Psychotherapy
Table of Contents
Individual Therapy
“What is going on in my life? How much do I want from me?” perhaps the most important question to the human mind. In bipolar short-term use, easy targeting periods do not occur for a long time, and if they do occur, these periods can be overcome with less. Another essential point is to have the conditions of sufficient competence to take the personal responsibilities of the patients (Simon et al., 2008).
My clinical experience has been that when working with people diagnosed with bipolar disorder, prominent problem areas require special interventions. Of course, each subject’s starting point in therapy is unique and any diagnosis should not lead to generalization. On the other hand, I would like to state that I am constantly renewing my treatment plan during the therapy process and working with an up-to-date approach, without ignoring the similarities and common points. In this context, I observed that working with clients diagnosed with bipolar disorder with individual adult therapy and EMDR therapy for trauma, SBET in group therapy, and couple therapy with clients with relationship problems were curative and added it to my clinical practice.
EMDR
(Eye Movement Desensitization and Reprocessing)
While it is not yet fully known how EMDR works, there is ongoing research into possible mechanisms for how EMDR improves experience reprocessing. The point on which the researchers agree is that what happens in the present can re-stimulate negative thoughts, emotions, and physical sensations that have emerged as a result of past experiences and are still a source of sadness for the client. It seems that by changing the relationship between these events, EMDR greatly reduces the stress experienced in the present, related to both past and present events.
Application Steps:
1) The first step is to get information about the client’s history. The therapist analyzes the client’s suitability for EMDR, draws up an appropriate treatment plan, and the event to be studied with EMDR is determined.
2) The therapist explains the EMDR process to the client and gets approval from the client. The therapist determines with the client a “safe place” to relax during and/or after the sessions.
3) In steps 3-6, the moment to work with EMDR is determined and processing is started using the EMDR procedure. The client chooses the picture that best describes the memory he wants to work with, and when he looks at this picture, he determines the negative belief he thinks about himself.
When he looks at that picture instead of this negative belief, what he wants to believe about himself is determined, and when he looks at the picture, he evaluates how valid the positive belief about himself is on a scale of 1 to 7. After identifying the feelings about that picture, the degree of discomfort between 0 and 10, and the distress that occurs in your body when you think about this picture, move on to the next step, desensitization.
4) In the desensitization stage, the client focuses on the double-sided stimulation (eye movements, sound or small touches) made by the therapist, thinking about the picture he wants to study, the negative belief he thinks about himself when he looks at this picture, his feelings, and the distress he experiences in his body.
5) During the placement phase, the client’s positive belief about himself is placed with bilateral stimulation.
6) In the body scanning phase, the client thinks about the picture that disturbs him, scans his body and determines whether there is any discomfort in his body. Bodily ailments are desensitized and reprocessed using bilateral stimulation.
7) In the closing phase, the therapist tells the client to note the feelings, images or bodily sensations that arise about the picture studied until the next session, and shows various relaxation exercises to cope with such situations.
8) The next session starts with the evaluation phase. A pre-session and subsequent changes are evaluated. After EMDR sessions, clients generally report that the emotional discomfort associated with the working memory has disappeared or greatly reduced and they have gained a significant amount of insight.
These acquired emotional and cognitive changes lead to positive changes in the behaviors and personal lives of the clients. EMDR is a psychotherapy technique that has been proven effective and widely used in coping with many psychological difficulties, especially trauma. Especially when it comes to bipolar disorder, working with an experienced psychologist about traumatic experiences can contribute to the emdr treatment process for the traumatic aspects of attacks.
Group Therapy
I started group therapies within the scope of my doctoral thesis in Istanbul University, Istanbul Capa Medical Faculty Psychiatry Service. I would like to briefly summarize the method I followed and its clinical results.
Note: When the pandemic conditions improve in 2021, face-to-face group therapies will start again. For detailed information, you can write to my contact address.
Social Cognition and Interaction Therapy (SBET)
Undoubtedly, the field of mental health creates the treatment map under the influence of many different external factors compared to other fields of health. Family relations, social life and work life, which are among these influence factors, are among the goals that patients expect to overcome in their individual therapy. After the success of the program, which was first applied to schizophrenia patients by Penn et al. in a hospital in the USA in 2005, its adaptation for bipolar disorder was implemented in 2013 (Lahera et al., 2013). The content of this therapy model, which is applied in many countries of the world, is that it sheds light on the point of social relations, which is one of the main problems encountered in business life, in a neurocognitive sense. The fact that the concepts of social cognition and mentalization discussed before are shared with concrete and visual examples from business life provides the opportunity to work in a structured and well-defined framework.
SBET, which is a group therapy technique that can also be carried out as individual therapy, was first applied in hospitals as a 15-week program, and it could be shortened to 8 weeks when specific goals were determined and developed (Zhang et al., 2019). SBET sessions, which are planned for 8 weeks with a focus on work life in bipolar disorder, last for a total of 90 minutes, with two 40-minute episodes and a 10-minute break once a week. It includes many practical applications, including understanding the facial movements of the other person correctly, in order to teach the situation experienced in stressful and tense times of business life to be divided into parts and to re-examine it and to evaluate it in a healthy way.
| Session | Steps | Content |
|---|---|---|
| 1-2 | Phase One: Promotion and emotions | Definition of SBET and social cognition, providing group interaction. Review of the importance of emotions in social situations. |
| 3-5 | Second Stage: Ability to evaluate the situation | The ability to predict the consequences of a situation, the ability to attribution, tolerance for uncertainty, the ability to distinguish between facts and estimates, and the ability to review evidence to make more realistic predictions. |
| 5-8 | Stage Three: Gaining Integration (Transfer | The ability to integrate learned skills and to notice and generalize their reflections on daily life. |
Clinical Observation Results of SBET Application
The clinical findings obtained after the SBET application show that mentalization-based group therapy provides a statistically significant improvement in the above-mentioned dimensions of functionality, but the financial dimension is an area where progress can be made in a longer period of time. After Group Therapy, some clients start a job or provide professional gain, etc. They are known to have started activities.
Within the scope of resistance to stigma, SBET provides benefits in this area as it creates the opportunity for patients to be together with people who have similar processes with them, in line with group interaction. It has been observed that patients have difficulties in the areas of face reading and recognizing emotions, and the applications in this area have a surprising effect on patients.
Although the last session includes a farewell and separation, it is known that bipolar patients have a meaningful relationship with ‘continuing and finishing a job’, which they have the most difficulty with. This has been effective in interpreting the last session as a successful ending, apart from a farewell, for the participants. After the end of the study, it was understood that the program was found to be effective and beneficial to a large extent in the individual evaluation interviews conducted with the patients.
Couple Therapy
“The two of you must be very caring about each other and yourself because you put most of your energy into fighting. Couples who do not care and are not different do not quarrel. Your fight shows that there is something worth fighting for.”
Problems can be seen in every relationship, but sometimes the problems can reach the level of deep disappointment for the couples and question the continuation of the relationship-marriage. Although it is sometimes possible to stop this negative trend with the couples’ own problem-solving skills, it may be necessary to develop new strategies, especially against the new problems that life brings. At this point, it can be said that a couples therapist is needed. I apply couples therapy sessions with the contribution of two schools that I have been trained in; Strategic Family Therapy and Imago Couple Therapy.
Consequences of Troubled Relationships:
A stressful relationship-marriage can leave unforgettable traces on the parties. Pain, worry, anxiety…etc. Emotions of high tension can lead to depression as well as trigger attacks for people diagnosed with bipolar disorder. When the relationship is in a deadlock, if no precautions are taken, the situation can bring the marriage to the point of ending like the destruction of dominoes. For this reason, it is necessary to identify and solve the problem without waiting for the problems to grow and become unsolvable.
What is Marriage Therapy?
Most people can make their marriage enjoyable again if they are willing to work on relationships. Nobody starts out as the perfect wife. Marriage; It requires some skills such as understanding yourself, understanding your partner, knowing how to argue, solving problems and accepting differences. Sometimes the ineffective and negative behavior patterns in the family we grew up with can be carried over to the relationship, and sometimes the difficulties of life can make it difficult to maintain a happy marriage. With therapy, it is aimed for couples to see each other as human beings, to understand the personality traits of the other person and to learn to accept the differences that can be removed.
If Your Spouse Doesn’t Want To Go To Therapy, What Way Would You Follow?
Some people find it difficult to seek help for their problems because of their social conditioning or personality structure. Sometimes, as a result of conflict in the relationship, one spouse may want to come to therapy, while the other may resist his request. The most common mistake; counseling brings the solution proposal to the agenda during a fight or at a time when the problem is intense, while the negative feelings have not yet subsided. Such an approach hinders or delays initiation of therapy.
When one of the spouses offers to seek psychological help during a fight, they may perceive it as a criticism or accuse the sick person and react. If your partner refuses to go to therapy despite all your efforts and encouragements, you can start doing things on your own. Of course, it is difficult to fix a troubled marriage alone, but at least talking to a marriage or family therapist can see your role in the problems experienced in the relationship, learn what you can do to resolve the conflict and improve the relationship, how to approach your spouse, and maybe persuade him to therapy with the support and guidance of the therapist. you can succeed. Sometimes, when one of the spouses starts to receive counseling and provides a development in the relationship with the changes he has made to himself, the other spouse starts to trust the psychotherapy process with this development in their marriage and later accepts to participate in the process.
