The Prototype of Psychotherapeutic Steps
Most people are used to the psychotherapy they see in movies, where one lies on a couch and the psychologist smokes a pipe and just listens to the patient's story. How does an evidence-based therapy look like and which are the steps in each meeting?
Every psychotherapeutic step depends on the specific paradigm that lies under the type of therapy used. The following steps refer to the cognitive-behavioral type of therapy because at this moment it is the best validated type of therapy.
The first meeting, as well as the ones which will follow lasts about 45-50 minutes. The main role of this meeting is an exploring one. The psychotherapist tries to obtain a general opinion about the patient's problems. He does not try to find out details but to make a general perspective which will allow him to evaluate his own competence regarding the certain problems. The second step is to inform the patient about the illness he presented. It is well to insist on the fact that mental illness can imply psychological or biological mechanisms, or both as well. Depending on the findings, the adequate treatment will be selected. Sometimes there will be necessary to combine psychotherapy with medical treatment. The third step on this first meeting is to inform the patient about the therapy. It is explained to him what exactly the psychotherapy is, how it works, what will be the structure of the meetings and what to expect. The psychotherapist can estimate the number and the cost of the meetings. He can also present the possible effects based on the literature of specialty. Next, the patient receives a set of psychological tests which are advisable to aim all the four levels: the subjective-affective level, the cognitive level, the behavioral level and the biological/physiological one.
During the second meeting the results from the tests (which were filled at home by the patient) are collected and they will be coded and analyzed for the third meeting. After this procedure, the psychotherapist applies a clinical interview to the patient in order to evaluate his health and/or illness state. This interview is recommended to be guided by SCID (the Structured Clinical Interview).
Furthermore, the third meeting starts by collecting additional data if needed. During the second step the general conceptualization is made based on the information collected from the interview and psychological examination. Then, a list of problems is established, translating the general conceptualization in the specific life problems the patient has. These three meetings can take place during a week, but there is no standard interval. At the end of them, the patient must know which are his problems, why these problems appeared and what is needed to be done to alleviate this problems. Some patients stop at this level because the gathered information gives them peace through the predictability it generates.
The following meetings (2 per week) focus on the problems written on the established list. Every problem on the list is decomposed in emotional and in practical problems. After the alleviation of the emotional problems the focus goes on the practical ones. These issues are being approached through the ABC model generated by A.T. Beck, 1976 and A. Ellis, 1994. After reaching every single problem on the list the therapy moves further to the next sequence which refers to the integration and the prevention of falling back into the same pattern. This type of meetings have the aim of making the patient understand the common elements implied in the diverse problems from the list (for example, the irrational cognition that "everyone must respect me" is specifically manifested in the relationship with the wife, or the boss, etc.). The second aim is to teach the patient to be his own psychotherapist, gradually stopping the meetings. Still, the psychotherapist leaves the patient the possibility to come back in case of recurrences and he can also follow the evolution of the patient through phone calls or short meetings, depending on the type of disorder.
To conclude, this type of therapy is part of the evidence-based therapy and unlike other types of psychotherapy, it is shorter and cheaper. Patients are informed about their diagnosis which is obtained through clinical interview and through psychological tests. They are also involved in the process of recovery, being only guided by the psychotherapist. The model used by the cognitive-behavioral therapists is the ABC model, model which emphasizes the major importance of thoughts and emotions and therefore the power of changing.
The first meeting, as well as the ones which will follow lasts about 45-50 minutes. The main role of this meeting is an exploring one. The psychotherapist tries to obtain a general opinion about the patient's problems. He does not try to find out details but to make a general perspective which will allow him to evaluate his own competence regarding the certain problems. The second step is to inform the patient about the illness he presented. It is well to insist on the fact that mental illness can imply psychological or biological mechanisms, or both as well. Depending on the findings, the adequate treatment will be selected. Sometimes there will be necessary to combine psychotherapy with medical treatment. The third step on this first meeting is to inform the patient about the therapy. It is explained to him what exactly the psychotherapy is, how it works, what will be the structure of the meetings and what to expect. The psychotherapist can estimate the number and the cost of the meetings. He can also present the possible effects based on the literature of specialty. Next, the patient receives a set of psychological tests which are advisable to aim all the four levels: the subjective-affective level, the cognitive level, the behavioral level and the biological/physiological one.
During the second meeting the results from the tests (which were filled at home by the patient) are collected and they will be coded and analyzed for the third meeting. After this procedure, the psychotherapist applies a clinical interview to the patient in order to evaluate his health and/or illness state. This interview is recommended to be guided by SCID (the Structured Clinical Interview).
Furthermore, the third meeting starts by collecting additional data if needed. During the second step the general conceptualization is made based on the information collected from the interview and psychological examination. Then, a list of problems is established, translating the general conceptualization in the specific life problems the patient has. These three meetings can take place during a week, but there is no standard interval. At the end of them, the patient must know which are his problems, why these problems appeared and what is needed to be done to alleviate this problems. Some patients stop at this level because the gathered information gives them peace through the predictability it generates.
The following meetings (2 per week) focus on the problems written on the established list. Every problem on the list is decomposed in emotional and in practical problems. After the alleviation of the emotional problems the focus goes on the practical ones. These issues are being approached through the ABC model generated by A.T. Beck, 1976 and A. Ellis, 1994. After reaching every single problem on the list the therapy moves further to the next sequence which refers to the integration and the prevention of falling back into the same pattern. This type of meetings have the aim of making the patient understand the common elements implied in the diverse problems from the list (for example, the irrational cognition that "everyone must respect me" is specifically manifested in the relationship with the wife, or the boss, etc.). The second aim is to teach the patient to be his own psychotherapist, gradually stopping the meetings. Still, the psychotherapist leaves the patient the possibility to come back in case of recurrences and he can also follow the evolution of the patient through phone calls or short meetings, depending on the type of disorder.
To conclude, this type of therapy is part of the evidence-based therapy and unlike other types of psychotherapy, it is shorter and cheaper. Patients are informed about their diagnosis which is obtained through clinical interview and through psychological tests. They are also involved in the process of recovery, being only guided by the psychotherapist. The model used by the cognitive-behavioral therapists is the ABC model, model which emphasizes the major importance of thoughts and emotions and therefore the power of changing.
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