Psychotherapy Orientations: Theories, Techniques & Approaches

Psychotherapy Orientations Introduction Theoretical Orientations Definition of Psychotherapy Psychotherapy - the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modi...

Psychotherapy Orientations Introduction Theoretical Orientations Definition of Psychotherapy Psychotherapy - the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify their behaviors, cognitions, and emotions, and/or other personal characteristics in direction that participants deem desirable.  Common Elements of Psychotherapy Positive expectations (self-fulfilling prophecy) belief or expectation that influences behaviors in a way that makes the belief come true. It happens in three stages: Expectation – A person holds a belief about themselves, others, or a situation. Behavioral Response – This belief influences how they act. Outcome Confirmation – Their behavior causes the belief to come true, reinforcing the original expectation. Strong therapeutic alliance strong, collaborative relationship between a therapist and a client Psychotherapy Orientations Psychoanalysis/Psychodynamic Psychoanalysis / Psychodynamic Theory (1 of 3) Sigmund Freud (1856-1939) Basis of neurosis was: – The conflict between id, superego, and ego – Ego’s defense mechanisms – Unconscious conflicts that originate in childhood  Psychoanalysis/Psychodynamic Theory (2 of 3) Defense mechanisms – ego’s protective method of reducing anxiety by unconsciously distorting reality. Repression - banishes distressing thoughts and feelings from consciousness Projection - disguise own threatening impulses by attributing them to others Rationalization - offers self-justifying explanations in place of the real, more threatening, unconscious reasons for one’s actions. Reaction formation - the ego unconsciously makes unacceptable impulses look like their opposites Displacement - diverting sexual or aggressive impulses toward an object or person that is psychologically more acceptable than the one that aroused the feelings Sublimation - expressing a socially unacceptable impulse in a socially acceptable way  Psychoanalysis/Psychodynamic Theory (3 of 3) if there is a conflict or too little of something in one stage like not getting enough sucking then it may lead to an unconsious conflict in future that leads to other things maybe like overeating If there is a conflict that is unresolved during one of these stages, then this conflict may manifest itself at a later age  Psychoanalysis/Psychodynamic Therapy (1 of 4) Goal: Gain insight into unconscious conflicts Free association say whatever comes to mind. – ex. suppressing the thought that u dont like someone's shirt. in free association u say it out loud to get out what your really thinking or feeling. Projective testing ambiguous picture is presented to client. not a pic of anything specific but patient has to say what they see. what u see is a reflection of what's truly going on inside of you. (monster- scared running from something) Transference projects feelings attitudes and thoughts from the past onto his psychoanalyst patient notices criticism then the patient may be sensitive to criticism bc their parents are critical so they are aware of that. if they're really submissive then maybe bc their parents were critical so they learned to keep the peace by agreeing w whatever the parents say. Resistance tendency for an individual to resist change of act in a way that undermines the therapeutic process. ex. maybe they're quiet or they cancel alot, forget ab sessions. things that can hurt therapy process.  Psychoanalysis/Psychodynamic Therapy (2 of 4) Interpretation - the therapist’s attempt to make sense of the patient’s experience, articulate a hypothesis about the patient’s unconscious experience, or draw the patient’s attention toward unconscious self-defeating patterns analyst plays role as expert and imparts their wisdom on the patient.  Psychoanalysis/Psychodynamic Therapy (3 of 4) Lack of research supporting the effectiveness of long-term psychoanalytic therapy (main criticism) ○ some research suggest that psychoanalysis is better than no treatment but don't know if its better than other therapy. ○ psychoanalysis (freud) Psychodynamic therapy evolved from psychoanalytic therapy ○ Concerned with interpersonal conflicts ○ Includes Brief Psychodynamic Therapy ○ uses many concepts freud believed. things from past to gain insight like relation with parent childhood experiences lead us to develop this inner model for adult relationships. however the patient acts in session and relate to therapist could be reflective of how they operate w other people and their other relationships. ○ many times sessions are unstructured. (patient decides what to talk about) ○ diff between psychotherapy and psychoanalysis: psychotherapy focus on interpersonal (w other people) conflicts while freud psychoanalysis is more about the inner conflicts.  Psychoanalysis/Psychodynamic Therapy (4 of 4) Brief Psychodynamic Therapy Targets a main interpersonal problem Time limited (e.g., 12-40 sessions) Requires more structure/planning Therapist is more active/directive Therapeutic alliance emphasized Limited research support some are skeptical, some say need more data, some say best for personality disorders.  Psychotherapy Orientations Adlerian Music: http://www.bensound.com/royalty-free-music  Adlerian Theory Alfred Adler (1870-1937) “Striving for Superiority” is the core motivation criticized freud's ideas. explored both conscious and unconscious. (freud: unconscious) individual psychology (created on therapy. understanding the individual.) says u grow up feelings sense of inferiority. envisioning this perfect life and idealized image of their life in future. when striving for superiority they make mistakes and cognitive distortions (black and white, jumping to conclusions) people think in incorrect ways as a result of striving for superiority. Basic mistakes -exaggerated, absolute, unwarranted conclusions Psychopathology is caused by striving for superiority in an unhealthy way Birth order influences personality and chosen lifestyle ○ believed birth order and experience influence our personality.  Adlerian Therapy (1 of 2) Also called Individual Psychotherapy Therapeutic relationship is egalitarian – patients and therapist insights are equally important. – also focuses on the family life and relationships, roles between everyone. Focus on the whole individual Lifestyle assessment – Family constellation interview – The Question: How would your life be different if you were well? try to find hidden motivation for these behaviors. ex: ‘maybe id be more successful’... maybe depression is a coverup for your fear of failure so you dont have to face it. – Early recollections: look at past and childhood. – Identify basic mistakes point out unhealthy ways of thinking  Adlerian Therapy (2 of 2) Future autobiography ○ write a biography but write it in an idealistic way you want it to look like. show them they dont need to be perfect. can still have a great life and successful. ○ gives them goals. define them, plan them. ○ exposing yourself to the idea of imperfection. Catching oneself ○ catching unhealthy behavior in the moment. (tells patient to catch yourself and notice your doing those unhealthy behaviors) Creating new images ○ aka new perspectives, the way your seeing yourself. ex. someone who had a hard life, went thru hell and trauma. cards stacked against them. they may see themselves as a victim. need to change that mindset and see themselves as a survivor. develop qualities of resilience and grit. Acting “As If” ○ many people don't have traits they wish they had… sooo just act as if you were confident. next time u feel an anger burst lets act as if your a calm person and hold back… person may become or see themselves as being more capable of being calm. Push-Button technique ○ behind every emotion its the though and belief that comes first which leads to emotion. ○ our thoughts dictate our emotions. and we have some control over our thoughts. think happy thoughts. Limited research support ○ some research shows better than placebo. many times its incorporated into other forms of therapy like CBT Many of its ideas have been incorporated into other therapies  Psychotherapy Orientations Humanistic, Motivational Interviewing Music: http://www.bensound.com/royalty-free-music Person-Centered Therapy (1 of 4) Carl Rogers (1902 – 1987) He was optimistic, said people strive to be better and everyone is inherently good. - studied things like reinforcement and punishment back then, and clinical psychologists were trained in psychoanalysis. Trained in psychoanalysis, but found that listening and letting the client lead worked better Found that psychoanalysis don't really work, he found that a good conversation that the patient led worked better. Human connection is key - more egalitarian. Believed in treatment outcome research Person-Centered Therapy (2 of 4) Features of Rogers’ personality theory: Conditions of worth – conditional positive regard Conditions Of worth are the conditions we think we must meet in order to get love and approval from others. - not unconditional love but only loved if they do the right things. straight A’s, sports- whatever to get approval from parents. Psychopathology arises from: – Discrepancy between ideal self and real self bc of COW we create an ideal self and real self. Feel like were not good enough. – Failing to learn and change from life experiences Goal of therapy is to become more aware and accepting of real self, and to reduce discrepancy between ideal self and real self he believes there has to be a nurturing environment.  Person-Centered Therapy (3 of 4) Necessary and sufficient conditions for therapy: – Unconditional positive regard acceptance of who the patient is – Accurate empathy – Genuineness Therapist takes a nondirective role patient can say whatever they wanna say Therapist uses reflection repeating back what the patient says. - help them learn to become self aware, - help them feel understood/seen. - has more control of their treatment - self autonomy-”u talk ab what u wanna talk about” - in contrast to freud's psychoanalysis. (patient comes to own conclusions rather than freud telling them whats wrong w them…. promoting self empowerment - better than asking too many questions- help patient continue to open up. - felt it was unnecessary to diagnose a patient. They may think they're broke- stigma- self fulfilling prophecy(“ i have depression i cant”).  Person-Centered Therapy (4 of 4) Contemporary person-centered therapy Classical person centered therapy is more affected than all theraspy except CBT for specific problems like anxiety disorders. Typically blended with other approaches Therapists are more active/directive compared to classical approach Includes Motivational Interviewing (MI) First make to help w addiction. – Developed by William R. Miller & Stephen Rollnick No matter what technique it rlly did not work well. Only research showed that the more empathetic the therapist was showed more benefit to patient. – Found that therapist empathy ratings were strongest predictor of positive outcomes (for behavioral self-control techniques)  Person-Centered Therapy: Motivational Interviewing (1 of 5) Collaborative, person-centered approach for addressing ambivalence about behavior change person may not know if thwy wanna change. This therapy allows them to explore theor ambivalence. this lets the patient decide if they want to change. Originally aimed at addiction, but now used for a variety of problems Righting Reflex can lead to resistance Natural tendency to just tell the patient what to do. Naturally the patient could rebel against that so they want the patient to mak their own ideas and decisions.  Person-Centered Therapy: Motivational Interviewing (2 of 5) MI addresses these 3 questions: Do you think it’s important to make a change? How confident are you that you can actually make the change? How committed are you to make the change?  Person-Centered Therapy: Motivational Interviewing (3 of 5) 4 General Principles of MI: Express empathy Develop discrepancy – How do you want to live your life? – How are you actually living your life? Roll with resistance (or Reflect Discord) if the patient is resisting change. the therapist is not going to argue with that. instead they will help understand the patients perspective. Support self-efficacy trying to elp the patient feel self autonomy and help make a change for themselves. Their decisions…. taking charger of own life- build confidence  Person-Centered Therapy: Motivational Interviewing (4 of 5) Core MI techniques (OARS Acronym): Open-ended questions not just Yes, no questions helps patients open up. Affirmations Statements that recognize the clients strengths. behaviors- skills- personality. “you've been working really hard to open up. Reflections – Double-sided reflections – capture both sides of the ambivalence reflect on reasons to change and not reflecting on reasons nto to change Summaries  Person-Centered Therapy: Motivational Interviewing (5 of 5) Therapist listens for change talk – then reflect and ask open-ended questions. The more someone talks about change, the more likely they are to change. Silence can provide space to think and reflect Motivational interviewing may be the first approach. then after the patient is commited they can bring in cognitive and behavioral techniques. they have to decide if theyre gonna make a change before they actually commit to doing it. MI is supported by research, especially for substance-related problems (Hettema, Steele, & Miller, 2005).  Psychotherapy Orientations Existential Music: http://www.bensound.com/royalty-free-music  Existential Therapy (1 of 4) Developed in the context of post WWI & WWII Focus on the immediate human experience (whats going on right now in your surroundings and yourself. self awareness) Anxiety is a normal part of human existence – Normal anxiety we should embrace it not run from it. proportional to the experience – Neurotic anxiety extra anxiety that results from not facing the normal anxiety. (like if you avoid a speech and call in sick and keep avoiding it so next time it's hard too.) Existential anxiety stems from: – Awareness of looming death – Threat of meaninglessness – Isolation – Necessity of making decisions (personal responsibility) stems from emotional avoidance, isolation, Psychopathology stems from low self-awareness, emotional avoidance, and struggling with existential anxiety Existential Therapy (2 of 4) Existential therapy is about: Finding meaning own personal meaning Facing death/isolation coming to terms w how we do feel alone sometimes Self-awareness; Discover/explore authentic self who are you what do u want and how do u get it. accept who u are Live life to the fullest Accept that we can’t control or know everything recognize that life is full of uncertainty Experience emotions authentically and in the present moment experience emotions authentically - face your emotions good and bad Personal freedom & taking personal responsibility for our choices Existential Therapy (3 of 4) Therapeutic relationship is authentic and filled with connection therapist is present. warm comforting relationship Therapist can give feedback and be confrontational “it seems like ur procrastinating that task cus ur being avoidant, dont wanna face it” Does not necessarily make use of prescribed techniques/procedures Paradoxical intention behave opposite to how u think or feel. if ur shy, and u wanna stay to urself cus its easier. dont isolate yourself, be sociable. (similar to acting as if… :adlerian therapy) Changing cognitive meaning change perspective. try to get more meaning from the things that are happening. Existential Therapy (4 of 4) Lack of RCTs investigating existential therapy – Goal of therapy is not to reduce symptoms but to live a better life Some studies found that existential group therapy is helpful for facing life-threatening illnesses (van der Pompe, Duivenvoorden, Antoni, & Visser, 1997; Kissane et al., 2003; Page, Weiss, & Lietaer, 2002).  Psychotherapy Orientations Gestalt Therapy Music: http://www.bensound.com/royalty-free-music  Gestalt Therapy (1 of 2) Fritz Perls (1893-1970) - Helped develop Gestalt Therapy (in the wake of WWII & growing Apartheid in South Africa). Founded the New York Institute for Gestalt Therapy. Existential & humanistic influences Emphasis on self-awareness & present moment who u are what u think, in the present moment - taking responsibility for your own decisions Personality is holistic – Shaped by context & interpretations have to understand the entire individual – One grows and becomes whole by being self-aware in the present moment (of sensory information, feelings, wants, beliefs) self awareness, using your senses. live in the present moment aware of what goes on inside u and around u. 3 Psychopathology stems from: – Living in the past – Worrying about the future – Clinging to illusions about self – Failing to learn from experience  Gestalt Therapy (2 of 2) Gestalt therapy emphasizes increasing self-awareness and current awareness of the present moment. Attention to body language (especially signs of suppressing emotion) Unfinished business Gestalt therapy experiments – Empty-Chair technique – Reversal technique act opposite of how they usually act - goal of trying to recapture their whole selves “I take responsibility for…”: use this phrase in convo. say this frase in conversation fot the next few minutes. Dream work Gestalt therapy better than placebo but less effective than CBT (Greenerg, Ellio, & Lietaer, 1994)  Psychotherapy Orientations Reality Therapy Music: http://www.bensound.com/royalty-free-music  Reality Therapy (1 of 4) William Glasser (1925-2013) – published “Reality Therapy: A New Approach to Psychiatry” (1965) Existential & humanistic roots Emphasizes personal freedom & responsibility Emphasizes therapeutic relationship  Reality Therapy (2 of 4) Choice theory (humans are internally motivated and can choose their own behaviors) Human behavior is driven by the following needs: – survival (or self-preservation) – love and belonging – power (or achievement or inner control) – freedom (or independence) – fun (or enjoyment) Quality World – one’s world of wants – People – Things/experiences/activities – Ideas or system of beliefs  Reality Therapy (3 of 4) Total Behavior consists of: acting, thinking, feeling, physiology Automobile analogy to describe total behavior choose to drive our car to the world we want. we create out life. People are responsible for own behavior (so no such thing as mental illness) direct control on front 2 wheels. indirect control on back 2 wheels. Unhappiness is often caused by one person trying to control another  Reality Therapy (4 of 4) Reality therapy – clients should choose their lives and take responsibility for their choices Explores 4 questions (WDEP) – Wants: What do you want? – Doing: What are you doing? – Evaluation: Is it working? – Planning: Should you make a new plan? Focus on present reality (not the past) Focus on personal strengths