Samenvatting boek Psychotherapy

Psychotherapy samenvatting
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Chapter 4 – behavioural therapy
Behaviour therapists  differ with respect to the importance placed on environmental
contingencies; the role of cognitions in understanding behaviour; and the need to develop a unique,
individualized, evidence-informed treatmentplan for each client versus relying on standardized,
session-by-session treatment protocols
 RCT’s

Behaviour therapy
- Directive, modelling alternative behaviours, teaching new skills
- Didactic (instruction, education, homework)
- Brief (about 16 sessions)
- Strongly rooted in empirical research

History
- Assumed that fundamental principles of learning occurred universally across humans &
animals  therefore, cultural factors were not viewed as an important consideration in the
development of behaviour therapy  now increasingly recognized

Racial/ethnic groups in Western countries show lower effects
- Due to values that underly behaviour therapy are incongruent
- Therapists may not routinely attend to cultural and systematic stressors
- Therapists may overlook cultural strengths

Concept of personality
- Individuals have characteristic patterns of feeling, thinking and acting
- Behavioural therapists  emphasize the role of context or situational factors in determining
an individual’s behaviour
- Operant conditioning seems to play a larger role in the development of personality than
classical conditioning

Radical behaviourism  behaviours are determined by patterns of reinforcement and punishment
from the environment

Behaviours are discussed as adaptive or maladaptive in a particular context
- Not ‘healthy’ or ‘unhealthy’
- Whether a behaviour is called pathological depends on the consequences and sociocultural
context

Understanding the problem  functional analysis
- Traditional: SORC (stimulus, organism, response, consequence)
- Nowadays: more symptom-focused assessment  measuring presence, absence, severity 
DSM-V

Behaviour therapy  big value of measuring outcome

,Assessment strategies in behavioural therapy
- Direct behavioural observation
- Monitoring forms and behavioural diaries
- Clinical interviews
- Self-report measures
 Multimodal approach often used (more than 1)

Transdiagnostic treatment manuals  parsimonious
- Provide broad interventions that can be applied to an array of clinical presentations
- Empirically supported and allow comorbidity

Common strategies in behaviour therapy
- Goal setting
- Psychoeducation
- Exposure based strategies
o In vivo exposure
o Imaginal exposure
o Interoceptive exposure (feared sensations)
o Virtual reality exposure
- Extinction/inhibitory learning

General principles
- Focus, intensity and duration under client’s control & enhanced by introducing
unpredictability over time
- Sufficient duration to really unlearn
- Intense enough, but not too overwhelming
- Practices should be spaced close together
- Stimulus varied across sessions
- Conducted in multiple contexts
- Focus on feared stimulus (no distraction)
- Response prevention
- Operant strategies
o Contingency management  arranging for different consequences to follow a given
response  natural reinforcement, self-management/self-control
o Shaping
o Extinction  response-cost procedures, response-contingent-aversive stimulation
o Target cues  stimulus control
- Behaviour activation (BA)  aimed at helping depressed patients increase their contact with
positive reinforcers and decrease patterns of avoidance and inactivity
- Social and communication skills training
- Modelling
- Problem-solving training
o Modifying problem orientation
o Teaching problem solving skills
 Problem definition and formulation
 Generation of possible solutions
 Selection of best solutions
 Implementation of selected solutions and evaluation outcome
- Relaxation-based strategies

, o Progressive muscle relaxation
 Early detection anxiety cues
 Progressive muscle relaxation
 Learning to apply relaxation skills when anxiety cues are first detected
- Emotion-regulation skills training

Exposure hierarchy  list of things that are feared, rank-ordered from most to least difficult 
bottom-up therapy

Cultural considerations
- Incorporating specific cultural values
- Working with resources within one’s community
- Making therapy accessible within the local context

Functional analytic psychotherapy (FAP)  idea that in-session reinforcement and contingent
responding to client behaviours can yield therapeutic benefit
 Helps clients identify clinically relevant behaviours  in-session and real life relevant

Motivational interviewing  collaborative conversation style used to help clients explore and resolve
ambivalence about making change

Behaviour therapy  helps clients to decentre from their thoughts  learn to recognize them as
mental events rather than indicators of truth or nature of self

Learning in interventions for certain problems may generalize to other, related problems

Ethics
- Therapists should attend to the power differential inherent in therapy and be sure that
mutually agreed upon goals are in place
- Also be aware of outside practice and exposure  changes in context challenge traditional
conceptualizations of the boundaries that surround therapy
- Also take culture into account

Effectiveness research: studying the use of behavioural interventions in frontline clinical settings
Efficacy research: in highly controlled research settings  more exclusion criteria, less representative
examples, not in context

Medication + CBT = effective
 Medication to influence the brain and learn easier

Internet & app CBT  more in primary care settings now  very effective

, Chapter 7 – person-centred and emotion-focused psychotherapies
Person-centered psychotherapy
Emotion-focused psychotherapy
Focusing-oriented psychotherapy
 All share the idea that psychotherapy is a process that’s based in human’s potential for
growth and creative actualization of their potential
 The main impetus for therapeutic change arises from clients themselves, mobilized in a
warm, accepting, empathic relationship with a therapist

Person-centered  Rogers
- First called client-centered  practice expanded to other realms of human interaction 
education & international conflict resolution

Carl Rogers
- Facilitating growth and testing hypothesis attitude in life
- Saw the client as the central figure in the therapeutic process, emphasizing that clients have
an innate sense of what they need to develop
- Role of therapist is to support this by focusing on clients’ present experience in therapy
- Non-directive therapy  fundamental emphasis on the therapist’s non-directiveness 
create a permissive, open atmosphere, designed to facilitate clients’ self-disclosure and
openness to their own experience

Eugene Gendlin
- Also important in development person-centered experiential psychotherapies (PCEP)
- Developed a method whereby he could communicate with people on both sides of various
issues
- Accept their entire system, try to formulate whatever point was being made within that
system
- The symbolization of experience

Laura Rice & Leslie Greenberg
- Established a research paradigm called “task analysis” to help illuminate different client
processes in therapy
- Then developed the process-experiential approach to psychotherapy
- Each developed models of specific in-session change processes
- Basis of PE-EFT = process-experiential/emotion-focused therapy

Person-centered concept of personality
- Humans are growing, changing organisms (living systems)
- Dynamic organisations that are constantly configuring and reconfiguring themselves as they
interact with their environments
- Traits and cognitive schemas evolve during life
- PCP  focus on how the organism organizes itself, navigates through the world and
confronts problems
- Focus on growth, the nature of the self, the idea of multiple realities, open internal and
external communication, the process of experiencing, emotion, and dialectical constructivism
- Rogers  capacity for growth as actualizing tendency  expanded to formative tendency 
tendency for things to move toward greater order, complexity and interrelatedness
- Built-in potential for resilience
- People’s capacity for self-righting is the primary force that makes psychotherapy work