Systems of Psychotherapy A Transtheoretical Analysis Ninth Edition James O, Prochaska University of Rhode Island John C. Norcross University of Scranton Prochaska, J 0., & Noreross, J.C. (2018) Defining and comparing the psychotherapies: An integrative framework. In S)stems of psychotherapy: A transtheoretical framework ‘th Edition (pp. 1-18), New York, NY: Oxford University Press. Moustakas Johnson Library MI School of Prof. Psychology 26811 Orchard Lake Rd. Farmington Hills, Mi 48334 Reproduced with Permission “Sere NOTICE ‘This material may be protected by Copyright law (Title 17 U.S. Code) OXFORDCHAPTER 1 ‘he fd of peyshotherapy has been Fragmented by faze shock and staggered by over choice ‘We have witnessed the hyperinflation of band name terpies dasig the pst sity years fn 1959, Harper Went 36 dlstnct systems of pychotherpy: by 1976 alo dzeoverd more than 130 heaps Inthe theapeute market place os pehape more approprinely the "jungle place” Recent estates ow put the sumer st ‘ve 00 an growing Pens, 211), The rolirationetherapleshasbeenaccom nied by an avalanche of ral chime Each ye fer adverts sella diferently eflve ‘nd uniquely aplcble, Developers of ae ye tems ually aim 80% o 100% sce, espe the absence of controled outcome reerch, 1A healthy diversity has detente into a0 Uuaeskty chaos. Stadents, practitioner, and patients are confonted with confurlon fag Ireratlon, and dsootent With 0 many ther apy systems claiming success, which theories ‘Roald be studied taught cc bought? ‘A book bya proponent of «particular ther spy yatem cn prove quite pentasve. We may ren find ourselves using the new Ideas and ‘methods in practice while reading the book ‘But when we turn to an advocate of «aly diferent approach, the confusion returns Tistening to proponents compare therapies does itl or or conuson excepto conkem the rule that tose who cana agsee on aie assumptions are oen reduced 1 calling each ‘her eames. ‘We believe that fragmentation and confusion in paychotherapycan best be educed by com parative anal of psychotherapy gts tha Highligh the many smilartes actos sytem ‘without busing the sential difference ‘comparative analysis requis rm under- standing of each of the odvidal epee of ‘therapy to be compared. In discusing each sytem, weft present x cnc example and Induce the developers) of the system. We teacethe syste theory of personality ast leads touts theory of peychopathslogy and cuits ints therapeati:proceses,therapeatic content, and therapy eellomip. We then fete the practicalities ofthe pachoterpy Following Summary of cotolld search on theft: es of that system, we ree central citlsms ff that psjehoherapy fom dere perspectives Each chapter concludes with an alse of the2 same patent (Mis. C) abd a consideration of fate nection Tm ouline form, or examination ofc py. chserapy system follows thi forma Aclinical example Asketch ofthe founder Theory of eronalty ‘Theory of psychopathology ‘Therpetic proces “Theapeutc content “Therapeutic reatonship Practica the therapy Efectivenesof the theca CCeficoms of the thay Analisis. Future dzetons Key tems Recommended readings Recommended webs In comparing systems, we wll sean eugea- tive modelo demonseate thee smarts and sirences. An imegratve model was sled In part because of i spit of rapprochement, seclang Wot wetland cova I each her “pyayste cahe than looking for what ost ‘uly ciczed.Integaton also represents the mainstream of contemporicy payee py. Research consiseny demonstrates that Integeation s+ the most poplar riettion of mental hea proesonals (Norse & ‘Alesander, 2018, Lacking fn most Integrative endeavors is 3 counpechesive model for thinking and working ‘eros toms Later inthis hap, we present fn ntegative model that is ophiticsted enough to do jusice wo the completes af ppchother ap, ye simple enough to reduce confusion in ‘the ld, Rather than bang to work with 50. plstheorscurntegeative del assumes that Aimed numberof proces of change under liecontempocay systems ofpjchsheray. The ‘model further demonstrates how the content of therapy canbe rece ofour dierent evel of personal fintoning, Paychotheapy estes ate compared onthe paricular process, combination of processes, ed to produce ange The sjtems ae ako ‘impared on how they conceptualize the most commen problems tat occur at each lee of Sytens of Pychoterey pervonal functioning, auch at fw slestem, Teckotitimacyandimpulse dyscontol Becase liniane are concerned primary with the real problems of act! patents we do po Uk our Comparative anaes merely 0 concepts and dat Ouran alo ince camparsn of how each major te conceptunies nd ests the came complex cet (is C. ‘We hae ited ur comparative anabss to 15 major systems of therapy Spies have been ‘mite because they ser fo be ing at ‘eat an are be et undisturbed besa they reso pooty developed that they have no Iden- ‘ible theo of personality or pchopathl- (ogy, ee Beas they ae primar variatlons on ‘hres lend considered inthe book. The fia fteren for excason I empical No therpy ‘ptm eat exuded if leat 1% of American ‘mental Rath professionals endorsed it as thle Primary total orientation, Table 11 m= Imarze the sleidented theoes of nical psjcholopss,couniling paycholopits soil ‘workers and counselors, Defining Peychotherapy _Anappropriate opening nove peychotherspy textbook would bet deine psychotherapy the subject mater isl. However, 20 singe dein tion of peychathrapy has won universal accep ‘nee Depending oa ones theoreti oretton, psychotherapy canbe conceptualized as ite Detional pasuation, heh cre, prychoroil ‘eucation, profsionally coached se change, Tehaiorl technology, 3 form of repsreating the purchase of fendslp oe comtemporary varlant of hamanism, moog others maybe fase o prc psychotherapy than o explain tor define (London, 986). ‘Our working defi of psychotherapy is as flows (Noro, 1990 Photeap he rm iets pp ‘aon of cal methods td inerpernl aes ese fro ested poche pcs forthe pupae of eating poe mol it behavior cogiiony moon anor ete fer soa characters in dcns at he partes ‘een dea. ‘This admitedly bond defnion s noneths= less reasonably balanced one and relive Defining & Comparing Payhotherpes ‘Tile Theor Osean of yhoo ies oe xis ae em copie a enact ra etapa . inept a dare ” static ™ apt * Paxton i oper Coed » sys ote » “Era Ral oh Rl No a 2 Gece a Sc Ra etel one i tems af theory and method, We he, or example, no specie the number or compontion af the pertipenty diferent theories and lets cll for difesat formats. ‘Simiarythe tsining and quaiicstone ofthe psjeodheapst have ot been dalneated. We recognize multiple processes of change and the ‘muldimensonal mature of change no tempt fesmade bere to dsm the methods or content of therapetic change. The requsement thatthe ‘method be “rive from eral peycho Jogi pints” slice broad o permit clini andor research aio ‘Our definition alo explicly mentions both “inkl methods and Interpersonal stances” 1 some therapy systems, the active change mechani ae ben construed a 4 eaten method n other stems, the therapy ration ship has ben teed ax the primary source ‘of change. Here the interpersonal states sod ‘experiences ofthe therapist ze placed co an qual footing with methods. nay, we Bly belive that any activity eine 2 psychotherapy shuld be conducted ‘only forthe" purpose of sisting peopl towards ‘mtuallyagred-apon goals, Otherwise—though ray be labeled prychoeherapy become & tube form of coetcon or pusihment Counseling Soci Workers Couns Pcs a “The Value of Theory ‘he term theory poseses mtipe meanings Inpopular wage, theory scared Wh prac” ‘ie empiiciam or certain. Inasetiile, theory is general defined a et of staterents ted fo explain the data ins given ate (are Goodson, 1976). ln psychotherapy, a tbery {ocsysem) isa consistent perspective on human Tehoroe prychopaliclogy aad the iechnicns ‘of therapeutic change. These eppeat to be the recent, ot peraps not sien, fentres ‘of psychotherapy theory. Explanatons of per Sonal and human development ar fequenty {acladed, bu, a we sal sein the belo, onsrtvt and integrative therapies, are not ‘haracterii ofall heres ‘When colleagues lara that we re revising cour tenbook on psjcotheragy theories, they fccasionally question the usefulness of theo: ies. Why not they ask, spy produce 3 wat fon the actual practice or accumulated fats of eyhotheapy? Our response takes many ors, ‘pending on our inood atthe tne, but goes something like this One fut way 0 lear shout psfeotheapy ist lear what the best ‘minds have had to ay abou iad to compare hat they ay. Fare, “able tet llroby sever be tained in peychatherpy, epi Imps sdvance i our knowledge fund despte a age body of research, Instead, ‘eory wlalwapsbe et us to provide tenting pprouimatons of "the rth” "Without guiding theory or system of sy shosherapy, clinicians ‘would be vane, Aleectnlescrestres bombarded with tery hundreds of preston and pecs of forma in in single session, fit move urgent to sk shoot ery memories, parent elstonship cs ‘meaning, disturbing eins, emronmental reinforcers recent cognition, real coals, ‘or vnmething cle in the Set otervew? At ay {ven time, shoul we empathize, direct, ech, ‘modal support, question, retract, inerpe, enon, or eminent na therapy seston? ‘A pohotherapy theory descbes the dina Phenomena, delinis the amount of relevant {nformation, organizes tht information, and legates i all toa oberent body of kno edge that pores our conception and det out exec, "Tne model of humanity embedded within 1 paychoterapy theory ls not merely a pil sophia issbe for purists 1 affects hich human capaciies wil be studied and ul vated, and which vl be ignored and under eveloped, Tresment inevitably fallow fom the clinicians undeying conception of patho ogy health, eal andthe therspeatc process (aadin, 1988). Systems of therapy embody Ailerent visions of life, which ipl diferent posslives of human existence (Messer & ‘Winok, 98) Te this regard, we want to spurte the mis conception tht psychotherapists aligning them Seles with a partial theory are unig Idap thir practices to the demands ofthe sit tion andthe patent. A voluntary dein to Intel oneself an adherent ofa theory doesnot onstutes etme commitment of tit adhe: fence or dogmatic reverence (Narr, 1985) {Good cniciane are exible and good theories, are widely appeabe, Thus we see theorles bring adapted forse na variety of ont and this view the edatonsip Is npetant because Systems of Paycotherpy 1 brings the content of therapy (the patent: feterpesoaal bebavioe) right into the consul Ing room. The content that acd to be changed thas cers during therapy. ae than the pe fon fcung on tes tt osc ote of the ensuing reo. Tnlight of these varios emphases onthe role of the therapeutic elaoship, wil be ne tssry fo determine foreach therapy sytem ‘whether the rltionship I cncated as (1) _preconion for chang, (2) proces f change, Sndlor (3s content tobe caged. Moreover ach chaper that fallow, we wl consider the ‘late cootbuton ofthe erp ation ‘hipto treatment sce a wel asthe tberpst Ibchaors designed to faclitate that rains. Hawthorne fect Paycholgits have kote for yrs that many people can impor in such Behave a8 Work ‘ut solely arent of having speck ten {on eld to them. Ip the cassie Hawthorne stuns Bomtlaberge Dicken, 138) ane {Mets of imped lighting on producti 2 factory, participants increased ther outer Teng obseried laa study and receting eta attention, Usually such improvement assumed ta be due to increases in morale, novel, and ‘teem that people experience fom having th fe allend 1b thea phenomenon that has ‘ome tobe known the Hawthorne ef. ‘One commonality among all paychosoch testments ir thatthe theres pays special sitenton tothe cleat Conequent steton Ins been sumed o be one of the comma fc tors that impact the sucess of therapy. Anjone ‘who as Been in psjchotheapy can aprecl- Ste the gratifcation that comes fom having & competent profesionals undivided tention for an hour This pei stenton may indeed inftence the couse of therapy—inclading ‘hose occasional esr in which patients do not Innpeote becuse they do aot wat to sseender such special atention Resarchers ba request Souda alten tion does indeed lead improvement, regard lea of whether the attention i lle by any ater therapeutic processes. In cise study (Paul, 1967), 50 of pubic speaking phobice demonsvated marked” improvement i their Defining & Comparing Paychotherspiee symptoms by ite of rceing an tention Plactto intended to contol for sonepectie {sabes sch as ateton (In pychotherepy $udles placebo conta group everest. ‘nen hat mimics the amount of tmeand ote tion eceved bythe paychoterapy group but {hat doesnot havea speci o intended ec) ‘Yas of eearchdemonstate that tention can ‘ea powefl common ator others 1 concade tht any particular pschother ap s more fective than an ate placebo, iienecernsy that erate nce conta for ateation eects o simply the pase of tne. Tri not enough to demonstrate + parla therapy beter than no tetment, Beause the improvement rm tat parts thera ‘ay Be deel the atti hen tothe PMGeverl resch deigos ate ane to mea or ental for the eft of atten inpayhotherpy: The most popular desig ito Use placebo groups in Pu ty; In Wich cil pas we gen ch te tn proces degre fo produce change, AN alerate design Io compare the effective is fone estiment wih that of enote sch 2 pychodynamlc therapy with cogatve he Sep. onetheapetc pproch doc bette than the other we cn conclude that he diferent Improvement due o more thn js eteton, eure the le eet tester ncaded— and therfore controled forthe eflects of Aten. However, we do ot know whether the fess fective therapy is anything other than placebo fle, even iit ao grester ‘improvement than 0 estnt ial sch comparative studies both therapies end tong nino improvement, Bar nee therapy does Beer han the other we cao! conte that thetheapes rearing more than Hath fits, less an aterton placebo control bas Abo been inched nthe st. To be con ‘ce cone evation oft phates ‘icy studies mux Include cords forthe awn fest and rete factor Other Commonalitis In his clase Persuasion and Healing, Jerome "Frank (1961; Frank Fra 1991) posed hat all pychotherapeutc methods are elaborations tnd varatons of age-old procedures of pyc Togial healing. The feature tht iingsish pajchodhoraples fom each other, however, eceve spec emphsis in he pluralistic comme pelive Amerian sacey. Because the pres tie and financial security of prchotherapits hinge on the showing that her particule sy tem ls moe success thn that of tela, Tle glory har tesdionaly been seconded to the Wdentifeaton of shad or common ‘oonponents, "Frank argues tar therapeutic change is pre ominaelys fonction of common fotos 3a ‘emotionally charged, coniding elton healing sein 9 rationale or concepts Scheme; anda therapeutic ritual. Other co fensval commonalities incode an inspiting fd wocly stationed therapist epportity for catharals acquis and practice of new behaviors exploration of the “ianer word” ofthe patient suggestion; and Interpersonal ening Geneve oon, 99). Now by all therapies seount for an appreciable mount of obierved improvement in cent So powerful are thee therapeutic commonalities that some cians hate proposed explicidy common fstorso principles theraples which tee consider in our chapter on eteraive Thea) Specific Factors At the same tne, common-factoes theorists recognize the value of nique or specie: Factors in disparate psychotherspis. A psy shotherpst cannot practice nonspecifically Specific Techniques apd relationships Al the treatment hoor Indeed, research has demon HMtated the difereatialellectivense of afew therapies with spect disorders, such as expo- sure therpies for severe anieydisndes patent management training fr conduct prob. lems and systemic therapy for couple confit Asa dicipine psychotherapy wil advance by Integrating the power of common factors with the pagmatics of specific factors. We 208 turn tothe processes of shange—the reaieiy spectic of unique contbuuons of «therspy stemProcesses of Change ‘There ees, a we sid eae inthe chapter, smtexpanding moras of prchotherspy theo: tan endless prolifrstion of spete teh igus. Coasier the reatvely simple cst of tmking cevation: In one of oar ea studies, We Heated more than 50 formal estes employed by heh professionals an 130 dite techniques asd by socesfil self cangers {0 sop smoking Te there no smaller and more lnvligile rmevwerk by which to examine aad ‘compar the pycotherapes? "The tranaheoreticalscrostheries— model redoces the therapeutic morass 10 a tmanagable mumber of change roceae There tre Ierally hundeds of global theres ofp. hotherapy. and we wll probably never zach ammon ground nthe hereto phulosoph ical resin Tere are thousands of pei oh niques in paehethrapy.and we wary age ‘onthe sess, moment to-moren metho 0 ‘ey contrast the processes of change rep Sata mide evel of bstraction betiren global Theorie (auch as poyehoanalsy, coal, abd Ihumanisle) and specic techniques (uch as dream analysis, progenive muscle rataton, and famly sulting). Table 12 Musas thls Ievermediate level of abstraction represented by the processes of change. 1 at thir intermediate level of anapsi processes oF peices of ehange—tha mea Ing points of convergence and contention ‘maybe found among paehotherapy systems. inal a ths intermedi evs tht expert py ‘hotherapis ppl feral hei teatnent lans—notin terms of lal theories or specific techniques but as change processes for thir chet Procese of change are the covert and overt cules that people use 10 ate emotions, ‘thous, bebviors oF relationships rested toa parle problem or mote general paterns of “ele L2 Lee Abatin ‘Stems of aychotherpy sg In fener woud, the processes archow peo le change, within pycoherapy and becween ‘herapy Sesion. Thee proces were died theoretical rom a comparative anal ofthe leading systems of prchothenpy (Prochasks 1979) and were confiemed erally by mul ple stds summarized in Chapter 17). lathe following etons,weitroduce these processes fchange ‘Consciousness Raising Traditionally, increasing an indiduals cone sciousness has been one ofthe plme change proces” in_payshotheapy:Conslousnest fabsing. sounds contemporary, yet thepists from avareyof estasonshave ben working far decades ireae the coneiounes ofc es, Begining wth Freud objective “to make the unconscious conscious” all scaled night paychotherapesbepn by working to cals the Tedivideals level of eareess, ts Siting that the insight or avareness therapies vor with onslosnet, hich frequently viewed a4 3 Thuan characters hat exerged with thee Taio of language. ‘With Language and consciousness, burans oot need to esp relexvely to every sie ulus For eanple te medhanil energy om ‘ad hing against our back does nt cause {stored wih morementInlads we roped ‘houghflly 10 the Information cootalned In {hat lowe, sac at wheter the hand toh Ing usa iendpating us on the back, het geabing us ora pare iting ws. To respond ‘etl. we process information to guid sin ‘making response appropiate othe station, Consciousness raising Deeps incre the tnformation aval to indi so they can ‘ake e mos eect sponses ie For each ofthese process te psebothere pie ocus an be on podcng change either in igs ‘loa eo hod Media Change proce, consi aw Clasetecbognes mer mani Gok bao snes eg coutreononing a, no chic emer Defining & Comparing Paychotherapes ‘he inaivdulsexpvienceo in dhe tau ‘tvironmen. When the nfermation gen ach ft conceras the indvidoaTs own actions and ‘aperiencen, we cll that feedback, An example ofthe feedback proces occured in the case oft [Reem and proper middle aged worn who wt ‘anaaeof st bow aney she appeared ool fs She could not connect er chiens ao nce of er of her recent rash of ulema cleats with rage, because she Kept isting ‘hat abe was not ange. Aller ewing videotapes, otherself iterating with member of psycho therapy group however, she was stunned. All he could say was, “My God, how angry T seem tobe? ‘When the Information gien a leat ca eco ensronmertal events cll this ech on. An ample of therapeutic movement de to educaon happened in the case of an aging rman who was dseesed that his tine to tan frectins and reach orgams had lncteased otiesby ove the years. He was ery reine ‘when he learned that sucha delay wat nora neh ee Deferer wand off tretening information shout cures in response to eduction and feedback These defese mactaris ave like Diners or “rose-colored gases" that selec tively tend oly to postive information and ‘goote negative Ina’ Cogative Binders pre ‘sent individals from increasing their com ‘clounest thou feedback or edustion fom smoutsde party. Fo example, my (JOPS) wil, who also a payehotherapis,confonted me with the fl Towing information that made te aware of my blinders: We weve trying to antpate eho Veo be on each other ist of exalt: tive india 1 was absolutly sue that my fest three guesses woeld be high on my wie lsc When T sald a flends name, my wie laughed and said that she ne lye thought ‘that but she wast atracted to him, She ls sid that she was now certain that heel was ‘ntl. My nex two guess were also wrong, ‘butmy wife quickly and covrecty guessed dat Tu thee ives tractive Iwas amazed 10 realtehow much U had een projecting over {he years and how my projection kept me from belgaware of the quaites tn men tha ey wife found appealing ow can our awarenest lead 0 behavior change? Think of our comtiousnes at» Beam ‘flight, The information unavalbleto uke 2 darker i which we cant be lor held back, ‘oF directed wthout knowing the sarc o the Inluenes Inthe darkness, eae Hin we do ‘ot posses sult ight or light gle us ‘ffeciely in ou ves For example, without being sae of ow oping normally eects tx al esponse an aging man oF wan) would ‘ot naw whether the best detioniould be to ‘dimithe or sh) was ver hell angve upon fer to eat to raster day a a aphrois lag totale Viagra, oF to enjoy ls orber present thavor witht ving up some media ere ype ofexualty, ‘As we wll se, many psychoterapy ss texte age hat people can change arena of faledconsousnessincrewing experiential tr extirenmestalinfornation presi una "alae tem The disagreement among these onscigonescssng pychotheres les whlch concrete techniques ae mest ectiein Cathars ‘Catharss as ne ofthe longest tations as 1 change proces and rel tthe therapetic ‘elas of pet-p feelings. Te ancent Greks ‘eve that expresng emotions mas a superb ‘mechani of proiding persona rel and chavo improvement. Human sufering was, suite erly le cut In contemporary termi “Tecit go etitg, cast hold back apymare as sing nn the Dine fn Foc Historia, cars used a hyde model of emotions, n which unaecepable isons Such as anger, gull, or aaisy—ae Backed from det expresion. The dating of of sch colon resus the presureseing leas, howerer Induct, ae when anger b expressed somatcaly through headaches, If enoions cn Iereleased more detly in poyehoterapy then their resertoi of energy i dacharg, and the eon le fieed fonts wurce of seams. Tn a diferent analogy, the pent with locked emotioes seen a molly cont pated, What these pants need t elas 5 {good emotional bowel movement this nal gy, psychotherapy serves ab a pychoogeal0 nem that enables patents to purge ther eo Hoa! blockage The therapeate proces is med at helping patients brea hough their “motional locks. By expresing the dark side of themselves inthe peesnce of another cles «an beter acept such emeions as matural phe ‘omens tat need not be ao severely ental ‘nthe fur, Most fe, his therapeu peocess as been the level of indvual experience, in which the catartweactons occur dec win the perion. We sal eal thi frm of catharsis om ectve emotional experiences. Asthe en su fests an intense emotional experience prodocet { papcholgilcorcton. el clinician rested a atari expe eae stra ears ago when she as fightog fe bout of depression. She was stageing to fet in tuch with the source of her depreeon, £5 she tonk mental health dy off fom ork ‘Alone at home, she put on muse and expesed he feelings in fee form of dance that she ‘oul perform only when no one le was pes ‘enced childhood rage toward her mother for seas being on her Back. She soon let here apt er ltene anger by tang he louse ‘oshrds By the ume her parte arived home, the fel elev and eened along her pat ‘et ooking atthe destoyed House, wondered ‘loud wheter she a lipped “The bel that caarticreactlons can be evoked by observing emotion scenes in the fronment dates Back st let to Aries ‘ertngs on theater and music In honor ofthis Tea, we wil allthis souce of catharsis dramatic rei “A patent suring from headaches, nso nis, and other symptoms of depresion fund Tinsel weeping hewaly during Ingmar Bergman mere Scone fom a Marioge. He ‘epan tocnpetene how dappiated be asin ‘mse for having traded a satisying marrage foe secu. His depresion bean ot because ‘ofthe ingplatlon he fk fons Borgia to leave ishopeleiy devitalized marrage Choosing The power of choice in. producing behavior cunge has been in the background of many Sptems of Psjcotherpy payhotherapy tems The concept of cows Ing has lacked especabty in he hgh eter rinitc worldview of most scents. Many ‘lniane have not wanted to provide am ition for thee eae secustons of ender tindednes by opel discussing feeder and hice Conseguent, we wll se that many therapy syne mpi siune that cents wll choose to change as ares of pochoog Cal trestment but do notarial he means by ‘which ents use the proces of choosing "Wilh so litle open consideration of choos Inga «change proces (with the exception of eiteotal and experiential there) is ro “lead tial to point how choice ope tet in poychctherpy. Some theo arp ‘oie ised, bees to edace choke to ‘other events ist advance he parade tht ch ‘refs determine our cholces Human ston Is ‘cen a frely chosen, and to sy that anything ‘lee determines our choce et how ba lth {in oracles a fe beings Few clinicians, hoe. er, accept such a radia view of feedom for ‘hei art thy Ble tht rns’ eons lt cote, Froma behavioral perspective, choice would bea patal funciona thesumber ofalemative responses avalble only one respons aval Ae, there sen0 choi. Frm a human er ‘pect the numberof alate responses cat ‘daly increse if we become more consis of erative that we have not previously on Sidra. For a vary of poycotherpy sytem then, an increase in choke Is thought 1 result from an increas in consciousness, “he feed to choose as tradtonall been ‘omrved as unigely oman behave made ppassible by the sequen of consciousness ‘that secompanies the development of language Respensbllty 6 the burden that accmpa- les the sarees that eae the ones able to despond, to speak foe ourselves. Ivar that choice and responsiblity are posse through Tnnguage and concousnes, i ems ony a ‘rl thatthe therapeutic process of choosing s 8 ‘esha or awarenen process “The eaten choker flow ffom accurte Information procsing that ental an swat. res ofthe consequenees of partial alterna thee Us menopausal woman wee informed, for example tha hormone replacement therapy Defining Comparing rychotherspee (CART) crema caused cancer inal women, them er best alternative would be to flow the infrmation she has ost proces. Wh ART, Iowever as with so many lie decison, we are sot avareof al he consequences of cole and th consequences are rarely abot, In these stations there are no defi external gude= Ines, and we ae confonted with the possi fn of choosing a alternative that might prove ‘erie mistake Then our ability to choo ‘ore carly «function of our aby to accept Sets nore in eng eon ‘An example of so-called existential anxiety vex sce in eallege stent who consed me About the panic atacks she was experiencing since the informed her parent ofher unplanned Pregnancy. They insisted that she get an abo Hin, but sb and her husband wed to have the babe They were both stadens and ecrey dependent om ber wealhy patent for Sane ‘support Her patents had informed ber that the consequence of hating 2 baby at thi ine ‘ould be danhertance, Beaute they baled ‘he would not finish college once the had a Baby In 21 yeas she had ever openly difered swith er parent and although she was con trolled by ther, se ad el protected bythe aswell Now ater afew psychotherapy sessions, the became more aware that er pane attack telested her need to chao, Her baie chee swat not whether ake eas going sacriice het fetustoherfamlsfrtune, but whether she was ng to cotnue to scrisce ere ‘AL an experiental level then, choosing favales becoming avare of nev aerate, Including the deliberate creation of ae aero tives forlving Ths proces alo lvoe expe cing the ansetyinerent in being sponsible forthe choice, We wl ell this experiential eve of choosing a move toward sel iberation ‘When changes nthe envionment make smote alerativssvlable to india soc ‘as more jobs being open to gays and lesbian, Se il eal this + move toward social ber: tion, Psychotherapists Working for such Soil change are ually called advocates, ‘With the exception feminist and miu tara theories ayers of paychotherpy acy ‘embrace wcllberaionasachange process vith ‘lens informal wy. Paychotherapy generally targets change In an individ, couple oF 8 fal nota entre solely. Noaetheless, most pyehotheapiss doin fact advocate personally for bowler steric changes tn, for example, acess to metal health cae, improved socal justice and broader human ight (tlre 2013). We Unt oursehes in this text to thse pychotherapy system thet te socal iteration 8 part of ther change proces and weaent Contact dre with patent ‘Conditional Stimuli _Athe opposite exteme from changing through ‘hooting is changing by modifying the co “ional. sill that contol our responses. ‘Akertion in conditional stil te inde ‘when the indvidls Behavior Is sited by asic (Psvlovin) condoning, When ros besome responses are condone, then beng conscious of the small vil rly proce ‘hangs, nor can condoning be overcome jst by choosing to change. We nee, literal 19 ‘agin either me can modify the way we Ia in response to particular snl, or we an mosify the environment f9 mime the probably f the small curing Changing ‘ur Bebvior tothe stile known a eu tercontaning, whereas changing the eer ‘ent voles timate control, ‘Counterconditonng was used inthe teat ment of @ woman with a penetation phobia ‘who responded to icterourte th svolotary ‘muscle Spasms. This condition, kaon as vag isms prevented penetration, She il no an {to mediy her enionment, but rather to change het responte to her partner. AS in mos oun tercandoning cae, the procedure tovaled « wadual approach to the condoned stimu tas ofinercoure wl learning en tncompati ‘be respoase She ese elma, which was ‘compatible wih the undesired ankety 20d ‘usc spasms that had previosly been ied byinterenire. Countercondioning is esring {Odo the eat oppste—rdasation instead af nse atertion instead of pay exponire Instead of avidance, or expe ‘Stim contol ents testrturing the vizonment to eedice the, prbabliy that ‘partisan conditional stimulus will occA high-strung college stdent sled fom 2 host fansisty symptoms, including considera Me diaress when diving his ear Whenever the ‘a began to shake i the slight, the stadent ‘would also begin to shake, He tebe this problem toa frightening episode ear inthe Year when the univer ant on his car broke With a staring nize. Not once but thee mes Ie broke before a mechanic dcovered that the rea cause wat 8 bent drive sha. Becaase the problem proved a function of coadtining ‘ountercondtoning was deemed he tretment of choice, Before the testment at under way, however the sent raed in hiscat for aan Because bia reqponte dd ot generale to his van, he solved his problem though his fon simular contol procedure. Himiating or avoiding environmental cues that provoke the problem: behavior i the core of similar contra. Contingency Control Tehavior x contrled by i consequences, As ‘ost of us have lawaed, a response ela forced, then the probably ofthat response Is fnerese. Ion heather and, 3 ptahnent follows a particular response, then we ate Less ly to emit that response. Ar BF Skinner ‘demonstrated, changing the contingencies gov ming our behavior freer least hanged behuvon. The extent to whlch a particle rei forer or pnishercontas behavior sa fan tio of maty arable, acuding the immediacy saliency and. schedule of the consequences, From hunmansie and cog points of ve sn individuals valuing ofthe consequences Is “Ibo important in eomtngeacy control TW bebavior changes are ade By mod sng the contingencies in the envionment ne call his contagency management. Dab, hey behavior ar flowed by reinforcement In select cases, undesirable, pthaogial be eer ae flowed by punishment ov example graduate stdent with a bash fal bladder wanted to increase his use of pub le restrooms he alo wanted more money #0 Impros is sty of ving. Therefore, he made a ontngeny contact with pe JOP) that eared ‘im two dlls foreach ve daring the week stern of ayhotserry he write ina public toon. am pleased to sSythat ost money on that case Seldon have Beha Hheapsts considered the alleratve, but there ate fective meant to modify our behavior without changing the “onrequenesthemicves, Modifying ou nr ‘al reaponees to external consequences Whe ‘out changing those consequenes wl be called ‘evaluation. ‘A phological shy man desired a lato ‘hip wih 3 woman bot avoided aking anyone fut because of his nlption that he would be ‘ected. Aer several intensive dicosons in Pychotrapy he began to acept that when 3 Woman tens down date tira statement abot Ievand not abourhim, Wed aot koow whether shes wating for someone ele to ask Re ot, ‘whether she does lke mustaches, whether ‘he iin a committed satonehi or whether She does know him well enough we simpy dont know what he sping no sys abou i. ‘Alter evaluating ho he woul inert bing turned down for dat the fll Began ak lng out women eve thoagh he war ted on Ife request fr a date The eater conse. uence of his behavior were the same, bathe Teetalted thelr personal meaing. Thal’ the hallmark of cognitive therapies Change your ‘hiking and thereby change your behavior. Initial Integration of Processes of Change A summary of thee change proces it pre Seated in Tbe 3 The processes of eonsiou es asng, catharsis and choosing represent the heart ofthe tration ugh or ware: ness peychotherapies, including the psycho tmalyde, existe ad humans trations ‘These prychothenpy systems focus primary fon the subjectne pects of the ingiidoa— the processes occurring within the kin ofthe ‘numa. This perspective onthe ind fds greater potential for inner-deted changes hat in counteract the external press fom the The process of ondtoal simul and con tungeney conta repeeseat the core of aeion therapies, inching thove Jn the bebo, ogee, and syst traditions. Ther py Shotberapy systems foci primaaly onthe ternal and erronmenta force tha st iis Defining & Comparing Pryshotherapes ‘Tle Change Pacee at Epes and Fone Les ‘re night Tepe Experiential ered pert coetine anal xperenes Choosing aperitif eration nelle soci bers on the individuals potential for inne ange. These processes are what the exes tahte would eal he moe bjective evel ofthe ve, trastheoretical model sug fess that t focus only on the awareness pre {ese of conslousnes,cathars and choice ie to act a if nner nectednes i the hole pte and to ignore the gensine hie the ‘ronment pets on inidoal change. On the other hand, the action emphasis nthe snore objective, entronmenal processes ser us ignores our potential for inner subjective ange Am Integrative model posits tate sythesis ofboth avarenent and action process provides, ‘mote balanced ad elective psychotherapy that over alngthe coninaoas dimensions of er ‘oar conta, subjective to abet unt tng and selnitated tn ensronmertal-indced changes Integrating the change process alors amore compete picture of humans by accepting fr potential rane change while ecogeicng thelimis imposed by eneronments and continy ‘gence. In Chapter 17, we ll mmarze the "starch evidence for these processes of change snd ur transtheorecal mode, Before completing our discussion ofthe pro cesses of chang, we offer to aditonal cm ‘ents about them. Fis lease do not confse ‘he change process with components of spe die therpy sptens, Consciousness rasig, otingeney conte, and the oer processes Se not methods sopgete by speci theoles, Rather, they ate gene change states hat 1s mor Behavioral Teas ere ee: coteronoing cat across may theres. Second the nas of ‘pany ofthe change proceses are probably ew to yeu, Bat rev assed that you Wl eowne familar and comfortable wth them a you move through the remainder ofthe book “Therapeutic Content “The process of change ae the dnctive con Iblis of sytem of poychotherapy. The ‘content tobe changed in particular theapy ‘stern ia age a eareyoer fo hat eye theory of personality and_psychopathobgy. Many books purportadlyfctsng on payin ‘therapy requ confuse content and pros. “They ind up examining the content of thes, ‘wich Une explanation about the change po esses. Asa consequence they areata Oks thre of personaly her has hei of Paychotheapy The datncion betwee proces and cient Inpsyhotheapy fundamental Ase shale, Peptotherapy systems without theories fpr Sonal ae primary proces theories an ave fee predetermined concepts about the coment therapy. Behavioral nepal, stem nd ‘oftionfocised theres atempt to caplne ‘the unique pect ofeach ene by esting the imposdin af formal content (Hed, 1991. Other stems, suchas Adlerian extent nd ‘uture-senstive therspes, which adopt cinge process fom aher therapy systems, primal ‘dees the content of therapy. Many ste of ‘therapy life primary in thei content wile greg on the change prcese.Put dienty, theres of personaly and pichopathologytll_us what needs tobe ‘hange theres of proces tll us haw change Bovanse prychotherpy sjsems espouse any move diesences legaing the content of therapy prover more ileal 0 being fwd and interation to this fragmented fila (A rereshing gaie i Mads (1986) compare tye moda fr personaly theories, We have ‘Map pars of Mads model in syathesiaing tnd pitting the vst aay of conent—the ‘hatin psychotherapy: "Moat therapy syueme asaune 4 cont view of personaly and psschopathoogy Some ‘nfict-eiented systems belewe peyehopaal- (ogy resus fom confit witin the nda. Forte weshallusethe term inapenonal con ‘lets, ndcsting thatthe competing forces exit ‘tin the person, sich a # confit between dese to be independent and fears of lesvng home. Other therapy systems focus on iterpere sonal confi, uch ab chron disagreements between s woman who likes to save money and aman whos to spend money. Another group ‘ftps focuser primacy om the cols that occur between Indvoal and sci ‘We sal eal these nid acl confit ‘rample the tension between vig ab openly {yl and the fear ostracism that may ret from hamephobia rally an lnctesing ni ber of herapesareconcered wth ping ind- ida go beyond conflict to atin aiient. nur Integrative model, we assume that ict? dyfunctions emanite fom conflts diferent lees of personality functioning. Some patents press inteapersnal confi, others evidence interpersonal confit ands ther te in confit with society. Se cents have resold ther principal confit and tn to payshotherapy ith quesions a to how they ‘on best cates more fling existence, "Benit pitents are troubled at diferente els of funcuoning, we wil compare the psycho- ‘therapy stems in bow they conceptualize and tect epi probleme at each level of cone. Atte [ntrapecsona eee wll examine how ‘ich thenpy system addresses conflicts over ltnslety and defenses, celeste, and personal respon Al the interpersonal level we wll ‘conser problems with intimacy and sexily, Systems of Prycotherpy communication, hostility, and interpersonal ono. At the indi soialleve e wll compare their perspectives on ajstnet versus teanzendence and unpale onto. Af the level of transcending conic o faleat, we wll amine theultimate quests of mening in ‘Meand the dea person tht would emewg fom succes pyehotberapy. Table 4 summarizes the therapeutic conten occuring at dierent levels of pesca one diferences abound over whether par ear peobles—such as adie, mood, and ‘eltonshipdrorders—ae most poftaly co epuaized as intaor Interpersonal confit “Ths, we expect isagrement over ou aig ‘ment of problems ta partclarlevel of person- ality fantioning Any viable dheor of personality can educeall pychopthoogy to ge lesel of Faetioning {har the theory assumes tobe cial For exam lean intraperional theory an marshal 3 con ining cave tha sexual duorders are piarly Ave to confit thin individuals, sch acon Alcs betwen sexual destes and performance nxeties By contrast an individ: soil theory Cou summon a cobetent argument that sex ‘a disorders ate priary duet the inevitable ftenoadiy Tapes le 1 Ant 1 Stamens ha pny nny ny Hoty ‘cm fais 2 rds nie 1 Auer and Sng ‘toronto Henig ‘te apee Defining & Comparing aycotherpie teosons between an individuals sexual dsier ta society's serua prohibition. Our intege te asamption thats eampratie analy of payhotherspes il demonstite tha prtular "ems have been expel ese in concep ‘alaig and testing problems related Yo thelr level of personality theory, a compatig psychotherapy systems, Wil scorer tat a theory’ level of personality wl Tagely cate the number of poole ia tbe oe sulting room and the focus of the therapeutic transaction Ia thor focuses on itraperional fnetioning, then the therspy is much more Ike to werk sly wit the nv, bees the bal problem is astumed to Le win the individual by cota theory concentrates ‘on Interpersonal functioning, thes i mace likey vate or more persons in conc, sucha a couple or fly member. Prychotheapies Tocing on individ social cont wll werk to change the cles, $f the therapist’ aes are on these of main stream society. For example, kn working ik & pedophile who experiences no inne coafct cover having setual tdaions wih cde, ‘rapist wl yt change the cent in that be ‘serait values converge eh society val ‘er that euch sexual Behavior fe unaseptabl However, the therapists vals ae onthe ide ofthe individual 1 a partieular coat, such fs Hspuneatino wanting to felyexpest his ently ina White- dominated workplace, thea a theepst i ar moe Likely to work for the cent and to suppoct moverents that are teansorming society. Ta comparing psycho therapy systems, then we Wil examine wie level of personality functioning is empbasied sed wheter such an expe eds to working, Primarily with an nua, with evo or more people together or with group aecing to ater sas. ‘THE CASEOF MRS. Psychotherapy systems are ot merely stale ‘combinations of change process, tore lea contents, and research studies, Theos temsare stand foremost, concerned vith Serious duordersafictng fellow humans. mn comparing systems, It is esenta t etre how the paychotherapes concept: Alize ad eeat the presenting problems of ‘vacua lent. The client sled fr cn patalveporposesis Ms. Mrs Cis a 479eaeold mother of ax * children: Alene, 17: Bary 15; Chas 1 Detea, :Fle,S:and Frederick 7 Without reading farther, an astute observer might dlacera Mrs. pesoealy configuration “The owdrlnese of children named alpha bevially and of childbirth every 2 years te consistent with obsexve-compaleve disorder (OCD) For the past 1D year, Mrs. C hasbeen Plagbed by compulsive washing, Her base line chars, in which she recorded ber behavior each day belo treatment began, indicated that she washed her hands 28 0 30 tesa day, 5 10 10 mioutes at «tine Her duly morning shower lated about 2 ous with rituals inveving each pert of her body, beginning with er rect IF she le track of where se was la here ‘ual then she woul Rave to act all oer ‘A couple of ures this had seule in her hnosind, George, going off to work while ‘ls wife was in the shower oly to etura & hours ater to finder sil inves inthe lengthy itu “To avoid enended showers, Gorge bad begun ebping his wile Keep track of her ital, s that at tes sb would yel out, "Which att, George?” and he would Jal back. “Lftar, Martha” ls perttpation in the shower ital requied George tse 45:00 AM in oer fo have his wife out ofthe shower Before he efor work at 700 AM. After 2 ear ofthis schedul, George was ready wexplade ‘George was, understandably, becom ing increasingly impatient with many of Is wif elated symptoms She would not let anyone wear apa of underwear more than onc and often woulda even et hese ‘underwear be washed, Tete were ple of diny underwear i each bedroom corner, ‘When we asked her husband to gar up the undermest forthe lundry, we stked ‘nim to count them, but he quit couaing sfferthethovsnth pit. He was depres6 a Seetceseae ae eee Sewanee = Sie reece Somos peepee once See aera ened eeereee ae See eee aes ae Scnunneiaana an weaoees acerca aaa See Sotelo ee tan oe pee fee ieomaes eee geass Srmeriaecar Fepelonspeiedorbet nto systems Paychotherpy she was "Feigid” She said she had ever been sexually excited in her Iie, but at leat forthe first 13 yeas of her marviage She engage in sexual relations t sats he husband However, nthe past? yeas they had had intercourse just twice because sex had become increasingly ‘uopleasant for be. To complete the lt Ms. C was clin cally depetod, Sead made aside ges ‘are by swallowing bole of aspirin since the ad aa aking that her peychotherapat ‘ee giving up oa her and her husband was. ety igo hepa ‘Mr Co compulsie stale revbed around an baeson with pinwoets, Het lest daghter ad come home wit po rors 10 years caer daring a svere h “epidemic. Mis. Chad to creo asc an iy while pregnant, sick wh the Ba eral, sintering fre demanding 1-year-ol4 chi, Her physician od her tho avoid hang the plawors spread throughout te fay, Nw C would need tobe extremly eral shout he cdr underwear dots, and ‘sheets nd tat she shoal boll ofthese testo ll any prom eggs. Me C con firmed tht both she an her shan were tlhe anions sbout a picworen epieic {the bome snd were both preocuped i lenin daring his ime. However, Mis. Cs preoccupation with lealies and iwormecontinad even ser i was cm firmed that her daughters pinwormne were sliminted "he C couple acknowledged slatvely ood marsiage before the pintoemeprode, ‘hey bad both waned szabl fly and Mr C's income a a busines execute had lowed hem to afford 3 large fy snd ‘omfortable home witout final stan, During the int 1 ears of their mariage, Mrs © had demonstated some of Bet ‘obsessive compulsive tas, but never © fica dooce that Me. © coosderd them 4 problem. Mr. C and the oer chléren ecalled many happy mes wih Mrs. C and they kept alive the warmth and love Defining & Comparing Pochotherapies tha they had nce shared th eis ow prrecepid pen "tC hid tom ose, uot ta, and sens epresed Cabal fa iy She wate tothe a ‘whom vere dominated by the who wae (fet incher land weighed 25 pode When Mie ¢ wera tenge, be her ‘ould wat up ore afr dates to etion Terbout wt she ad done he ene wet {otirantfiliw her nade Retold “Baste no expetion of ange expecally toward hic nd when she woul ty {Spinner ptt few poly be was fe ell er to stop. Met Cs mer Sra colcmpalive woman who repent ‘Sy rgaled her dager abut her Sgt Srth ex She ah feqesty warned bet Tnghesaout ur and te com sé cllinss tn dewopng a ppehotherpy pan fr Mrs G oe ofthe dere gnostic Cheslon as whether Min C a aged teh sees obese compalve Soe ita chizophreie proces A all tery et pyclogial eg was completed od the tt ee were coos wih tose frm previa tha iad fo tvidence of thought onder orsign At ppchse procs Hs Chad previous undergone tal years of otal Beak etme, od throughout tat ime the lane had tion conadred ber probe oe tree te nnpeyts ratre The ‘nly te schizophrenia was ore a8 3 Alagnos ws ater some exten ind ‘idl ppcoterpy fled to sd To a7 Improvement. The easen i a iie Wariba Me wis deontting sere ‘OCD tht was gong to be extreme i tote tthe end of he loing chapters, we srl ec how each ofthe ppctberapy {es might explain Mea C's problems ad how the trestmert might ep ero ve: Cone thee devesating peocupuons Key Terms tion therapies soreness isght) therapies pn choosing cores (nospeci factes ‘onsiosnes ring tingecyennagerest ‘corrective croton expesenses Enontercondioning ‘raat rele suction expectations feedback Hieber fect Integration plhcebo Process of change Phy setiberton social iberaton Speci factors Stra contsl ‘erapeue coment theory manatee Notes 1 Wei engl thee ce and pti angeiy thoughout this teback bse 2p nd been we ws renin realy newtalon th guaran poe. ‘ee cannot demonstate tha ove conceal rr” Wecanot for camp, dense i {empires manner ta hi wma prem ‘ere deo angry lings cue of her sae ‘a. Neverthe stl uel pico teins of a hens proens as case dat tons ae presen rougher is Book, they wil be dcebed fo te manne hte fund Inost bbl forthe purposes af wane. wt ‘otasaming some uit lio he nlRecommended Readings Camongny LG. & Beles 1B (Es. 208 ‘nen of torpetic share tat mak. New “oe Oxf Ute res, Fr De Fri (991, en and ea tg (rd). Bato: hos Hope Uiersy Dathan, PB, & Gorman 1. M. (Fas). 018 “ete at er (he) New Ys Oar Unies Ps | orem 1 Cr & Lambert, Mj. (e). 218 ‘aoe rion that mak Se ed) New Yrs Ons Unter Pree Noten Cy Yannoni Fed, DK ‘Ede (2010) ory prtataapy:Cay ld chnge nd ed. Wigan, DC Arran Pacelogial Asociton, Lambert Me] (EL) DIS, Haak of poche pandas). Ne Yor ey ad S (1996 only hone A eonpa tie an (he). Pace Grove CA: Bras! Cie Prochins |. 0, Nocsn, |, Diem, (0995) Charging fr god Now Yr ron, Joule Ameion foes of Othpsary: American Tawra f Pchaty erful of PchahcrpyAchiesofGene Poca: Bey ‘ean and Cr erento Bt oar 1 Pyehthoapy, Clea Cae Salis ial Systems of Paychtherapy and Phthalic Wk ours Cound and ates Coueling ond Panhahrpy Rasa, Iernaonal oa for (he Aavocemen of Courting Srl of Chit And Adlon Pct, onl of Chest yc Seto, ural of Cale Set Pop: ura of Cong en Cat Byala oral ofCenpeary Pct: Teoma ef Cowra Devore ral of Couuing Pac Iara of nent, Ci nd Adlent Ponty Sra of Senta eat Couelings Prgmete Case Stas in Bychahepy Jor! of Poca Nery nd Meal Heath Seve Price Into yhathonpy: Pychatepy and Phanatic: Bychatenpy — Reur Rbaiaton Coumsng eli Vee The rt and Sen of Byhatonpy Recommended Websites American Auction for Mariage and Faniy Tears s ingore American ache Acinic ony Amercan pce Nunee Anode nore America chloe Asocatin voncapry! ‘atonal Auction of Socal Worker Salty for Pychotherapy Reseach: woop ‘hecashery”