Archive for September, 2009

What is Holistic Psychotherapy?

Wednesday, September 9th, 2009

The word holistic has been used to describe health care practices that include acupuncture, massage therapy, Reiki, naturopathy, and homeopathy. These practices attempt to bring harmony to the physical, energetic, and/or nutritional states of individuals.

Holistic Psychotherapy also seeks to bring balance between these systems. However, as with all psychotherapy, its primary focus is the treatment of psychological and emotional pain that manifests in depression, anxiety, trauma and related disorders. It is the way in which holistic psychotherapy treats these disorders that marks its departure from conventional psychotherapy and denotes its singular effectiveness.

Generally speaking traditional psychotherapy focuses on problematic thoughts and behavior, interprets the underlining meaning of these thoughts and behavior, and then provides solutions that are practiced by clients and adjusted as circumstances warrant.
Unlike traditional psychotherapy, Holistic Psychotherapy optimally fosters growth and healing by noting the synergistic relationship between all the ways we experience ourselves and the world-thinking, feeling, doing, and sensing. Holistic practitioners then channel this knowledge through methods that support the healthy interaction between the processes of the thinking mind, the feeling body, and the emotionally laden spirit to bring growth and healing.

Holistic Psychotherapy engages methods that encourage us to talk, feel, act and sense in ways that make our experiences manageable, safe, and empowering. Holistic Psychotherapy helps us make sense out of anxious and depressed states, manage overpowering feelings, bring solutions to our problems, and teaches us how to effectively plan for our future.
Holistic psychotherapy recognizes, for example, that depression is a symptom. Depression might feel like the problem but it is really the messenger that tells us we are suffering an imbalance somewhere in self. Pain is the red light that signals us to stop. Just as you would not continue driving a car with the engine light blinking without risking breakdown so ignoring depression risks a physical and emotional breakdown.

Holistic Psychotherapy is the equivalent of preventive medicine. A holistic practitioner will asses what area or areas of self are causing distress—the mind, the body, or the emotions-and how each area is effecting the other. A holistic psychotherapist has state of the art tools and methods honed by years of practice and ongoing training to help individuals, couples, and families identify the source of depressed and anxious experiences while helping to alleviate them, and then provides guidance to develop preventive skills to protect against reoccurrence.

Holistic Psychotherapy is not eclectic psychotherapy or a bag of techniques learned once in a workshop. It is a conscious, skillful organic blending of eastern methods of healing with western healing psychotherapies that safely support you to engage all your ways of experiencing-thinking, feeling, sensing, doing-so that you relate to yourself with understanding, respect, appreciation, and joy.

Holistic Psychotherapy recognizes that you have all the answers and its function is to help you access those answers with competence, responsible action, and a felt sensation of healthy control.

Classification of Mental Disorders & Multi-Axial Assessment (DSM IV-TR & ICD 10)

Saturday, September 5th, 2009

Classification of Mental Disorders &

Multi-Axial Assessment

(DSM IV-TR & ICD 10)

Diagnosis involves accumulation, interpretation & categorization of data. The main aim of this is to enable the clinician to use the most effective treatments available for that condition and to allow them to make accurate assessment of prognosis.

The Importance of diagnosis:

  • Allows inter-professional communication
  • Allows us to select appropriate treatments for patients
  • Allows assessment of prognosis
  • Allows scientific research to be preformed

However psychiatric diagnoses have been criticized because:

  • They provide little information about aetiology
  • They can carry pejorative connotation (negative labeling)
  • Patients don’t always fall into neat categories. Some may have some but not all of the characteristic features of one or more different diagnostic categories (hence the terms schizoaffective & borderline personality)
  • The uniqueness of an individual patient is lost when labels are applied; one cannot fully convey a patient’s predicament with a single label
  • Historically psychiatric diagnosis has low reliability & Validity (in general psychotic conditions have high reliability and neurotic  conditions low reliability)

Both current diagnosis in psychiatry are categorical and can be monothetic (i.e. all criteria must be present e.g. Hypochodriasis) or Polythetic (some must be present e.g. Borderline personality disorders).

The International Classification of Diseases (ICD-10) 1992

Mental disorders are described within chapter V (F) of the ICD 10. There are 10 categories within this chapter & each is further subdivided into further 10.

Categories are denoted by the letter F (for mental disorders chapter), followed by a number for the main group (e.g. F3 for Mood Disorders), followed by a further number for the category within the group (e.g. F32 for depressive episode). A fourth character (or third no) is used if it is necessary to subdivide further (e.g. F32.2 for severe depressive episode without psychotic symptoms)

In Schizophrenia, a fifth character is used to specify the course of the disorder (e.g. F20.01 for paranoid schizophrenia, episodic with progressive deficit).

Different versions of the ICD 10 are available & it is therefore flexible and acceptable to a variety of users for a variety of purposes:

1. Clinical descriptions & diagnostic guidelines: for general clinical, educational & service use.

2. Diagnostic criteria for research

3. Primary care version.

4. Multiaxial version.

Main categories in ICD-10

F0  Organic, including symptomatic, mental disorders (e.g. dementia)

F1 Mental & behavioral disorders due to psychoactive substance use

F2 Schizophrenia, schizotypal & delusional disorders

F3 Mood (affective) disorder

F4 Neurotic, stress related & somatoform disorders (anxiety disorders, OCD)

F5 Behavioral syndromes associated with physiological disturbance & physical factors (e.g. eating disorders, sexual dysfunction)

F6 Disorders of adult personality & behavior (personality disorders and gender identity sexual preference.

F7 Mental retardation

F8 Disorders of psychological development (language and speech disorders)

F9 Behavioral & emotional disorders with onset usually occurring in childhood or adolescence (e.g. conduct disorders and hyperactivity)

Diagnostic & Statistical Manual of mental disorder (DSM) IV-TR (revised):

Published by the American Psychiatric Association (APA), it is a multi-axial classification. An assessment on several axes, each of which refers to a different domain of information that may help the clinician plan treatment & predict outcome:

  • Provide more information about the patient than does a single category
  • Facilitate comprehensive & systemic evaluation
  • Provide a format for organizing & communicating clinical information & for reflecting the complexity of clinical situations
  • Promotes the application of the biopsychosocial model

However, multiaxial system increase the time involved in making the diagnosis, are therefore not easy to apply in everyday clinical practice. Axes IV & V offer rather crude measurement of dubious reliability & validity.

Axis I  Clinical Disorders (may be >1)

Axis II  Personality disorder, Mental retardation

Axis III  General Medical Condition (potentially relevant to the mental disorder)

Axis IV  Psychosocial & Environmental Problems (which may affect the diagnosis, treatment or prognosis of the mental disorder)

Axis V  Global Assessment of Functioning (GAF): Psychological, social & occupational functioning on a hypothetical continuum of mental health-illness, on a scale 0-100.

State whether GAF is for the current period, at discharge or admission. Exclude impairment due to physical or environmental limitations.

References:

1. Stevens L, Rodin I, Psychiatry: An illustrated colour text, Churchill Livingstone 2001

2. Steple D. Oxford Handbook of Psychiatry, Oxford University Press, 2006

3. World Health Organisation (WHO): ICD10 Classification of Mental and Behavioural Disorders (1992)

4. American Psychiatric Association. The Diagnostic and statistical Manual of Mental Disorders (DSM-IV).1994

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5 Tips for Mental Balance From a Psychotherapist

Tuesday, September 1st, 2009

Living doesn’t really need to be such a battle. As soon as we let go of just a few old thought habits, things are likely to become a whole lot easier. Here are just a few things you can do in order to maintain good mental balance:

1. Let Go of the Need to Be Right – Is working ourselves up into a state of needless excitement simply because of a need to prove we were right anything other than an exercise in frustration and futility? If only we had been able to take a small step backwards and look at the situation in a calmer, less egotistical manner, then perhaps we might have been able to see – and to react – a little differently. After all, what have we really accomplished by always being right? Does it really bring respect, or does it simply breed resentment? Simply by giving up the burning need to be always right, we free ourselves – and others – to get on with the really useful and productive things in life. We may play being the know-it-all, but who really likes a know-it-all? A little inner humility goes a long way in the mental balance department.

2. Let Go of Being Perfect – Understand that being excellent does not mean being perfect. Sometimes it’s easy to demand too much of ourselves. If we imagine that we need to be perfect because this means that we cannot be criticised, then we need to do some serious work on self-acceptance. Don’t waste your time attempting to make something absolutely perfect. It really is far more effective and useful to finish a task in a timely manner than it is to spend forever in a futile attempt to be perfect. There really is no point in dragging things on forever trying to get it perfect. Do your very best and then move on. Do this often enough and your best – and you – will just keep on getting better in a natural, progressive and balanced manner.

3. Let Go of Trying – And start doing. This is where those advertising people working for Nike were on the money: What a wonderful slogan! ‘Just Do It!’ With that attitude we pretty much guarantee positive results. And, of course, mental balance is all in the attitude. The problem with trying, as opposed to doing, is that whenever we try, we set ourselves up to fail. You didn’t try to open this page, you just did it. You didn’t try to get out of bed, you just did it. We give ourselves excuses when we merely try. Lying to ourselves about ourselves and making excuses for ourselves really isn’t the best way to achieve mental balance: We need to get honest. We either do it or we don’t. It really is that simple. The choice is simple: either we act or we don’t. Did I mention simple? When we allow ourselves to let go of trying, then we allow ourselves to begin doing. And doing allows us to move forward and grow. Set goals and start achieving them — go on, just do it!

4. Let Go of Mistakes – We can learn from our successes and learn from our mistakes too – and then we need to move on. Every single experience we ever have contains some kind of lesson – even the ones we don’t get right – if only we allow ourselves to see and learn. Mistakes are there, after all, to be learned from, which is why they’re called ‘successive approximations’ in the language of psychology. Each time we make a mistake it’s an opportunity to learn to get it right. Dwelling on our mistakes and beating ourselves up for them is a futile pursuit. Take the lesson and move forward. A well balanced self is a self that uses and is guided by life’s lessons. Such an attitude leads to a life full of excellence – and mental balance.

5. Let Go of the Past – The past is there for a myriad of reasons – to instruct and inform, for example – but it is not meant to be lived in. To do so robs us of all we ever really have: Now. When we catch ourselves continually spending time in the past, then maybe we need to think about working with a professional who can help us come to terms with and move on from the past. Each one of us has a past and each one of us has gone through experiences that were difficult and unfair. Because of this, each one of us has the need to forgive. Failure to do this makes us prisoners to the past. And if forgiveness seems just a bit too difficult at the moment, at least consider that anger and resentment does not hurt the person or people who have hurt us – they just keep us in chains to them. Letting go of the past usually involves finding a way to forgive – and don’t forget, this means forgiving ourselves, too. Do this and we truly will live in a state of real mental balance and inner peace.