Setting the Framework

1
Setting the Framework

• Defining Psychotherapy
• Chapter 1

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Our Definition of Psychotherapy

• Psychotherapy is 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, emotions,
  and/or other personal characteristics in
  directions that the participants deem desirable.

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Informed Intentional

• Informed by what?
• Theory Experience
• Intentional
• There is a purpose/goal
• Systematic

4
Clinical Methods and Interpersonal Stances

• Clinical Methods
• Specific techniques developed from practice and
  research
• Interpersonal Stances
• Ways of being

5
Established Psychological Principles

• Again, psychotherapy is theory driven
• Personality theories
• Theories of psychopathology
• Social psychological theory
• Cognitive/information processing theories

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Assisting People

• Psychotherapists do not drive the boat
• Patients make changes not psychotherapists

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Modify Behaviors, Cognitions, Emotions and/or
Characteristics

• Psychological suffering manifests as
  dysfunctional behavior, thoughts and/or feelings
• The stuff of therapy includes all psychological
  processes
• In many ways directly modifying one of these
  processes can change any or all the others
• Different systems often focus on modifying
  different processes

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Participants Deem Desirable

• Participants Patient Therapist
• There is no set psychological process to address
• Participants examine the patients current
  perspective/functioning to develop goals
• Therapy is COLLABORATIVE
• Never should it be one-sided

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The Importance of Theory

• A theory is a set of assumptions that organize
  the data of natural phenomena for the purposes of
  explanation and hypothesis generation
• What makes a good theory?
• Is it comprehensive?
• Is it logical?
• Is it parsimonious (simple, not too simple)?
• Does it agrees with empirical research?
• Does it generate ideas/research?
• Is it disconfirmable?
• Is it practically useful?
• Without a theoretical orientation therapy suffers
• No consistency
• Lack of organization
• Lack of prioritization

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Therapeutic Commonalities

• Do therapies share common elements?

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Positive Expectations

• The belief that therapy will be effective
• Significant degree of outcome predicted by
  client/therapist belief in the effectiveness of
  the therapy
• Critical precondition for therapy to play out
• It is more than a placebo

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Therapeutic Relationship

• Composed of a number of factors
• Mutual respect
• Agreement on goals
• Agreement on tasks
• Therapist skills of
• Acceptance
• Warmth
• Empathy
• Encouragement of risk taking
• The most robust and most important common factor
• Some studies show that it accounts for 60 of
  outcome
• Patients view more important than therapists

13
Hawthorne Effect

• Improvement secondary to attention being given
• Therapeutic attention is special specific and
  non-reciprocal
• What makes therapy different than friendship is
  that the attention paid is one-sided.

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Outcome by Type of Factor
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Specific Factors Techniques

• Factors unique to specific therapies
• Biofeedback
• Systematic desensitization
• Dream interpretation
• Cognitive restructuring
• Some specific techniques are especially
• helpful with certain symptoms and
• disorders
• Exposure with anxiety disorders
• Cognitive interventions with depression

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Processes of Change

• Through what does change occur?

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Consciousness Raising

• Finding facts ideas that support the behavior
  change
• Self-Reevaluation behavior change is important
  in personal identity
• Environmental Reevaluation realizing positive or
  negative impact of healthy behavior on ones
  social physical environment

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Catharsis

• Emotional release can lead to change
• Corrective emotional experience
• Stimuli come from within
• Dramatic Relief
• Experiencing emotion in others
• Psychological laxative

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Choosing

• Results from an increase in consciousness,
  awareness of alternatives, and results in
  increased responsibility
• Self-liberation
• Individual becomes of aware of alternatives
• Social liberation
• Changes in the environment open up alternatives

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Conditional Stimuli

• Change occurs through the modification of the
  conditional stimuli that control our responses
• Counterconditioning associating a response
  incompatible to the problem response to
  controlling stimuli
• Stimulus control Change the probability of
  occurrence of a stimuli

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Contingency Control

• Behavior change through altering the relationship
  between a behavior and its consequences
  (reinforcement, punishment)
• Contingency management
• Direct modification of the environmental
  contingency
• Reinforcement something never reinforced or was
  punished
• Remove reinforcement from a problem behavior to
  decrease the behavior
• Reevaluation
• Modify the behavior without changing the
  contingencies

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The Content of Psychotherapy

• What needs to be changed?

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Psychotherapeutic Content

• Process How ----- Content What
• Content is often specific to the system
• Psychoanalytic Unconscious
• Existential Meaning finding
• Behavioral Overt behavior
• Cognitive Thought patterns
• One factor that relates to most types of content
  is CONFLICT

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Types of Conflict

• Intrapersonal Conflict Conflict taking place
  within the individual
• Anxieties and defenses, self-esteem identity
• Interpersonal Conflict Conflict taking place
  between individuals
• Intimacy, c0mmunication, problem resolution
• Individuo-social Conflict Conflict taking place
  between and individual and some institution
• Adjustment to social role, discrimination
• BEYOND CONFLICT Meaning and Fulfillment