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Cognitive Behavioral Psychotherapy Lecture 1 Page: 1


The Medical Model

• Based on the premise that deviant behavior is the result of a disease.

• A group of symptoms go together and is the result of a specific disease that has
a specific etiology or course of development

• Three Types of disease

1. Infectious Diseases
2. Systemic Diseases
3. Traumatic Diseases

• The infectious disease model gained significant consideration in connection to

mental illness after the discovery of general paresis (neurological degeneration
resulted from syphilitic spirochete that resembled forms of mental illness (i.e.

• The infectious disease model has not gained substantial support over the years
as a comprehensive model of mental illness, but there are many infectious
diseases that have behavioral concomitants.

• Systemic disease model has significant levels of support in some forms of

mental illness such as schizophrenia, major depression, bi-polar disorder. The
Systemic disease model is the foundation for psychiatry and the theory behind
psychotropic medications

• Traumatic Disease model also has significant support in relationship to mental

illness in connection to head injury, birth defects, and PTSD
• DSM IV is essentially structured based on a medical model as a view of mental
illness representing syndromes of disease

• However, for many behaviors considered deviant, there is no known organic

cause, and in order to account for many of these behaviors, aspects of the
medical model have been extrapolated and altered.
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Intrapsychic of Quasi-Medical Models

• Holds to a traditional medical model in that

1. It assumes that symptoms result from some underlying disease process.
Although psychological disease are not considered to be real entities, expect
as a result of reification, they are functional analogously to the systemic or
traumatic disorders in the medical model.
2. To arrive at the root of the problems treatment must focus on the underlying
psychic state. It focuses on psychological forces that are assumed to exist
within the individual. (Drives needs, impulses, motive, and personality

Implications of the Intrapsychic Models

• Most significant is the notion that there is an underlying psychopathology, and

that for treatment is not aimed at the symptoms themselves but the underlying
pathology. As in medicine treatment of the symptoms is only an acceptable
alternative if one is unable to identify the underlying pathology, or the
underlying pathology has no known effective treatment.

• Psychological testing (assessment), in particular personality testing is

substantially based on an intrapsychic model. Projective personality testing in
particular in that these tests purport to examine subconscious or even
unconscious aspects of psychological functioning.

• Notion of Symptom Substitution has been suggested as a consequence of

symptomatic treatment.

• This concept suggests that if maladaptive behavior is altered without treatment of

the underlying disorder, other symptoms might be substituted for the problematic

• There has been considerable dispute about symptom substitution. Disagreement

has center around:
1. Whether symptom substitution occurs
2. whether it can be assess empirically
3. whether substitute symptoms can be predicted in advance
4. whether the occurrence necessarily support a psychodynamic position
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Critiques of the Intrapsychic Model

• Contributions of Freudian Psychoanalytic Models
1. early focus on the scientific study of psychological processes
2. focus on psychological causes of disorders
3. use of psychological (vs. somatic) procedures in the treatment of
psychiatric problems.

• Challenge to the quasi-medical intrapsychic model

1. Behavior therapist encourage pts to test reality with a notion of
“things are not as bad as you think”
2. Psychodynamic therapists look at the problems that pts express as
personality or characterological defects, deficits, inabilities, or
deeply rooted causes that communicates a message that “things are
not as good as you think.”

• Three traditional challenges to the psychodynamic model

1. several of its propositions can not be scientifically established
(unconscious intrapsychic elements in particular)
2. inconsistencies within the theory itself and the therapeutic
procedures derived from the theory
3. the lack of empirical support


• Behaviorism emerged in the 1930 and 1940’s and psychologist played a much
bigger role in the conceptualization and treatment of psychological disorders.

• Ivan P Pavlov (1849-1936) Classical Conditioning (S-R)

• Edward L Thorndike (1874-1949) Law if Effect (B-C part of A-B-C)
• John Watson (1878-1958) Radical behaviorism (Restrict the Science of
Psychology to that which can be observed and measured)
• B. F. Skinner 1904-1990) Operant Conditioning (A-B-C) Three Partied
Configuration and the Correlational relationship between A-B rather than the
cause and effect relationship between S-R

• Behaviorism brought scientific methodology and principles derived from

learning theory. As these principles were applied to behavioral problems, the
field of behavior therapy or behavior modification rapidly emerged.
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• The diversity of over 400 psychotherapies can be reduced to fewer than six
families of theories that endorse different “root metaphors” about how best to
study human experiences.

• At the beginning of the century there were three dominant perspectives,

psychoanalysis, behaviorism and the seeds of modern cognitive therapy.
Eclecticism was not popular in the first half of the century.

• Psychology as a multifaceted dynamic tension among three powerful forces in

human experience: doing thinking and feeling.
1. Behaviorists: argue action and its consequences determine human thinking
and feeling
2. Cognition is the prime mover
3. Feeling is primary and most powerful

• 1960’s the decade of behavioral therapy (Why did this not dominate
Psychology?) A. too reductionistic B. Under-estimated the importance of the
therapeutic relationship and placed too much emphasis on the power of the
science behind the theory.

• In the decade of the 70’s there was a cognitive revolution in clinical psychology
and an integration of cognitive and behavioral theories and therapies

• In the 1980’s came another revolution with a shift of focus to emotional

processes in learning and adaptation.

• In the final decade there has been a marked increase in eclectic and integrative

Evolutions beyond the Cognitive Revolution

• Just as there are many contemporary variants of behaviorism, there are also
different forms of cognitivism. At last count, there were over 20 different
forms of cognitive psychotherapy, and two (some say three) major theoretical
developments subsequent to the first cognitive revolution in psychology.

• The first wave of cognitive theories borrowed extensively from computer

metaphors, sensory register, and processes of short-term, long-term memory
banks. For many years information processing and cognitive theories were
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• The second cognitive revolution has been called connectionism

1. a shift away from computers toward biological studies of nervous
2. a rejection of exclusively linear (serial) models of information
processing “massively distributed parallel processing”
3. subsymbolic processes that cannot be expressed in symbolic form.

• Hermeneutics has recently received recognition as a field of study relevant to

cognitive science. Hermeneutics refers to the complex process of interpretation.

• Hermeneutics is often described as a multidisciplinary approach that

acknowledges that “meaning” resides neither in the reader nor in the text, but
rather, in the dynamic engagement of both, with exah encounter necessarily

• Constructivism is characterized by three fundamental features:

1. the assertion that knowing is proactive and participatory
2. the acknowledgment of tacit (unconscious) processes in all learning and
3. the acknowledgment that learning and knowing are comprised of
complex, developmental and dynamic self-organizing processes

• Metaphor of an “active organism”

• Ongoing debate regarding the nature of unconscious processes as to whether

they represent what was typically seen or viewed by psychodynamic
approaches. In cognitive theory unconscious processes are seen as self-
organizing processes (deep structure).