On October 23rd, 2014, we updated our
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psychotherapy is indeed effectivePsychotherapy alone did not differ in effectiveness from medication pluspsychotherapy.No specific modality of psychotherapy did better than any other for anydisorder .Psychologists, psychiatrists, and social workers did not differ in theireffectiveness as treaters; and all did better than marriage counselors andlong-term family doctoringLong-term treatment did considerably better than short-term treatment ..
the type of treatment is not a factor.the theoretical bases of the techniques used, and the strictness ofadherence to those techniques are both not factors,the therapists strength of belief in the efficacy of the technique is afactor.the personality of the therapist is a significant factor,the alliance between the patient and the therapist (meaning affectionateand trusting feelings toward the therapist, motivation and collaborationof the client, and empathic response of the therapist) is a key factor
Effect size: the difference between treatment and control groups,expressed in standard deviation units.An effect size of 1.0 means that the average treated patient is onestandard deviation healthier on the normal distribution or bell curvethan the average untreated patient.0.8 is a large effect0.5 is a moderate effect0.2 is a small effect (Cohen, 1988).
Abbass et al. (2006) 0.97 12 studiesLeichsenring et al. (2004) 1.17 7 studiesAnderson & Lambert (1995) 0.85 9 studiesAbbass et al. (2009) 0.69 8 studiesMesser & Abbass (in press) 0.91 7 studiesLeichsenring & Leibing (2003) 1.46 14 studiesLeichsenring & Rabung (2008) 1.8 7 studiesde Maat et al. (2009) 0.78 10 studies
General psychotherapy Smith et al. (1980) 0.85 475 studies Lipsey & Wilson (1993) 0.75 18 meta-analyses Robinson et al. (1990) 0.73 37 studiesAntidepressant medication Turner et al. (2008) 0.31 74 studies Moncrieff et al. (2004) 0.17 9 studies
Lipsey & Wilson (1993) 0.62 23 meta-analysesHaby et al. (2006) 0.68 33 studiesChurchill et al. (2001) 1.0 20 studiesCuijpers et al. (2007) 0.87 16 studiesÖst , (2008) 0.58 13 studies
Doesn’t remember your name and/or doesn’tremember your issues from one session to thenextDoes not pay attention or demonstrate he or sheis listening and understanding you.Habitually late, cancels, or changesappointmentsInsufficient and specific training or supervisionMakes guarantees and/or promises.Unlicensed or has many complaints. -Critical of your behavior, lifestyle, or problems.Tries to push spirituality or religion on to you.
“looks down” at you or treats you as inferior.Blames your family, friends, or partner, orencourages you to blame themFocusing on him/herself instead of you.Tries to be your friend.Initiates touch, romance, or sex relation.Reveals identities of his or her other clients.Cannot accept feedback or admit mistakes.
Talks too much or not at all Psychobabble” that leaves you confused. Acts as if she or he has all the answers and keepstelling you how to best fix things.Encourages your dependency by allowing you to getyour emotional needs met from the therapist. Therapist“feeds you fish, rather than helping you to fish foryourself.”Tries to keep you in therapy against your will.Ridicules other approaches to therapy.Tries to get you to use control over your impulseswithout appreciating or attempting to resolveunderlying conflicts .
Pushes you or constantly avoids highlyvulnerable feelings or memories.Overly emotional, affected, or triggered byyour feelings or issues.Does not empathize or empathizes toomuch.
THE PLACE, ROOM, OFFICE, FURNATURE.TIME AND DATE.FEE, WHY
Emotions Past Defenseexperiences focus resistance Recurring themes
Motivation Past & currentPersonality type focus relations & with therapist Fantasy life
hysterical schizoid depressive obsessive
Stimulus Conscious subconscious Ego Un-ConsciousImpulse Id
defenses StimulusAnxiety Conscious subconscious Ego Un-Conscious Impulse Id
In life we experience conflicts with others.When conflicts occur, we experience feelings.These feelings tell us what we want and mobilize us to act on our desires.However, most patients seek therapy because they cannot channel their feelings into effective action.Instead, they become anxious and use defenses.These defenses create the presenting problems and symptoms from which our patients suffer.
• What is therapeutic relationship?• Is a key factor.• Why it is important?• What are its ingredients? •
• Drop out = 47% (why)• The first 7 sessions• Co-creating therapeutic relationship (alliance= collaborative relation = not kind warm supportive or empathic relation but it is a relationship designed to accomplish a specific task)
• 1--THE PROBLEM• -DEFENSES D,P, V, IND• 2--A SPECIFIC EXAMPLE• -DEFENSES R, RR, REG,• 3--FEELINGS AT THAT TIME• -DEFENSES F, DISP, RAT conflict triangle• 4--THE IMPACT OF FEELING ON BODY• -DEFENSES
•• Is this a defense, feeling or anxiety?• What is the name of this defense? (………)• Yes, so, you need to see, clarify, round about, block defense, and focus again upon the problem (pressure). • •• Never explore this way
•• Is this defense, feeling or anxiety?• What is the name of this defense?• Yes,• so, you need to see, clarify, round about, block defense. and focus again upon the problem (pressure). •
(……………………….) • .. ..!. •
• SPECIFIC EXAMPLE• YOU WILL BE FACED BY DEFENSES• DETAILED EXAMPLE (file)• WHY• HOW• WHEN
Awareness ofStimulus from bodyenvironment activationA person appears feelings Body mobilization Dog barks or licks face
Stimulusleads to Defensively Habituallyemotion conceals used in currentFEELINGS emotions relations Child & Fear of loss of caretaker (anxiety attachment provoking (adaptive st) survival of self and other)
1) A cognitive label: “I am sad.”2) Awareness of physiological arousal: heaviness in the chest and tears3) The motoric impulse: cryingLet’s look at another feeling.1) A cognitive label: “I am angry.”2) Awareness of physiological arousal: sensation of heat rising from the solar plexus.3) The motoric impulse: hands clenched and arms are raised.
• AGAIN YOU WILL BE FACED WITH SOME OTHER DEFENSES• Such as denial through fantasy• Displacement• Self abandon , dismissal
Pressure Face theChallenge DEFENSES
• . • . . • • . •.
Ludwig Binswanger, Freud once wrote that“psychoanalysis is a cure through love.” Through ourconstant attention to the patient’s inner life and by blockingthe defenses that strangle it. Through our constant moment to moment attention to thepatient’s feelings we actively demonstrate our concern forhis/her right to be free from those inhibiting defenses thathave perpetuated his/her suffering. For, as Frieda Fromm-Reichmann said,“To redeem one person is to redeem the world.”