the patient too much passivity, fails to set mutually agreed goals from the start or to review progress of therapy regularly.
FORMAL INDIVIDDUAL PSYCHOTHERAPY NON-DIRECTIVE (EVOCATIVE) PRINCIPLES
More intensive than supportive type, aims to achieve enduring personality change through a systematic scrutiny of the patient's past and present psychological life.
* Promotes insight and encourage patient to discover answers himself.
* Recollection and recounting of issues, feelings, situations.
Therapist interventions:
Enquiry—
Asking questions to elaborate patient's account.
Clarification—
Pointing out and linking events so that patient is helped to understand repeated patterns in his feeling and thinking.
Explanation—
Interpretation. Offered as hypotheses for discussion. The precise content depends on theoretical model to be used. Occasionally used for the primary purpose of evoking emotional response (prokaleptic) rather than on content validity.
Guidance of discussion—
Ensure that emotionally painful but relevant topics are dealt with adequately rather than avoided.
Confrontation—
Concerning inconsistencies, evasions and other defense mechanisms.
Therapist attitudes
Basic approach as for supportive therapy. In some variants, such as client Centered Expressive Therapy, expression of therapist's own feelings is encouraged, together with 'genuineness acceptance of patient with unconditional positive regard and accurate empathic understanding'.
References:
http://www.psychologyinfo.com
http://www.mayoclinic.com
http://www.redorbit.com
http://www.health.harvard.edu/
http://www.accessmylibrary.com
http://www.appi.org
http://ajp.psychiatryonline.org
http://www.factspllc.com
and others
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