Medicine has three great branches: prevention, curing by technical means, and healing-and psychotherapy is the embodiment of healing: a holistic approach in which systematic human dialogue becomes a humanizing enterprise for the relief of suffering and the advancement of self-esteem. Questions such as what is the meaning of my life and what is significant? are answered in a different way after exposure to a gifted psychotherapist. Changes occur in cognition, feelings, and behaviour. This is why psychotherapy is dangerous and exciting: it changes people. Hence the need for supervision and ongoing training and self-awareness on the part of the therapist.
Psychotherapy stands in stark contrast to the increasingly questioned technical, machine-based realm of medicine, and we accord it great prominence here, in the hope that our explicit descriptions, and their reverberations throughout our books will produce corresponding reverberations in our minds and in our daily work in any branch of medicine, to remind us that we are not machines delivering care according to automated formulae, but humans dealing with other humans. So, taken in this way, psychotherapy is the essence of psychiatry-and the essence of all psychotherapy is communication. The first step in communication is to open a channel. The vital role that listening plays has already been emphasized.
It is not possible to teach the skills required for psychotherapy in a book, any more than it is possible to teach the art of painting in oils from a book. So what follows here is a highly selective tour round the gallery of psychotherapy, in an attempt to show the range of skills needed, and to whet the reader's appetite. It is not envisaged that the reader will try out the more complicated techniques without appropriate supervision.
The psychotherapies may be classified first in terms of who is involved in the treatment sessions: an individual, a couple, a family, or a whole group; and secondly they may be classified by their content and methods used: analytic, interpersonal, cognitive, behavioural.
Behavioural therapies
Aim to change behaviour, eg if avoiding crowded shops (agoraphobia) is the issue, a behavioural approach focuses on the avoidance-behaviour. Such approaches will define behavioural tasks that the patient is expected to carry out between sessions.
Cognitive therapy
Focuses on thoughts and assumptions, promulgating the idea that we respond to cognitive representations of events, not to raw events alone. If this is so, cognitive change may be required to produce emotional and behavioural change. So in the above example of agoraphobia, the therapist would encourage articulation of thoughts associated with entering crowds. The patient might report that she becomes anxious that she might be about to faint-fearing that everyone will think her a fool. These thoughts would be looked at using a Socratic approach: Have you in fact ever fainted? How likely would you be to faint? If someone fainted in front of you in a shop, what would you think? Are they foolish?
Long-term psychoanalytical therapies
Are concerned with the origin and meaning of symptoms. They are based on the view that vulnerability arises from early experiences and unresolved issues, eg from childhood. The therapist adopts a non-dominant stance, encouraging the patient to talk without inhibitions. The therapist encourages change by suggesting interpretations for the content of the patient's talk.
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