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H.M.Zainie Hassan.A.R.dr.SpKJ(K)
Psychoanalysis
In 1881 Anna O,neurotic young woman
treated by Josep Breuer, that patients
symptoms disappeared when she expressed
them verbally while hypnotied. Freud use
the technique with Breuer in 1895 in studies
on Hysterya.
Freud eventually gave up placing his
patients in hypnotic trance, instead them to
recline on a couch, concentrate with their
eye closed on past memories related their
symptoms. That concentration methode
eventually became the technique of free
association is one of hallmark s of
Psychoanalysis .
Psychoanalysis
Psychoanalytic Process
involves bringing to the surface repressed memories and
feelings by means of a scrupulous unraveling of hidden
meanings of verbalized material and of the unwitting ways in
which the patient wards off underlying conflicts through
defensive forgetting and repetition of the past.
The overall process of analysis is one in which unconscious
neurotic conflicts are recovered from memory and verbally
expressed, reexperienced in the transference,reconstructed by
the analyst, and, ultimately, resolved through understanding.
Freud referred to these processes as recollection, repetition,
and working through, which make up the totality of
remembering, reliving, and gaining insight.
Psychoanalytic Psychotherapy
which is based on fundamental dynamic
formulations and techniques that derive from
psychoanalysis, is designed to broaden its
scope.
Its focus the patient current conflicts and
current dynamic patterns
The strategies of psychoanalytic psychotherapy
currently range from expressive (insightoriented, uncovering, evocative, or interpretive)
techniques to supportive (relationship-oriented,
suggestive, suppressive, or repressive)
techniques.
psychoanalytic psychotherapy rarely uses the
couch; patient and therapist sit face to face.
Brief Psychodynamic
Psychotherapy
Brief psychodynamic psychotherapy is a timelimited treatment (10 to 12 sessions) that is based
on psychoanalysis and psychodynamic theory.
It is used to help persons with depression, anxiety,
and posttraumatic stress disorder, among others.
Brief psychodynamic psychotherapy has gained
widespread popularity, partly because of the great
pressure on health care professionals to contain
treatment costs.
It is also easier to evaluate treatment efficacy by
comparing groups of persons who have had shortterm therapy for mental illness with control groups
than it is to measure the results of long-term
psychotherapy
Dialectical Behavior
Therapy
Patients are seen weekly, with the goal of improving interpersonal skills and
decreasing self-destructive behavior using techniques involving advice, metaphor,
storytelling, and confrontation, among others. Patients with borderline personality
disorder especially are helped to deal with the ambivalent feelings that are
characteristic of the disorder. Marsha Linehan, Ph.D., developed the treatment
method, based on her theory that such patients cannot identify emotional
experiences and cannot tolerate frustration or rejection. As with other behavioral
approaches, DBT assumes all behavior (including thoughts and feelings) is learned
and that patients with borderline personality disorder behave in ways that
reinforce or even reward their behavior, regardless of how maladaptive it is.
Genetic Counseling
Genetic counseling is a process that
provides information (medical, technical,
and probabilistic) to the patient (and
family) at risk for developing a specific
disorder. The provision of information
occurs in conjunction with helping them
adapt emotionally and psychologically to
the diagnosis (or threat of it), thus
facilitating informed decision making. The
process aims to minimize distress, to
increase one's feeling of personal control,
and to facilitate informed decision making.
Biofeedback
Biofeedback involves the recording and
display of small changes in the physiological
levels of the feedback parameter. The display
can be visual, such as a big meter or a bar of
lights, or auditory. Patients are instructed to
change the levels of the parameter, using the
feedback from the display as a guide.
Biofeedback is based on the idea that the
autonomic nervous system can come under
voluntary control through operant
conditioning. Biofeedback can be used by
itself or in combination with relaxation. For
example, patients with urinary incontinence
use biofeedback alone to regain control over
the pelvic musculature. Biofeedback is also
used in the rehabilitation of neurological
disorders. The benefits of biofeedback may
be augmented by the relaxation that
patients are trained to facilitate.
Behavior Therapy
Cognitive Therapy
Cognitive therapy assumes that perception and experiencing, in general, are active
processes that involve both inspective and introspective data. The patient's
cognitions represent a synthesis of internal and external stimuli. The way persons
appraise a situation is generally evident in their cognitions (thoughts and visual
images).
Hypnosis
Hypnosis, in contemporary lay thought, is often
steeped in mystery and its powers believed to
border on magic. In reality, hypnosis is a
powerful means of directing innate capabilities
of imagination, imagery, and attention. During
the hypnotic trace, focal attention and
imagination are enhanced and simultaneously
peripheral awareness is decreased. This trance
may be induced by a hypnotist through
formalized induction procedures, but it can also
occur spontaneously. The capacity to be
hypnotized and, relatedly, the occurrence of
spontaneous trance states is a trait that varies
between individuals, but is relatively stable
throughout a person's life cycle.
Interpersonal Therapy
The typical course of ITP lasts 12 to 20 sessions over a 4- to 5month period. ITP moves through three defined phases: (1) The
initial phase is dedicated to identifying the problem area that
will be the target for treatment; (2) the intermediate phase is
devoted to working on the target problem area(s); and (3) the
termination phase is focused on consolidating gains made
during treatment and preparing the patients for future work on
their own (Table 35.11-1).
Psychiatric Rehabilitation
Psychiatric rehabilitation denotes a wide range
of interventions designed to help people with
disabilities caused by mental illness improve
their functioning and quality of life by enabling
them to acquire the skills and supports needed
to be successful in usual adult roles and in the
environments of their choice. Normative adult
roles include living independently, attending
school, working in competitive jobs, relating to
family, having friends, and having intimate
relationships. Psychiatric rehabilitation
emphasizes independence rather than reliance
on professionals, community integration rather
than isolation in segregated settings for persons
with disabilities, and patient preferences rather
than professional goals.
Combined Psychotherapy
and Pharmacology
The use of psychotropic drugs in combination with
psychotherapy has become widespread. In fact, it has
become the standard of care for many patients seen by
psychiatrists. In this therapeutic approach, psychotherapy
is augmented by the use of pharmacological agents. It
should not be a system in which the therapist meets with
the patient on an occasional or irregular basis to monitor
the effects of medication or to make notations on a rating
scale to assess progress or side effects; rather, it should
be a system in which both therapies are integrated and
synergistic. In many cases, it has been demonstrated that
the results of combined therapy are superior to either
type of therapy used alone. The term pharmacotherapyoriented psychotherapy is used by some practitioners to
refer to the combined approach. The methods of
psychotherapy used can vary immensely and all can be
combined with pharmacotherapy.
Reference
Sadock, Benjamin James; Sadock, Virginia
Alcott: Kaplan & Sadock's Synopsis of
Psychiatry: Behavioral Sciences/Clinical
Psychiatry, 10th Edition