With the progress and development of life sciences, the pure biomedical model is gradually transformed into a social-psychological-biomedical model, but the current high incidence of psychological disorders in general hospitals (24% of the total number of consultations) and the low recognition rate of non-psychiatrists (only 15.9%) due to the lack of training, which can easily lead to missed diagnoses. This bias needs to be changed urgently. The author was invited to discuss the applied aspects of psychotherapy with the participants in three main areas.
I. Theoretical and Analytical Aspects
Traditional Chinese medicine has already elaborated on psychotherapy, for example, the “Ling Shu”, which says, “Speak with its goodness, guide it to what it makes, and open it to its suffering”. The concept of psychotherapy is also known as “psychological therapy”. The concept of psychotherapy: Psychotherapy is also called psychiatric treatment. It is the application of the principles and methods of psychology to treat the patient’s psychological, emotional, cognitive and behavioral problems by using the mutual response and relationship between the therapist and the person being treated. The aim is to solve the psychological difficulties faced by the client, reduce anxiety, depression, panic and other psychiatric symptoms, improve the client’s non-adaptive behavior, including the perception of people and things, interpersonal relationships, and promote personality maturity to deal with psychological problems and adapt to life in a more effective way. Treatment is conducted through three stages: clarification, comprehension, and treatment.
The theoretical models are classified according to the main academic theories and points of implementation.
1. Analytical psychotherapy → psychoanalysis → inner spirituality.
2. Cognitive psychotherapy → cognitive therapy → cognitive modification.
3.Supportive psychotherapy→Supportive treatment→Adaptation to reality.
4.Behavioral psychotherapy → behavior therapy → modification of behavior.
5.Interpersonal psychotherapy → marriage and family groups → interpersonal relationships.
Cognitive therapy about irrational cognition includes: arbitrary inference, selective generalization, transitional derivation, exaggeration and reduction, and all-or-nothing thinking. Ellis’ rational-emotional therapy is about rational treatment of irrationality. The three main features include absolute claims, overgeneralization, and bad to great.
Psychotherapy implementation is categorized according to the participants: individual psychotherapy, couple psychotherapy, family therapy, and group therapy; and according to the duration of treatment: long-term, short-term, and limited-term treatment.
Healing factors of psychotherapy: correction of non-functional cognition; handling of psychological impedance; promotion of maturation of ego function; improvement of ego defense mechanism; training and development of new behavior; improvement of interpersonal relationship; change of human attitude.
II. Operations and talks
The main example of treatment is through the case of panic disorder (PD), the most prominent impostor of internal medicine disorders, who visits internal medicine with cardiac, respiratory, and neurological manifestations. Internal medicine physicians are more trusted than specialists as the first physicians for PD if they have knowledge of the relevant psychology and operational interview skills. The most important thing in psychotherapy is to establish a good counseling or therapeutic relationship. Currently, only cognitive behavioral therapy (CBT) has been proven effective in rigorous clinical trials.
PD involves four main aspects of the condition.
1. physiological aspects: a “sympathetic storm”, especially highlighted by cardiovascular and respiratory symptoms.
2. emotional aspects: extreme anxiety, worry, and fear, with severe episodes often combined with depressive symptoms.
3. cognitive aspects: belief that one is about to die of asphyxiation, inattention, dissolution of reality, temporary memory loss, and secondary hypochondriacal notions.
4. behavioral aspects: seeking help, mostly in the emergency room.
Often repeatedly seen in internal medicine, often diagnosed with acute myocardial ischemia, hysteria, asthma, etc. CBT views panic symptoms as patients automatically assigning false meanings to stimuli that are not sufficient to elicit a violent response and subsequently cause emotional reactions and behavioral changes. Patients often do not recognize only remember the misperceptions, but constantly adopt various ways to alleviate the resulting maladjustment. Treatment is to alleviate symptoms by changing the patient’s misperceptions and behavioral reframing. Cognitive help breaks the vicious cycle between emotional anxiety and somatosensory sensitivity; behavioral help desensitizes the patient to the stimulus causing the panic.
Operate through the following steps.
1. psychoeducation: a didactic approach.
2. continuous monitoring and recording of panic: journaling.
3. breathing training: rhythmic abdominal breathing.
4. cognitive reconstruction: identification and recording of worries caused by one’s hypersensitivity.
5. Exposure: the most central therapeutic step.
III. Reflections
William Osler said, “The practice of medicine, is a science-based art. It is a profession, not a trade; it is a vocation, not a profession; by its very nature, medicine is a vocation, a social mission, an expression of humanity and emotion.” That’s why physician-patient communication is a necessary skill for our physicians in the 21st century. We are trained to quickly identify psychological disorders, to choose the best treatment (medication combined with cognitive-behavioral therapy or other forms of talk therapy), to establish a harmonious and constructive doctor-patient relationship, to help patients recognize their inner conflicts, to correct misconceptions, to release themselves, to learn to face reality, to increase their psychological freedom and not to force themselves to achieve perfection. In psychotherapy, we need to pay attention to the “three hearts and two minds”. (Three hearts: patience, care, and caution; two intentions: awareness of the role of the consultation and interview relationship, and understanding the patient’s meaning beyond words).
IV. Conclusion
As the first consulting general hospital physicians, although not as systematic psychotherapy as specialists, but from the clinical practice, every contact between doctors and patients has a wide range of psychotherapeutic significance. At the time when the patient is most in need of help to save his or her life, the best and fastest treatment for the patient is to show understanding and give a reasonable explanation of the patient’s illness with the organic combination of a physician’s personality, literacy, experience and theory, and to stimulate the patient to explore the psychological mechanism of his or her psychological disorder by creative psychotherapy according to the patient’s comprehension, life events, age, personality, etc. It also improves compliance with medication, which is also the basis for curing the disease and preventing its recurrence. General hospital physicians will also experience a greater sense of accomplishment from effective treatment, leading to a virtuous cycle of greater willingness to focus on the psycho-spiritual health of their patients.