Psychotherapy

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Psychotherapy

• ASPECTS OF THERAPY
• A. Free Choice
• - Client must want therapy for change

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• B. Hopes Expectations
• 1. Expectations about the future affect the
  present
• gt Belief that therapy will work powerful
  treatment itself
• Placebo effects
• Hormones immune system

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• 2. Different expectations of therapy by client
  therapist
• gt increase similarity in expectancies

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• C. Therapist-Client Interaction
• 1. Therapist Qualities
• Nonspecific Factors
• - Empathy - Warmth
• - Genuineness

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• Experience
• Client-therapist matching

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• Therapeutic Alliance
• - Joint goals how to achieve them
• - Therapists cooperative spirit
• - Clients ability to trust
• gt Stronger alliance better outcome

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Insight-Oriented Therapies

• Psychoanalysis Psychoanalytic Psychotherapy
• 1. Assumptions
• a) Disorder childhood problems unconscious
  conflicts

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• b) Purpose of Symptoms express conflict
  protect from conscious awareness of conflict
• c) Goal of therapy uncover conflict to free
  person from symptoms

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• Methods
• a) Therapist behavior
• Anonymous
• Abstinent
• Ambivalent

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• b) Free association dream interpretation
• - analyst interprets

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• c) Transference
• - patient comes to regard therapist as parent
  enacts old relationship
• d) Countertransference
• - therapist develops personal feelings for client

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• Psychoanalysis vs. PsychoanalyticPsychotherapy
• a) Time Expense
• - 5 times/week for 5 years
• vs. 1-2 times/week for 1-2 years

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• b) Interaction
• - little vs. much therapist input
• - couch vs. chair
• - focus child sexuality aggression vs.
  other issues

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Humanistic Therapy

• Assumptions
• a) Optimistic People are good seek
  self-actualization
• b) Disorder incongruence
• - parents dont provide unconditional positive
  regard
• - person conforms to them

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• c) Goal of therapy client accepts self
• - restructure self-concept to match reality
• - strive toward self-actualization

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• Methods
• Therapist behavior nonjudgmental, warm, genuine
• Relationship Therapist client are equals
• - client vs. patient
• - therapist is nondirective
• - client knows what is best
• - needs facilitator to discover
• Method - therapist mirrors/reflects client

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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

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• Methods
• a) Therapist behavior confrontational
  directive
• b) Nonverbal cues
• c) Role-playing - act out relationships
• - empty chair
• - letter writing
• d) Dream interpretation

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Cognitive-Behavioral

• WHY of behavior is unimportant
• Change current thoughts/behaviors
• (sx focus)

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• Ellis Rational Emotive Therapy (RET)
• 1. Assumptions
• a) Disorders irrational beliefs
• - perfectionism
• b) Goal of Therapy substitute rational for
  irrational thoughts

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• Methods
• Therapist Behavior dispute beliefs
• - Therapist as Educator
• - Therapist client are active
• - Homework

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• Becks Cognitive Therapy
• 1. Assumptions
• a) Disorders irrational beliefs
• - irrational beliefs differ by disorder
• - Affect, Behavior, Cognition
• b) Goal of Therapy change irrational beliefs

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• Methods
• a) Therapist warm, but disputes
• b) Guided Imagery move from unrealistic
  fantasies toward realistic gratification
• c) Homework
• - test out irrational beliefs
• - situational analysis

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• Behavior Therapy
• 1. Assumptions
• a) Disorders learned responses that can be
  unlearned
• - Behavior is situationally specific
  so treatment must be specific

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• b) Accept clients report as valid
• c) Goal of Therapy change maladaptive
  behavior
• - substitute adaptive behavior

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• Methods
• a) Therapist Behavior
• - directive, gives advice
• - also warm
• - Client controls focus of therapy
• - Therapist how to change

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• Functional Analysis
• reinforcements contingencies
• Problem - What
• Antecedents - When
• - Where
• Consequence - How (is problem rewarded)
• - Change cues/contingencies to change behavior

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• c) Flooding
• - expose to worst fears until person can
  tolerate without anxiety
• - imaginal or in vivo

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• d) Systematic Desensitization
• - gradually expose to fear
• - start with least fearful
• - in vivo or imaginal
• - with or without relaxation

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• e) Aversive Conditioning
• - pair negative behavior with aversive stimulus
• - in vivo or imaginal
• - last resort

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Family Couples Therapy

• Assumptions
• a) Disorder occurs in context of family marital
  relationships
• - Communication biggest problem
• - Relationship issues

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• b) Goal of Therapy change interactions so that
  patient no longer needs the problem behavior

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• Methods
• a) Problem-Solving
• State problem
• Restate in others words
• Suggest solutions
• Evaluate solutions
• Agree on solution try it

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• b) Structural Family Therapy
• - problems in family structure
• - change by unbalancing current system
• c) Family Systems Tx
• - reduce over-involvement
• - promote healthy individuation

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Group Therapy

• Assumptions
• a) Advantages
• - Not alone in problem
• - Additional support of group members
• - Some problems relevant for groups
• - Cheaper

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• b) Disadvantages
• - self-disclosure to many
• - confidentiality
• - less therapist attention

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• Methods General
• - 8-10 people in circle
• All provide feedback support
• Therapist is less directive
• Therapist may self-disclose

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• Methods Specific
• a) Psychodrama - each persons problems enacted
  as a play
• b) Assertiveness Training
• passive assertive aggressive
• c) Social Skills Training

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Eclecticism

• Technical Eclecticism
• Use techniques of different orientations
• Theory either one or none
• Many therapists

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• Theoretical Eclecticism
• Integrate different theories
• Based on common principles of behavior and on
  nonspecific factors
• Problem basic assumptions of theories conflict

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• Challenge rigid adherence to one theoryvs.
  superficial knowledge of several
• Must have a plan, conceptualization of each
  case that drives therapy

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Effectiveness of Psychotherapy

• Outcome studies
• Meta-analysis
• - statistical combination of many studies

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• 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

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• Some research Effectiveness generalizes to real
  therapy (external validity)
• Other research research therapy vs. clinic
  therapy

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• 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

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• Issues
• Match therapy to problem
• Match therapy to client

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Ethical Legal Issues

• Clients Rights
• 1. To treatment
• - cannot just be confined

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• 2. To efficacious treatment
• - statistical vs. clinical significance
• - 70 spontaneous remission
• - but therapy is better
• - continued improvement
• - right to not be abused

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• Must terminate therapy (refer to someone else)
  if
• - not efficacious
• - problem between therapist client

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• 3. To confidentiality
• - increases trust disclosure
• - exceptions
• suicide/homicide
• child abuse
• subpoenas

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• 4. To informed consent
• - explanation of treatment, purpose,
  projected outcome
• To refuse treatment
• - a limited right

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Forensic Psychology

• Determining mental competency
• For involuntary commitment
• At the time of committing a crime
• Criteria
• - result of a mental disease or defect
• - cant appreciate wrongfulness
• - cant conform behavior to the law

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• Frequency
• - almost never used
• - rarely effective when used
• - when used and person NGRI,more time in
  hospital than in jail

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• At time of trial
• - participate in own defense
• 4. At time of execution
• - retribution