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Online Essay Club No. 22: Psychotherapy

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'The mind is like an iceberg, it floats with one-seventh of its bulk above water.' Freud

With reference to the literature, discuss the impact of psychotherapy on the modern day management of mental illness.

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difficult and vast topic!

introduce psychotherapies and various techniques.

i would touch upon all the fields, illnesses in psychiatry where psychotherapy is used.

proven effctiveness in : depression, anxiety, PTSD, bereavement, OCD, eating disorders, childhood problems, etc. of course i need to brush up on the statistics.

possible use in : personality disorders, psychosis, forensic settings

i might discuss the impact upon the patient, psychiatrists, service providers, carers, etc.

the future outlook for psychotherapy, and prospects.

important names in various fields of course, that i am going to brush up.

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i would also consider adding a few further issues;

-hugely under resourced psychotherapy services in most areas

-how the services find it very difficult to match the expectations of the clients

-long waiting lists

-how allied professionals shiuld be trained in psychotherpeutic skills so that they can take up cases which will ease the pressure a bit

-how families, friends and relatives should play an important role in supporting the patient rather than expecting the overstretched NHS to take care of all aspects of care.

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psychotherapy - any therapy that has an effect on the psyche.

I would talk initially about historico-cultural 'psychotherapy'- hippocrates, galen, casting out of demons (both historically and in modern day religious healing), medieval healing streessed the importance of setting aside the orthodox or galenic practitioners by their ethics and etiquette - the behaviours which are approprite to a physician, giving them the gravitas appropriate to their status, and setting them apart from the quacks - engendering healing through the belief that patients had in their physicians - a kind of placebo or therapeutic alliance and hence - psychotherapy!

I would go on and talk about how freud revolutionsed wesern medicine by introducing concepts such as the unconscious in his topographical model of the mind ( he trained as a neurologist and hence his ealier theories had a bit of a concrete flavour to them) and his later structural theory with the id, ego and superego. He worked in vienna treating mainly middle class jewish neurotics.

Freud had a huge impact on the way psychiatry is practised. Coming form a neurological background he eventually moved to more esoteric ground - theories which helped to explain phenomena/patterns and manifestations of psychological distress but which can neither be proven nor unproven acoording to a scientific paradigm ( Karl poppers theory)

Modern day psychotherapy takes its roots from freud . Broadly speaking, modern day psychotherapy can be classed as level 1 - general supportive therapy - something which every doctor and every mental health proffessional should be able to perform, to increasingly complex levels with psychodynamic therapy being the most akin to therapy as pratised by freud.


single person/ individual

1short term

2 long term


or cat




couple therapy - relate councelling/psychodynamic

group long/ short term therapy



client centred rogerian.....

Mental illness is seen in various settings:

GP -mild/mod depressive illness, anxiety disorders - councelling by practice councellor +-drugs

voluntary sector eg relate/cruise - bereavement councelling/

2 care - inpatient out pt setting - clinical psychologists - cbt mod/severe depreession classic study showed that best out come is with both cbt and antidepressants; anxiety disorders - cbt/anxity managent

relapse prevention in schizophrenia - classic study by leff and vaughn in the 70's re high ee and relapse prevention - role for psycho education and family therapy in reducing high ee and thus relapse rates.

ocd - cbt and high dose ssri

cbt and psychosis..


by whatever definition, psychotherapy has been used across the ages and in all cultures to effect a way of healing.

modern day studies on the effectiveness of psychotherapy show that therapeutric alliance seems to be the common factor related to outcome. Unlike drugs, it is diiifficult to carry out double blind randomized rcts in psychotherapy research, but outcome studies have shown it to be effective:-

Else guthrie - ibs and brief theapy BJpsych

f margison, G MggRath outcome reaserch.

modern day psychotherapy is an important component of psychiatric care.. :)

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