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PSY 3333 2

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Wolberg’s (1967) definition of psychotherapy
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a form of tx for problems of an emotional nature a trained person deliberately establishes a professional relationship with a patient object of… removing, modifying, or retarding existing symptoms mediating disturbed patterns of behavior promoting positive personality growth & development
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Efficacy
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the extent to which the average person receiving the tx in clinical trials is demonstrated to be less significantly dysfunctional than the average person not receiving any tx empirical evidence supports the efficacy of psychotherapy
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effectiveness
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the extent to which the client reports clinically significant benefit from a treatment fewer studies exist of the effectiveness of psychotherapy
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The 1995 Consumer Reports study
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psychotherapy resulted in some improvement for the majority of respondents psychiatrists, psychologists, and social workers were rated relatively highly and equally psychotherapy alone and psychotherapy + medication resulted in similar improvements longer tx was related to more improvement
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Patient variables that affect therapy
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level of patient’s distress: Clarkin and Levy (2004) found that: severe disturbance → poorer outcomes comorbid personality disorders → even worse outcomes intelligence: brighter individuals seem better able to handle the demands of psychotherapy verbal process requires patients to establish connections requires a degree of introspection Age patients younger than 40 tend to be better candidates cognitive-behavioral and psychodynamic approaches can be efficacious for older adults motivation research findings are mixed methodological problem of defining patient motivation openness to therapeutic process → better results gender no clear findings regarding gender of patient therapist/patient gender combination may be important in certain cases race, ethnicity, socioeconomic status YAVIS (Schofield, 1964) -YOUNG ATTRACTIVE VERBAL INTELLIGENT SUCCESSFUL no clear findings regarding social class and outcome significant differences in socioeconomic status of patient and therapist → decreased patient motivation for therapy sensitivity of the therapist is nevertheless important
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Therapist variables that affect therapy
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age and gender: no affect on outcome patient-therapist similarity with regard to ethnicity: no clear affect on outcome personality findings are mixed not enough research empathy, warmth, and genuineness generally positively correlated with outcome grew largely out of Carl Rogers’s system of client-centered therapy emotional well-being self-awareness is an important quality therapists often engage in their own psychotherapy professional experience research findings do not support this as a factor which affects therapy outcome expert role is still an important facet of therapy professional identification: no evidence supports the idea that one profession is best in therapy
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Course of clinical intervention and the basic components
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initial contact assessment intake interview case history interviews with others psychological testing consultation with others setting treatment goals implementing treatment termination, evaluation, and follow-up
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Features common across psychotherapies
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the expert role of the psychotherapist catharsis therapeutic relationship/alliance initial reduction of anxiety/tension interpretation/insight building competence/mastery
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Breuer
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Freud
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Charcot
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Key features of psychodynamic psychotherapy and theory
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Freud’s theory of personality structure
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Id instinctual urges with a desire for immediate gratification governed by the pleasure principle, the basic tendency to maximize pleasure and minimize pain as rapidly and automatically as possible pleasure principle uses primary process thinking: primitive and directed by the desire for immediate drive discharge Ego organized, rational system that uses perception, learning, memory, etc. towards need-satisfaction the “executive” of the personality operates on the reality principle and employs secondary process thinking, which is reality-oriented and based on a conceptual organization of memories mediates the demands of the id, the superego and the world Superego develops from the ego during childhood arises specifically out of the resolution of the Oedipus complex represents the ideals and values of society as conveyed to the child via the parents serves to block unacceptable id impulses,pressure the ego to serve the ends of morality rather than expediency
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Psychic determinism
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everything we has psychological meaning and purpose, is goal-directed
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Unconscious motivation
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the important causes of disturbed behavior are unconscious, thus one goal of therapy is to make the unconscious conscious
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“Psychopathology of everyday life”
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psychic determinism: everything is a determined; there are no accidents slips and mistakes are conscious expressions of the unconscious wishes examination of these behaviors in the context of free associations → insight
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The role of defense mechanisms and the specific defenses mentioned
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intrapsychic conflict leads to the implementation of ego defense, or defense mechanisms defenses are generally regarded as pathological because they divert psychic energy away from more constructive activities and they distort reality fixation: excessive frustration or satisfaction could lead to a rigid clinging to a particular mode of satisfaction characteristic of that stage regression: the reinstatement of a mode of seeking satisfaction that is no longer age-appropriate repression: the banishment from consciousness of highly threatening aggressive or sexual material suppression: active efforts to keep something out of mind denial: automatic refusal to acknowledge an experience as one’s own reaction formation: unconscious impulse expressed consciously by its behavioral opposite projection: one’s unconscious feelings are attributed not to oneself but to another rationalization: an uncomfortable experience is given a justification intellectualization: appearing to address an uncomfortable experience by separating emotional reaction from theorizing about the issue sublimation: redirecting uncomfortable experiences in socially acceptable ways
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Psychoanalytic alternatives
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although psychoanalytic theory went through many transformations with the work of the neo-Fruedians (Adler, Jung, Rank , etc.) the major components remained the same alternatives varied by what they emphasized changes from traditional psychoanalysis include: frequency of sessions and duration of therapy are reduced therapist not necessarily sitting behind patient free association is not as heavily relied upon dream interpretation plays a lesser role
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Carl Rogers’ background
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in the late 1930s, psychoanalysis was the dominant force Carl Rogers received his Ph. D and began working at a child guidance center rogers was influenced by: otto rank (will therapy): believed that the patient should be allowed the opportunity to exert his or her will in therapy Jessie Taft (relationship therapy): focused on the relationship between the therapist and the patient client-centered therapy anchored in phenomenological theory
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Theoretical propositions of client-centered therapy
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the person is the best source of information about the self objectivity is rejected in favor of the inner world of experience as reported by the person basic human tendency is towards maintaining and enhancing the experiencing self: self-actualization under conditions of complete absence of threats to the self, experiences inconsistent with the self may be examined and perceived, and the structure of the self revised to assimilate them client-centered therapy provides those conditions by offering a warm, accepting, permissive, and nonjudgmental atmosphere
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Core features of client-centered therapy
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psychotherapy: “the releasing of an already existing capacity in a potentially competent individual, not the expert manipulation of a more or less passive personality” (Rogers, 1959, p 221) → growth potential three therapist characteristics that precipitate these conditions: empathy unconditional positive regard genuineness or congruence to convey empathy is to transmit to the client a sense of being understood as an attitude, empathy is simply communicated by one’s presence as a set of techniques: thick vs thin attention therapist refuses to impose “expertness” therapist communicates in a genuine way “i am with you” therapist shares empathy in a tentative , open, unfinished way silent reflection: eye contact, nodding, posture literal reflection: repeating paraphrasing reflection: rephrasing client’s statements in different words synthetic reflection: adding something to what the client is saying that the therapist hears but not sure the client is hearing pattern reflection: putting or theme to what a person is saying; organizing what may seem disconnected process reflection: reflecting, commenting on client internal experience or on process between client and therapist unconditional positive regard respect for the client as a human being acceptance is offered without exception or conditions can be difficult when the client’s behaviors and attitudes challenge the therapist’s own beliefs, values Congruence genuineness expression of behaviors, feelings, or attitudes that the client stimulates in them client-centered therapy is best practiced when the therapist approaches the therapy with these values and attitudes, not engaging in simple techniques or methods given a therapeutic atmosphere of congruence, unconditional positive regard, and empathy, clients will discover their own capacity for growth and self-direction Rogers viewed clients not as destructive but as possessing a constructive force striving towards health and self-fulfillment
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Pros of the client-centered therapy approach
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provided a serious alternative to the psychoanalytic approach the becoming, evolving person replaced the sick patient, the victim of early experiences emphasis was placed on the relationship between the client and therapist attitude over techniques led to a shorter and more time-convenient form of therapy the less active role of the therapist required less training opened up therapy with the use of recordings research suggests that client-centered therapy is moderately
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Cons of the client-centered therapy approach
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avoidance of assessment and lack of emphasis on past experiences may impair the therapist’s ability to understand the patient every client is treated in a similar manner a more active and directing style of psychotherapy might be necessary with certain types of patient presentations reliance on client-reported experience leads to information which is given under defenses, distortions, and incompleteness illusive and easily confused
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Wolpe and systematic desensitization (definition, how it works, the process in therapy, its intended use, etc.)systematic desensitization
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counterconditioning (Wolpe): the substitution of relaxation for anxiety extinction: the patient visualizes anxiety-inducing situations or stimuli but without negative results, the anxiety responses are eventually extinguished Habituation: a decrease in responding to repeated presentations of the same stimulus therapeutic components: instructions lead to patient’s optimism regarding treatment therapists use of positive reinforcement SD is a process where a patient acquires new skill in place of anxiety response
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The influence of Rotter and Bandura
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brought in cognitive constructs to behavior
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Exposure therapy
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Masserman (1943): found that avoidance behaviors in cats could be extinguished if the cats were the forced to remain in the anxiety-provoking situation without any opportunity for escape exposure therapy: gradually re-introducing the patient to the anxiety-provoking stimulus or situation, in vivo or imaginal initially leads to increased levels of anxiety or fear patient learns that there is no basis for the fear and develops the ability to break the association between the stimuli/situation and the fear response Behavior Therapy: Exposure Therapy – Barlow & Cerny (1988) exposure should be of long rather than short duration exposure should be repeated until all fear/anxiety is eliminated exposure should be graduated patients must attend to the feared stimulus and interact with it as much as possible exposure must provoke anxiety
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Positive reinforcement
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reward the desired behavior with positive reinforcement
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Aversion therapy
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Consists of administering an aversive stimulus to inhibit an unwanted emotional response. Thereby diminishing its habit strength (Wolpe 1975) an unpleasant stimulus is placed in temporal closeness to the undesired behavior the individual associates the undesired behavior with the unpleasant stimulus, leading to a conditioned response the aversive agent is presented systematically and consistently aversive agents have typically included mild electrical shock and drugs other punishment based interventions include response cost, covert sensitization, and overcorrection critics of aversion techniques raise concerns regarding inhumaneness
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Aaron Beck and cognitive psychotherapy
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involves the use of both cognitive and behavioral techniques to modify dysfunctional thinking patterns that characterize the clinical presentation cognitive triad: depressed individuals harbor negative beliefs about themselves, their world, and their future focuses on the connection between thinking patterns styles, emotions, and behavior patients are helped to address and change maladaptive ways of thinking that lead to/maintain depression and other negative effects
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Shaping
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reward behavior that approximates the specific desire behavior, then selectively reinforce behavior which more and more closely resembles the desired behavior
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Time-out
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removing an individual from a situation in which the undesired behavior is reinforced thus leading to extinction
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silent reflection
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eye contact, nodding, posture
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literal reflection
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repeating
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paraphrasing reflection
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rephrasing client’s statements in different words
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synthetic reflection
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adding something to what the client is saying that the therapist hears but not sure the client is hearing
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pattern reflection
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putting or theme to what a person is saying; organizing what may seem disconnected
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process reflection
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reflecting, commenting on client internal experience or on process between client and therapist