Table of Contents
The fundamental components of a medical consultation are observations on pathogenesis, diagnosis, treatment, and health counseling. Never advise your patients on the topics that you are not an expert at.
No advice at all is better than insufficient advice.
|Patient Education||Providing information about the nature, extent, and treatment of the disease; about the risks, complications, and side effects of treatment; about the chances of recovery and improvement, and about the consequences of no treatment.|
|Patient Informing||Educating through media: books, brochures, instructional videos, and events on the subject.|
|Patient Counseling||Discovering and developing one’s personal resources|
|Patient Training||Developing and practicing complex therapies in small groups (in cases of chronic diseases, e.g. diabetes).|
THE OBJECTIVES of patient education: illness awareness, improved illness behavior, increased quality of life, reduced medical expenses, more favorable disease prognosis, the relief of reference persons, changes in attitude and behavior.
Four Therapy Modes
The four essential therapy modes are:
- Individual therapy: classical therapeutic setting
- Group therapy: the feeling of being understood and accepted by other participants, developing appropriate behavior and acquiring social skills
- Family therapy: conflict resolution through the social environment
- Couple therapy: can identify destructive relationship behavior and helps develop specific communication skills in conflict-prone and threatened relationships
Mental disorders can cause a considerable suffering to the patient. The goal of psychotherapy is to alleviate or eliminate it. Psychotherapy sets itself apart from medical treatment methods, such as surgical operation or medication, by the different tools it uses. The different approaches of psychotherapy have the following features in common:
- Verbal and non-verbal communication
- Professional counseling (as different from advice provided by friends/acquaintances)
- Psychotherapeutic procedures are not random but can be both studied and taught
- Mutual trust between the patient and the therapist
- In the U.S. and Canada (as in most countries of the world), “psychologist” is a legally protected occupational title and requires a doctoral degree and licencing.
Psychodynamic psychotherapy is based on Freudian psychoanalysis (here you can read everything on the psychodynamic model) and on the concepts of depth psychology developed by Jung and Adler. According to these approaches, the disorder stems from the patient’s childhood experiences: traumatizing events and suppressing emotions into the subconscious create symptoms that the patient is currently suffering from.
Remembering, Repeating and Working Through (Freud 1914)
Psychodynamic psychotherapy is also referred to as insight therapy. Remembering and relieving past emotions should lead to an emotional relief. This reduction of stress is called catharsis. Arising in the subconscious, internal conflicts should be brought to the surface through various methods. The most important ‘tools’ of psychodynamic psychotherapy are the methods of free association and interpretation.
A client is asked to express his associations, thoughts, desires, and feelings without censoring or editing his flow of ideas. Freud assumed that this flow cannot be random, it reflects the associations of intrapsychic processes. Thus, hidden, subconscious processes come to light.
Interpretation: Analysis of Resistance, Transference/Countertransference and Dreams
When a patient projects negative, unwanted feelings, such as hatred or envy, onto a therapist, transference occurs. Previous experiences are thus reactivated by a therapist. However, a client is always the one who initiates transference. Countertransference, on the contrary, is always initiated by a therapist. Countertransference occurs whenthe therapist redirects the transference processes toward a client.
Dreams are particularly suitable for gaining access to repressed desires and primal needs hidden in the id. The goal of a psychoanalyst is to differentiate the manifest content of the dream from the latent content.
Recent Developments in Psychoanalysis
- Standard approach: Client-therapist relationship lasts for years, a patient is mainly in a lying position, therapy is focused on psychosexual conflicts, id-ego-super-ego relations, and global changes in personality
- Depth-psychology oriented psychotherapy: shorter therapy duration, a client is in a sitting position, the focus of therapy shifts from psychosexual conflicts to interpersonal relationships and conflicts, self-concept, and particular areas of concern
The objective of the classic behavior therapy is behavior analysis and modification. While psychodynamic therapy focuses on internal conflicts, behavior therapy concentrates on symptoms.
Like any other type of behavior, problem behavior is based on learning processes (the core hypothesis of behavior therapy).
Five approaches of behavior therapy:
- Confrontational method
- Operant conditioning
- Assertiveness and self-confidence training
- Cognitive therapy
Here you can read everything about systematic desensitization and flooding.
Operant conditioning works with such techniques, as shaping, prompting, and fading:
- Time Out: Removing reinforcements through social isolation; leads to natural contingencies which decrease problem behavior
- Satiation: The problem behavior ist acted out so often that what used to be a pleasant activity becomes unpleasant
- Token Economy (Token-Reinforcement System): The tokens are to be given for each desired behavior and are to be taken away for inappropriate behavior. Exchanging tokens for real rewards. Token economies have shown to be successful with the mentally ill patients and students who have problems in academic advancement.
Assertiveness and Self-Confidence Training
Assertiveness and self-confidence training is one of the earliest forms of behavior therapy. It helps develop interpersonal skills through role-playing and modeling.
Cognitive techniques expand the approaches of cognitive behavioral therapy to the assumption that patterns of thought and perception significantly influence behavior. The change of cognitions through reinterpretation and reattribution causes the change in behavior.
Rational-Emotive Behavior Therapy (REBT) by Ellis
I have worth only if I am perfect.
Such irrational beliefs, which trigger fears and negative emotions, are to be discovered through REBT. Clients examine their beliefs and replace them with more realistic versions with higher self-esteem.
Cognitive Therapy by Beck
Everything went wrong again. I am a total failure.
According to Beck, such negative cognitions are the reason of genesis and continuity of depression. Therapy is to reveal these distorted, subjective perceptions and replace them with an alternative mode of thinking. It is essential to learn how to attribute failure to external factors, to break the vicious circle and work out constructive solutions through self-fulfilling prophecies.
Cognitive Behavior Therapy: Meichenbaum’s “Self-Talk” Approach
I already know that tomorrow’s presentation will be a disaster.
Meichenbaum blames such negative inner monologues and self-statements for causing emotional distress. Similarly, he claims that the effect of self-statements can be applied vice versa. Practicing positive inner monologues (“I will make small steps and step by step, I will achieve my goal”) helps overcome anxiety and modify behavior.
Person-Centered Therapy by Rogers
Based on humanistic views, Roger’s approach proceeds on the assumption of the human innate need for individual self-realization. The conflict between one’s desires and expectations and the rules, standards, and outer criticism can cause inner conflicts. Rogers holds these incongruities accountable for the inferiority complex, depressions, and anxieties.
The objective of person-centered therapy is to teach a client to recognize and accept his own needs and emotions “under” the imposed standards and norms.
Processes of Person-Centered Therapy
The three core conditions for successful therapy are:
- Unconditional positive regard: accepting, unconditional personal regards of a therapist no matter what information a client shares
- Empathy: showing sympathy and understanding
- Congruence: a therapist “truly” interacts with a client without hiding behind a professional or personal façade
People do not live in isolation but are a part of social systems. These systemic constellations affect how we think and feel. Systemic therapy focuses exactly on the dynamics of different systems (e.g. business, family, etc.).
Each member of the system both affects it and is affected by it. The interaction between the members of the system is regulated by certain patterns, structures, and rules. These interactions and their rules do not always have a positive result for every member, causing emotional distress of individual members. The most common form of systemic therapy is family therapy.
Praxis of Systemic Therapy
Questions and Comments
Asking circular questions is an important technique of systemic therapy. The approach, which is based on the fact that all information reflects the relations between individuals, is articulated in this form of circular questions:
- “Why do you think your brother broke any contact with your parents?”
- “How do you think your mother explains the reasons why your sister tried to commit suicide?”
Another important technique is reframing, or reinterpretation. A consultant validates patient’s statements from different angles and finds a different explanation of the symptoms and behavior patterns.
- “We hardly ever hear from our son, he does everything alone, he completely excluded me from his life” will transform to “Your son tries to become independent, to stand on his own two feet and make something out of his life. Maybe he just wants to impress you and prove to you that he can make it by himself?”
The metaphoric technique works more on the emotional level rather than on the pure verbal level. In family structures (constellations), one organizes this system and its members according to his or her perception. Closeness and distance, gestures and mimic thus express the relationships between the members.
Gestalt Therapy by Perls
The gestalt therapy is to help patients to bring themselves in harmony with the environment and, where possible, accept the rejected aspects of the self.
Definition: Biofeedback is a scientifically proven method of behavior therapy. It makes the processes that are usually unconscious observable through feedback. German Society of Biofeedback
Measurable parameters (muscular tension, blood pressure, etc.) are to be physiologically derived and then returned to a patient in forms of luminous or acoustic biofeedback. Common fields of application include:
- Tension headaches
- Bruxism (grinding teeth)
Autogenic Training by Schultz
The method of concentrative self-relaxation is based on hypnosis. Body posture, imaginary images, and relaxation experiences are classically conditioned with concise statements. The resulting internal formula triggers a measurable physical relaxation.
Progressive Muscle Relaxation by Jacobson
The objective of the progressive muscle relaxation is to achieve deep relaxation through a voluntary muscle contraction and relaxation. A patient contracts individual muscle groups for approx. 1-2 minutes, focuses on the feeling of tension, and then releases the tense muscle group for 3-4 minutes. The focus should be not on the intense contractions but on the perception of subtle tensions.
The thoughts of a meditator are focused on an object, a symbol, or thought-content. One should try to disconnect from the environment. Mantras can help to achieve this state. Meditation can be an effective instrument in treating anxiety, depression, and chronic pains.
Popular Exam Questions on Medical Psychology and Sociology
Answers are located below the references.
1. Miss S. is suffering from depression and thus is undergoing a psychotherapy treatment. The most striking are her perceptions of herself, the environment, and the future. As a result of a series of unpleasant experiences in social context, she always blames herself. Her therapist chooses an approach that uses specifically directed questions to clarify for the patient her inadequate vision. Then together they try to find more realistic explanations. Which form of psychotherapy is described in this example?
- Cognitive therapy
- Directive psychotherapy
- Circular questions
- Classical Psychoanalysis
2. A patient does not know how to deal with her depression anymore and wants to get treatment at an ambulatory clinic. After medical history evaluation and physical examination, the psychotherapist documents the loss of positive reinforcements. Patient’s mood is due to progressing social withdrawal and the lack of social reinforcements. Through which approach does the therapist explain the depression?
- Social systemic constellations
- Behavior therapy
- Depth psychology
- Social phycology
- Genetic approach
3. Austrian neurologist Sigmund Freud is considered the founder of psychoanalysis. Which approach is not used in psychoanalysis?
- Transference analysis
- Resistance analysis
- Free association
- Systematic desensitization
- Dream analysis