Psychotherapy

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

Who practices psychotherapy?

• Prescribing– Psychiatrists

– Psychoanalysts

– Nurse Practitioners

– Psychologists (some)

• Non-Prescribing– Psychoanalysts

– Clinical Psychologists

– Social Workers

– Counsellors (MA, Religious counsellors)

– Co-counsellors, peer therapy

Modes of Psychotherapy

• Dyadic– Adult

– Child

• Non-dyadic– Couples therapy

– 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. Focused (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 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.

Event

IntermediateBeliefs

CoreBeliefs

AT

Emotion

Behavior

• 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

Non-specific dimensions of psychotherapy

• 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