Академический Документы
Профессиональный Документы
Культура Документы
Compiled by:
Michelle H (07120110086)
M. Alif Novaldi (07120110079)
Preceptor:
dr. Dharmady Agus, SpKJ
Department of Psychiatry
Faculty of Medicine Pelita Harapan University
Dharmawangsa Sanatorium
2015
Table of Content
Chapter 1
Introduction
Supportive psychotherapy is widely practiced and may in fact be the treatment
provided to most psychiatric patients. Since the 1950s it has been recognized that
psychotherapy should be systematically taught as an modality apart from analysis and
that it shoud be conceptualized on its own terms, not as a lesser form of analysis.
However, supportive psychoteraphy has seldom been taught. Paul Dewald (1971)
described expresivve therapy and supportive therapy as the poles of the continuum of
dynamic psychotherapies. Most patients receive a therapy that incorporates both
supportive and expressive elements.
Chapter 2
PART 1 : Psychotherapy
I.
Definition
II.
Based on the same principles and techniques as classic psychoanalysis, but less
intense. There are two types : (1) Insight-oriented or expressive psychotherapy
and (2) supportive or relationship psychotherapy. Patients are seen one or two
times a week and sit up facing the psychiatrist. The goal of resolution of
unconscious psychological conflict is similar to that od psychoanalysis, but a
greater emphasis is placed on day-to-day reality issues and a lesser emphasis on
the development of transference issues. Patients suitable for psychoanalysis are
suitable for this therapy, as are patients with a wider range of symptomatic and
characterological problems. Patients with personality disorders are also suitable
for this therapy. A comparison of psychoanalysis and psychoanalyticaly oriented
psychotherapy is presented in Table 29-1.
In supportive psychotherapy, the essential element is support rather than the
development of insight. This type of therapy often is the treatment of choice for
patients with serious ego vulnerabilities, particularly psychotic patients. Patients
in a crisis situation, such as acute grief, are also suitable. This therapy can be
continued on a long-term basis and last many years, especially in the case of
patients with chronic problems. Support can take the form of limit setting,
increasing reality testing reassurance, advice, and help with developing social
skills.
Basic Technique
The analysis of transference by the interpretation of resistance is important for the
psychoanalytic psychotherapist. To promote the patients examination of the
phenomena of transference and resistance, both the analyst and the therapist are
guided by prin- ciples that establish a confidential, safe and predictable environ- ment
geared toward maximizing the patients introspection and focus on the therapeutic
relationship. The patient is encouraged to free associate, that is, to notice and report as
well as she or he can whatever comes into conscious awareness (Tables 66.4 and
66.5). Therapeutic neutrality and abstinence are related concepts. Both foster the
unfolding and deepening of the transference, as well as the opportunity for its
interpretation. The psychoanalytic psychotherapist assumes a neutral position vis-vis the patients psychological material by neither advocating for the patients wishes
and needs nor prohibiting against these. The patient is en- couraged in the therapeutic
relationship to develop the capacity for self-observation. Neutrality does not mean
nonresponsive- ness; it is nonjudgmental nondirectiveness.
Abstinence refers to the position assumed by the psychoan- alytic psychotherapist
of recognizing and accepting the patients wishes and emotional needs, particularly as
they emanate from transference distortions, while abstaining from direct gratification of those needs through action. Abstinence is a principle that guards against the
therapists gratification at the patients ex- pense. For example, as the treatment
experience deepens into a more consolidated transference neurosis, there may be a
strong tendency by the patient to experience the therapist as the impor- tant person in
the patients life around whom the characteristic conflictual issues are manifested. By
maintaining a neutral and abstinent position with respect to the patients needs and
wishes, the psychotherapist creates a safe atmosphere for the experiencing and
expression of even highly charged affects, the safety required for the patients
motivation for continued therapeutic work. The position held by the psychiatrist is
neither sterile nor overstimulating and promotes the establishment of a meaningful
therapeutic relationship.
The rule of free association dictates that the patient should verbalize to the best of
her or his ability whatever comes into awareness, including thoughts, feelings,
physical sensations, memories, dreams, fears, wishes, fantasies and perceptions of the
analyst. Whereas at first glance this requirement appears to be unscientific, in fact, the
psychiatrist and patient quickly come to appreciate that no thought or feeling is
random or irrelevant but rather that all mental content is relevant to the patients
emotional problems. Indeed, much productive therapeutic work is focused on those
instances when the patient is not able to speak about what is on his or her mind.
Many psychoanalytic psychotherapists also use the tech- nique of dream
interpretation, although recently there may be less emphasis on this. Freud placed
great emphasis on the inter- pretation of dreams because he discovered that such a
technique provided insights into the working of the unconscious. In a simi- lar
fashion, slips of the tongue, jokes, puns and some types of forgetfulness are attended
to carefully by the therapist because they are nonsleep activities that also provide
insight into the pa- tients unconscious mental processes. Good technique does not
necessarily include pointing out to the patient these events each time they occur, for
they may often be a source of intense embar- rassment. Rather, the slips are noted as
helpful data in assessing the patients inner thoughts.
the premise that behavior is shaped by being coupled with or uncoupled from anxietyprovoking stimuli. Just as Ivan Pavlovs dogs were conditioned to salivate at the
sound of a bell once the bell had become associated with meat, a person can be
conditioned to feel fear in neutral situations that have come to be associated with
anxiety. Uncouple the anxiety from the situation, and the avoidant and anxious
behavior will decrease.
Behavior therapy is believed to be most effective for clearly delineated,
circumscribed maladaptive behaviors (e.g phobias, compulsions, overeating, cigarette
smoking, stuttering, and sexual dysfunctions). In the treatment of conditions that can
be strongly affected by psychological factors (e.g hypertension, asthma, pain, and
insomnia), behavioral techniques can be used to induce relaxation and decrease
aggravating stresses (Table 29-2). There are several behavior therapy techiques.
during a period of 12 weeks. Patients are made aware of their own distorted cognitions and
the assumptions on which they are based. Homework is assigned; patients are asked to record
what they are thinking in certain stressful situations and to ascertain the underlying, often
relatively unconscious, assumptions that fuel the negative cognitions. This process has been
referred to as recognizing and correcting automatic thoughts. The cognitive model of
depression includes the cognitive triad, which is a description of the thought distortions that
occur when a person is depressed. The triad includes (1) a negative view of the self, (2) a
negative interpretation of present and past experience, and (3) a negative expectation of the
future.
Cognitive therapy has been most successfully applied to the treatment of mild to moderate
nonpsychotic depressions. It also has been effective as an adjunctive treatment in substance
abuse and in increasing compliance with medication. It has been used recently to treat
schizophrenia.
V. Family Therapy