PSIKOTERAPI

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Eri Achmad P S I K I A T E R
eriachmad@yahoo.co.id
Freuds Mind Topographie Model
 Psychological therapy
Describes as
The interaction between a therapist and a client that
aims to impart beneficial changes in the clients
thoughts, feelings and behaviours
Often known as
Psychotherapy or talking therapy, may be useful in helping a
client improve their overall sense of well-being
Professional disciplines; clinical psychologist, psychiatrists,
occupational therapists, mental health nurses, art and drama
therapists, and counsellors. Provided they have had adequate
training and supervision
 Counselling and Supportive
Psychotherapy
Psychotherapy is sometimes distinguished from
counselling, although they exist on a continuum;
from counselling and supportive psychotherapy
(least complex), to psychodynamic psychotherapy
and sophisticated cognitive therapy (more
complex and requiring more specialist training)
Counselling is usually brief in duration and is
recommended for patients with minor mental
health or interpersonal difficulties, or for those
experiencing stressful life circumstances (grief)
 Counselling helps patients utilize their own
strengths, with the therapist being reflective and
empathic
The provision of relevant information and advice is
also considered to be counselling, which is
undertaken by healthcare professionals of all
specialties
Types; person-centered counselling, problem
solving counselling
Psychotherapy
Psychotherapy is commonly thought of as an
interpersonal process, involving a verbal and/or nonverbal
interchange between a patient who exhibits psychological
problems and a trained therapists to aid in life problems
Psychotherapy is often used either alone or in
combination withmedication to treat mental illnesses
 Psychotherapy, or "talk therapy", is a way to treat
people with a mental disorder by helping them
understand their illness. It teaches people
strategies and gives them tools to deal with stress
and unhealthy thoughts and behaviors.
Psychotherapy helps patients manage their
symptoms better and function at their best in
everyday life.
 How Does Psychotherapy Help?
Understand the behaviors, emotions, and ideas that
contribute to his or her illness and learning how to modify
them
Understand and identify the life problems or events -- like a
major illness, a death in the family, a loss of a job, or a
divorce -- that contribute to their illness and help them
understand which aspects of those problems they may be
able to solve or improve
Regain a sense of control and pleasure in life
Learn coping techniques and problem-solving skills
 Modifying unconscious thoughts, feelings and
fantasies that give rises to distressing symptoms
and these processes are kept unconscious by
defence mechanisms
The essential aim of psychotherapy is to facilitate
conscious recognition of symptom-causing
unconscious processes
Through transference and counter-transference
processes
Defense Mechanism
 Psychotherapeutic aporaches
A comprehensive review of psychotherapy research showed that
common factors (occurring in any model of therapy) account for
85% of the therapeutic effect, whereas theoretical orientation
only accounts for 15%.
Therefor, the use of a modality with which the patient can
identify and work may be more important than the theoretical
basis of the therapy itself.
Common therapeutic factors include client factors (personal
strengths, social supports), therapist-client relationship factors
(empathy, acceptance, warmth), and the clients expectancy of
change
Goals
Increases sense of well-being, reduce discomfort
Learn to identify and change behaviors or thoughts that adversely
affect life
Explore and improve relationships
Find better ways to cope and solve problems
Learn to set realistic goals
Changing maladaptive behavior pattern
Improving interpersonal & other competencies
Helping the patient to resolve inner conflict
Modifying individual assessment of himself & the world around him
 Employs range of techniques based on relationship
building, dialogue, communication and behavior
change designed to improve the mental of
individual patient or group
During psychotherapy, a person with a mental
illnes talks to a licensed and trained mental health
care professional who helps him or her identify
and work through the factors that may be
triggering the illness.
10 minute break..
Types of Psychotherapy
 Types of Therapy
Individual/Interpersonal:This therapy involves only the patient
and the therapist
Group:Two or more patients may participate in therapy at the
same time. Patients are able to share experiences and learn that
others feel the same way and have had the same experiences
Marital/couples:This type of therapy helps spouses and partners
understand why their loved one has a mental disorder, what
changes in communication and behaviors can help, and what they
can do to cope
 Your brain on psychotherapy
Psychotherapy-related changes in brain activity
are strikingly similar within patients who share the
same psychiatric diagnosis.
Psychotherapy and pharmacotherapy achieve
similar efficacy and are associated with
overlapping but not identical changes in brain-
imaging profiles
Roffman J. et al. Neuroimaging and functional neuroanatomy of
psychotherapy. Psychological med 2005 35:1385-1398
 Who seeks therapyand why?
Children
behavioral, school, family issues
Adolescents
as above and issues of separation and peer relationships
Young adults
all of above plus career issues
Mature adults
all of above plus issues of changing relationships, family alignments,
health, work and social status
Older adults:
all of above plus end of life issues
 When to consider psychotherapy
Signs that you could benefit from therapy include:
You feel an overwhelming, prolonged sense of helplessness and
sadness.
Your problems don't seem to get better despite your efforts and
help from family and friends.
You find it difficult to concentrate on work assignments or to carry
out other everyday activities.
You worry excessively, expect the worst or are constantly on edge.
Your actions, such as drinking too much alcohol, using drugs or
being aggressive, are harming you or others.
 Contraindication of psychotherapy
Psychotic patient with severe behavior
Organic psychosis (acute phase)
Patients who are unmotivated
Hysteria patients
Unlikely to respond; antisocial personality
 Family:Because family is a key part of the team that helps people
with mental illness get better, it is sometimes helpful for family
members to understand what their loved one is going through, how
they themselves can cope, and what they can do to help
Psychodynamic therapy
Brief Psychotherapy
Behavior therapy
Cognitive therapy / CBT
Hypnosis
Psychiatric Rehabilitation
 Psychodynamic Therapy
Psychodynamic therapy is based on the assumption
that a person is having emotional problems because of
unresolved, generally unconscious conflicts, often
stemming from childhood. The goal of this type of
therapy is for the patient to understand and cope better
with these feelings by talking about the experiences.
Psychodynamic therapy is administered over a period of
at least several months, although it can last longer,
even years.
 Interpersonal therapy
Interpersonal therapy focuses on the behaviors and
interactions a patient has with family and friends. The
primary goal of this therapy is to improve
communication skills and increase self-esteem during a
short period of time. It usually lasts three to four
months and works well for depression caused by
mourning, relationship conflicts, major life events, and
social isolation.
 Psychodynamic and interpersonal therapies help
patients resolve mental illness caused by:
Loss (grief)
Relationship conflicts
Role transitions (such as becoming a mother, or a caregiver)
 Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a blend of two
therapies: cognitive therapy (CT) and behavioral therapy.
CT was developed by psychotherapist Aaron Beck, M.D.,
in the 1960's. CT focuses on a person's thoughts and
beliefs, and how they influence a person's mood and
actions, and aims to change a person's thinking to be
more adaptive and healthy. Behavioral therapy focuses on
a person's actions and aims to change unhealthy behavior
patterns.
 Cognitive-Behavioral Therapy
Cognitive-behavioral therapy helps
people with mental illness to identify
and change inaccurate perceptions that
they may have of themselves and the
world around them. The therapist helps
the patient establish new ways of
thinking by directing attention to both
the "wrong" and "right" assumptions
they make about themselves and
others.
 Cognitive-behavioral therapy is recommended for
patients:
Who think and behave in ways that trigger and perpetuate
mental illness.
Who suffer from depression and/or anxiety disorders as the
only treatment or, depending on the severity, in addition to
treatment with antidepressantmedication.
Who refuse or are unable to take antidepressant medication.
Of all ages who have mental illness that causes suffering,
disability, or interpersonal problems.
 Starting Therapy
Therapy works best when you attend all scheduled
appointments. The effectiveness of therapy depends on
your active participation. It requires time, effort, and
regularity
As you begin therapy, establish some goals with your
therapist. Then spend time periodically reviewing your
progress with your therapist. If you don't like the therapist's
approach or if you don't think the therapist is helping you,
talk to him or her about it and seek a second opinion if both
agree, but don't discontinue therapy abruptly
 Identify sources ofstress: Try keeping a journal and note
stressful as well as positive events
Restructure priorities: Emphasize positive, effective
behavior
Make time for recreational and pleasurable activities
Communicate: Explain and assert your needs to someone
you trust; write in a journal to express your feelings
Try to focus on positive outcomes and finding methods
for reducing and managing stress