Medical psychotherapy


Medical psychotherapy: what is it?History of medical psychotherapyWhy medical psychotherapy?What does the medical psychotherapist do?Layout of the handbookRecommended readingPsychotherapeutic medicine: thinking cradle to graveUndergraduate therapeutic attitudePostgraduate therapeutic attitudeMedical psychotherapeutic attitudeThe three RsRecruitmentRenewalRevalidationPsychotherapeutic psychiatryThe future of medical psychotherapyRecommended readingConcepts and modelsConcepts and models: introductionHistorical contextModels of therapyMonism versus pluralismIntegrationMedical psychotherapy modalitiesTraining in medical psychotherapiesRecommended readingPsychoanalytic psychotherapyKey conceptsThe talking cureThe unconsciousModels of the mindPsychic determinismDevelopmental approachThe Oedipus complexDefence mechanismsRepetition compulsionResistanceTransferenceCountertransferenceKey contributorsWhat is the evidence base?Psychoanalytic psychotherapy trainingRecommended readingCognitive behavioural therapyCognitive behavioural therapy trainingSystemic family and couple therapyFamily therapy trainingGroup therapy and group analysisGroup therapy and group analysis trainingCognitive analytic therapyInterpersonal psychotherapyInterpersonal therapy trainingPsychodynamic interpersonal therapyDynamic interpersonal therapyDynamic interpersonal therapy trainingDialectical behaviour therapyMentalization-based treatmentMentalization-based therapy trainingSchema therapySchema therapy trainingMindfulness-based interventions and therapiesMindfulness-based therapies and interventions trainingTherapeutic communitiesArt psychotherapyDramatherapyMusic therapyMusic therapy trainingCounsellingCounselling trainingGeneral therapeutic competenciesCompetencies frameworkGeneric competenciesCompetency frameworksTherapeutic allianceEngaging the patientDealing with emotionsVignette 1: less complexVignette 2: more complexDealing with breaks and endingsVignette: endingAssessing and managing riskRisk assessmentRisk managementConfidentiality and disclosureVignette: managing self-harmUsing supervisionRecommended readingAssessmentIs my patient suitable for psychotherapy?Practicalities of the assessmentThe assessment processPatient and therapy acceptabilityChoiceConsentRisk-benefit equationContraindicationsOutcomes of assessmentWhat type of therapy?Different forms of therapiesSpecific factors may favour a particular modalityShort-term versus long-termLimitations in availabilityPatient preferenceFormulationBiopsychosocial modelPs in formulationPsychodynamic assessment and formulationInitial referralConducting the assessmentPsychodynamic formulationClinical uses of psychodynamic formulationOutcome of assessmentVignette of psychodynamic assessment and formulationInitial referralAssessmentFormulationOutcomeRecommended readingCognitive behavioural assessment and formulationAssessment: general criteriaAssessment of information neededFormulationWhy bother with formulation in cognitive behavioural therapy?Types of formulationHow to construct a cognitive behavioural therapy formulationLongitudinal formulationCase exampleRecommended readingAssessing the course of therapyWhy should the course of therapy be assessed?Who should assess the course of therapy?How should the course of therapy be assessed?When and how frequently should reviews be held?In which setting should reviews be held?Assessing the outcome of therapyCrucial concepts in measuring therapeutic outcomeWho can assess the change?What can be the measured outcome?Recommended readingConsultationConsultation as acute reflective practiceThe patient and professional linkDistinction between consultation and assessmentWho can use therapeutic help?Great expectations: patient and professionalConsultation without assessmentLearning from the experience of othersCure and curiosityMedical psychotherapy consultationDependency and destructiveness in consultationDoubt in the patient and professional relationshipVignette of consultation without assessmentVignette of consultation with assessmentPsychoanalytic formulation: the elusive patientRecommended readingTreatmentTherapy in clinical practiceSettingThe therapistBeginning the therapyOutpatient therapyInpatient therapyPublic or private sector?Funding and its impact in public sector therapiesFunding in private therapyReferrals in public and private therapyTeamwork and confidentialitySummaryRecommended readingPsychoanalytic psychotherapyKey techniques and competenciesSpectrum of interventionsInterpretationsUse of countertransferenceWhat changes?Clinical population and contextsIndications for psychoanalytic psychotherapyService provisionCase vignettesCase oneCase twoRecommended readingCognitive behavioural therapyKey techniques and competenciesWhat changes?Clinical populations and contextsCase vignettesRecommended readingSystemic family and couple therapyWhat changes?Clinical populations and contextsCase vignettesGroup therapy and group analysisCognitive analytic therapyClinical population and contextsCase vignettesInterpersonal psychotherapyCase vignettesPsychodynamic interpersonal therapyDynamic interpersonal therapyDialectical behaviour therapyClinical populations and contextMentalization-based treatmentSchema therapiesMindfulness-based interventions and therapiesTherapeutic communitiesArt psychotherapyDramatherapyMusic therapyCounsellingProblems through lifeLife: cradle to graveInfantsChildrenFamilyAdolescenceYoung adulthoodAdultsMidlifeLater lifeLived experienceLoveHatredSexualityEthnicity and cultureTransitions and disruptionsLossLoss through absenceLoss through deathTrauma—acute and cumulativeEmotional abuseSexual abuseRecommended readingViolence and aggressionDefinitions and epidemiologyPsychoanalytic accounts of aggressionDifferent types of violencePathways from aggression to violenceSex differencesSuicide and self-harmRecommended readingPsychotherapy and psychiatric disordersIntegrating psychotherapy in psychiatrySongs of innocence and of experienceIntegration of psychotherapy in psychiatryWhat is painful about reality?Hell is other peoplePsychotherapy and psychiatryPsychoanalysis: couched in ambivalent termsCognitive behavioural therapy: how’s the water?Systemic therapy: phantom limb painDual training in medical psychotherapy as a model of integrationIntegration and the sense of lonelinessExtinction, evolution, and hybrid vigourRecommended readingPsychotherapy and medicationThe relationship between psychotherapy and medicationPrinciples of prescribingPrescribing during psychiatric crisesSplit treatment modelPatients’ use and experience of medicationSummaryAnxiety and anxiety disordersAnxietyPsychoanalytic perspectivesDevelopmental classification of anxietyDSM-5 anxiety disordersPsychological treatments for anxiety disordersAffective disordersDiagnosis and classificationPrevalenceWider significancePrinciples of treatment services for depression and allied disordersTreatment provisions for depression in psychological therapy servicesConclusionPsychosesFamily interventionsCognitive behavioural therapy for psychosisPsychodynamic therapyThe Open Dialogue approachOther psychological approachesCommon featuresEating disordersEpidemiologyDiagnosisDifferential diagnosisAetiologyClinical featuresManagementGeneral principlesTreatment of anorexia nervosaMedicationSubstance misuseClinical definitionsTheories of addiction developmentTreatment approachesPsychosociai interventionsPsychological therapies specific to addiction treatmentMotivational-based approachesContingency managementNetwork therapyPsychodynamic psychotherapyDialectical behaviour therapyAcceptance and commitment therapyMindfulness-based relapse preventionSexual dysfunctionSexual cycleClassification of psychosexual disordersAssessment of sexual dysfunctionManagement of sexual dysfunctionGeneral principlesSpecific treatmentsCouple therapySystemic therapyCognitive behavioural therapyPsychoanalytic psychotherapiesPhysical treatmentsConclusionParaphiliasDiagnosisPrevalence and co-morbidityAetiologyTreatmentPsychodynamic therapyService provisionTrauma-related conditionsDiagnosisPrevalenceTreatment of acute stress reactions/debriefingTreatment for post-traumatic stress disorderTreatment for persistent complex grief disorderTreatment for complex traumaMedically unexplained symptomsWhat is/are medically unexplained symptom(s)?Prevalence of medically unexplained symptomsCo-morbidityCriticisms of the conceptPsychological therapies for medically unexplained symptomsResponses from health-care practitionersGender dysphoria and intersex conditionsConditions treatedSpecialist psychotherapy services for gender identity and intersex conditionsPsychotherapy for intersex conditionsIntellectual disabilityDefinition of intellectual disabilityPrevalenceMental ill health and IDDIdentification of mental disorders in IDDPsychological treatments for adults with IDD and mental ill healthDementiaTypes of dementiaPrevalenceDSM-5Care principles, diagnosis, and assessmentTreatment interventions: pharmacologicalTreatment interventions: non-pharmacologicalRecommended readingPersonality disorderTheories of personality developmentPersonality and personality developmentWhat are you like?Questions about personalityTrait theoryTheories of personality developmentTheories of personality development: attachment theoryPersonality and the selfDisorders of the selfRecommended readingPersonality disordersAssessment of personality disorderClassification of personality disorder: dimensions or categories?Clinical assessment: psychiatricTypes of personality disorderPsychotherapeutic assessmentCognitive behavioural therapy formulationRecommended readingBorderline personality disorderAntisocial personality disorderCluster A personality disordersCluster C personality disordersNarcissistic and histrionic personality disordersPersonality disorder servicesFurther service developmentPsychological therapy in secure settingsForensic patientsRelationship between mental disorders and violencePsychopathyTypes of securityLow secure servicesDefinition of low securityLow secure treatment objectivesPsychiatric intensive careMedium secure servicesMedium secure hospitalsWomen’s enhanced medium securityAdolescent medium secure unitsMedium secure personality disorder servicesHigh secure servicesHigh secure hospitalsEvidenced-based therapy in high securityDangerous and severe personality disorder unitsPsychological therapies in prisonPrison statisticsPsychiatric morbidity in prisonsOrganization of servicesPrison-based treatment programmesPsychotherapy in prisonsEvidenced-based therapy in secure settingsRecommended readingEthics and boundariesApproaches to medical ethicsJustice and psychotherapyValues-based practice in psychotherapyVirtue ethics and psychotherapyWhat is good psychotherapy?Good psychotherapy is competently done therapyPsychotherapy as a 'good’ practice for people: moral enhancementProfessional guidelines in psychotherapyPsychotherapy protocols and codesConsent and psychotherapyConsent in medical practice generallyInformed consent in psychotherapyConsent to psychotherapy: can therapy ever be involuntary?Autonomy and psychotherapyBeneficence and non-maleficence in psychotherapyConfidentiality and psychotherapyBoundary setting and maintenanceBoundary violations in psychotherapyCase examplesRecommended readingThe systemPlanning psychotherapy services within psychiatric careHistorical contextCurrent trends in differentiating patients at referralCurrent referral streamsImproving Access to Psychological Therapies servicesSecondary careTertiary and specialist servicesThe need for a psychotherapy pathwayRecommended readingService user involvementTypes of service user involvementApproaches to involvementService user involvement and personality disorderPrinciples of good service user involvementChallenges associated with service user involvementBenefits associated with service user involvementPsychotherapeutic understanding of organizational processesThe conscious and unconscious processes at workOrganizational processesRisk, fear, and defencesUnderstanding of therapeutic organizationsPatient and staff relationshipsThe canary in the minePsychotherapy and managementThe contextManagement 'of and in’ the NHSWhat are the organization’s tasks and objectives?Whose needs are being addressed?Leadership versus management in health careA model of psychotherapeutic leadership in health-care managementTeaching psychotherapy to mental health professionalsTask of teachingMethods of teachingTopics: applicationTopics: practiceBalint groupsWhat is a Balint group?The aim of a Balint groupA psychoanalytic lensThe observer errorSetting up a Balint groupPresenting in a Balint groupThe doctor-patient relationshipBalint terminologyThe bad doctor-patient relationshipCradle to grave Balint groupsVignetteReflective practice groupsWhat are reflective practice groups?Running a reflective practice groupVignette A: reflective practice group in an inpatient psychiatric wardReflective practice reflectionsVignette B: reflective practice group in a crisis teamPsychotherapy researchResearch in psychotherapyWhat is research?Why do research in psychotherapy?Research in psychotherapy: a historical overviewResearch methodologyDifficulties in doing research in psychotherapyOutcome research in psychotherapyProcess research in psychotherapyNew ways forwardNeuroscience and psychotherapyThe brainPeriods of brain growth and developmentHow does this apply to clinical practice?Memory and learningMemory and emotionsMemory and attachmentsMemory and early traumaConsciousnessLearning throughout lifeApplications to the practice of psychotherapyPsychotherapy as a learning experienceThe therapeutic relationshipConcepts of change arising from the neurosciencesThe plasticity of the brainImplications for psychotherapy techniquePsychiatric specialties: medical psychotherapies, applications, and researchGeneral adult psychiatry: medical psychotherapies, applications, and researchHistory of medical psychotherapyGeneral adult psychiatry roots of medical psychotherapyPsychotherapy experience in training psychiatristsPsychiatry as a cross-bearingPsychiatry as bearing limitationMedical psychotherapy practiceWhat do medical psychotherapists do?Medical psychotherapy applicationsTraining in medical psychotherapyMedical psychotherapy researchForensic psychiatry: forensic psychotherapies, applications, and researchPrinciples of forensic psychotherapyWhat does the forensic psychotherapist do?Forensic psychotherapies for offender patientsTrainingResearchResearch in specific psychotherapies for offendersThe developmental roots of violent and antisocial behaviour (See E Violence and aggression in Chapter 6, pp. 304-8.)Child and adolescent psychiatry: child and adolescent psychotherapies, applications, and researchHistorical linksCurrent role of the child and adolescent psychiatristParent-infant psychotherapyAttachment and mentalizationChild and adolescent psychotherapyFamily therapyConsultation and applied workPsychiatry of intellectual disability: psychotherapies, applications, and researchTraining in psychotherapy for adults with intellectual and developmental disordersClinical practiceApplicationsResearch evidencePsychiatry of old age: psychotherapies, applications, and researchRehabilitation and social psychiatry: psychotherapies, applications, and researchPsychiatry of addictions: psychotherapies, applications, and researchTraining in psychotherapies in addictionsRecommended readingLiaison psychiatry: psychotherapies, applications, and researchResearch evidence
 
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