Topics: practice

Why do mental health professionals need to know about psychotherapy? This is a question that is asked occasionally. One possible answer is that psychotherapy is already part of their practice. Attendees are trained professionals providing a talking treatment to the patients they work with. They listen to their patient’s feelings; they are interested in their life, and they keep them in mind. They work with their patients in addressing their maladaptive coping strategies and challenge destructive patterns of behaviour. They aim to form structured, boundaried, and containing relationships and understand why this is sometimes hard to achieve or sustain. They help their patients formulate their difficulties and come up with plans for the future. To know more about the practice of psychotherapy increases both their awareness of the resources of the psychotherapeutic approach and their confidence in the use or application of some psychotherapeutic ideas in their practice.

Teaching mental health professionals about different modalities of treatment

Keep the teaching about the different modalities of treatment straightforward and relevant. Do not spend a lot of time describing treatments that are not available in the local service. For example, it works well to compare two different, but well-recognized, treatments that are available locally such as psychodynamic psychotherapy and CBT (see Table 10.1) (see E otherapy in Chapter 2, pp.

20-30, and in Chapter 5, pp. 163-72; Cognitive behavioural therapy in Chapter 2, pp. 30-4, and in Chapter 5, pp. 172-84).

Table 10.1 Comparison of two psychotherapy treatments.

Psychodynamic

CBT

Treatment

length

1-2 years NHS

6-25 sessions NHS

Session time

50 min

Varies

Regular

Usually once weekly or occasionally more frequent sessions

Can vary, generally weekly

Focus

Early life/past important in present difficulties and therefore important to explore past in the present and ‘working through’. Patient can talk about anything on his/her mind, not focused on ‘the presenting problem’

Focus on patient’s current problems. Patients are taught skills to use with future problems

Therapeutic

relationship

Emphasis on the therapeutic relationship and the bringing of earlier relationships into the present through exploration of transference influenced by countertransference

Collaborative

emphasis

Homework

No

Yes

Coping

strategies

Improve over time and exploration

Direct challenge

Formulation

Early experiences and feelings repressed in unconscious that then find expression in present day-to-day experiences. By addressing these hidden and repressed feelings, an individual is gradually freed of patterns of destructive behaviour

Uncovering dysfunctional core beliefs and automatic negative thoughts. Different adaptive coping strategies practised

Patient

commitment

High

Medium to high

Recommended reading

Freud S (1917). Mourning and melancholia. In: Strachey J, ed. The Standard Edition of the Complete Psychological Works of Sigmund Freud, volume 14. pp. 237-60. Hogarth Press and the Institute of psychoanalysis: London.

Holmes J (1991). A Textbook of Psychotherapy in Psychiatric Practice. Churchill Livingstone: Edinburgh.

Lucas R (2009). The Psychotic Wavelength. Routledge: London.

Peters S (2012). The Chimp Paradox. Random House: London.

 
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