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APPROACHES TO PSYCHOTHERAPY • • Introduction Treatment of psychological distress and disorders through verbal, cognitive and behavioral techniques; - many different schools of psychotherapy. - listening, empathy, interpretation, and action may all be involved. • At the core of any psychotherapy is an EMPATHIC RELATIONSHIP, the THERAPEUTIC ALLIANCE. • THREE MAJOR SCHOOLS: 1. PSYCHOANALYTIC (PSYCHODYNAMIC) 2. COGNITIVE-BEHAVIORAL (CBT) 3. HUMANISTIC • BUT THE MOST FREQUENTLY USED AND EVIDENCE BASED IS (CBT) Psychodynamic Psychotherapy • Sigmund Freud • There have been a multitude of variations that have evolved and the term most often used to broadly encompass these approaches is "Psychodynamic." • Terms such as: neurosis, conflict, attachment, object relations, unconscious, defense mechanisms, id, ego, superego, drives, libido, transference, countertransference, and countless more have emerged from this approach. • A THEORY OF CONFLICTS • Psychodynamic therapies work to make the unconscious conscious so that we can have greater insight into our needs and behavior and therefore more control over how we allow these conflicts to affect us. PROCESS OF PSYCHODYNAMIC PSYCHOTHERAPY • - Process more important than content. • The symbolic meaning to a behavior or pattern of behavior. (E.G., exploring the process of RESISTANCE) • Symptom reduction seen as superficial. All behavior seen as symbolic: "nothing happens by accident." (example of being late). TECHNIQUES OF THERAPY • OPENING PHASE (FREE ASSOCIATION): The analyst hardly ever says anything except to make an “interpretation” (i.e., the unconscious motives behind your actions or thoughts are pointed out to you). There are no excuses for missing a session, and payment is required whether you attend the session or not.•. . . and this goes on for several years. • CATHARSIS • DREAM ANALYSIS • ANALYSIS OF TRANSFERENCE • ANALYSIS OF RESISTANCE • Interpretation Structural Model of Personality:(id, ego, superego) The Divisions of MIND: consiuoness, pre-conscious, and unconsciousness. Cognitive Behavior Therapy: The use of cognitions to modify behavior
Approaches to psychotherapy • • Cognitive behavior therapy is a clinically and research proven breakthrough in mental health care. Hundreds of studies by research psychologists and psychiatrists make it clear why CBT has become the preferred treatment for conditions such as: Depression and mood swings, Shyness and social anxiety; Panic attacks and phobias; Obsessions and compulsions (OCD and related conditions); Chronic anxiety or worry; Post-traumatic stress symptoms (PTSD and related conditions); Eating disorders (anorexia and bulimia) and obesity; Insomnia and other sleep problems;
Cognitive behavior therapy* combines two very effective kinds of psychotherapy — cognitive therapy and behavior therapy. Cognitive-Behavioral Therapy (CBT) is a practical approach that seeks to define concrete goals and uses active techniques to reach them. The cognitive-behavioral therapist looks at patterns of thinking and behavior and how these patterns are reinforced and maintained by the person within his or her environment. A functional analysis of thinking and behavior is performed, often using log sheets and graphs to better understand thought and behavior patterns in the context of daily routines. Once an understanding of symptoms and behavior is achieved, the therapist and client together devise changes in the patterns and continue tracking. This process is repeated until the original goals are met. Attention to irrational thinking patterns (e.g., automatic thoughts, catastrophic thinking) is central to the approach as well. Some of the techniques and programs that are usually associated with CBT are relaxation training, systematic desensitization, assertiveness training, and social skills training. Historically, Cognitive-Behavior Therapy (CBT) has its roots in the work of behaviourists such as Ivan Pavlov, John Watson, Joseph Wolpe, and B.F. Skinner. Skinner, in particular, developed theories of operant conditioning that were the basis of behavior therapy, which views the consequences of behavior as shaping future behavior. Associated with Skinner are terms such as stimulus-response, positive reinforcement, and contingencies of behavior. Skinner's emphasis was on observable behavior. It was theorists such as Albert Bandura (Social Learning Theory) and cognitive therapy and cognitive-behavioral therapy originators such as Albert Ellis (Rational Emotive Behavior Therapy), Aaron Beck (Cognitive Therapy), William Glasser (Reality Therapy) and Donald Meichenbaum (Cognitive-Behavioral Therapy) that brought thought and emotion into this approach. How Cognitive Behavior Modification Works • Cognitions such as beliefs, attitudes and even emotions can cause behavior • Much maladaptive behavior is caused by inappropriate or illogical cognitions • Many of our cognitions may not be accurate representations of reality • By changing these cognitions, the behaviors that they lead to will in turn be changed • Usually employed with individuals who suffer from: • dysfunctional automatic thoughts - involving content specific to an event. • schemata - general rules about themselves or the world associated with an event. (THE TRIANGLE). Cognitive Distortions • These individuals often engage is self-statements that affect their behavior. • “All or Nothing” Thinking • Selective Abstraction • Overgeneralization
Approaches to psychotherapy • Magnification • Minimization • Personalization • Labeling (Mislabeling) • Catastrophizing • Mind-reading • Negative Predictions Methods of Cognitive Behavior Modification 1. Self-Instruction Training: (Overt-Covert), 2. Thought-Stopping. 3. Cognitive restructuring 4. BEHAVIORAL RE-ATTRIBUTION 5. COGNITIVE RE-ATTRIBUTION 6. BEHAVIORAL EXPERIMENTATION 7. SCHEMA ANALYSIS REIFROCEMENT • Positive reinforcer: A stimulus that when added to a situation, increases the likelihood that a response will occur. • Positive reinforcement: reward • Negative reinforcer: A stimulus, that when removed from a situation, increases the likelihood that a response will occur, relief. • Negative reinforcement: relief • Punishment – try to decrease the likelihood of a response • Positive punishment – something unpleasant occurs • Negative punishment – something pleasant is removed TOKEN ECONOMY • A behavior therapy procedure, based on operant conditioning principles, in which institutionalized patients are given tokens, such as poker chips, for socially constructive behavior, and are withheld when unwanted behaviors are exhibited. The tokens themselves can be exchanged for desirable items and activities such as tea or coffee and extra time away from the ward.Token economy, in short term trials, was effective at reducing the negative symptoms of schizophrenia. . For example, patients in a mental hospital are given tokens they can exchange for food or coffee when they make their beds, groom themselves, get up and go to sleep at the correct hours, and so on; they are fined (tokens are taken away) for assault or destruction of property. Other Techniques • Time-out: weaken undesired behavior by temporarily removing positive reinforcement.Example: Sending a student who frequently interrupts classroom routine to sit in an empty room for 10 min. (Punishment II) • Response Cost: tokens are withdrawn when child makes an undesired response • Extinction: weaken undesired behavior by ignoring it.Example: A mother ignoring a whining child, or a teacher ignoring a student who speaks out of turn. • FLOODING: This is the type of exposure therapy that starts with the most feared rather than the least feared stimulus is called flooding; If conducted only in the imagination, it is sometimes called implosion. The therapist controls the timing and content of the scenes to be imagined or confronted, and instead of trying to relax, the
Approaches to psychotherapy patient is told to experience the fear fully until it subsides. Flooding is quicker than systematic desensitization, but relapse may be more common, and the procedure is simply too frightening for many patients. SHAPING: Method of getting a response to occur by reinforcing successive approximations to the desired response. Successive approximation: the gradual process of reinforcing behaviors that get closer to some final desired behavior. Operant conditioning can be used to shape behavior so that patients perform complex actions or acquire skills that were formerly beyond their capacities.
Client-Centered Therapy Developed by Carl Rogers. The goal is to help clients become fully functioning Therapist expresses unconditional positive regard Therapy is nondirective Two Basic Human Needs 1. Self Actualization: the need to fulfill all of one’s potential. 2. Positive Regard: the need to receive acceptance, respect, and affection from others. Positive regard often comes with conditions attached (“Conditions of Worth”): We must meet others’ expectations to get it. This is called Conditional Positive Regard. Basic Human Problem: The two needs are often in conflict. Satisfying one may mean giving up the other. Effect on Personality: We get a false picture of who we are—our interests, motivations, goals, abilities. We have a need for positive self-regard (to like and respect ourselves).Conditional positive regard from others becomes conditional positive self-regard.This means we will like and accept only those parts of ourselves that other people like and accept.The self-concept pulls away from the real self; we get a false picture of who we really are. This mismatch is called Incongruence. • For a healthy self to emerge, people need positive regard – love, warmth, care and acceptanc. • Ideal Self – what the person is striving to become. • Real Self – what the person is. The further the ideal self is from the real self, the more alienated and maladjusted persons become. Incongruence has many harmful effects. One is that it prevents self-actualization. You have to know who you are to fulfill your potential. The therapist tries to bring the self-concept closer to the real self: • • •
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