1. Military Psychology Gerhard Ohrband – ULIM University, Moldova 10 th lecture Psychotherapy and counselling

2. Course structure 1. Introduction: Historical Overview, main applications 2. Environmental Stressors 3. Leadership 4. Team Effectiveness 5. Individual and Group Behaviour 6. Clinical Psychology 7. Selection and Classification 8. Training 9. Human Factor Engineering 10. Psychotherapy and Counseling 11. Terrorism 12. Trauma Therapy 13. Psychological Warfare 14. Ethical Issues for a Psychologist in the Armed Forces 15. Review: Preparation for the exams

3. Content Psychodynamic therapies Cognitive behavioural therapies (CBT) Humanistic Therapies Systemic therapies Drug therapies Yoga, meditation and alternative therapies In detail: CBT (Rational-emotive therapy – RET; Beck’s Therapy) Alexander Technique

4. Cognitive Behavioural Therapy What is CBT? historical perspectives differences and similarities with other therapy schools

5. What is CBT? Cognitive Behaviour Therapy focus on unlearning disfunctional or learning new functional behaviour and cognitions focus on the “here and now” instead of digging in a client’s past application of findings in experimental psychology (learning theories)

6. What is CBT? focus on accurate diagnostics and therapy evaluation (constant and final) tailoring a therapy plan according to an individual’s specific needs eclectic approach (using that which works) typically, highly structured and relatively short therapies (approx. 12-17 sessions)

7. History 1950s Joseph Wolpe: Behavioural Therapy 1970s Cognitive Behaviour Therapy

8. Who is who?

9. Structure of a CBT Therapy first encounter – formulating first hypotheses as to the nature of the problem diagnostics and classification establishing therapy goals and making a therapy contract constant evaluation of therapy progress if necessary, strategy change final evaluation: have previously set goals been met? preparing client for time after therapy

10. CBT and Psychoanalysis CBTPsychoanalysis diagnosticsvery important for differentiated treatment less important, one-for- all treatment knowing about the causes not so important, focusing on the “here and now” very important etiologylearning, defective cognitions childhood traumas, defense mechanisms therapy durationshortlong scientific basisbased on experimental psychology based on case studies and introspection

11. Techniques in CBT systematic desensitization (Wolpe) – fear and phobia aversion therapy – drinking, smoking, transvestism, overeating behaviour modification – schizophrenia, mental retardation reinforcement of adaptive behaviours token economies modeling social skills training cognitive behaviour therapy

12. Discussion Criticisms: focus on the symptoms of a psychological problem to the exclusion of its root causes symptom substitution Evidence: symptom substitution does not appear to occur (Baker, 1969)

13. Literature Baker, B.L. (1969). Symptom treatment and symptom substitution in enuresis. Journal of Abnormal Psychology, 74, 42-29. Ellis, A. (1973). Rational-emotive therapy. In R. Corsini (ed.), Current Psychotherapies, Itasca, IL: Peacock. Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford, CA: Stanford University Press.

14. Internet resources http://rebt-cbt.net/ http://rebt-cbt.net/ REBT-CBT NET The Internet Guide to Rational Emotive Behavior Therapy and Cognitive Behavior Therapy http://www.nacbt.org/ http://www.nacbt.org/ The National Association of Cognitive-Behavioral Therapists (NACBT) The NACBT promotes and supports the practice of cognitive- behavioral therapy. The NACBT Website provides the latest information on CBT, including credentials they offer. A National Referral Database is also a feature of this site! Student and professional memberships are available.

15. Rational-Emotive Therapy (RET) Albert Ellis, clinical psychologist from New York Maladaptive thoughts are at the root of many psychological problems Therapist challenges a patient’s beliefs Differences/similarities with other cognitive therapies

16. ABC model of maladaptive behaviour Final exam night “I’m stupid.” “If I don’t get an A, I’m worthless.” Fear; severe anxiety Poor test performance 3-year-old son throws tantrum “I’m an incompetent Parent.” Guilt Lack of effective discipline Boss does not give raise “I must get a raise or else the world isn’t fair.” Righteous indignation Loss of motivation A ctivating event irational B eliefs aboutnegative activating event C onsequences

17. Essence of RET Not activating events (A) but beliefs (B) about activating events lead to emotional distress or bad behavioural consequences (C) “must”urbation RET therapists attempt to change patient’s thinking through logic, persuasion, occasional lecturing, and even prescribing specific activities

18. Basic assumptions Ellis believes that most irrational beliefs derive from a few basic assumptions that people wrongly make I must do extremely well and win approval or else I am a rotten person Others must treat me considerately and kindly and precisely the way I want them to treat me The conditions in which I live must be arranged so that I get everything I want in life, quickly and easily, and I don’t get anything I don’t want. I must be loved and admired by everyone who comes in contact with me

19. 10 irrational beliefs First-order beliefs: 1. I have to be loved and appreciated in everything, always and by the whole world. 2. I have to have talent and to be able to succeed in every important activity 3. Life is a catastrophe if things do not go the way I want.

20. Second-order beliefs 4. People who do bad things are detestable and deserve to be punished. 5. If there is something troubling, I am concerned and shocked by this thing. 6. I have to find solutions to make life better. 7. Inner and emotional unhappiness come from outside pressures, but I have possibilities to control my feelings and to escape from hostility and depression.

21. Second-order beliefs 8. It is easier to evade the confrontation of life’s difficulties than to start more profitable activities to control myself. 9. My past is of capital importance and, something which influenced your life in the past has to govern your present feelings and behaviours. 10. You can reach to happiness through inertness, through inactivity or through passive enjoyment and without personal commitment, engagement.

22. A-B-C-D-E D – discussion. Modification of beliefs. The therapist helps the patient to modify his irrational belief system E - effect. The effect represents the adoption of a more rational conception about the world

23. Criticism “RET therapists do not try to build warm, caring relationships with their clients.” Assumption: such a relationship is crucial to successful therapy RET point of view: an overly warm and caring therapist reinforces the client’s desire to be loved by everyone – an irrational belief that is often the root of the client’s problem in the first place

24. Literature Dryden, W. and Ellis, E. (1988). Rational-emotive therapy. In K.S. Dobson (Ed.), Handbook of cognitive- behavioral therapies (pp. 214-272). New York: Guilford. Ellis, E. (1984). Rational-emotive therapy. In R.J. Corsini (Ed.), Current psychotherapies (pp 196-238). Itasca, IL: Peacock. Ellis, E. and Bernhard, M.E. (1985). Clinical applications of rational-emotive therapy. New York: Plenum Haaga, D.A.F. and Davison, G.C. (1991). Cognitive changes models. In F.H. Kanfer and A.P. Goldstein (Eds.), Helping people change (3 rd ed., pp. 248-304). Elmsford, NY: Pergamon Press.

25. Beck’s cognitive therapy Aaron Beck, University of Pennsylvania Many psychological disorders are the result of cognitive distortions – faulty beliefs about oneself and other people. Focus on identifying and correcting such faulty reasoning Initially limited to depression, later treatment of many other psychological disorders (Freeman and others, 1989)

26. Problem-solving training Maladaptive approach ProblemAdaptive approach Generate a single solution Complain to your friends Can’t get a date Generate multiple solutions Discuss problem with friends Join a singles’ group Read a book on interpersonal relationships Work on improving \ yourself – buy new clothes, start a hobby, take a night course

27. Literature Beck, A.T. (1987). Cognitive models of depression. Journal of Cognitive Psychotherapy, 1, 5-37. Freeman, A., Simon, K.M., Beutler, L.E. and Arkowitz, H. (Eds.) (1989). Comprehensive textbook of cognitive therapy. New York: Plenum.

28. Social Skills Training What are social skills? Why train social skills? Which are groups who would profit especially from a Social Skills Training? Are there cultural differences? SST at school SST with autistic children

29. Example: SSST (Simulated Social Skills Training) Training in German schools Goal: rehearsal of new behaviour patterns, behaviour training Time: ca. 90 minutes per task Procedure: divide the whole group in triads (A, B, C), the criterion could be reciprocal liking. The groups are relatively autonomous as how they budget their time.

30. Rules You train only one sequence at one time with a person (A) One person (B) plays the interaction partner Person C observes the scene The behaviour should not be longer than 3 minutes (30 seconds would be sufficient for a training) The behaviour sequence is repeated until the whole group is satisfied with the results Every triad member fulfills all roles (A,B,C) at least at one time

31. Trained behaviour How do I say “no”? How do I interrupt a person, who talks much? How do I begin a difficult conversation with … ? How do I ask a smoker not to smoke in my presence? How do I criticize? How do I say sorry? …

32. Procedure A decides which behaviour sequence to train B and C give feedback, which A can try to implement in the next trial

33. Alexander-Technique form of education that is applied to recognize and overcome reactive, habitual limitations in movement and thinking usually learned from an Alexander Technique teacher in one-on-one sessions, using specialized hand contact and verbal instructions also taught in groups, often using short individual lessons in turn as examples to the rest of the class

35. History Alexander was a Shakespearean orator who developed problems with his voice. After doctors informed him there was no physical cause, he carefully observed himself in multiple mirrors. This revealed that he was needlessly stiffening his whole body in preparation to recite or speak. It took eight years to successfully apply his empirical observations on himself to solve his own voice problems. Alexander regarded the empirical scientific method to be the foundation of his work. He used self-observation and reasoning to make the physical performance of any movement easier: sitting, standing, walking, using the hands and speaking. F.M. Alexander trained educators of his technique mainly while living in London, UK from 1931 until his death in 1955, except for the wartime period between 1941 to 1943 which were spent teaching with his brother Albert Redden Alexander (1874–1947) in Massachusetts, USA. During his lifetime, F.M. Alexander gained considerable support for his work from many contemporaries including John Dewey, Aldous Huxley, George Bernard Shaw, and scientists Raymond Dart, George E. Coghill, Charles Sherrington, and Nikolas Tinbergen.

36. Problem Reliance on automate control in how we use our body/mind Loss of correct sensory appreciation of what we really do Acquisition of unadaptive patterns (e.g., constant tensions, chronic stiffening of the neck) Inability to make it again “right” because of incorrect sensory appreciation “end-gaining”

38. Goals Regaining conscious control of our body/mind Regaining a freedom of how we want to react in every situation Doing things more easily with less strain Not letting others or ourselves to push our “buttons”

39. Basic principles Primary control neck and head relationship leads quality of motion and response this determines the success of results for good or ill Inhibition recognize and prevent habitual limitations

45. Literature Cacciatore, T.W., Horak, F.B. and Henry, S.M. (2005). Improvement in automatic postural coordination following Alexander Technique lessons in a person with low back pain. Physical Therapy 85 (6), 565-78. Maher, C.G. (2004). Effective physical treatment for chronic low back pain. The Orthopedic clinics of North America 35 (1), 57-64. Stallibrass, C; P Sissons, C Chalmers (2002). Randomized Controlled Trial of the Alexander Technique for Idiopathic Parkinson's Disease Clinical Rehabilitiation 16 (7), 695-708.