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02 Stages of Psychotherapy Process

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Zsolt Unoka, M.D., PhD. Department of Psychiatry and Psychotherapy Semmelweis University, Faculty of General Medicine unoka.zsolt@med.semmelweis-univ.hu  It begins when a patient first contacts a therapist, and ends at the conclusion of the therapy. The psychotherapeutic process is usually divided into three phases:  The first phase begins with the first meeting and ends by signing a therapy contract. The main task of the first phase is to assess the necessity of psychotherapy, and t
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  Zsolt Unoka , M.D., PhD. Department of Psychiatry and Psychotherapy Semmelweis University, Faculty of General Medicine unoka.zsolt@med.semmelweis-univ.hu   It begins when a patient first contacts a therapist, and ends at the conclusion of the therapy. The psychotherapeutic process is usually divided into three phases:  The first phase begins with the first meeting and ends by signing a therapy contract. The main task of the first phase is to assess the necessity of psychotherapy  , and to find the appropriate type of therapy.  The second phase starts after signing the therapy contract and lasts until starting the conclusion of the therapy. This second phase takes up the lion's share of the therapeutic work  .  The third phase is the conclusion of psychotherapy  . We start it after reaching the desired result, or when the therapy proves to be unsuccessful. The conclusion of the therapy is preparation for the prevention of relapse, as well.  The phase leading to the psychotherapeutic intervention  Getting in contact :  The first impression is found to be a determining factor in many aspects of life. After the first psychotherapeutic interview, 15-17% of the patients do not go to the first session, and further 26-30% drop out after the first or second session. The discussion of the patient's ambivalent feelings about therapy can help them a lot in making a decision.  Setting up a diagnosis :  Psychiatric diagnosis: (DSM-IV):  I. Psychiatric diseases and other conditions worthy of clinical attention  II. Personality disorder, mental retardation  III. Somatic conditions  IV. Psychosocial and social environmental problems  V. Comprehensive summary of functioning  The most important dimensions of psychotherapeutic diagnosis :  The ability to fulfil essential needs:  The positive objective of psychotherapy is to reach a state of psychic health.  In the case of psychic health the person is capable of fulfilling their essential needs in a harmonic way, without restraining others by breaking the rules of social cohabitation.  Example :  Social needs. Affection, intimacy, sexual life, relationship, friends, workplace relations, integration into larger groups are all important elements of our lives. It is necessary for humans to feel safe in such fields and to feel that their relationships are stable. They must feel accepted and that they can rely on care from others.  Inner barriers to realizing needs: ▪ Abandonment: Conviction of the patient that they cannot rely on others. ▪ Mistrust/Abuse: Others want to abuse them. ▪ Defectiveness/Shame: If their defects are revealed, they will be desolated or humiliated. ▪ Emotional deprivation: they cannot expect care, appreciation, support.
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