• Major Theoretical Models in Clinical Psychology

• The Psychodynamic Approach

• The psychodynamic perspective maintains certain
assumptions about human behavior and psychological
problems
• First, the psychodynamic perspective holds that human
behavior is influenced by intra-psychic (within the
mind) drives, motives, conflicts, and impulses, which are
primarily unconscious
• Second, various adaptive and maladaptive ego defense
mechanisms are used to deal with unresolved conflicts, needs,
wishes, and fantasies that contribute to both normal and
abnormal behavior.
• Third, early experiences and relationships, such as the
relationship between children and their parents, play a critical
and enduring role in psychological development and adult
behavior.
• Fourth, insight into these mostly unconscious influences
combined with working through them (discussing and integrating
them into everyday life) help to improve psychological functioning
and behavior.
• Finally, the analysis of the transferential relationship that
develops between the patient and therapist also helps to resolve
conflicts and improve psychological functioning and behavior.
– Psychology should focus on understanding mental
processes, especially the unconscious level of the mind.
– There are three levels of consciousness -- the conscious,
preconscious, and unconscious levels.
– Only the unconscious mind is thought to be of
importance.
– Conscious thought processes are seen as mostly
unimportant.
– Humans are born with powerful sexual and aggressive
drives that are housed in the unconscious mind and make
basic survival possible both for the individual and species.
– The adult personality is unchanging. Deep core
personality traits are set by age five or six and virtually
impossible to change after that.
• Freud’s Psychoanalytic Perspective: Freud’s psychoanalytic perspective is
often called classical analysis or classical Freudian analysis. Freud
developed an understanding of human behavior based on three mental
structures that are usually in conflict.
• The id, developed at birth, operates on the pleasure principle and
represents all of our primitive wishes, needs, and desires.
• The ego, developed at about age one, operates on the reality principle
and represents the rational and reasonable aspects of our personality
helping us to adapt to a challenging world.
• Finally, the superego, developed at about age 5 following the successful
resolution of the Oedipus complex, represents the internalization of
familial, cultural, and societal norms and mores
• The superego includes the ego ideal (the perfect image
or representation of who we are and who we can
become) and our conscience (the rules of good and bad
feelings, thinking, and behavior). The conscience
involves what we perceive to be “right” and “wrong.”
• Inevitable conflict between the id, ego, and superego
lead to anxiety and discomfort and the need to utilize
ego defense mechanisms
• Defense mechanisms are strategies developed by the
ego to protect the person from these internal and
mostly unconscious conflicts
• Thus, they help us cope, either adaptively or
maladaptive, with the inevitable anxiety and discomfort
associated with being human.
• Freud also outlined several psychosexual stages of development
that he regarded as universal.
• These include the oral, anal, phallic, latency, and genital phases.
Libidinal, or life energies, are channeled toward different areas of
the body that demand gratification during each of these phases.
• Potential conflicts and problems can develop as a byproduct of
fixations at any one of these stages. For example, one might
become fixated at one stage of development (e.g., oral) due to too
much or too little stimulation during that stage.
• This fixation may then result in problems in adulthood such as
smoking, eating, or drinking too much.
• The goal of Freud’s approach was insight (understanding the
unconscious factors that lead to problematic feelings, thinking,
and behavior) and working through of the insights to improve
daily functioning.
• The working through process involves a careful and in-depth
examination of the role of unconscious wishes, drives, impulses,
and conflicts in everyday life.
 • Techniques used in Freud’s approach
• Free association Stating whatever is on the patient’s mind without
filtering.
• For example, Mary is encouraged to say whatever is on her mind no
matter how silly or embarrassing it may be to her.
• involves exploring a person's unconscious through spontaneous word
association
• Clients are encouraged to say whatever comes to mind when the
therapist presents them with a word, no matter how trivial, illogical, or
irrelevant the response may seem.
• It is the therapist's job to interpret the responses as patterns in the
associations that are identified
• Transference
• Projecting the issues and dynamics between the patient and
significant figures in their lives (e.g., mother, father) onto the
therapist.
• For example, Mary’s feelings of love and longing for her father are
projected onto her male therapist.
• It is the transfer of feelings from the past to someone in the
present.
• Usually, it involves these feelings being transferred from the
client onto the therapist
• Counter transference
• Therapist responding to the transference of the patient through
projecting their needs, wishes, and dynamics onto the patient.
• For example, Mary’s therapist experiences Mary as being similar
to his mother and behaves toward her as he would behave
toward his mother.
• Dream analysis

• Understanding the unconscious influence of dreams in everyday life.

• Dream analysis is the investigation of repressed feelings that can be

expressed in our dreams. Psychoanalytic theory believes repressed
feelings often manifest themselves in our dreams. This happens
because our defenses are lowered when we sleep.
• Dream analysis helps uncover this unconscious material.

• For example, Mary reports that she had a dream that she came to a
therapy session and her therapist was not there to see her. In
discussing her dream, she reports fears of being neglected by her
therapist as well as other important figures in her life.
• Dreams have two levels of content:
• Latent content, or hidden motives, wishes, or fears
• Manifest content: This refers to the dream as it actually appears

• Dream analysis takes place as the therapist uncovers the

disguised, latent content within the actual, manifest content of
the dream.
• Usually this involves identifying symbolic meaning in the dream.
• Sometimes, free association with different dream elements is
used in the process.
 Behavioral Therapy
• Behavioral therapy is focused on helping an individual
understand how changing their behavior can lead to changes in
how they are feeling.
• The goal of behavior therapy is usually focused on increasing the
person’s engagement in positive or socially reinforcing activities.
• Behavior therapy is a structured approach that carefully measures
what the person is doing and then seeks to increase chances for
positive experience
• Techniques in behavioral therapy
• The behaviorist approach proposes two main processes whereby
people learn from their environment:
• Classical conditioning (CC) was studied by the Russian
psychologist Ivan Pavlov.
• while looking into natural reflexes and neutral stimuli he
managed to condition dogs to salivate to the sound of a bell
through repeated associated with the sound of the bell and food.
• The principles of CC have been applied in many therapies. These
include systematic desensitization for phobias (step-by-step
exposed to a feared stimulus at once) and aversion therapy.
• B.F. Skinner investigated operant conditioning of voluntary and
involuntary behavior. Skinner felt that some behavior could be
explained by the person's motive.

• Therefore behavior occurs for a reason, and the three main behavior
shaping techniques are positive reinforcement, negative reinforcement
and punishment.

• Behaviorism also believes in scientific methodology (e.g. controlled

experiments), and that only observable behavior should be studied
because this can be objectively measured.

• Behaviorism rejects the idea that people have free will, and believes
that the environment determines all behavior.
• Self-Monitoring — This is the first stage of treatment. The person
is asked to keep a detailed log of all of their activities during the
day. By examining the list at the next session, the therapist can
see exactly what the person is doing.
• Example — Bill, who is being seen for depression, returns with his
self-monitoring list for the past week. His therapist notices that it
consists of Bill going to work in the morning, returning home at
5:30 p.m. and watching television uninterrupted until 11 p.m. and
then going to bed.
• Schedule of Weekly Activities — This is where the patient and
therapist work together to develop new activities that will
provide the patient with chances for positive experience.
• Example — Looking at his self-monitoring sheet, Bill and his
therapist determine that watching so much television alone gives
little opportunity for positive social interaction.
• Therefore, they decide that Bill will have dinner out with a friend
once a week after work and join a bowling league.
• Role Playing — This is used to help the person develop new skills
and anticipate issues that may come up in social interactions.
• Example — One of the reasons that Bill stays home alone so
much is that he is shy around people. He does not know how to
start a conversation with strangers. Bill and his therapist work on
this by practicing with each other on how to start a conversation.
• Systematic Desensitization —
• Systematic desensitization was developed by Joseph Wolfe
and was designed for clients with phobias. This treatment
follows a process of “counter conditioning” meaning the
association between the stimulus and the anxiety is
weakened through the use of relaxation techniques, anxiety
hierarchies and desensitization
• The process of systematic desensitization is applied to an
example of a client with a fear of spiders as per below:
•
• Step 1: Build a hierarchy of the anxiety-arousing stimuli including the
degree of fear experienced from 5 to 100.

• The client lists all anxiety arousing stimuli, such as: (1) Looking at the
spider; (2)Holding a spider in their hands.

• Step 2: Train the client in deep muscle relaxation.

• Relaxation techniques thought to the client.

• Step 3: Client works through hierarchy while using relaxation techniques.

• Talks about anxiety of spiders and practices relaxation techniques.

• Step 4: (used in some cases) Client confronts real fear.

• Client is presented with a real spider and holds it in his/her hands.

• Exposure Therapies — Exposure therapies are designed to expose

the client to feared situations similar to that of systematic

desensitization

• The therapies included are in vivo desensitization and flooding.

• In vivo desensitization involves the client being exposed to real

life anxiety provoking situations.

• The exposure is brief to begin with and eventually the client is

exposed for longer periods of time to the fearful situation.

 ``
• To begin with the client would be shown a spider in a container

on the other side of the room for one minute. This would

gradually increase in time as well as the client getting closer to

the spider until eventually the client is able to be sitting near the

spider for a prolonged period

• Behavior Modification — In this technique the patient will

receive a reward for engaging in positive behavior.

• Flooding —
• Flooding involves the client being exposed to the actual or
imagined fearful situation for a prolonged period of time. The
example of the client with the spider fear would be that the client
would be exposed to the spider or the thought of a spider for a
prolonged period of time and uses relaxation techniques to cope.
• There may be ethical issues in using these techniques with certain
fears or traumatic events and the client should be provided with
information on the techniques before utilizing them so he or she
understands the process.
• Aversion Therapy — The most controversial of the behavioral
treatments, aversion therapy is used by therapists as a last resort
to an aversive behavior
• This treatment involves pairing the aversive behavior (such as
drinking alcohol) with a stimulus with an undesirable response
(such as a medication that induces vomiting when taken with
alcohol).
• This is designed to reduce the targeted behavior (drinking
alcohol) even when the stimulus with the undesirable response is
not taken (medication).
•
• Modeling — Modeling is used as a treatment that involves improving
interpersonal skills such as communication and how to act in a social
setting.
• Techniques involved in modeling are:.

• Live modeling involves the client watching a “model” such as the

counselor perform a specific behavior, the client then copies this
behavior.
• Symbolic modeling involves the client watching a behavior indirectly
such as a video.
• Role-playing is where the counselor role-plays a behavior with the client
in order for the client to practice the behavior.
•
• Participant modeling involves the counselor modeling the
behavior and then getting the client to practice the behavior
while the counselor performs the behavior.
• Covert modeling is where the client cannot watch someone
perform the behavior but instead the counselor gets the client to
imagine a model performing the behavior
•
 Cognitive Psychotherapy
• Cognitive therapy is based on the theory that much of how
we feel is determined by what we think.
• Disorders, such as depression, are believed to be the result of
faulty thoughts and beliefs.
• By correcting these inaccurate beliefs, the person’s
perception of events and emotional state improve.
• Research on depression has shown that people with
depression often have inaccurate beliefs about themselves,
their situation and the world. :
• A list of common cognitive errors and real life examples
• Personalization — relating negative events to oneself when
there is no basis.
• Example — When walking down the hallway at work, John
says hello to the company CEO. The CEO does not respond
and keeps walking. John interprets this as the CEO’s lack of
respect for him. He gets demoralized and feels rejected.
However, the CEO’s behavior may have nothing to do with
John. He may have been preoccupied about an upcoming
meeting, or had a fight with his wife that morning.
• Dichotomous Thinking — seeing things as black and white, all or
none. This is usually detected when a person can generate only
two choices in a situation.
• Example — Mary is having a problem at work with one of her
supervisors who she believes is treating her badly. She convinces
herself that she has only two options: tell her boss off or quit. She
is unable to consider a host of other possibilities such as talking to
her boss in a constructive way, seeking guidance from a higher
supervisor, contacting employee relations, etc.
• Selective Abstraction — focusing only on certain aspects of a
situation, usually the most negative.
• Example — During a staff meeting at work, Susan presents a
proposal for solving a problem. Her solution is listened to with
great interest and many of her ideas are highly praised.
However, at one point her supervisor points out that her
budget for the project appears to be grossly inadequate. Susan
ignores the positive feedback she has received and focuses on
this one comment. She interprets it as a lack of support from
her boss and a humiliation in front of the group.
• Magnification-Minimization — distorting the importance of
particular events.

• Example — Robert is a college student who wants to go to

medical school. He knows that his college grade point average will
be used by schools during the admission process. He receives a D
in a class on American History. He becomes demoralized thinking
now that his lifelong dream to be a physician is no longer
possible.
• Cognitive therapists work with the person to challenge thinking
errors like those listed above.
• By pointing out alternative ways of viewing a situation, the
person’s view of life, and ultimately their mood will improve.
• Research has shown that cognitive therapy can be as effective as
medication in the long-term treatment of depression.
 Cognitive Behavioral Therapy
•Cognitive behavioral therapy (CBT) can help you out-think negative

patterns that may be keeping you from depression recovery — and from

enjoying life.

•Maladaptive irrational and automatic thoughts such as, “I’m a failure,”

“No one will love me,” and “I can’t do anything right,” might be examined,

challenged, and altered using cognitive-behavioral techniques such as

thought stopping and rehearsal of positive self statements.

•There are numerous cognitive-behavioral techniques that may be

employed to help assess and alter behavior

• Examples of Cognitive–Behavioral Techniques
• Counter conditioning Developing a more adaptive response to
environmental stimuli. For example, Mary does aerobic exercise
when feeling anxious rather than taking anti anxiety medication.
• Exposure Gradual or all at once approach to the feared situation
or stimuli. For example, Mary is encouraged to gradually take
longer and longer bus rides.
• Behavioral Contract
• An agreement between therapist and patient that outlines
specific consequences of behavior. For example, Mary agrees to
decrease coffee consumption by two cups per week until she no
longer drinks caffeinated coffee.
• Participant Modeling

• Demonstrating the desired behavior for the patient. For example,

Mary watches others confidently learn to drive a car without fear
before she tries to do the same.
• Behavioral Rehearsal Practicing how one might handle a given
problem situation. For example, Mary frequently practices
breathing techniques so that they become automatic.
• Thought Stopping
• Stopping irrational or defeating thoughts by interrupting the
negative or problematic pattern of thinking (e.g., yelling “stop” to
oneself) and inserting more positive and adaptive thoughts (e.g.,
“I can handle it, I’m as worthy of love as anyone else”)
• For example, Mary stops her thoughts that she cannot handle
walking into the bank by yelling “stop” to herself when she finds
herself engaged in maladaptive and negative thinking, and inserts
more positive thoughts in their place such as “I enjoy my new
found independence by going to the bank anxiety free.”
 • Humanistic therapy
• Basic Humanistic Principles:
– Humanistic perspective asserts that psychology should focus
on both behavior and mental processes, not just one or the other.
– The goal of the humanistic psychology is to understand the human
potential for growth and development.
– Humanistic theorists view each human being as having unlimited
potential for growth and development.
– Humanistic theorists stress that human beings are complex and
unique organisms and that they cannot be understood by simple,
one dimensional analysis.
 – While humanistic theorists do not necessarily deny the
existence of an unconscious mind, they tend to stress that
humans are, by nature, rational beings and therefore place
more emphasis on conscious thought.
– The adult personality constantly changes and develops across
the entire human life-span. Change is always possible.
• The humanistic theory stresses that humans are ultimately free to
choose their behaviors and their emotional responses to events
around them
• humanistic theorists reject the ideas that humans are controlled by
unconscious drives or by environmental forces.
• In addition, they see humans as rational beings who are free to
choose and therefore we are ultimately responsible for our
actions and for our emotional responses to life events.
• Because of their belief in self-actualization, humanistic theorists
tend to view humans as being good by nature. They are not
suggesting that humans only do good things, but rather that,
overall, humans have a tendency to want to improve themselves
and their surroundings, and therefore are 'good' by nature.
• The humanistic perspective tends to view people as being active,
thinking, creative, and growth oriented.
• Helping others is partially accomplished through understanding
concerns, feelings, and behavior through the eyes of the patient.
• Humanistic professionals tend to assume that people are
basically well-intentioned and that they naturally strive toward
growth, love, creativity, and self actualization.
 Humanistic Concepts and Techniques
• Active listening Intense listening to the patient using
paraphrasing, summaries, reflection, and other techniques.
• Empathy Conveying a sense of being heard and understood
• Unconditional positive regard Fully accepting the feelings and
thoughts of the patient.
• Congruence Being genuine in behavior.
• Self-actualization Innate movement toward growth and
fulfilling one’s potential.
• Peak experiences Moments when self-actualization is reached.
• The Client-Centered Perspective:
• The client centered perspective of Carl Rogers stands out as
the most classic example of the humanistic approach.
• Rogers used nondirective techniques such as active
listening, empathy, congruence, and unconditional positive
regard to understand and help others.
• Rogers felt that sincere empathy was needed in order for
people to feel accepted and understood, and ultimately to
enable growth to occur.
• Unconditional positive regard
• refers to the belief that no one should be negatively judged or
evaluated in the therapy experience or elsewhere. Rather, respect
and acceptance should prevail.
• Unconditional positive regard can be a challenge for professionals
working with individuals who have attitudes or behaviors that one
finds offensive (e.g., sexual abuse of children, stealing, racist
comments).
• Unconditional positive regard does not mean that these behaviors
or attitudes are accepted as being okay. Rather, it is the person who
is fully accepted.
• Congruence, or genuineness,
• refers to harmony between one’s feelings and actions. Thus, the
professional should strive toward emotional honesty in his or her
relationship with others.
• Genuineness also implies that the professional will not try to hide
his or her feelings from others, yet still present a professional
attitude and character
• Maslow’s Humanistic Perspective:
• Abraham Maslow (Maslow, 1954, 1971) originated a further
variation of the humanistic approach. He emphasized the
importance of self actualization that refers to the impulse and
desire to develop fully one’s potential
• His focus on self-actualization highlighted the role of unmet
needs. He felt that humans have a hierarchy of needs beginning
with basic biological requirements for food, water, and warmth.
• Once these needs are met, one is free to focus on higher level
needs such as safety and security.
• Again, as these higher level needs are met, one can then focus on
needs for love, belonging, and acceptance.

• Finally, at the top of the hierarchy is self actualization.

• Maslow believed that people who experienced self-actualization
were characterized by an acceptance of themselves and others,
efficient perceptions of reality, social interests, creativeness,
mystical or “peak” experiences, as well as other qualities
• Although Maslow believed that everyone has the potential to
achieve self-actualization, few were thought to succeed because
of unmet needs at lower levels. Maslow felt that less than 1% of
the population ever reach self-actualization
• The Gestalt Perspective:
• The gestalt perspective within the humanistic approach originated with
the work of Fritz Perls
• Assumptions of the gestalt approach include the notion that problems
occur due to our inability to be truly aware of our current feelings,
thoughts, and behavior and to our excessive focus on the past and future
rather than the present
• The gestalt approach focuses on being keenly aware of one’s here and
now or present experience.
• The gestalt approach seeks to help people live in the immediate moment
by frequently requesting that people work toward an awareness of
current thoughts and feelings.
• Techniques include making believe that an important someone
such as a spouse, boss, or mother is in the room with you sitting
in an empty chair.
• Talking to the person as if they were there helps someone
become better in touch with feelings and behavior.
• For example, Mary might be asked to pretend that her mother is
in the room with her. The gestalt therapist might encourage Mary
to talk with her mother as if she was sitting in an empty chair in
the office.
• Mary would be asked about her immediate feelings and thoughts
as she spoke with her mother in the room