Psychological Interventions.

The foundations

Zoltan Kovary PhD

ELTE PPK
Department of Clinical Psychology and Addictology
2015/16 Autumn Semester

History & institutional

framework

Historical introduction I.

Pre-historical phase

Magical practises
Ancient greeks &
romans
Medeival age

The beginnings of
scientific approach

Arabian & jewish

medicine
Reneissance

Paracelsus

Historical introduction II.

19th century
The triumphal of hypnosis
French schools
Charcot
Bernheim &Liebault
Beginnings of
Psychoanalysis
20th century
Psychoanalyis
Behaviorism
Other trends
Individual
Group
System approaches
Institualization

Psychotherapy in Hungary

From 1913: The Budapest

School of Psychoanalysis

After WW2

The decades of stagnation

The school of Ferenc Mrei

The contribution of Sandor

Ferenczi
Uprising and decline in the 1920s
and 30s

Appearance of new methods

From the 1980s

Workshops
Modern trends

The question of
competences

Professional protocol

Psychiatrist
Psychologist
Clinical psychologist
Psychotherapist

Training systems

Gradual training

Bachelors and master

degree

Postgradual degree
Psychotherapists training

Psychologists competence

Psychologist
Primary psychoterapy
care
Crisis intervention
Supportive therapy
Patient management
Clinical psychologist
Clinical cases
Psychotherapist
Psychotherapy with
special methods

Training systems for clinical psychologists and

psychotherapists in Hungary
Psychologist

Physician

(Master)

150 hours of
training
therapy

Clinical
psychologist
(4 years)

+100 (=250) hours of training

therapy

Specialist (not
only psychiatrist)

Specific method
training

Psychotherapist
training

Psychotherapist
exam

Introductory
phase for
nonpsychiatrists

Institutional framework

Health Care

Hospitals (inpatients)
Departments of Psychiatry
Other departments
Institutes for psychoterapy
Ambulances (outpatients)
Psychiatric ambulances
Drug ambulances

Private practise

Centers
Team-work
Supervison

The foundations of
psychotherapies

What is psychotherapy?
The common characteristics of
definitions

Methods
Psychological disorders
Communication
Professional qualifications
Means and subject are the
same
Repeated and targeted
encounters
Relationship
Process

Criteria for psychological interventions

I.

Firt interview is compulsory

Personal contact and
relationship
Framework and contracts
Trial phase
Attitudes of the helper
Professional competence

Methodological preparedness
Practise
Self care
Professional community

Criteria for psychological interventions

II.

General aim: help the

psychological work of the
clinet
Method: focused
interventions
Attitudes towards the
methods
Happenings

Mutual facilitation
Understanding the relationship
Opening up

Classifications of
psychotherapies

Profoundity

From supportive to dynamic

Based on trends
From PA to cognitive, etc..

Basic forms

Different aims

Symptoms, personality or
relationship

Time

Individual, group & system

approaches

Short term or long term

Verbality

From verbal to expressive

Helping & everyday relationships

Common means

Reassurance, diversion,
dimming
Supporting ventilation
Defence
Empathy
Confrontation
Reinforcement
Guidance

Specificities of the helping

relationships

Professional AND intimate

relationship
Frameworks
Has explicit aims
Patient and helper have to
match
Cannot be forced
Has to be terminated
Complications

Helper syndrome
Burn out
Training therapy and continuous
supervison!

The process of therapy

Phases of psychotherapy
process

Antecedents of first
encounter
Preliminary
phase
Preparatory phase
Introductory phase
Middle/ main/ working
phase
Termination - Closure
After closure Follow up

Structure of a
psychotherapy session

Attunement
Transition
Warm-up
Main phase
Closure
Transition
Decay

Preliminary phase of
psychotherapy

Overlaps with psychiatry

Overlaps with pedagogy
Diagnosis, indication and
reklationship building is
organically interconnected!

Psychotherapy diagnosis is
NOT psychiatric diagnosis

Lasts until the contract is

signed (1-5 sessions)
Contains
psychotherapeutic effects

Steps of diagnosis in
psychoterapy

Psychiatric diagnosis
Motivational diagnosis
Relational diagnosis
Diagnosis of fitting together
Environmental relational
diagnosis
Diagnosis of suitability
Diagnosis of specific method

Indication

Is the particular therapist

and therapy is suitiable for
the treatment of the
particular patient?
Based on psychotherapy
diagnosis
Contraindications

Form of pathology
External pressurre
Secret
Relatives, friends
Revulsions
Sexual attraction

Psychotherapy contract
what is it about?

Aims
Actions

Formal characteristics
Conditions

Therapist
Patient

Space
Time
Frequency
Payment

Absence

Happenings in preliminary
phase

First session

Relief, hopes

Shakedown, socialization, trust

(1-5 sessions)
Emergence of the main theme
Emotional involvement the
question of acceleration
Problems

Escape into health

Early failure
Haste
Worsening

Working phase

Therapeutic honeymoon:

If caring is important:
fixation & stagnation
It turns out, if

5-20 sessions
First results

diagnosis
And indications were OK

Negative reactions of the

social environment
Emergence of negative sides

Therapeutic effects

During the session

After the session
In everyday life
Be careful!

Maybe the symptoms appear

only within therapy
Maybe the symptoms
disappear only within therapy

How does psychotherapy

cure?

Changes the functioning,

that forms in sociocultral
context

Processing experiences
Regulating tension, emotions
Bahavioral control
Motivations
Communication
Interpersonal functioning

What about detectable

neural changes?

Common factors-researches

Duncan, 2002

Specific factors

Individual therapies

Psychoanalysis
Behaviorism
Humanistic psychology
Cognitive therapies
Relaxation

Group therapies
System approaches

Couple therapies
Family therapies

Non-specific factors

Personality of the client

Personality of the therapist

The nature of the problem

Intelligence
Motivation
Personality traits
Empathy
Unconditional positive regard
Congruency
Being personal

The relationship

Mutuality
Balance
Partnerships

Termination - closure

If it works out fine, has to be

finsihed

Termination is fixed in the

contract

Dynamic press

From the beginning of the third

part
Hard to judge (together)

Have we reached the goals?

Gladness
Panic
Worsening

Continuation? Follow up?

Psychological features of
closure

Intensification of
symptoms, relapses
Separation
individuation theme
Mourning
The effects of formal
losses
Summary
Gratitude

After closure

Follow up
Can be judged 3
months after closure
Control sessions?

The insecurity of the

therapist?

Therapist will remain

the patients therapist
lifelong

Back to therapy

Approx. 50% - its not

final
Fractional therapy

Improves selfknowledge

3-6 months breaks

To avoid dependence
Have to avoid any other
kind of relationship!

Business, sexual, friendship

Colleagues?

Handing over patients

Without overlaps!
New therapist, new
themes, new
diagnosis, new aims
Therapist do not
discuss their cases
after handover!