Nick has been diagnosed with major depression. His GP is considering referring Nick for psychodynamic psychotherapy. According to the GP, Nick has certain qualities he thinks are important for a good prognosis in psychodynamic psychotherapy.
Which of the qualities shown by Nick has been shown NOT to predict good response in psychodynamic psychotherapy?
C. Most psychotherapists consider certain qualities in their patients as prerequisites for engaging in psychodynamic psychotherapy. These include psychological mindedness: curiosity about oneself and the capacity for self-scrutiny. Those who are unable to articulate and comprehend their inner thoughts and feelings cannot negotiate with the fundamental analytical words and their meanings. The inability to examine one’s own motivations and behaviours precludes benefits from the analytical method. Introspectiveness: the person should be able to experience and learn from intense affects or conflicts without acting them out. The person should be able to form reasonable object relationships, usually the capacity to form and maintain, as well as to detach from, a trusting object relationship is essential. High motivation: the patient needs a strong motivation to persevere, in light of the rigors of intense and lengthy treatment. The desire for health and self-understanding must surpass the neurotic need for unhappiness. The person should be able to tolerate frustration and therapeutic regression.
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Brief psychodynamic psychotherapy has been shown NOT to be of benefit in which of the following conditions?
B. Inclusion criteria for brief psychodynamic psychotherapy diagnoses: depression, mild to moderate; anxiety, post-traumatic stress disorder, social, panic; somatoform disorders; eating disorders; opiate dependence;. Patient characteristics include good object relationships (has had at least one relationship); highly motivated, ‘willing’ patient; narrow symptom/problem focus; interpersonal difficulties. Exclusion criteria for brief psychodynamic psychotherapy include a diagnosis of severe depression, bipolar disorder, psychosis, suicidality; obsessive compulsive disorder (OCD); severe somatizing disorders; severe eating disorders; poor object relationships; poor motivation; chronic, severe character pathology; diffuse, ill-defined symptomatology. Most of the above criteria are derived from a systematic review of psychodynamic psychotherapies by Leichsenring in 2005.
Which of the following therapies involve ‘strokes’ that people exchange and ‘games’ that people play?
C. Transactional analysis developed by Eric Berne in 1960s. According to Berne, transactions are stimuli presented by one person that evoke a corresponding response in another. Berne defined psychological ‘games’ as stereotyped and predictable transactions that people learn in childhood and continue to play throughout their lives. Strokes, the basic motivating factors of human behaviour consist of specific rewards such as approval and love. All people have three ego states that exist within them: the child (the primitive element), the adult (the reality element), and the parent (an introject of the values of a person’s actual parents). The therapeutic process helps people to understand whether they are functioning in a child, adult or parent mode when interacting with others. It is thought that as patients learn to recognize characteristic games being repeated throughout life, they can ultimately function in the adult mode as much as possible in interpersonal relationships.
Focusing on a detail out of context while ignoring other, more salient features in the situation is called:
B. The statement refers to selective abstraction, one of the cognitive biases seen in depression. Other cognitive biases include arbitrary inference, drawing a specific conclusion in the absence of evidence or when the evidence is contrary to the conclusion; overgeneralization, drawing a conclusion on the basis of one or more isolated incidents; dichotomous thinking, the tendency to classify experience in one of two extreme categories, ignoring more moderate variations; personalization, the tendency to relate external events to oneself; magnification/ minimization,- exaggerating (i.e. catastrophizing) or belittling the significance or magnitude of an event.
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Global, rigid, absolute, and overgeneralized convictions about the self that have powerful effects on how we perceive ourselves are called:
A. Core beliefs are global, rigid, absolute, and overgeneralized convictions about the self, others, and the personal world that have powerful effects on how we perceive ourselves and our context. They often have their root in early childhood development. An example of core beliefs is ‘I’m incompetent’. These lie dormant until they are activated by certain situations (which reflect childhood events that laid down the core belief). At the next level are ‘intermediate thoughts’, which consist of rules, assumptions, and attitudes that we use to evaluate ourselves as well as other people and personal experiences. On most occasions, these rules tend to contradict the core belief (in a way reinforcing them). Examples of intermediary beliefs might be ‘I need to succeed in everything I do, in order for me to be seen as competent’. A special class of intermediary beliefs is the conditional rule, which takes the form of ‘If … then’ statements (e.g. ‘If I succeed in everything I do, only then others will consider me competent’). Automatic thoughts are cognitions that intervene between external events and a person’s emotional reaction to the event. For example, the belief that people will laugh at me when I don’t get a distinction at the exam is an automatic thought that occurs to someone who has the aforementioned ‘core belief’.
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