Seminar on psychotherapies held

Psychotherapies poorly understood by professionals across Pakistan: experts

Rawalpindi

Psychotherapies are very poorly understood by professionals across the country as these are not given due importance whereas the vital role of psychotherapy in treatment of mental health problems including depression and phobias cannot be ruled out.

Professor of Psychiatry and Head of the Institute of Psychiatry at Benazir Bhutto Hospital Dr. Fareed Aslam Minhas expressed this while talking to the participants of a seminar hosted by the institute with a theme ‘An Overview of Psychotherapies; Principles of Cognitive Behavioural Therapies (CBT)’.

Assistant Professor of Psychiatry at the Khyber Teaching Hospital Dr. Bashir Ahmad conducted the seminar that was attended by consultants, residents and house officers from departments of psychiatry and neurology along with psychologists.

Talking to participants in the inaugural session, Professor Minhas expressed his concerns for the dearth of psychiatrists in the country and the need for more trainees’ induction, enhancing supervisory skills and thereby improving patient care.

He said that extending these opportunities, the holding of like seminars for trainees in the institute were in fulfilment of his responsibilities as head. However, he added, the burden of trainees all over Pakistan is upon his shoulders as dean of faculty of psychiatry at College of Physicians and Surgeons Pakistan. “In addition the psychologists that are interns here at the institute are also part of the responsibility on my shoulders.”

I envision for my trainees all over Pakistan to be cognizant of the basic nuts and bolts of psychotherapies and beyond, he said. He informed the audience of the collaborative efforts of the Institute of Psychiatry with the WHO that seeks to extend Problem Management Plus Training throughout the country for disaster struck areas.

Introducing Dr. Bashir with the participants, he said that people sitting in Punjab cannot comprehend the strength of the trainees and trainers in KPK. He shared his vision of grooming younger supervisors through such sessions.

Dr. Bashir began his presentation by saying that the scope of the topic is beyond one particular workshop however he would focus mainly on the basics of psychodynamic psychotherapies and cognitive behaviour therapies. He lamented the usual muddled practice of psychotherapies where the “therapists” are unaware of the foundational concepts.

Psychotherapy is a development of a trusting relationship leading to the free communication and leads to understanding, integration and acceptance of self, he said.

He then went on to describe the need for psychotherapies. In some of the psychiatric ailments like minor depression and phobias, psychotherapies are the first line of treatments. Even in illnesses where pharmacological interventions are primary, psychotherapies help prevent relapse. Psychotherapies, in view of evidence, combined with pharmacological interventions are much more effective than either medications or psychotherapies alone. There will be 35-40 per cent of depressive patients who will not adequately respond to pharmacological interventions, explained Dr. Bashir.

Additionally, some patients will prefer to abstain from pharmacological treatments and choose psychotherapies due to personal reasons, he said.

The discussion then proceeded to psychoanalysis. Founded by Sigmund Freud the aim of psychoanalysis is to release repressed emotions and experiences and make the unconscious conscious; allowing the patient to deal with the conflicts, he said.

He added the downside of this particular methodology is the long duration of sessions: spread across five days per week and the overall therapy may extend over years. Various shorter versions have been developed, including brief psychoanalysis, and a combination of cognitive and psychoanalytical therapy known as CAT (cognitive analytical therapy). Psychoanalysis uses ink blots, slips of tongues, free associations, dreams interpretations, resistance, and transference and counter-transference, he said.

He then steered the discussion towards Behaviour Therapies. Cognitive approaches were integrated with behavioural therapies to produce CBT. CBT has the strongest evidence base of all the psychotherapies. In the developed countries mental health institutes are sure to have CBT facilities for their patients, said Dr. Bashir.

Dr. Bashir briefly alluded to Cognitive Restructuring. An important prerequisite is that the patient takes responsibility to change; if patients do not accept this responsibility then that puts a question mark in their suitability for CBT.

At the end, he explained all the six principles of CBT in detail for the young health professionals and announced that Group CBT service is being offered in Khyber Teaching Hospital and that an accredited six-month CBT certification will be starting from Jan 1, 2017 affiliated with Khyber Medical University.