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Department of nervous diseases, psychiatry and medical psychology




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Ministry of Health of Ukraine

Bukovynian State Medical University

Department of nervous diseases, psychiatry and medical psychology


Approved on the methodology meeting

of the Department of nervous diseases, psychiatry

and medical psychology

on the “22” of April 2010 (Report No 2).

Chief of the Department

_______________________

Professor V.M.Pashkovskyy


MethodOLOGical Guidance

for the lesson

Theme 9: Basic methods of psychotherapy at general practitioners’ work. Indication and contra-indication towards holding hypno-suggestion, individual and group rational psychotherapy, methods of psychodynamic, art-therapy. Psychotherapy of attitude towards disease. Psychological help in crisis.


For 4-th year students of medical faculty No 2


Module 1. Medical psychology

Topical module 2. Practical aspects of medical psychology


Сhernivtsi, 2010


^

1. Actuality Aim

The high dynamics of sociotechnocratic development of modern society, improvement of the information technologies, scientific and technical achievements along with the improvement of the quality of life bring about the elevation of psychological and emotional tension, complication of an individual’s behavioral patterns, and, finally, put forward harsh requirements to the integrative activities of all mental processes as a whole.

2. Hours: 2


3. Teaching goal

The students must know:


  • Indication for psychotherapy;

  • Contra-indication for psychotherapy;

  • Methods of psychotherapy;

  • Psychotherapy of attitude towards disease;

  • Psychological help in crisis.

and be able to:

  • objectively and scientifically determine the psychotherapy;

  • interpret Indication and contra-indication for psychotherapy;

  • analyze psychological peculiarities of methods of psychotherapy;

  • to determine the psychotherapy of attitude towards disease;

  • to determine the psychological help in crisis.


Assimilate practical skills

  • analyze psychological peculiarities of personality during psychotherapy;

  • communication with patients;

  • experimental-psychological research of personality.


^ 4. List of disciplines necessary

for learning theme 1


Title of the discipline

Content of the discipline necessary for learning medical psychology

Anatomy

Brain construction

General psychology

Psychic functions of a normal person. Consciousness and self-consciousness. Psychology of personality.

Neuropsychology

Functions of different brain structures.

Normal physiology

Brain functions. Physiology of high nervous activity.


^ 5. Content of the theme

Internal” tendencies in development of psychotherapy itself:

  • extensive development.
    Vast amount of forms and modalities of psych therapy (over 600);

  • confrontation of neurodynamic and psychodynamic concepts of patho- and sanogenesis;

  • simultaneous existence of a considerable amount of competing professional organizations — International Federation of Psychotherapy (IFP), European Association for Psychotherapy (EAP), European and World Psychoanalytic Associations (ЕРА, WPA), European Association of Gestalt-therapy (EAG), European Association of Positive Therapy (EAPT), etc.;

  • undetermined professional requirements to psychotherapy.

Rigidity of professional doctrines and organizational ways of providing healthcare continues modeling psychotherapy as a rather narrow specialty, concentrated in psychiatric field.

The fundamental and applied research concerning the psychosocially induced mechanisms of morbid conditions development and the psychotherapeutic methods of their treatment and prevention are clearly insufficient. This leads to the insufficiency of the mass methodical provision of psychotherapy application in treatment process and the unjustified uncontrolled invasion of people without medical education into psychotherapy.

The “internal” tendencies in development of psychotherapy are in its extensive character leading to existence of a large number of psychotherapy forms and modalities, which disorientates the professional community and creates a comfortably safe situation for non-professional and clearly charlatan directions in educational and treatment activities.

In Ukraine, psychotherapy is defined as a system of curing influence on a patient through his or her mental sphere. Some foreign associations adhere to an opposite viewpoint. Thus, according to the “Declaration in Psychotherapy” adopted by the EAP on October 21, 1990 in Strasbourg, psychotherapy is a peculiar humanitarian field of science, practicing of which is a freelance and independent profession… education in one of the psychotherapeutic modalities… include: theory, personal therapeutic experience and practicing under supervision… obtaining of this kind of education is possible on condition of the former training in the field of humanitarian and social sciences.

In the professional sense part of their work, physicians-psychotherapists are to observe the postulates of the “Bases of Legislature of Ukraine on Healthcare” of November 19, 1992 No. 2801-XII. Special attention is to be paid to:

Article 32. “… In order to prevent harming the population’s health, carrying out of group therapeutic sessions or similar procedures utilizing hypnosis and other techniques of psychic or bioenergetic influence without a special license issued by the Ministry of Health of Ukraine is prohibited”.

Physicians-psychotherapists also must observe the Law of Ukraine "On Psychiatric Help" No. 1489-III adopted on February 22, 2000.

Article 6. “… Medical professionals… providing psychiatric healthcare… who… have learned of a person having a mental disorder, of turning for psychiatric help and treatment in a psychiatric hospital, or admission to psychoneurological institutions… or other information on the mental health condition, or the person’s private life, cannot divulge this information…”.

Article 7. “… The methods of diagnostics and treatment and medications allowed by the Ministry of Health of Ukraine are used only for diagnostic and therapeutic purpose according to the type of mental disorders…”.

Thus, realization of the psychotherapy concept under modern conditions requires creation of a new professional paradigm, reorganization of the system of psychotherapeutic help to people, and elaboration of the differentiated system of physicians’ preparation in the field of psychotherapy.


^ Resocialization of patients as the ultimate aim of the treatment process

For establishing of this new direction, the Ministry of Health of Ukraine has taken measures towards essential improvement of the organizational structures and the forms of psychotherapeutic care.

In order to develop psychotherapy and adequately establish it in the modern system of medical care for the people, the following issues should be solved.

  1. Creating of the conceptual professionally concise model of the psychotherapy development. An integrative model of psychotherapy should be created, containing the necessary attributes of the completed medical act: diagnosis of the pathological state of a patient; identifying the individually typological traits of the patient; constitution and realization of the psychotherapeutic directives; achievement of medical results in the form of maximal possible reduction of the morbid symptoms; patient’s rehabilitation with the maximal recovery of the patient’s social status and quality of life.

  2. Development of the traditional psychotherapeutic methods that were used in Ukraine. Optimization of various forms of suggestive psychotherapy, and their differential application depending on the leading pathological symptoms.

  3. Adaptation, development of the techniques of usage and introduction of the methods that had not been used in Ukrainian psychotherapy before: psychoanalytical techniques: existential modality — Gestalttherapy, non-directive psychotherapy, etc.; behavioral therapy — and systematic desensitization, immersion, paradoxical intention, etc. Improvement and differentiation of using the methods of operant confirmation, and bioadaptive regulation.

  4. Integration of the system of psychotherapeutic care into general medical institutions. Broadening the use of psychotherapy techniques in somatic medicine. It is important to increase the number of psychotherapeutic consultancy rooms in the general medical practice according to Appendix 26 and Appendix 2 to the Directive No. 33 of the Ministry of Health of Ukraine, and also to precipitate establishing of psychosomatic units in the structure of regional general hospitals, which is envisaged by Appendix 1 of the Directive No. 33 of the Ministry of Health of Ukraine.

  5. Psychotherapeutic care in the structure of specialized stages of medical assistance needs immediate organizational and personnel strengthening: the obstetric and gynecological units, pediatric and gerontologic networks, dispensaries of the radiation protection of the people, subunits of catastrophe medical care, etc.
    Medical specialty of child psychotherapist should be introduced.

  6. The development of psychological counseling and direction in psychic correction. Elaboration of a concept of a psychological model of psychotherapy and determining the range of psychotherapeutic and psychocorrectional measures for medical psychologists.

  7. A research expansion is necessary in psychotherapy. The code of the academic specialty “Psychotherapy” in the appropriate list of the Higher Certification Committee of Ukraine.
    Psychotherapy should be introduced into the curricula of the institutions of higher medical education as a major, not a minor course.

  8. The further elaboration of the departmental normative and legislative base in psychotherapeutic care provided for the people.

Most forms of psychotherapy use only spoken conversation, though some also use various other forms of communication such as the written word, artwork, drama, narrative story, or therapeutic touch. Psychotherapy occurs within a structured encounter between a trained therapist and client(s). Purposeful, theoretically based psychotherapy began in the 19th century with psychoanalysis; since then, scores of other approaches have been developed and continue to be created.

Therapy is generally used to respond to a variety of specific or non-specific manifestations of clinically diagnosable crises. Treatment of everyday problems is more often referred to as counseling (a distinction originally adopted by Carl Rogers) but the term is sometimes used interchangeably with "psychotherapy".

Psychotherapeutic interventions are often designed to treat the patient in the medical model, although not all psychotherapeutic approaches follow the model of "illness/cure". Some practitioners, such as humanistic schools, see themselves in an educational or helper role. Because sensitive topics are often discussed during psychotherapy, therapists are expected, and usually legally bound, to respect client or patient confidentiality.


^ 5.2. Theoretical questions:

  1. Indication for psychotherapy.

  2. Contra-indication for psychotherapy.

  3. Methods of psychotherapy.

  4. Psychotherapy of attitude towards disease.

  5. Psychological help in crisis.


^ 5.3. Practical training during the tutorial

1. Clinical observation of the behavior of patients during the psychotherapy.

2. Research the psychotherapy of attitude towards disease.


5.4. Materials for self-control

A. Questions for self-control:

  1. Indication for psychotherapy.

  2. Contra-indication for psychotherapy.

  3. Methods of psychotherapy.

  4. Psychotherapy of attitude towards disease.

  5. Psychological help in crisis.


B. Tasks for self-control

1. Typical, ordinary – II level.

2. Untypical, no ordinary – III level.

C. Tests for self-control.


Literature

  1. R.J.Gatchel An introduction to health psychology. – New York: Random house. – 386 p.

  2. Lectures.

  3. Internet resource.

  4. Вітенко І.С., Вітенко Т.І. Основи психології: Підручник для студентів вищих медичних навчальних закладів ІІІ – ІV рівнів акредитації. – Вінниця, 2001.

  5. Вітенко І.С., Чабан О.С., Бусло О.О. Сімейна медицина: психологічні аспекти діагностики, профілактики і лікування хворих. – Тернопіль, ”Укрмедкнига”, 2002.

  6. Гавенко В.Л., Вітенко І.С., Самардакова Г.О. Практикум з медичної психології. – Харків: Регіон-інформ, 2002.

  7. Квасенко А.В., Зубарев Ю.Т. Психология больного. М., 1980.

  8. Лакосина Н.Д., Ушаков Г.К. Медицинская психология. М., 1984.

  9. Менделевич В.Д. Клиническая и медицинская психология. – М.: Мед.прес., 1998.

  10. Мягков И.Ф., Боков С.Н. Медицинская психология: основы патопсихологии и психопатологии: Учебник для вузов.- М.: Издательская корпорация „Логос”, 1999.



Prepared by assistant N.V.Grinko


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