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- Herausgeber: Icon Books
- Kategorie: Fachliteratur
- Serie: Graphic Guides
- Sprache: Englisch
What is psychotherapy? How can we choose wisely from so much on offer?This book provides a valuable summary of the main therapies: the "talking cures" of psychoanalysis, behavioral and cognitive techniques, somatic solutions, humanist gestalt and existential approaches, and individual and group therapies.
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Veröffentlichungsjahr: 2015
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Published by Icon Books Ltd, Omnibus Business Centre, 39–41 North Road, London N7 9DP Email: [email protected]
ISBN: 978-184831-344-6
Text copyright © 2012 Icon Books Ltd
Illustrations copyright © 2012 Icon Books Ltd
The author and illustrator has asserted their moral rights
Originating editor: Richard Appignanesi
No part of this book may be reproduced in any form, or by any means, without prior permission in writing from the publisher.
Contents
Cover
Title
Copyright
A Problem Old as Humanity...
What is Psychotherapy?
Psychotherapy and Counselling
Main types of Psychotherapy
Who is a Psychotherapist?
Who is a Psychiatrist?
Other Therapists
How to choose a Therapist
Why do People Need Psychotherapy?
Depression
Who Gets Depression?
Anxiety
The Mystery of Anxiety
Phobias
Obsessions and Compulsions
Eating Disorders
Bulimia and Anorexia
Self-harm
Schizophrenia
Other Forms of Schizophrenia
Diagnosis of Schizophrenia
Examples of Major Categories of Mental Disorders
Distinctions between Psychosis and Neurosis
The Immediate Goals of Psychotherapy
The Broader Goals of Psychotherapy
Why is Psychotherapy Important?
Helping Others ...
Brief Background to Psychotherapy
St Augustine
St Thomas Aquinas
Medieval Madness
Descartes’ Dualist Philosophy
Mesmerism
Hypnosis and Hysteria
Asylums in the 19th Century
Asylums in the 20th Century
The Closing of Asylums
Psychotherapy Today
Somatic Therapy
Neuroleptics (Major Tranquillizers)
Anti-depressants
Anti-manics
Anxiolytics
Psychodynamic Therapy
Psychoanalysis
Techniques of Psychoanalysis
Free Association
The Analyst’s Role in Free Association
Word Association
Interpretation of Actions
Transference
Achieving Insight
Dream Interpretation
Symbolism in Dreams
The Use of Dreams
Hypnosis
Projective Techniques
Psychoanalytically Oriented Psychotherapy
Child Therapy
What can be Treated by Psychodynamic Therapies?
Behaviour Therapy
Behavioural Techniques
Classical Behaviour Therapy
Typical Procedure for SD
Implosion
Flooding
Aversion Therapy
Covert Sensitization
Behaviour Modification
Token Economy
Extinction
Punishment
Social Learning Therapy
Modelling and Cognitive Techniques
Cognitive Therapy
Rational-emotive Behaviour Therapy (REBT)
The ABC Model
Example of the ABC Model in Use
Other Common Irrational Beliefs
The Role of the REB Therapist
The Aims and Successes of Rebt
Cognitive Restructuring Therapy
Beck’s Triad Model
Goals of Cognitive Restructuring
Treatment Using CRT
Attributional Therapy
Changing Attributions
Stress Inoculation Therapy (SIT)(or Self-Instruction Training)
Humanistic Therapy
Rogerian Therapy and Counselling
Non-directive Therapy
Three Main Elements of Rogerian Therapy
Role of the Rogerian Therapist/Counsellor
Gestalt Therapy
The Techniques of Perls
Role-playing and Dialogue
Amplification
First-person Speaking
Gestalt Therapy’s “Rules for Clients”
Existential Therapy
Existential Therapists
The Goals of Existential Therapy
Group Therapy
Variations within Psychodrama
Transactional Analysis
Games People Play
The Encounter Group
Sensitivity Training
Other Group Therapies
Laughter Therapy
Complementary (or Alternative) Therapy
What is Complementary Therapy?
Physical Therapies
Other Mainly Physical Therapies
Relaxation Therapies
Dietary Therapies
What is a Healthy Diet?
Energy Therapies
Other Energy Therapies
Faith Therapies
Creativity Therapies
Self-help Books
How to Win Friends and Influence People
Evaluation of Therapies
Measurements of Therapies
The Placebo Effect
Psychotherapy Placebos
The Power of Placebos
Scientific Evaluations of Therapies
Other Research and Comparisons
The Gender Issue
The Culture Issue
Cultural Normality and Tolerance
A Growth Industry
Ethics of Therapy
How to Become a Psychotherapist
References, Bibliography and Recommended Reading
Biographies and Acknowledgements
Further Information
Index
A Problem Old as Humanity...
He’s not well. But we can’t find anything wrong with him! He appears fit and healthy. But he’s behaving oddly. What shall we do? He needs psychotherapy! Someone will have to invent it ... Who says?
What is Psychotherapy?
Literally, psychotherapy means “mind-healing”. In practice it is the treatment of disorders by using psychological methods - in addition to, or instead of, purely medical procedures. But there is often little agreement about exactly what those methods include. Indeed, many disagree about how the term itself should be used.
Psychotherapy is anything that heals ... Or makes you feel better ... But isn’t psychotherapy just another word for counselling? No! Counselling is just one type of psychotherapy ... and there are others ...
Psychotherapy and Counselling
Psychotherapy really began with Sigmund Freud’s psychoanalysis in 1894. But since the mid-20th century there have been other approaches. Today the term “psychotherapy” includes many different forms of help given by trained professionals to individuals or groups of people.
Therapists who call themselves counsellors tend to follow a non-directive, non-judgemental, client-centred approach. Many psychotherapists tend to be more directive and more active in suggesting or prescribing ways their clients can be helped. This is the broad distinction used in this book – although some counsellors call themselves psychotherapists and claim the terms are synonymous.
Main types of Psychotherapy
When a person needs help, the first step is usually to consult a medical doctor who will attempt diagnosis and medical therapy. If that is not effective, then various psychotherapeutic approaches can be considered. There are today several hundred psychotherapies available! But, for convenience, the therapies in this book will be divided into seven main groups. The first is medical or somatic therapy – literally “body therapy”, mainly using drugs.
The basic assumption in somatic therapy is that there is a chemical imbalance causing the problem. Here, take one of these every night – you’ll soon feel better!
The other six are non-medical therapies.
Most “counsellors” are trained mainly in humanistic therapy, but often use cognitive and behavioural techniques too.
Who is a Psychotherapist?
A major problem is that simply anyone can call him or herself a therapist or psychotherapist! Even those claiming to possess “qualifications” need very careful scrutiny. Professional bodies exist to recognize training and regulate members’ conduct.
Psychologists who are qualified psychotherapists should have a university degree in psychology and specialist training. Similarly, trained counsellors should normally be members of a professional counselling body. The qualifications, training and ethics of various psychotherapies are discussed later in this book ...
Who is a Psychiatrist?
Psychiatrists are qualified medical doctors (MDs) who have further specialized training in psychiatric approaches, such as those based on psychoanalysis. In Britain, psychiatrists must be medically qualified and are thereby subject to the rules of the British Medical Association (BMA).
In other countries, however, the medical requirements for psychiatrists are not always so strict.
The USA has the American Psychiatric Association, the American Psychological Association and the American Psychological Society.
We will look at psychiatric treatment in more detail later on ...
Other Therapists
In addition to psychiatrists, psychologists and counsellors, there are many others who call themselves “therapists”. For example, people with certificates in aromatherapy - the application of pleasant-smelling substances, often by massage (in fact, one of their journals is simply called Therapist). But this is controversial, especially in view of the non-scientific nature of the theories and claims of aromatherapy.
But it is not disputed that aromatherapy can be a relaxing and enjoyable experience that can make you feel better. But then, so can many other activities ...
Want some therapy, dear?
How to choose a Therapist
Your medical general practitioner may be able to recommend certain therapists - for example, those offering psychoanalysis, cognitive-behaviour therapy, osteopathy, chiropractic or acupuncture treatments. Recommendations from clients of therapists are also valuable. But there are other things to check.
• Is the therapist professionally qualified? if so, what exactly are the qualifications?
• How experienced is the therapist?
• Is the therapist willing to co-operate with your doctor?
• Does the therapist belong to a recognized professional association, with publicly available register, that you can contact through an address or phone number?
• Does the relevant professional association have published codes of practice (ethics), complaints and disciplinary system?
Am I and the therapists covered by insurance policies? How much does the treatment cost?
Why do People Need Psychotherapy?
The general reason why people need therapy is that they are finding everyday life too difficult.
This may include personal problems of day-to-day living and problems of communicating with others, at home or at work. I just can’t cope!
The most common reasons people seek help, or have it requested by others, are to do with depression, anxiety or problems such as phobias, obsessions and compulsions. Less common conditions include eating disorders (anorexia and bulimia), self-harm and schizophrenia. Sometimes people want to generally increase their confidence and improve social skills.
Depression
Depression is the most common psychiatric complaint and was described by the Ancient Greek physician Hippocrates (460-377 BC), who called it “melancholia”. A person who is depressed typically experiences the following symptoms …
I feel very sad ... Everything seems hopeless ... Nothing ever goes right ... I am useless... Other symptoms include lack of energy, lethargy, tiredness ... Slowness in thinking and action ... Loss of appetite or over-eating ... Disturbed sleep or insomnia ...
Clinical depression is distinguished from unhappiness caused by grief, which is considered an appropriate response to the loss of a loved person or object, or other clear reasons for unhappiness. Depression is diagnosed only if the depressed mood seems disproportionate to the cause, by being over-long or severe.
Manic depression or bi-polar depression is a rarer special case where a person alternates between extremes of being sad and inactive, followed by being elated and very active.
Who Gets Depression?
Just about anyone may get depression at some time in their lives, although certain people seem to be born with the tendency, or acquire it early on. Depressive illness brought on by events in life is sometimes called reactive depression. Whereas that which is without identifiable external causes is endogenous depression (meaning “from inside”). This distinction, however, is not always useful, because in some people depression can come and go. Also, it’s not clear why people react to events in different ways. Statistically, depression is more common in women (especially between 35 and 45 years of age) than men, although men become more prone as they get older. About 10% of the population suffer depression at any one time, regardless of economic status or social class.
Many famous and successful people, like Winston Churchill (1874-1965), have suffered from depression ... I called depression my “Black Dog” – it was a frequent companion.
Other famous people who had recurrent depression include Johan Wolfgang von Goethe (1749-1832), Martin Luther (1483-1546), Robert Schumann (1810-56), Leo Tolstoy (1828-1910), Vincent Van Gogh (1853-90) and Hugo Wolf (1860-1903).
Anxiety
Anxiety is a chronic complex emotional state typified by extreme apprehension and continuous dread. General Anxiety Disorder (GAD) is diagnosed when there are no particular reasons for such feelings or there is overreaction to everyday events. Anxiety can also be associated with difficulties in coping with excess stress, especially those linked to losses, such as in bereavement, divorce or unemployment.
When there are specific situations that cause anxiety, then it may be classified and treated as a phobia ... However, because GAD is generalized and non-specific, it is often harder to deal with.
The Mystery of Anxiety
A major aspect of the complexity of anxiety is its subjective nature. Existential psychotherapists, for example, argue that because we have the freedom to make many choices, and are ultimately responsible for our own actions, then anxiety is actually an inevitable and essential aspect of human existence. In other words, they claim it is normal and healthy to experience anxiety!
We are all condemned to freedom and must choose for ourselves who we are. At times, when anxiety becomes unbearable – and is too detrimental to daily living – help is usually needed to cope with it.
Phobias
A phobia is an extreme, irrational and uncontrollable fear of an object or situation. Phobias may be “learned” - and therefore “unlearned” - through classical conditioning, operant conditioning or imitation of a role model. Here are two common phobias …
I can’t stay in the house if there’s a spider! I can’t go out of the house! I can’t bear open spaces!
The specific nature of most phobias means that they can often be treated relatively quickly and easily, because clear goals can be defined and worked towards. We will see this described later in Cognitive-Behavioural Therapy - CBT.
Obsessions and Compulsions
Obsessions are persistent, recurring ideas. Whereas compulsions are repetitive behaviours. This can be a useful distinction for therapeutic approaches, even though the two often go together, with obsessions frequently leading to compulsive behaviours.
Obsessional ideas usually have a strong emotional component - for example, the idea that we are surrounded by germs that can easily enter our bodies and make us ill. Associated emotions might include fear and disgust, and perhaps resentment or hatred, of the environment or other people.
Such an obsession about the need for cleanliness could lead to the compulsion of repeated hand-washing and other excessive behaviours. One famous case was that of the multi-millionaire recluse Howard Hughes (1905-76).
As with phobias, compulsions can usually be treated fairly easily by measurable increments towards definite goals. (Again, CBT is often used.)
Eating Disorders
The most common eating disorder is over-eating - consuming more calories than are required for the amount of activity a person does. Some people do this in order to feel better in the short-term.
The long-term effects of over-eating are obesity and related illnesses, such as heart disease and diabetes. Comfort food! In both the USA and the UK, approximately one in four people are clinically over-weight Obesity is rising in most Western countries.
Bulimia and Anorexia
Less common disorders, but also rising in the West, are bulimia and anorexia. Bulimia nervosa usually involves “bingeing” – excessive eating, followed by drastic and unhealthy means of removing the food – by induced vomiting or abuse of laxatives. Anorexia nervosa is chronic loss of appetite and the desire to eat, leading to extreme weight loss.
Anorexia occurs mainly in teenage girls who think of themselves as being “fat”, even when they are very thin. Western media are blamed for such harmful influences.
Anorexia and bulimia can sometimes appear together in the same person.
