Psychosocial+Interventions+in+Adults

=**Psychosocial Interventions in Adults**=


 * 1. Discuss general principles for all psychotherapies.**

The general principles for all psychotherapies is for a healing agent who is trained in socially sanctioned methods of healing meets with a sufferer who seeks relief from the healing agent to develop a healing relationship. Psychotherapy acts to combat demoralization and feelings of loss of control, helping to produce beneficial changes in the patient’s assumptive world, improve patient’s coping and adaptation skills, and reduce patient’s symptoms.

Psychotherapy is used to treat generally 5 categories: the psychotic, neurotic, shaken, misbehaving, and discontented. The psychotic patient is usually treated with antipsychotics, but the medications usually don’t work so well so psychotherapy is usually used to augment treatment. Neurotic patients include those with anxiety disorders such as OCD, mood disorders, and bipolar disorders without psychotic components. Shaken patients are usually those with adjustment disorders caused by excessive stress or difficulty, excluding normal bereavement. Misbehaving patients blurs the line between substance addiction and antisocial disorders and can also include battering men or women. The discontent patients are those that aren’t really depressed but have angst about life (and usually plenty of money to burn every week).


 * 2. Describe the basic approach.**

The basic approach is to develop an emotionally charged confiding relationship between patient and therapist in a healing setting. This is done through using a rationale or conceptual scheme that provides a plausible explanation for the patient’s symptoms and prescribes a procedure for resolving them. The procedure requires the active participation of both patient and therapist and is believed by both to be a means of restoring the patient’s health.


 * 3. Describe the usual therapeutic approach.**

Psychodynamic psychotherapy works by understanding a conflict are and the defense mechanisms used by the patient to protect themselves from the uncomfortable feelings or affect associated with a given experience. Using free association, interpretation, clarification, and supportive techniques, the therapist disables the patient’s defense mechanisms to force them to experience their uncomfortable affect. Presumably, by forcing the patient to face their uncomfortable affect, they can reintegrate with it and develop healthier, mature defense mechanisms.


 * 4. Compare and contrast with other therapies.**

Cognitive-behavioral psychotherapy acts to identify and alter cognitive distortions. The idea is that the patient tends to have a distorted, negative perspective and patterns of thinking. The therapist tries to identify these cognitive distortions and attempts to correct them. Usually, this involves imaging a situation and listing out automatic thoughts and feelings and then thinking about those thoughts objectively. By challenging the patient about how they feel, the patient learns to train their mind and alter their thinking. Next, the therapist may turn attention towards schemas or underlying beliefs/attitudes and attempt to correct them using the same technique.

Supportive therapy acts to maintain or reestablish the healthy level of functioning. The therapist is usually acting as a guide/mentor/coach and supports intellectualization and cognitive coping. There is usually no interpretation of transference; instead the therapist uses suggestion, reinforcement, advice, teaching, reality testing, cognitive restructuring, and reassurance. Medications are frequently used.

Behavioral therapy or behavior modification acts to eliminate involuntary disruptive behavior patterns and substitute them with appropriate behaviors. Techniques used include systematic desensitization which involves combining relaxation therapy with progressive exposure and desensitization of phobias, etc. Another, different approach is exposure therapy, where patients are exposed to their phobia and cannot escape, relying on habituation and extinction to treat phobias rather than relaxation. Other techniques involve implosion therapy and flooding, aversive therapy (pairing noxious stimuli with disruptive behavior patterns), and biofeedback.


 * 5. Discuss patient selection criteria.**


 * **Psychotherapy** || **Patient Selection** ||
 * Psychodynamic || Good ego strength, personality disorders, neurotic disorders, psychosocial problems, and some major depressions and schizophrenia when combined with medications during periods of remission ||
 * Cognitive-behavioral || Unipolar or bipolar non-schizophrenic depression, anxiety disorders, substance abuse, personality disorders, and eating disorders. ||
 * Supportive || Relatively healthy individuals exposed to stressful life circumstances, individuals with serious illness or ego deficits, adjustment disorders, schizophrenia, major depression with psychotic elements ||
 * Behavioral || Habit modification, targeted symptoms, phobias, some psychophysiological responses (headaches, migraine, hypertension), sexual disfunction. ||


 * 6. Discuss appropriate length of therapy.**

1 session typically equals 60 minutes.


 * **Psychotherapy** || **Duration** ||
 * Psychodynamic || Months to years ||
 * Cognitive-behavioral || 15-25 sessions ||
 * Supportive || Brief, lasting days to weeks, or very long term, lasting years ||
 * Behavioral || Usually time limited ||


 * 7. Discuss group, couples, and family therapies.**

Individual therapies are the most common, followed by group therapy. Group therapy has the benefit of vicarious learning among group members and is often used to treat misbehaving individuals. Marital therapies provide help with a focus on the couple’s well being, rather than either individual. Family and family group therapies are usually used when the focus of the therapy is on a child or a child issue.