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Psychological Interventions.
The foundations
Zoltan Kovary PhD
ELTE PPK
Department of Clinical Psychology and Addictology
!"#$"% Autumn &emester
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'istory ( institutionalframe)or*
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'istorical introduction I.
Pre+historical phase ,agical practises Ancient gree*s (
romans ,edeival age
The -eginnings ofscientific approach Ara-ian ( e)ish
medicine /eneissance
Paracelsus
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'istorical introduction II. "0th century
The triumphal of hypnosis 1rench schools
Charcot
2ernheim (Lie-ault
2eginnings ofPsychoanalysis
!th century
Psychoanalyis
2ehaviorism
3ther trends Individual 4roup &ystem approaches
Institualization
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Psychotherapy in Hungary
1rom "0"56 The 2udapest&chool of Psychoanalysis The contri-ution of &andor
1erenc7i 8prising and decline in the "0!9s
and 5!9s
After :: The decades of stagnation
The school of 1erenc ,;rei Appearance of ne) methods 1rom the "0
:or*shops ,odern trends
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The question ofcompetences
Professional protocol Psychiatrist
Psychologist
Clinical psychologist Psychotherapist
Training systems 4radual training
2achelor9s and masterdegree
Postgradual degree
Psychotherapist9s training
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Psychologists9 competence Psychologist
Primary =psychoterapy>care Crisis intervention
&upportive therapy Patient management
Clinical psychologist
Clinical cases
Psychotherapist Psychotherapy )ith
special methods
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Training systems for clinical psychologists andpsychotherapists in 'ungary
Psychologist
?,aster@
Clinicalpsychologist
(4 years)
&pecific methodtraining
Psychotherapisttraining
Psychotherapisteam
Physician
&pecialist ?notonly psychiatrist@
Introductoryphase fornon+psychiatrists
"#! hours oftrainingtherapy
B"!! ?#!@ hours of training
therapy
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Institutional framework
'ealth Care 'ospitals ?inpatients@
Departments of Psychiatry 3ther departments
Institutes for psychoterapy Am-ulances ?outpatients@
Psychiatric am-ulances Drug am-ulances
Private practise
Centers Team+)or*
&upervison
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The foundations of
psychotherapies
Wh t i h th ?
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What is psychotherapy?The common characteristics of
denitions
,ethods Psychological disorders
Communication
Professional ualifications ,eans and su-ect are the
same /epeated and targeted
encounters /elationship Process
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Criteria for psychological interventionsI.
1irt intervie) is compulsory Personal contact and
relationship
1rame)or* and contracts Trial phase Attitudes of the helper Professional competence
,ethodological preparedness
Practise &elf care Professional community
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Criteria for psychological interventionsII.
4eneral aim6 help thepsychological )or* of theclinet
,ethod6 focusedinterventions
Attitudes to)ards themethods
'appenings ,utual facilitation 8nderstanding the relationship
3pening up
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Classications ofpsychotherapies
Profoundity 1rom supportive to dynamic
2ased on trends
1rom PA to cognitive etc..
Basic forms Individual group ( system
approaches
Different aims &ymptoms personality or
relationship
Time &hort term or long term
Verbality 1rom ver-al to epressive
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'elping ( everyday relationshipsCommon means
/eassurance diversiondimming
&upporting ventilation Defence Empathy Confrontation
/einforcement 4uidance
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&pecificities of the helpingrelationships
Professional AFD intimaterelationship
1rame)or*s 'as eplicit aims Patient and helper have to
match Cannot -e forced 'as to -e terminated Complications
'elper syndrome 2urn out
Training therapy and continuoussupervison!
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The process of therapy
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Phases of psychotherapyprocess
Antecedents of firstencounter
Preparatory phase Introductory phase ,iddle$ main$ )or*ing
phase
Termination + Closure After closure G 1ollo) up
Preliminaryphase
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Structure of apsychotherapy session
Attunement
Transition :arm+up ,ain phase Closure Transition Decay
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Preliminary phase ofpsychotherapy
3verlaps )ith psychiatry 3verlaps )ith pedagogy Diagnosis indication and
re*lationship -uilding isorganically interconnectedH Psychotherapy diagnosis is
F3T psychiatric diagnosis
Lasts until the contract is
signed ?"+# sessions@ Contains
psychotherapeutic effects
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Steps of diagnosis inpsychoterapy
Psychiatric diagnosis ,otivational diagnosis
/elational diagnosis Diagnosis of fitting together Environmental relational
diagnosis Diagnosis of suita-ility Diagnosis of specific method
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Indication =Is the particular therapist
and therapy is suitia-le forthe treatment of theparticular patient>
2ased on psychotherapydiagnosis Contraindications
1orm of pathology
Eternal pressurre
&ecret
/elatives friends
/evulsions
&eual attraction
h h
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Psychotherapy contract what is it a!out?
Aims Actions
Therapist Patient
1ormal characteristics Conditions
&pace Time
1reuency Payment
A-sence
H i i li i
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Happenings in preliminaryphase
1irst session /elief hopes
&ha*edo)n sociali7ation trust?"+# sessions@
Emergence of the main theme Emotional involvement G the
uestion of acceleration Pro-lems
Escape into health
Early failure 'aste :orsening
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Working phase
=Therapeutic honeymoon>6 #+! sessions
1irst results
If caring is important6fiation ( stagnation
It turns out ifJ diagnosis
And indications )ere 3K
Fegative reactions of thesocial environment
Emergence of negative sides
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Therapeutic e"ects
During the session
After the session In everyday life 2e carefulH
,ay-e the symptoms appearonly )ithin therapy
,ay-e the symptomsdisappear only )ithin therapy
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How does psychotherapy
cure? Changes the functioning
that forms in sociocultralcontet Processing eperiences /egulating tension emotions 2ahavioral control ,otivations Communication Interpersonal functioning
:hat a-out detecta-leneural changes
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=Common factors>+researches
Duncan ""
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Specic factors
Individual therapies Psychoanalysis 2ehaviorism 'umanistic psychology Cognitive therapies /elaation
4roup therapies &ystem approaches
Couple therapies 1amily therapies
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#on$specic factors
Personality of the client The nature of the pro-lem Intelligence ,otivation Personality traits
Personality of the therapist Empathy 8nconditional positive regard Congruency 2eing personal
The relationship ,utuality 2alance Partnerships
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Termination $ closure If it )or*s out fine has to -e
finsihed 'ave )e reached the goals
Termination is fied in the
contract Dynamic press 1rom the -eginning of the third
part 'ard to udge ?together@
4ladness Panic
:orsening
Continuation 1ollo) up
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Psychological features ofclosure
Intensification ofsymptoms relapses
&eparation Gindividuation theme
,ourning The effects of formal
losses &ummary 4ratitude
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%fter closure
1ollo) up Can -e udged 5
months after closure Control sessions
The insecurity of thetherapist
Therapist )ill remainthe patient9s therapistlifelong
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&ack to therapy
Appro. #! + its notfinal
1ractional therapy Improves self+
*no)ledge
5+% months -rea*s To avoid dependence
'ave to avoid any other*ind of relationshipH 2usiness seual friendship
Colleagues
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Handing o'er patients
:ithout overlapsH
Fe) therapist ne)themes ne)diagnosis ne) aimsJ
Therapist do not
discuss their casesafter handoverH