Approaches to Therapy #1 – Flashcards

1. A science and an art - its important to note that treatments of psychological disorders is not entirely scientific. A. Cannot be likened to fixing a machine - There are no rules or prescriptions that universally apply to the treatment of all psychological disorders.Some may respond to drug therapies, talking therapies, cognitive behavioral therapies, and some not at all. B. Cannot be likened to treating physical ailments - There may be no easy diagnosis for one who suffers psychologically. They may fit into a diagnostic category or they may not. There symptoms may fall across a range of a diagnostic category. C. Psychologically, people are complex creatures - when we start to think about psychotherapy, the treatment of psychological disorders is more of an art. There reasons for entering therapy are often multifaceted. To be an effective/skilled therapist, it is absolutely critical that you have both an insight into and an empathic understanding of the clients psychic. Must be able and willing to listen with empathy so we get in the frame of reference of our clients.

A. Alleviation of suffering- Unlike medicine, psychotherapy is not simply the alleviation of suffering. Oftentimes people report to therapy when they have difficulties in daily life functioning and they just want to return to normal, to return to baseline. B. Facilitation of growth - Therapy is also growth promoting, you can grow as an individual. You can recognize and realize and aspire to your potentials in the context of group or individual psychotherapy. The clinical endpoint is not always clear.

Historical approaches to psychotherapy- In the 17th Century Clinicians used approaches such as: Exorcism, noisemaking, beating the individual, starvation, torture, bitter potions. By the 18th century, They were chained to the walls of dark dungeon like hospitals called asylums. The idea is to remove those who suffer from society. 19th century- a spirit of humanitarian reform swept throughout USA and Europe. The treatments of psychopathology also became more humane. Beginning of Clinical Psychology

Clinical psychotherapeutic reform began to form in the 19th century when Freud began to formulate psychoanalysis. Began with the case of Anna O. Victorian Vienna was infamous for its rules on how women ought to act. It was a very repressive towards women, few rights, and none on sexuality out of their husbands. Women had to repress their sexuality and therefore it was always on their mind. So For Freud, sex and repressed sexuality laid at the core of the development of psychopathology. "Talking cure," or "chimney sweeping" - Freud develops psychoanalysis Free association - his main technique for psychoanalysis. The idea is that logical inconsistencies and pauses reflect repressed traumatic experiences from ones past.

In the middle of their endless streams of ideas patients would come into unpleasant thoughts and memories. In discussing the unpleasant thoughts and when they were on the break of an important but painful insight patients would stop their free association go blank, lose their train of thought, change subject or argue with the therapist. He referred to this pattern of avoidance as resistance.

An unconscious defense mechanism used to keep personal insights (painful memories) out of conscious awareness. Importantly however, these sources of resistance reflect sources of emotional turmoil. When the therapist notices resistance it is his or her ask to recognize them and go in deeper and come to the root of psychopathology.

- Freud noticed another curious phenomenon. Many of Freud's patients developed amorist feelings toward him. Freud assumed that he was not the actual target of his patients passion and feelings but rather people have an unconscious tendency to transfer passionate feelings about important others onto the therapist. (Transference) Transference can be used psychotherapy. Like Resistance, by delving deeper into the transferences, one can gain insight to the causes of psychopathology.

Traditional and orthodox psychoanalysis is very costly, labor intensive and time consuming, especially for the patient. These days many psychoanalysts use briefer approaches to psychoanalysis. Techniques to speed healing process: the therapist sits face to face with the client. therapist engages in a more active encounter with the client. The therapist asks direct questions of the client rather than interpreting, and more of a conversation. The therapist spends less time plunging into ones deep psychic past and spends more time on focusing on issues that are in the clients present moment, here and now

1. Psychoanalysis takes too long and is too costly. We have a dozen approaches to psychotherapy many of which work within a few weeks or months. Why spend all this time and money on an approach that takes so long 2. Psychoanalysis is not truly therapeutic. Patents leave therapy no better off than when they entered. 3. Psychoanalytic interpretations cannot be disproved. The reason for this is unconscious processes and other topics that get interpreted in psychoanalysis simply do not lend themselves to scientific input.

Psychoanalysis dominated the psychological landscape for about thirty years (1880s to 1910s). Around 1912-1915 particularly in the USA psychologists began to doubt the healing power of self awareness. Psychoanalysis at the time seemed to work but it was very long and there were many dynamics that were not scientific. In the USA, a new approach to therapy developed that was based on behavioral principles. Within the behavioral approach to therapy there was a strong and exclusive focus on maladaptive behaviors. What does knowledge of ones unconscious mean? - For the behavioralists the problem is not in the unconscious but rather the problem is on maladaptive behaviors that cause the person pain and suffering in the here and now. It was maladaptive behaviors, not unconscious forces that needed to be altered

: Maladaptive behaviors arise and recur over time through conditioning. All behaviors that we observe in others are controlled by environmental contingencies of reinforcement. When we see maladaptive behaviors we can understand those behaviors as being conditioned and controlled by environmental contingencies. If you accept that assumption than it follows logically that those same behaviors can be unlearned through de-conditioning. That all behaviors are controlled by contingencies than by removing those contingencies we can alter or extinguish maladaptive behaviors.

There are several approaches to therapy that are founded on Classical conditioning techniques: Flooding: Counter-conditioning (Mary Cover Jones) Systematic desensitization (Joseph Wolpe) Aversive conditioning

the patient is exposed to the feared stimulus all at once. That fear is learned and conditioned. In the therapeutic encounter the situation can be controlled so that the patient does not have any real negative consequences. The anxiety disappears after repeated exposure to that stimulus without negative consequences.

it is a procedure to counteract anxiety among patients with phobias. The idea is that you expose the patient to the feared stimulus and at the same time you expose them to a pleasurable experience that is not at all related to fear or anxiety. The idea is that you can't engage in a pleasurable experience and still experience anxiety, fear and worry. Overtime you begin to associate the feared stimulus with pleasurable experience and pleasurable outcomes. Famous case Peter- three year old boy afraid of rabbits. Took him into a room with a caged rabbit. Peter is given milk and crackers and encouraged to eat and drink. As he does the rabbit is moved closer and closer. When the cage is close enough and Peter is not showing anxiety or fear the rabbit is taken out of the cage. White rabbit eventually ends up in his lap and he is petting the rabbit while eating his milk and crackers.

- is a very successful form of de-conditioning that was founded by a south African psychiatrist named Joseph Wolpe. Three key components: A. Relaxation - First, the patient in the therapeutic encounter is taught relaxation techniques. Deep Breathing and muscle relaxation techniques. B. Hierarchy of fear- After they have learned relaxation, the patient is asked to create a hierarchy of fears. There are experiences around the feared stimulus that get progressively more anxiety provoking. C. Exposure - you start at the base. Go to see the therapist the day before of the feared stimulus . Go into the doctors office with the therapist. Pair the anxiety experience with relaxation. With enough relaxation the anxiety will dissipate. The anxiety response cannot coexist with relaxation/ pleasure.

- a therapeutic technique that is used to elicit aversive rather than pleasurable responses to a harmful stimulus. It is used with treatment of alcoholism. You put some substance in the drink that makes the person sick (they throw-up) and eventually the person associates alcohol with being sick.

Operant conditioning technique. We can shape someone's behavior so that it becomes more adaptive by reinforcing adaptive behavior and by removing reinforcement for maladaptive behavior. Example: woman with Schizophrenia lived in a home. Walked around wearing 25 pounds of clothing. The patient was weighted before being allowed to enter into the dining hall. She was allowed in the dining hall only if she weighted a certain amount. After thirteen weeks she was only wearing a normal amount of clothing.

Operant conditioning technique. oftentimes in institutional settings staff creates large scale reinforcement. The patients can earn tokens, gold stars for engagement in desired behaviors. When the patient has acquired enough of them, they can cash them in for a prize such as Weekend passes, books, candy, TV privileges. The idea is that patients can cash in on good behavior.

The behavioral approach dominated psychopathology from 1920s to 1960s During the 1960s the cognitive revolution occurred in psychology- cognitions can shape our behavioral and emotional responses. From a cognitive perspective, Maladaptive cognitions underlie maladaptive behaviors. If you change maladaptive cognitions, beliefs than you will change maladaptive behaviors. There are two main cognitive approaches to psychotherapy: Rational emotive behavior therapy and Cognitive Therapy

Albert Ellis To show the Chain of events leading to psychopathology Ellis proposed ABC model: A (Activating event) - you being rejected by someone else. B (Beliefs) - from that activating event you tell yourself no one ever likes me and no one is ever going to like me. C (Consequences of those beliefs) - from that belief (no one ever likes me) we tell ourselves I might as well give up going to social events and trying to meet people all together. The task within REBT is for the therapist to rationally convince the client that although A leads to C. It only leads to C through the intersection of your beliefs. If you didn't misinterpret the activating event, than you would not feel the need to stop going to social events, the consequence would not follow. Etc. Conclusion - If we restructure those maladaptive beliefs, if we interpret an appraised reality, in more adaptive ways, then Adaptive behaviors will necessarily follow.

the idea is that we have cognitive schema, these schema are automatic thoughts that arise within us after certain life events. Something bad/unpleasant happens to us and a whole bunch of thoughts start running through our minds. Maladaptive schema create and maintain depression. There is a cognitive triad in depression that involves three types of maladaptive schema: Negative views about oneself, negative views about ones experience, and negative views about ones future. Within cognitive therapy, these schema can be brought to the surface, to our awareness and can be altered. People can be reeducated to think in more maladaptive ways and by reeducating people cognitively Depression and other maladaptive behaviors can subside.

Carl Rogers noticed that his clients had a strong inner drive toward fulfillment of one's potential. Rogers theorized that humans are naturally oriented towards psychological growth and realization of ones potential. There is an actualization tendency that defines all of life including humans. For Rogers, All the therapist needs to do is to create a warm, accepting environment in which that inner drive towards self actualization can be realized.

Rogers developed Person centered therapy. For Rogers a successful therapist must do the following four things: Trust the client -trust the growth instinct within the client, that they will move towards self actualization with the right conditions Focus on feelings of client - rather than on behaviors and cognitions of client, Be present minded focused- Therapist must be focused on feelings of here and now. Must make the client responsible for his or her own change in growth. In contrast to psychoanalysts, to behaviorists, and cognitive therapists it is the Client that is solely responsible for his change in growth. Clients will move towards self actualization with consistency and without fail so long as they have the appropriate supports within the therapeutic encounter.

1. Empathy - the task of the therapist is to get into the mind of the client and understand their life from the first person perspective. 2. Genuineness - the therapist is to drop his or her façade. Genuinely express true feelings or thoughts in the therapeutic encounter. 3. Unconditional positive regard - any thoughts or feelings are to be cherished and prized. (NO loving if... you do..)

Perls sought to make people responsible for their own growth and development. The starting point was the same. There is a natural drive towards self actualization and the client can and ought to be responsible for movement towards self actualization. Unlike Rogers however, Perls sought to get his clients to speak in ways that were brutally honest. Group therapy would be used and the participants would interact with each other in ways that were brutally honest. Also differed from Roger's approach to therapy in three other ways: 1. Focus on feelings that are unconscious 2. Focus on dreams and interpretation of dreams 3. Techniques used are often dramatic and confrontational