Setting the Framework

Defining PsychotherapyChapter 1

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.

Informed & Intentional

Informed by what? Theory & Experience

Intentional There is a purpose/goal Systematic

Clinical Methods and Interpersonal Stances Clinical Methods

Specific techniques developed from practice and research

Interpersonal Stances Ways of being

Established Psychological Principles Again, psychotherapy is theory

driven Personality theories Theories of psychopathology Social psychological theory Cognitive/information processing

theories

Assisting People

Psychotherapists do not drive the boat

Patients make changes not psychotherapists

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

Participants Deem Desirable Participants = Patient & Therapist There is no set psychological process

to address Participants examine the patient’s

current perspective/functioning to develop goals

Therapy is COLLABORATIVE Never should it be one-sided

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

Do therapies share common elements?

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

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 Patient’s view more important than therapist’s

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.

Outcome by Type of Factor

Specific Factors: Techniques• Factors unique to specific therapies

Biofeedback Systematic desensitization Dream interpretation Cognitive restructuring

• Some specific techniques are especiallyhelpful with certain symptoms anddisorders

Exposure with anxiety disorders Cognitive interventions with depression

Through what does change occur?

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 one’s social & physical environment

Catharsis

Emotional release can lead to change Corrective emotional experience

Stimuli come from within Dramatic Relief

Experiencing emotion in others

“Psychological laxative”

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

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

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

What needs to be changed?

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

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