Psychotherapy
ASPECTS OF THERAPY
A. Free Choice
- Client must want therapy for change
B. Hopes & Expectations
1. Expectations about the futureaffect the present
=> Belief that therapy will work= powerful treatment itself
Placebo effects
Hormones & immune system
2.Different expectations of therapy by client & therapist
=> increase similarity in expectancies
C. Therapist-Client Interaction
1. Therapist Qualities
“Nonspecific Factors”
- Empathy- Warmth
- Genuineness
Experience
Client-therapist matching
2. Therapeutic Alliance
- Joint goals & how to achieve them
- Therapist’s cooperative spirit
- Client’s ability to trust
=> Stronger alliance = better outcome
Insight-Oriented Therapies
Psychoanalysis & Psychoanalytic Psychotherapy
1.Assumptions
a) Disorder = childhood problems& unconscious conflicts
b)Purpose of Symptoms = express conflict & protect from conscious awareness of conflict
c)Goal of therapy = uncover conflict to free person from symptoms
Methods
a)Therapist behavior
Anonymous
Abstinent
Ambivalent
b) Free association & dream interpretation
- analyst interprets
c)Transference
- patient comes to regard therapist as parent& enacts old relationship
d)Countertransference
- therapist develops personal feelings for client
Psychoanalysis vs. PsychoanalyticPsychotherapy
a)Time & Expense
- 5 times/week for 5+ years
vs. 1-2 times/week for 1-2 years
b)Interaction:
- little vs. much therapist input
- couch vs. chair
- focus = child sexuality & aggression vs. other issues
Humanistic Therapy
Assumptions
a)Optimistic: People are good & seek self-actualization
b)Disorder = incongruence
- parents don’t provide unconditional positive regard
- person conforms to them
c) Goal of therapy = client accepts self
- restructure self-concept to match reality
- strive toward self-actualization
Methodsa) Therapist behavior = nonjudgmental, warm,
genuineb) Relationship: Therapist & client are equals
- “client” vs. “patient”- therapist is nondirective- client knows what is best- needs facilitator to discover
c) Method - therapist mirrors/reflects client
Gestalt Therapy
Assumptions
a)Disorder = out of touch with true self
- not accepting gestalt (whole)
b)Goal of therapy
- improve awareness of self-aspects
- take responsibility for them
Methodsa)Therapist behavior = confrontational &
directiveb)Nonverbal cuesc)Role-playing - act out relationships
- “empty chair”- letter writing
d)Dream interpretation
Cognitive-Behavioral
• WHY of behavior is unimportant
• Change current thoughts/behaviors
(sx focus)
Ellis’ Rational Emotive Therapy (RET)
1.Assumptions
a) Disorders = irrational beliefs
- perfectionism
b) Goal of Therapy = substitute rationalfor irrational thoughts
Methods
• Therapist Behavior: dispute beliefs
- Therapist as Educator
- Therapist & client are active
- Homework
Beck’s Cognitive Therapy
1.Assumptions
a) Disorders = irrational beliefs
- irrational beliefs differ by disorder
- Affect, Behavior, & Cognition
b) Goal of Therapy = change irrationalbeliefs
Methods
a)Therapist: warm, but disputes
b)Guided Imagery: move from unrealistic fantasies toward realistic gratification
c)Homework
- test out irrational beliefs
- situational analysis
Behavior Therapy
1.Assumptions
a) Disorders = learned responses that can
be unlearned
- Behavior is situationally specific sotreatment must be specific
b) Accept client’s report as valid
c) Goal of Therapy = change maladaptive behavior
- substitute adaptive behavior
Methods
a) Therapist Behavior
- directive, gives advice
- also warm
- Client controls focus of therapy
- Therapist = how to change
b) Functional Analysisreinforcements & contingenciesProblem - What Antecedents - When
- WhereConsequence - How (is problem rewarded)- Change cues/contingencies to change behavior
c)Flooding
- expose to worst fears until person can tolerate without anxiety
- imaginal or in vivo
d)Systematic Desensitization
- gradually expose to fear
- start with least fearful
- in vivo or imaginal
- with or without relaxation
e)Aversive Conditioning
- pair negative behavior with aversive stimulus
- in vivo or imaginal
- last resort
Family & Couples Therapy
Assumptions
a)Disorder occurs in context of family & marital relationships
- Communication = biggest problem
- Relationship issues
b) Goal of Therapy = change interactions so that “patient” no longer needs the problem behavior
Methods
a)Problem-Solving:
State problem
*Restate in other’s words
Suggest solutions
Evaluate solutions
Agree on solution & try it
b)Structural Family Therapy
- problems in family structure
- change by “unbalancing” current system
c)Family Systems Tx
- reduce over-involvement
- promote healthy individuation
Group Therapy
Assumptions
a)Advantages
- Not alone in problem
- Additional support of group members
- Some problems = relevant for groups
- Cheaper
b)Disadvantages
- self-disclosure to many
- confidentiality
- less therapist attention
Methods: General
- 8-10 people in circle
- All provide feedback & support
- Therapist is less directive
- Therapist may self-disclose
Methods: Specific
a)Psychodrama - each person’s problems enacted as a play
b)Assertiveness Training
passive — assertive — aggressive
c)Social Skills Training
Eclecticism
Technical Eclecticism
• Use techniques of different orientations
• Theory: either one or none
• Many therapists
Theoretical Eclecticism
• Integrate different theories
• Based on common principles of behavior and on nonspecific factors
• Problem = basic assumptions of theories conflict
• Challenge = rigid adherence to one theoryvs. superficial knowledge of several
**Must have a plan, conceptualization of each case that drives therapy
Effectiveness of Psychotherapy
• Outcome studies
• Meta-analysis
- statistical combination of many studies
Smith & Glass (1977)
• 375 controlled studies
• Average client better than 75% of controls
Smith, Glass, & Miller (1980)
• 475 controlled studies
• Average client better than 80% of controls
• Some research: Effectiveness generalizes to real therapy (external validity)
• Other research: research therapy vs. clinic therapy
• Effects seen in 3-4 months for 50%
• Effects seen in 6 months for 75%
• But, many clients terminate early
• Few differences among therapy types
Issues
• Match therapy to problem
• Match therapy to client
Ethical & Legal Issues
Clients’ Rights
1.To treatment
- cannot just be confined
2.To efficacious treatment
- statistical vs. clinical significance
- 70% spontaneous remission
- but therapy is better
- continued improvement
- right to not be abused
Must terminate therapy (refer to someone else) if
- not efficacious
- problem between therapist & client
3.To confidentiality
- increases trust & disclosure
- exceptions:
suicide/homicide
child abuse
subpoenas
4. To informed consent
- explanation of treatment, purpose, & projected outcome
5. To refuse treatment
- a limited right
Forensic Psychology
Determining mental competency
1. For involuntary commitment
2. At the time of committing a crime
Criteria
- result of a mental disease or defect
- can’t appreciate wrongfulness
- can’t conform behavior to the law
Frequency
- almost never used
- rarely effective when used
- when used and person NGRI,more time in hospital than in jail
3. At time of trial
- participate in own defense
4. At time of execution
- retribution
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