Psychotherapy/Psychotherapies

Overview
• What is psychotherapy?
• Who does psychotherapy?
• Approaches to psychotherapy.
• Classification of psychotherapies.
• Three examples of psychotherapy:
– psychoanalysis
– cognitive therapy
– interpersonal therapy.
 Psychotherapy
• “Psychotherapy…is a fiendish and
expensive way of tampering with the lives
of patients weak enough or foolish enough
to seek outside help with personal problems
for which, in fact, only will power is any
solution.”

• Quentin Crisp
 Definitions
• Somatic therapies
– Medicines
– Electroconvulsive Therapy
– Surgery
– Historical
• Insulin coma treatment
• Hydrotherapy
• Removal of teeth
• Hysterectomy
• Social Treatments
– Environmental therapy
– Work therapy
– Moral therapy
• Psychological treatments
– Talk-therapy
– Hypnosis
– Psychodrama
– Behavioral therapy
• “Despite their diversity…all
psychotherapies attempt to relieve suffering
and psychological disability by inducing
changes in patients’ attitudes and behavior.”

– Jerome Frank 1991

 Psychotherapies
• Psychoanalysis (Freudian, Jungian)
• Cognitive Therapy
• Dialectical Behavioral Therapy
• Existential Psychotherapy
• Interpersonal Psychotherapy
• Gestalt Psychotherapy
• Motivational interviewing
 Who practices psychotherapy?
• Prescribing • Non-Prescribing
– Psychiatrists – Psychoanalysts
– Psychoanalysts – Clinical Psychologists
– Nurse Practitioners – Social Workers
– Psychologists (some) – Counsellors (MA,
Religious counsellors)
– Co-counsellors, peer
therapy
 Modes of Psychotherapy
• Dyadic/Individual • Non-dyadic
– Adult – Couples therapy
– Child – Family therapy
– Group therapy
 Classification Schemes
• Exploratory (insight oriented, expressive,
uncovering)
– insight into unconscious psychic conflict
– Goal: structural change in personality
• Supportive (suppressive)
– support adaptive ego defenses
– Goal: strengthen adaptation
• Evocative Psychotherapies
– Seeks to improve total psychological
functioning by providing a supportive,
accepting therapeutic relationship in which
unconscious experiences can emerge into
awareness leading to change.
• Psychoanalysis
• Existential Psychotherapy
• Self-actualizing therapies (Rogers, Maslow)
• Directive Psychotherapies
– Symptom- or problem-focused.
  Cognitive
• Cognitive Therapy (Beck)
• Rational Emotive Therapy (Ellis)
• Social Learning Therapy (Bandura)
  Behavioral
• Reinforcement
• Counter-conditioning
  Abreactive
• Primal therapy
• EMDR
• Schools and Practitioners
– Eclecticism
– Cross-trained
– Self-selection
– General (e.g., psychoanalysis, client-centered
therapy) vs. Condition-specific (e.g., Dialectical
Behavioral Treatment for Borderline
Personality Disorder, CBT for Panic Disorder)
 Psychoanalysis
• Freud
• Office-based psychiatry
• Drive theory
– Structural model of the mind (ego, id, superego)
• Derivations: Ego psychology, Object
Relations Theory, Self Theory
• Unconscious
• Psychic determinism: past as prologue
 Psychoanalysis: Basic premise

• By making the implicit explicit, the

uncontrollable becomes controllable.
• Psychoanalysis in practice
– Free association
– Transference
– Resistance
 Cognitive Therapy
• Aaron Beck
• “Common sense psychology”
• Psychological problems result from faulty
learning, making incorrect inferences on the
basis of inadequate or incorrect
information, and not distinguishing between
imagination and reality.
• Patients systematically misconstrue specific
kinds of experiences
 Cognitive Distortions
• All-or-nothing thinking (black-white,
polarized, dichotomous thinking)
• Catastrophizing (‘fortune telling’)
• Emotional reasoning
• Mind reading
• Over-generalization
• ‘Should’ and ‘Must’ statements
• Etc.
 Core
Beliefs

Intermediate
Beliefs
Event

AT

Behavior

Emotion
• Cognitive Therapy techniques to modify
intermediate and core beliefs:
– Socratic questioning
– Behavioral experiments
– Cognitive continuum
– Rational-emotional role playing
– Acting ‘as if’
– Using others as reference points
– Self-disclosure
 Interpersonal Psychotherapy
• Psychotherapy should focus on what
happens between people, not on the brain,
mind, unconscious, etc.
• Social attachments are protective against
stress and depression.
• Depression is related to interpersonal
relationships--as cause and consequence.
 Interpersonal functioning and
Depression
• Grief
• Role Transition
• Interpersonal Disputes
• Interpersonal Deficits
Interpersonal Therapy in Practice
• Focus on the here-and-now
• Personality restructuring is not attempted
• Assessment:
– inventory of relationships
– quality and pattern of interactions
– cognitions regarding self, others, roles
– associated emotions.
Why Does Psychotherapy Work?
• Re-moralization
• Supportive, non-judgmental attitude of therapist
• Expression of emotions
• Unanalyzed positive transference
• Unanalyzed negative transference
• Identification with the therapist
• Strengthening ego functions
 Further Reading
• “Freud and Beyond” by Stephen Mitchell
and Margaret Black
• “Approaches to the Mind. Movement of
the Psychiatric Schools from Sects toward
Science” by Leston Havens
• “Persuasion and Healing” by Jerome Frank