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Individual Psychotherapy in General Psychiatry
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By far the greater part of basic psychodynamically informed psychotherapy is carried out on an individual basis in the course of consultations. Such psychotherapy is often referred to as supportive psychotherapy and is integral to the care of all patients, in psychiatry particularly those with psychotic disorders such as schizophrenia and mood disorders.
Where appropriate such a psychotherapeutic approach can be modified as the patient's clinical state changes or particular problems or issues become evident. The options then might be:
Counselling - for specific problems such as housing or financial difficulties or for alcohol problems.
Behaviour therapy - to learn techniques to cope better with anxiety, phobias, compulsions.
Cognitive therapy - to learn alternative styles of understanding themselves in relation to others and to perception of self and own past and future.
Family sessions - to understand the family dynamics affecting recovery, to involve the family in ongoing treatment and to facilitate any necessary change in the way the family handles the tensions which may have caused or contributed to a family member's illness.
Marital sessions - similar objectives to family sessions but involving only the spouse and the patient.
Psychodynamic work - readily integrated into supportive psychotherapy, such a shift in emphasis can help a patient understand their symptoms, anxieties in a personal context. Such understanding itself allays anxiety because the patient has a better grasp of themselves and it also points the way to personal change to reduce relapse.
Group work - may occur in whole ward groups or specific group sessions.
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Specific Psychotherapies
For many patients with life stress, neurotic or personality difficulties direct referral for psychotherapy is more appropriate for assessment and a decision as to the appropriate form of psychotherapy.
Individual Psychotherapy
In the case of psychotherapy the range of therapy varies from 10 sessions of 50 minutes on a weekly basis through to psychoanalysis, i.e., 3-5 sessions (50 minutes) per week for 2-5 years.
Within that range, perhaps two-thirds of cases would be seen once weekly for 6-18 months. The setting would be that of the therapist and patient both seated in normal face-to-face style engaged in conversation with therapist using a non-directive technique, but employing transference interpretation.
Group Psychotherapy
Psychodynamic/psychoanalytical is often practised in a group setting - 6-8 patients with usually two therapists, meeting once per week for 1½ hours for a period usually of 18 months to 2 years generally on an outpatient basis. The style is again non-directive with the focus being on both transference and group verbal interaction interpretations.
Marital Therapy
Psychodynamic understanding can be applied to marital problems with the "patients" being either one or both partners in the marriage. Usually both partners are seen together by two co-therapists at approximately fortnightly intervals for an average of 6-10 sessions of 1-1½ hours.
Psychosexual therapy often is based on a combination of psychotherapy styles focused on the psychosexual problem of the patient or couple.
Family Therapy
Usually involves psychodynamic techniques applied to the natural group of the family - whether 2 or 3 generations. Most frequently used in Child and Family Psychiatry units.
Cognitive Analytic Therapy
Brief (12-20 sessions) therapy focused on target problem using elements of cognitive therapy and psychoanalysis..
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