Clinical Psychology

Clinical Psychology

• Field of psychology that specializes in the investigation, assessment, diagnosis, prevention, and treatment of psychological disorders and emotional, intellectual, behavioral, or social problems.
• Involves teaching and clinical supervision for the application of principles, methods, and procedures for understanding, predicting, and intervening.

History of Clinical Psychology

• Officially emerged in 1896 with the founding of the first psychological clinic by Lightner Witmer at the University of Pennsylvania.
• Between the First and Second World Wars, clinical psychologists were involved in selecting and preparing soldiers and treating those with war trauma.
• Demand for clinical psychologists surged after World War II due to the need to treat war veterans with PTSD and other psychological disorders.

Psychotherapy

• A process of deliberate and planned interaction to influence behavioral disturbances and emotional states of distress.
• Goals: reduce symptoms or change personality through teachable techniques based on the theory of normality and dysfunction.

Phases of Psychotherapy Research

• 1st phase: Legitimation
  • Questioned by Eysenck (1952) in his study "Effects of Psychotherapy".
  • Clinical trials with random distribution of people by conditions demonstrated the effectiveness of psychotherapeutic interventions.
• 2nd phase: Comparison between therapies
  • Luborsky, Singer & Luborsky published the meta-analysis: "Verdict of the Dodo Bird" (no model is more effective for all types of problems in all circumstances).
• 3rd phase: Comparison between therapies for specific problems
  • Identifying effective interventions for specific problems and circumstances.
• 4th phase: Processes and change mechanisms
  • Castonguay and Beutler (2005) identified empirically validated principles of change.

Genetic Model of Psychotherapy

• Integrates input, process, and output variables to describe how psychotherapy works at different levels.
• Input variables: therapist variables, patient variables, and societal variables.
• Process variables: treatment model, therapeutic operations, and therapeutic bond/alliance.
• Output variables: post-session results in patient's psychological functioning and life situation, and societal results.

Common Factors in Psychotherapy

• Client characteristics: emotional or psychological suffering, expectations regarding therapy, motivation for change.
• Therapist characteristics: training and experience, social role attributed to the therapist.
• Therapeutic relationship: quality of the therapeutic alliance, trust, empathy, authenticity, and collaboration.
• Therapeutic processes: shared or similar in different therapeutic approaches.
• Psychotherapeutic context: environment where the therapy takes place.

Active Listening

• Process of change in psychotherapy divided into four phases:
  • Relationship: building a therapeutic alliance, establishing a safe and supportive environment.
  • Exploration: helping the patient explore their problems, emotions, behaviors, and thoughts.
  • Insight: identifying patterns of thinking, emotions, or behaviors that perpetuate problems.
  • Action: applying insights to make concrete changes in the patient's life.
• Three steps in the active listening process:
  • Receive message: psychologist is attentive to the client's verbal and non-verbal behaviors.
  • Process message: psychologist processes the message received.
  • Send message: psychologist responds to the client.

Active Listening Techniques

• Clarification: open-ended question designed to clarify ambiguities in the client's message.
• Paraphrase: rephrasing the client's main words and thoughts in a concise and clear statement.
• Reflection of feelings: rephrasing the affective component of the client's message, emphasizing the emotional tone.
• Summary: summarizing the client's message, bringing together emotional and content aspects that suggest a pattern or consistency.

Psychotherapy Models

• Psychoanalytic and psychodynamic
• Cognitive-behavioral
• Humanists
• Systemic and integrative/eclectic therapies### Psychoanalytic Therapy
• The therapeutic relationship is central, with the therapist attempting to remain neutral and anonymous to encourage the client to project their feelings and thoughts onto the therapist.
• The therapist is in a position of authority, and transference and countertransference mechanisms are crucial in the therapeutic process.
• Techniques used in psychoanalytic therapy include:
  • Transference interpretation: observing and interpreting the client's projections to bring underlying feelings and conflicts to awareness.
  • Interpretation of resistance: interpreting the client's resistance to the therapeutic process.
  • Dream analysis: exploring the contents of the client's dreams to interpret symbols and narratives as expressions of the unconscious.
  • Free association: encouraging the client to verbalize their thoughts without censorship, facilitating access to unconscious thoughts and feelings.

Applications of Psychoanalytic Therapy

• Psychoanalysis: a long-term process of self-exploration.
• Didactic psychoanalysis: part of the training to become a psychoanalyst.
• Brief dynamic therapies: self-exploration and promotion of insight.

Limitations of Psychoanalytic Therapy

• Inequality in situations of immediate risk: psychoanalytic therapy may not be suitable for situations that require immediate action.
• Some traditional psychodynamic approaches may have a rigid, binary view of gender and sexuality.

Dissociative Disorders

• Dissociative disorders represent a failure to integrate various aspects of identity, consciousness, and memory.
• Theories about the etiology of dissociative disorders relate to early trauma.
• Treatments for dissociative disorders include:
  • Psychodynamic therapies.
  • Hypnotherapy: inducing a state of sustained attention and suggestion to explore dissociated parts of the mind and repressed memories.
• Risk factors for dissociative disorders include:
  • Child abuse (physical and sexual).
  • Traumatic or extremely stressful situations.
• Treatment logic: identifying and dealing with repressed memories and teaching skills to deal with everyday life.

Humanistic Models

• Emphasize an individual-centered approach, focusing on personal growth and self-realization.
• Promote a deep and conscious understanding of oneself to gain insights into internal processes, values, and meanings underlying behaviors.
• Recognize that existential anxiety is an inherent part of the human condition.
• Assumptions:
  • The person is an inseparable whole, with biological, psychological, relational, social, and spiritual/existential aspects in constant interaction.
  • The person has an intrinsic potential to update and develop in a harmonious way in relation to others and the environment.
• Therapeutic objectives:
  • Create a safe environment: a therapeutic, welcoming, empathetic, and non-judgmental space.
  • Facilitate personal development and client fulfillment.
  • Awareness of personal freedom: helping the client recognize their ability to choose and take responsibility for their decisions and actions.

Techniques Used in Humanistic Therapy

• Promoting rapport/empathy: understanding the client's experience and expressing empathy.
• Emotional expression techniques: helping clients get in touch with and express their emotions and process unresolved emotions.
• Emphasis on the here and now: focusing on the client's current experience and feelings.

Limitations of Humanistic Therapy

• Limited capacity for reflection: patients with psychotic disorders may have limited capacity for self-reflection and introspection.
• Risk situations and crises: humanistic therapy may not be suitable for situations that require immediate action.

Existential Approaches in Psychotherapy

• Developed by Viktor Frankl, Rollo May, and Irvin Yalom.
• Focus on fundamental themes of human existence, aiming to help individuals find meaning and authenticity in their lives.
• Key concepts:
  • Capacity for reflection and self-awareness.
  • Freedom and responsibility.
  • Search for identity and courage to be.
  • Search for relationships with others.
  • Search for meaning.
  • Anxiety as a human condition.
  • Awareness of death and non-existence.

Emotionally Focused Therapy

• Theoretical model of human functioning based on the adaptive role of emotion.
• Emphasizes consciousness, acceptance, understanding, and transformation of emotion.
• Techniques:
  • Use of emotional markers: identifying clues in the client's speech or behavior that indicate the presence of a specific emotional problem.
  • Empty chair technique: imagining a significant person sitting in an empty chair and expressing feelings and thoughts directly.
  • Two-chair technique: moving between two chairs, representing different parts or aspects of oneself that are in conflict.

Cognitive Behavioral Therapy

• Behavioral model based on the idea that behaviors are acquired through conditioning that occurs in interaction with the environment.
• Psychopathology is typically learned through reactions to life experiences.
• Principles:
  • Psychic phenomena are best studied and described at the level of observable behavior.
  • Human behavior is determined by a multi-level conditioning process.
  • Pathological behavior can be treated through interventions that are based on the principles of human learning and the individual can be led to change by modifying experiences or training their adaptive skills.
• Limitations:
  • Inadequacy in explaining complex psychopathologies.
  • Experimental basis vs. real-life application.
  • Difficulty verifying learning histories.
  • Neglect of cognitive factors.### Systematic Desensitization
• Used in the treatment of phobias and anxiety
• Gradually exposes the client to the feared object or situation while they learn to relax
• Exposure can be live or in imagery (imagining the feared situation)

Cognitive Restructuring

• Used to identify and modify negative or distorted thinking patterns
• Helps clients change their thoughts and behaviors to improve their mental health

Cognitive Behavioral Therapy (CBT)

• Places emphasis on identifying and challenging irrational or dysfunctional thoughts
• Clients receive homework in the form of behavioral experiments to test their thinking
• Aims to develop coping skills and promote positive changes

Applications of CBT

• Useful in treating various disorders such as PTSD, depression, anxiety, and eating disorders
• Effective in relieving symptoms of depression and preventing relapses

Limitations of CBT

• Technical approach can be too focused on applying specific techniques rather than developing a strong therapeutic relationship
• May not be effective for more complex or profound issues such as deep trauma or severe personality disorders
• Some clients may resist CBT due to its direct and structured approach

Panic Disorder Treatment

• Cognitive behavioral therapy:
  • Exposure-based treatment
  • Cognitive restructuring of dysfunctional beliefs about bodily sensations
  • Breathing training
  • Cognitive restructuring therapy
  • Interoceptive exposure
  • Prevention of safety behaviors

The Systemic Approach

• Focuses on systems of relationships, such as families, couples, or groups
• Sees the family as an interdependent system, where each member influences and is influenced by the others
• Therapeutic objectives:
  • Unblock dysfunctional interaction patterns
  • Maximize differentiation between individuals
  • Identify the "unspoken rules" of the family
  • Develop better borders and forms of communication

Family Life Cycle – Developmental Approach

• Organizes changes in the family into a set of sequential and qualitatively distinct stages with characteristic developmental tasks
• Crises experienced by the family may be related to different stressful situations associated with expected transitions in the life cycle or non-normative crises

Eclectic and Integrative Approaches

• Eclectic approaches use techniques from different psychotherapy traditions without a theoretical model
• Integrative approaches develop theoretical models that integrate concepts and techniques from various traditions
• Focuses on common factors in psychotherapy, such as the therapeutic relationship and techniques

Dialectical Behavioral Therapy (DBT)

• Integrative approach that combines elements of cognitive, behavioral, humanistic, and psychodynamic therapies
• Uses a dialectical approach to synthesize change strategies and acceptance strategies
• Consists of weekly group therapy, weekly individual therapy, and telephone contacts
• Skills taught include:
  • Mindfulness
  • Interpersonal effectiveness
  • Emotional regulation
  • Tolerance of discomfort

Borderline Personality Disorder

• Conceptualized through biosocial theory, which emphasizes the interaction between biological vulnerabilities and the invalidating environment
• Deficits are identified in four areas of operation:
  • Behavioral
  • Interpersonal
  • Cognitive
  • Emotional

Ethics

• Code of ethics of the Order of Psychologists Portuguese
• General principles:
  • Respect for the dignity and rights of people
  • Competence
  • Responsibility
  • Integrity
  • Beneficence and non-maleficence
• Specific principles:
  • Informed consent
  • Confidentiality
  • Professional relationships