Criterii minimale de formare. Durata : 4 ani. Nivele de formare:. Nivel I - psihoterapeut sub supervizare - ore. Nivel II- psihoterapeut autonom - ore. Din cele 10 cazuri clinice, 6 sunt obligatoriu de prezentat in gr upul de supervizare; 4 cazuri pot fi prezentate in grupele de intervizare c onstituite din minim 3 psihoterapeuti in supervizare sau un psihoterap eut in supervizare si un psihoterapeut specialist.
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Abstract The article presents a case study in which the posttraumatic stress disorder PTSD was approached in an integrative, psychiatric and psychotherapist manner. The client, a highly hypnotizable person aged 65, diagnosed with PTSD and panic attacks, required, on the psychiatrist's recommendation, specific pharmacotherapy combined with psychotherapy.
The psychotherapeutic intervention consisted of 23 sessions using cognitive-behavioural hypnosis techniques that led gradually to treating the symptoms, while the psychiatric treatment was no longer needed. This case study highlights the characteristics of an integrative approach that combines psychological and psychiatric intervention techniques.
The article presents a case study in which the posttraumatic stress disorder PTSD was approached in an integrative, psychiatric and psychotherapist manner. Hypnosis, as a means of directly accessing the unconscious, can be used as adjuvant treatment in eclectic, psychodynamic and cognitive behavioural therapies. The inclusion of the cognitive behavioural therapy and hypnosis was facilitated by similar techniques and theoretical positions, such as the similarity between the cognitive strategies used in cognitive behavioural therapy and Milton Erickson's therapeutic model.
There are several clinical models that provide different perspectives for this integration Chapman, , such as the Cognitive Skills Model Diamond, , the Cognitive Development Model Dowd, and the Cognitive Behavioural Hypnosis Model Kirsch, Hypnosis has been combined with the cognitive behavioural therapy in treating anxiety disorders, pain, obesity, depression, hypertension, smoking cessation, etc.
E-mail address: violeta. Published by Elsevier B. PTSD is a syndrome following the exposure to an extreme stressor. Extreme traumatic events are considered natural disasters, war, hostage taking, family or urban violence, rape, serious accidents and many other situations involving life threatening and the observation of another person's death. These events are even more traumatic when they appear suddenly and unexpectedly. The central issue in trauma is not pain or fear, but helplessness and weakness Spiegel, The symptoms of PTSD refer to repeated intrusions of painful memories, efforts to avoid thoughts, feelings or activities that stir up memories, the inability to recall important aspects of the trauma, the feeling of being detached or estranged from the others, a decreasing interest in activities usually pleasant, a narrow range of emotions and the sense of a futile future.
If individuals suffering from PTSD are in a spontaneous dissociative state during and immediately after the trauma, hypnosis can be helpful in getting to traumatic memories by recreating that precise kind of mental state Spiegel, The present case study examined the effects of adding hypnosis to a cognitive-behavioural treatment for treating PTSD.
Bisson showed that the combination of hypnosis and cognitive behavioural therapy may reduce some acute stress disorder symptoms.
Lynn et al. He has two daughters aged 34 and 40 years. The year brought in the unexpected death of the client's alcoholic wife, two days after an altercation during which he hit her in the presence of their younger daughter. The reason for the aggression was the fact that the mother forbade the daughter to visit her, because of her reproaches concerning alcohol abuse.
Hence D. There had been an investigation, and at the police station, D. He feared the police since the communist times, when he was questioned concerning some illegally purchased gas cylinders. Prison was associated to death, because he felt incapable to adapt to the prison environment. The cause of his wife's death, established by the forensic expert, was a hematoma caused by the oblique roof of the cellar where the beverage was kept that she seldom hit with her head.
Posttraumatic stress started half a year after his wife's death. The symptoms evolved over six years, and in , when he turned to the psychotherapist, the client was under psychiatric treatment with Rivotril, Rexetin and Mirzaten. In the past three years, D.
He was thinking: "I was wrong to make wine; if there was wine in the cellar Intrusive thoughts, that preserved the feelings of guilt, were also his wife's words who, right after the fight, said: "you slapped me forever". The emotional symptoms consisted in dysfunctional negative emotions in the form of guilt: "I'm to blame for my wife's death", "I am guilty for not acting in time, I should have taken her to the doctor for the hematoma, and solve her drinking problem".
The patient has a brother and a sister. He describes his parents as good educators who knew how to educate him without using coercive or punitive methods. At 8 years old he fell into a well and almost drowned. Premorbidly, he rarely experienced panic attacks. He was also suffering from somatic diseases, such as prostate problems and vertigo syndrome.
DSM-IVdiagnosis : Axis I clinical disorders : posttraumatic stress syndrome, panic attacks, although he also presents symptoms of depression, they have a secondary character compared to PTSD diagnosis and do not involve a separate diagnosis; Axis II personality disorders : nothing clinically significant; Axis III somatic diseases or other medical conditions : prostate problems, vertigo syndrome; Axis IV psychosocial stressors : son-in-law consuming alcohol; Axis V GAF- global assessment of functioning : GAF 50 current: Perhaps the traumatic event in the childhood when the client fell into the well turned during his life into a predisposing factor which, when experiencing another traumatic event his wife's death - trigger and in the presence of other favouring conditions for instance, alcohol consuming son-in-law , generated the onset of the clinical symptoms.
Panic attacks, unresolved grief, guilt, nightmares, tremor, intrusive memories, avoidance behaviour regarding the cellar. The therapeutic objectives aimed at establishing a psychological report adjusted to psychotherapy, identifying and correcting dysfunctional beliefs, stabilizing and reducing the symptoms, treating traumatic memories, resuming daily activities, preventing relapse by identifying and preparing for risk.
The establishment of the hypnotherapeutic relationship involved a process carried out in four stages Linden, The psycho-diagnosis, which involved the analysis of the data from the clinical interview SCID , the P. Questionnaire, the Freiburg Personality Inventory, as well as the clinical observations, have shown a depressive-anxious configuration based on a personality structure with anxious-avoiding elements.
The patient met 7 of the 13 panic attack criteria and he manifested the symptoms of re-experiencing predominance, avoidance and symptoms of hyper-excitation. There were no signs of experiencing psychotic or dissociative episodes.
The first issue addressed during the treatment was the issue of panic attacks including panic about panic. The psychological evaluation revealed that the patient had two panic attacks a day. The therapeutic intervention aimed to eliminate the panic attacks involved the acquisition of specific strategies for managing anxiety, as well.
The assessment of the level of hypnotizability showed that the patient was highly hypnotizable. The identification and correction of dysfunctional beliefs was conducted simultaneously with the treatment of the traumatic memories by using the systematic desensitization version of the cognitive-behavioural hypnotherapy within which the therapeutic suggestions are identified through the cognitive restructuring technique called the Two-Column Method Chapman, The aim of this method is to generate a set of rational thoughts that can be used as hypnotic suggestions to reduce the patient's anxiety.
In the wake state, the client was instructed to split a page into two columns; on one side of the page he put down the thoughts provoking anxiety and on the other side of the page the therapist listed the hypnotic suggestions later used in hypnosis, during the systematic desensitization. Also, in the treatment of traumatic memories during hypnosis were used: the age regression and progression, the emotional bridge Hawkins, and the inhibition of intrusive images through the technique "Stop", exposure to traumatic memories, and the "anxiometer" technique.
The technique "Stop" means blocking automatic intrusive thoughts by shouting aloud the word "Stop". During trance, in the imaginary plane, the client was exposed to ranked anxiogene situations with the indication to evaluate and modify the level of anxious manifestations developed. Simultaneously, hypnosis was used in identifying and modifying cognitive schemes, which are considered to operate at subconscious level, predisposing and helping in preserving automatic thoughts, dysfunctional behaviours and feelings of the client.
Changing these schemes prevents relapse when the client is facing similar situations in life David, Addressing the issue of the unsolved mourning involved considering all the aspects related to his wife's death. The patient was reassured that after a close person dies, it often happens to experience a wide range of feelings such as guilt, shame, fear or anger.
The man was encouraged to think about what he felt about his wife and their relationship. The patient worked on accepting and encouraging the expression of feelings other than guilt. He began to experience a variety of new feelings such as anger, because she did not accept to receive help with her drinking problem, relief because she was not paralyzed. The identified regret categories were: acts that he did, but he wishes he didn't do hitting his wife , acts that he did not achieve, but he wishes he did forcing his wife to go to a rehab clinic , acts that others did, but he wishes they didn't he wishes his wife hadn't had drinking problems , acts that others did not do, but he wishes they did he wishes his wife had stopped drinking , comparisons between his present life and the past when his wife was alive.
The 10 steps for moving beyond regrets were applied Beazley, : listing the regrets, regrets examination, changing toxic thought patterns, grieve losses, identifying compensations, identifying the lessons, developing compassion for and learning to forgive others, forgiving oneself, maintaining a life free of regrets.
Other therapeutic techniques were used, such as metaphors, the empty chair technique and the "Box of Memories" Chapman, , as a means of adapting to the past. Of the psychotherapeutic prescriptions that the client had to accomplish, we mention: the application of rational thoughts during self-hypnosis, the paradoxical prescription not to avoid intrusive thoughts and to plan the time for reliving the memories, the task to clean and use the cellar this last task was accomplished after the eighteenth session.
The present case study adds further evidence to the accumulating research Lynn et al. The intervention took place over 23 sessions, with a follow-up at 3 and 6 months.
During the tenth session, the assessment revealed the absence of panic attacks and limb tremor. Consequently, the psychiatrist decided to eliminate the treatment with Rivotril and Rexetin, keeping only half the dose of Merzaten. At the end of the treatment, the patient no longer needed psychiatric treatment.
The client's strengths were the high level of hypnotizability and an increased motivation for psychotherapy, reflected in the application of psychotherapeutic prescriptions. The motivation came from the desire to increase the quality of his life. The limit of this research is that it used a case study for showing that hypnosis improves treatment outcome, but the generalization of this result needs randomized clinical trials.
American Psychiatric Association. Bucuresti: Asociatia Psihiatrilor Liberi din Romania. Beazley, H. Bisson, J. Adding hypnosis to cognitive behavioural therapy may reduce some acute stress disorder symptoms, Evidence based mental health, 8 4 , Bryant, R. Hypnotherapy and cognitive behaviour therapy of acute stress disorder: A 3-year follow-up, Behaviour research and therapy, 44 9 , Chapman, R.
The clinical use of hypnosis in cognitive behaviour therapy. A practitioner's casebook, Springer Publishing Company, Inc. Dafinoiu, I. Hipnoza clinica. Tehnici de inducfie. David, D. Diamond, M. The cognitive skills model: An emerging paradigm for investigating hypnotic phenomena.
Chaves Eds. Buffalo, NY: Prometheus Books. Dowd, E. Cognitive developmental hypnotherapy. Rhue, S. Kirsch Eds.
Formare in Hipnoza Ericksoniana
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Hipnoza clinica. Tehnici de inductie. Strategii terapeutice
Braila Soseaua Barnova, nr. Cuza, B-dul Carol I, nr 11, Iasi. Educatie, grade, diplome diploma de licenta in psihologie sociologie, , Universitatea Al. Cuza, Iasi diploma de doctor in psihologie cu lucrarea Rolul expectantelor in evolutia comportamentului sugerat , conducere de doctorat, expert cncsis, 3.