Ch 13 Psychotherapy


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Ch 13 Psychotherapy

  1. 1. Psychotherapy
  2. 2. It is easier to build a child than repair an adult.
  3. 3. What is Psychotherapy? <ul><li>… a formal process of interaction between two parties, each party usually consisting of one person but with the possibility that there may be two or more people in each party, for the purpose of amelioration of distress in one of the two parties relative to any or all of the following areas of disability or malfunction: cognitive fx’s (disorders of thinking), affective fx’s (suffering or emotional discomforts), or behavioral fx’s (inadequacy of beh), with the therapist having some theory of personality’s origins, development, maintenance and change along with some method of treatment logically related to the theory and professional and legal approval to act as a therapist. </li></ul><ul><li>R. Corsini </li></ul>
  4. 4. Estimate of Percent of Time Spent by “Counselors” and “Psychotherapists” in Professional Activities <ul><li>Process Counseling Psychotherapy </li></ul><ul><li>Listening 20 60 </li></ul><ul><li>Questioning 15 10 </li></ul><ul><li>Evaluating 5 5 </li></ul><ul><li>Interpreting 1 3 </li></ul><ul><li>Supporting 5 10 </li></ul><ul><li>Explaining 15 5 </li></ul><ul><li>Informing 20 3 </li></ul><ul><li>Advising 10 3 </li></ul><ul><li>Ordering 9 1 </li></ul>
  5. 5. Therapies <ul><li>Psychotherapy </li></ul><ul><li>Procedures in which a trained person establishes a relationship with an individual seeking help, in order to remove or modify existing symptoms, change disturbed patterns of thought and behavior, and promote personal growth. </li></ul>
  6. 6. Psychodynamic Therapies <ul><li>Freud </li></ul><ul><li>Disorders stem from hidden, inner conflict </li></ul><ul><li>Free association – tell analyst whatever comes to mind </li></ul><ul><li>Sessions last 45 minutes </li></ul><ul><li>Fixed schedule of fees & appts (if deviate from, calls for investigation & analysis) </li></ul>
  7. 7. Four Phases of Psychoanalytic Treatment <ul><li>1. Opening Phase </li></ul><ul><li>1 st contact </li></ul><ul><li>History taking </li></ul><ul><li>Everything person says & does are all clues to unconscious processes </li></ul><ul><li>Lasts 3-6 months </li></ul><ul><li>2. Development of Transference </li></ul><ul><li>Major portion of therapeutic work </li></ul><ul><li>Emotionally, analyst assumes major significance in the life of the person </li></ul><ul><li>Transference helps person understand how one misperceives, misinterprets, and relates to the present in terms of the past </li></ul>
  8. 8. Four Phases of Psychoanalytic Treatment <ul><li>Working Through </li></ul><ul><li>Analysis of transference </li></ul><ul><li>Working through = repetition, elaboration and amplification </li></ul><ul><li>Resolution of Transference </li></ul><ul><li>Termination phase of tx </li></ul><ul><li>Date is set for ending tx </li></ul><ul><li>Analyst aims to resolve patient’s unconscious, neurotic attachment to him/her </li></ul><ul><li>Sudden aggravation of symptoms </li></ul>
  9. 9. Humanistic Therapies <ul><li>Focus on helping “clients” (not patients) to become themselves </li></ul><ul><li>Person-Centered Therapy </li></ul><ul><ul><li>C. Rogers </li></ul></ul><ul><ul><li>Full potential </li></ul></ul><ul><ul><li>Clients can choose what to talk about and provide their own insights </li></ul></ul><ul><li>3 Impt Concepts: </li></ul><ul><li>Congruence – corresponds between thoughts & behaviors of therapist. Therapist does NOT put up a professional “front.” </li></ul><ul><li>Unconditional Positive Regard – accept client no matter what </li></ul><ul><li>Empathy – an attitude of profound interest in client’s world of meaning. </li></ul>
  10. 10. Gestalt Therapy <ul><li>F. Perls </li></ul><ul><li>Person must acknowledge all parts of behavior, cognitions & emotions </li></ul><ul><li>Techniques: </li></ul><ul><ul><li>“ What are you feeling now?” </li></ul></ul><ul><ul><ul><li>Discussing incongruencies </li></ul></ul></ul><ul><ul><li>Two-chair technique (assume roles of others & themselves) </li></ul></ul>
  11. 11. Behavior Therapies <ul><li>Three Main Approaches </li></ul><ul><li>Applied Behavior Analysis – </li></ul><ul><li>direct extension of Skinner’s work </li></ul><ul><li>Fundamental assumption = behavior is a fx of it’s consequences </li></ul><ul><li>Uses reinforcement, punishment, extinction & stimulus control </li></ul><ul><li>2. Neo-behaviorist Mediational Stimulus-Response Model – </li></ul><ul><li>Derived from Pavlov’s work </li></ul><ul><li>Uses classical conditioning </li></ul><ul><li>Tech’s = systematic desensitization & flooding </li></ul><ul><li>3. Social-Cognitive Model – </li></ul><ul><li>3 processes = external stimulus, external reinforcement; cognitive mediational processes </li></ul><ul><li>Person is agent of change </li></ul><ul><li>Assumption = change person’s interpretation of an experience; have therapeutic success </li></ul>
  12. 12. Common Characteristics of Behavior Therapies <ul><li>Commitment to scientific model </li></ul><ul><li>View abnormal behavior as “problems of living;” not illnesses </li></ul><ul><li>Abnormal behavior is assumed to be acquired & maintained the same as normal behavior </li></ul><ul><li>Focus on present, not past </li></ul><ul><li>Tx strategies are individually tailored </li></ul><ul><li>Understanding the origins of a problem is NOT essential to tx’ing the behavior </li></ul>
  13. 13. Cognitive Therapies <ul><li>Rational-Emotive Behavior Therapy </li></ul><ul><li>Albert Ellis (1950s) </li></ul><ul><li>People are born with potential to be rational, as well as irrational </li></ul><ul><li>People can be self-preserving, as well as self-destructive </li></ul><ul><li>Irrational thinking & self-destruction tends to be exacerbated by culture & family (greatest in early years) </li></ul><ul><li>People perceive, think, emote & behave simultaneously </li></ul><ul><li>Tech’s = highly cognitive, homework-assigning, discipline oriented, role-play, assertion training, suggestion & support </li></ul><ul><li>Do not believe a warm relationship is necessary </li></ul><ul><li>Stress unconditional acceptance & close collaboration, but point out deficiencies in behavior </li></ul><ul><li>Real “cause” of upsets lies in people, NOT what happens to them </li></ul>
  14. 14. Two Types of REBT <ul><li>1. General REBT </li></ul><ul><li>Teach clients rational and appropriate behaviors </li></ul><ul><li>2. Preferential REBT – </li></ul><ul><li>Teaches how to dispute irrational ideas & inappropriate behaviors & to become more creative, scientific thinkers </li></ul>
  15. 15. Ellis songs… <ul><li>&quot;Love Me, Love Me, Only Me!&quot; (To the tune of &quot;Yankee Doodle&quot;) </li></ul><ul><li>Love me, love me, only me or I'll die without you! Make your love a guarantee, so I can never doubt you! Love me, love me totally; really, really try, dear; But if you must rely on me, I'll hate you till I die, dear! Love me, love me all the time, thoroughly and wholly; Life turns into slushy slime 'less you love me solely! Love me with great tenderness, with no ifs or buts, dear: For if you love me somewhat less, I'll hate your goddamned guts, dear! </li></ul>
  16. 16. Songs… <ul><li>Glory, Glory Hallelujah! </li></ul><ul><li>(Battle Hymn of the Republic) </li></ul><ul><li>Mine eyes have seen the glory of relationships that glow </li></ul><ul><li>And then falter by the wayside as love passions come and go! </li></ul><ul><li>I’ve heard of great romances where there is no slightest lull </li></ul><ul><li>But I am skeptical! </li></ul><ul><li>Glory, glory hallelujah! </li></ul><ul><li>People love ya till they screw ya! </li></ul><ul><li>If you’d cushion how they do ya, </li></ul><ul><li>Then don’t expect they won’t! </li></ul><ul><li>Glory, glory hallelujah! </li></ul><ul><li>People cheer ya then pooh-pooh ya! </li></ul><ul><li>If you’d soften how they screw ya, </li></ul><ul><li>Then don’t expect they won’t! </li></ul>
  17. 17. A. Beck’s Cognitive-Behavior Therapy <ul><li>Believes how one thinks largely determines how one feels & behaves </li></ul><ul><li>Client’s maladaptive interpretations are treated as testable hypotheses </li></ul><ul><li>Processing of info is crucial </li></ul><ul><li>In psychological dx’s a systematic bias is introduced into processing info </li></ul>
  18. 18. Strategies <ul><li>Collaborative Empiricism – views clients as a practical scientist who lives by interpreting stimuli, but has been temporarily thwarted by info-gathering, biased processes. </li></ul><ul><li>Guided Discovery – discovering what threads through a client’s misperceptions & linking them to past experiences. </li></ul><ul><li>Goal = shift the info-processing to a more “neutral” condition so that events will be evaluated in a balanced way. </li></ul>
  19. 19. Questionable Therapies… <ul><li>Primal Therapy </li></ul><ul><li>Arthur Janov </li></ul><ul><li>&quot;Primal Therapy is not just making people scream. It was the title of a book. It was never 'Primal Scream Therapy'. Those who read the book knew that the scream is what some people do when they hurt. Others simply sob or cry. It was the hurt we were after, not mechanical exercises such as pounding walls and yelling, 'mama'.&quot; </li></ul><ul><li>Subliminal Tapes </li></ul><ul><li>Thousands of videotapes and audiotapes purported to contain repeated messages are being marketed with claims that they can help people make friends, reduce pain, conquer fears, relieve depression and do many other things. </li></ul><ul><li>Many researchers have found that subliminal tapes provide no benefit to the user. </li></ul>