Defining Psychotherapy Chapter 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 especially helpful with certain symptoms and disorders  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