9 May 2024 – Go Retire Psychiatrist

In observance of May being Mental Health Month, this is one of my Dirty Dozen lectures. It’s on the elements that are shared among some of the important psychotherapy methods.

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Dirty Dozen on Common Elements of Psychotherapy by Jim Amos, MD

What is Psychotherapy?

-Change facilitation

-Self awareness development

-Doesn’t necessarily have to occur in formal therapy encounters

-Can happen between patients and a wide range of professionals

Patient Variables and Relationship Factors

-Ability to relate, psychological mindedness

-Therapeutic alliance

-Readiness to change

-Respect, listening for understanding

Placebo, Hope, and Expectancy Effects

-Power of providing a “treatment experience”

-An emotionally charged relationship in which therapy instills hope for change

-A particular set of procedures that enhance belief in the therapist’s competency

-A therapeutic explanation of the problems that fits the patient’s belief system

Motivational Interviewing

-Intended to raise patient’s awareness of ambivalence between opposing thoughts and behaviors

-Accepts the “yes, but” responses without confrontation

-Emphasizes validation, reflection, reframing

-Source: Miller, W. R. and S. Rollnick (1991). Motivational interviewing : preparing people to change addictive behavior. New York, Guilford Press.

Motivational Interviewing cont. Stages of Readiness to Change

-Precontemplation

-Contemplation

-Preparation

-Action

-Maintenance

-Termination

Cognitive Behavioral Therapy (CBT)

-Foci of treatment are internally based cognitions and challenging, unhelpful or harmful thoughts and behaviors.

-Time limited

Interpersonal Therapy (IPT)

-Focus on interpersonal communications with others

-Focus on helping improve communication and social support in the present

-Time limited

Psychodynamic Psychotherapy

-Focus of treatment is on understanding contributions of early life experiences to psychological functioning and unhelpful or harmful behaviors

-Can be lengthy or open-ended

Essential Operations of Psychodynamic Psychotherapy

-Accepting: Therapist affirms the patient’s past and present subjective experience

-Understanding: Therapist appreciates both the conscious and unconscious contributions to the patient’s emotional problems

-Explaining: Therapist expresses, through interpretations, his or her understanding to the patient

Integrating Therapies

-Skillfully staged combinations of approaches may be more successful than one used alone

-Cognitive behavioral or interpersonal approaches first for more immediate symptom relief

-Psychodynamic approaches first for increasing self-awareness and exploring the need for change

References

-Dewan, M. J., MD,, B. N. Steenbarger, PhD,, et al., Eds. (2004). The Art and Science of Brief Psychotherapies: A Practitioner’s Guide. Core Competencies in Psychotherapy. Washington, DC, American Psychiatric Publishing, Inc.

-Miller, W. R. and S. Rollnick (1991). Motivational interviewing : preparing people to change addictive behavior. New York, Guilford Press.