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Psychotherapies

Several forms of psychotherapy, including some short-term (10-20 weeks with interpersonal or cognitive behavioral treatments) can help people in case of affective disorders (anxiety and depression).

Talking therapies, together with exercises that can be performed at home, can be useful in behavioral therapy, helping patients to gain insight into the possible causes of their condition, and teaching them to “reprogram” their attitudes and emotional affective reactions (thinking) towards disturbing thoughts and situations associated with depression.

We only mention here Cognitive, Behavioural and Ericksonian therapy. The last, as the author had a specific training in that.

Psychodynamic therapies are sometimes used in depression to analyze and resolve emotional conflicts, though these therapies are more effective when the symptoms of depression are starting to diminish.

They will be considered more extensively in the Smiline Manual.

Behavioral therapy
The aim of behavioral therapy is to control anxiety by administering controlled amounts of the stimulus (or situation) causing anxiety until the brain habituates to the fear. A patient suffering from blood phobia would be treated by seeing pictures of a scalpel, then the scalpel itself, then a vial of blood and so on.

There is a risk, however, that if treatment is discontinued too suddenly the anxious feelings might worsen (paradoxical effect). If undertaken properly behavioral treatment bring relief in just two or three sessions.

Social anxiety or Obsessive Compulsive Disdorder/OCD) may require longer sessions and take longer to treat.

Cognitive Therapy
Cognitive therapists encourage patients to use the power of thought to control anxiety.

First popularized in the 1980s, cognitive therapy teaches people with anxiety to reconfigure their view of the world and attach different values to specific factors involved in the pathogenesis of anxiety.

Patients suffering from social-anxiety disorder, for instance, might assume that people whispering at a party are gossiping about them.

A cognitive therapist will teach them to rethink this assumption and adopt a more realistic perspective. Some behavioral therapists question cognitive techniques arguing that a brain accustomed to reasoning (“receptive to reason”), would not be too anxious to start with, given its ability to identify the situation or context causing the discomfort.

Increasing numbers of cognitive therapists are currently incorporating “behavior-modifying” techniques into their treatment.

Ericksonian Therapy
Like all other aspects of the Ericksonian approach, assessment is inextricably tied to utilization. This is the fabric of the Ericksonian model‑utilization interwoven with assessment. The therapist is a designer, tailoring the treatment to fit the particular circumstances of the patient. Assessment provides the measurements from which interventions are fashioned. It allows the clinician to decide what to utilize and how to utilize it.

Erickson blurred the boundaries between assessment and other aspects of treatment. He demonstrated that assessment is a process, not a static stage. Assessment is ongoing; it occurs throughout therapy. Ericksonian practitioners are mindful of assessment from the initial contact with a patient to termination. The utilization perspective promotes a continuous sorting of information (e.g., feedback from the patient, changes in the social network, the therapist's own associations) and evaluating those items that are to be discarded and those that are to be incorporated to attain therapeutic ends.

Key Principles
Assessment in the Ericksonian framework rests on two guiding axioms.

Everyting Can Be Utilized

Erickson, of course, was the exemplification of this proposition. He utilized aspects of his own character and background, dynamics in the therapeutic relationship, and multitudinous varlables associated with his patients. Even supposedly undesirable factors (e.g., resistance, lack of insight, previous treatment failures) were fodder for Erickson's techniques (Haley, 1973). His work illustrated the multiple dimensions in each person's life and every therapeutic encounter that cari be utilized: time, space, the real and imagined, hopes, fears, accomplisliments, skills. So, an important facet of assessment is to maintain an open and broad perspective regarding the myriad possibilities that exist for utilization.

Not EverythIng Will Be UtIlized

There are simply too many data, too much experience to track and use in a particular session or overall treatment process. Therefore, the second crucial task of assessment is that of winnowing out those aspects of the therapeutic context that offer the most promise for having an impact when utilized. This is the artistry of assessment; in an individualized treatment approach, each therapist will discover an array of things that can be utilized and from these create a therapy suited to a particular patient.

Principles of hypnotic induction
Initiating hypnotic induction is a little like fostering love. One cannot elicit an emotional state, such as love, by intoning, "Go deeply into love." Similarly, one does not elicit hypnosis by commanding a passive patient, "Go deeply into trance."

Note a key word in the previous sentence, elicit. Hypnosis is elicited, not induced (despite the label "induction"). Ernest Rossi (1976) cogently expounded the elicitation model in a number of the books that he coauthored with Milton Erickson, including Hypnotic Realities.

The word "induction" coniures up images of implanting suggestions in a passive patient. Elicitation speaks to the essence of the matter.

The hypnotherapist establishes conditions that allow the patient to bring forth previously dormant trance components.

Psychotherapy and hypnotherapy
Brent B. G, Jeffrey K. Zeig: The Handbook of Ericksonian Psychotherapy; The Milton Erickson Foundation Press, Phoenix, Arizona. 2001)

We stress the impressive impact of SMILINE GAME as a means and a coadiuvant in the psychotherapeutic strategies whatever will be the technique that is utilized.

SMILINE GAME offers the therapist an unique opportunity to display to the patient a number of options (resourches) with the most objective approach.

In addition the therapist is not involved himself in the discovering process with further advantages on a professional and ergonomical standpoint.

In order to outline shortly the principles of SMILINE GAME PHYLOSOPHY we will summarize what follows

  • Therapeutic use of the smiline game
  • The patient sits in a chair in front of a desk and the therapist sits in front of him or her.
  • The person is reassured and is asked to relax by teaching him or her fast-acting techniques (e.g. breathing)
  • Continue with a complete medical history.

Then, ask the patient to fill out the SLC 90 or other questionnaire to identify the anxiety/depression problem.

Give the patient the problem cards and ask whether any of the conditions exist or have relevance to his or her life

The information relating of the investigation conducted with the help of the problem cards is compiled in a clinical record with a complete description of the relative notes.

Thus, the therapist completes the ad-hoc questionnaire on the clinical record with the degree of depression/anxiety/sleep disorder/somatic disorder/pains/lifestyle/diet, and otherwise.

The resource cards (excluding the problems) are shown and described first with the chart of the explanation of the values and the therapist asks a preliminary question:

Is there someone that you trust who knows you and is willing to listen to you (with skill, availability/desire and attachment)?

If there is, here are some of the possible representations of these persons. Indicate and select the corresponding card.

If there are several people, the patient can select all the corresponding cards, regardless of how many there may be.

Then, the therapist asks the patient

At present do you engage in one or more of the (physical or intellectual) activities illustrated here?

The patient is asked to select the cards, shuffling through them all to find the activity or activities that he or she is engaged in at the present time.

The therapist asks him or her to select one or more of the activities that he or she considers 'possible' or interesting from the ones that he or she does not currently practice.

These should be set aside from the activities currently practiced.

Then the therapist describes the situational anchors.

Escapes and opportunities.

The escapes are illustrated after asking the patient if he or she considers the conditions of his or her life (family, work, study, occasional socialization) to be satisfactory (not stressful, not conflicting or disturbing).

If his or her opinion is very negative, several escapes may be suggested if only as possibilities that may not be practicable at that time (desire).

The therapist asks if the patient has an interest or willingness - even if only hypothetical and not as a real opportunity of comparison, association or socialization through opportunities (resources/situational anchors) which are illustrated in accordance with the figures of the cards.

Then the patient and therapist go back to the problem cards. The cards are given back to the patient who looks at them together with the therapist and critically considers what difficulties and what options are available in light of the proven effectiveness of many of the procedures, but especially in relation to the patient's actual willingness to work together.

It may be useful to place all the cards on the table (with the selected cards well visible) so that they can be used in the discussion/description/telling of the patient's experience, past and present and especially in relation to future possibilities.

Remember that a reassuring and relaxing approach (tone of voice, hand gestures) and a peaceful meeting place (appropriate décor, colors, cleanliness, without unpleasant odors or loud noises) are important factors to comforting and inducing collaboration with the patient.

It is also essential to reassure the patient that his or her condition is temporary and be sure to express confidence in the excellent outcome of the treatment.
(link:
www.smiline.net)
(link: www.joyofliving.net)

Author: Riccardo Ciancaglini

The Author reserves complete title and full intellectual property rights for articles, photographs, graphics, audio and video materials. In no event may users or third parties publish, re-write, sell, distribute, or broadcast the aforementioned property in any form and by any medium.

 
 
 
 


 


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