Treatment Methods
Contents
Lecture 1 common factors..........................................................................................................1
Literature Lecture 1 Common Factors...................................................................................4
Lecture 2 Client-Centered and Emotion-focused therapy..........................................................5
Client-Centred Therapy..........................................................................................................6
Literature Marjorie C. Witty on Client-Centred Therapy (35-48).........................................8
Emotion-Focused Therapy (EFT)..........................................................................................8
Literature Alberta E.Pos and Lrslie S. Greenberg on Emotion Focused Therapy (25-31). .11
Literature R. Elliot and L.S. Greenberg on EFT..................................................................12
Lecture 3 CBT..........................................................................................................................13
Literature CBT Beck............................................................................................................19
Literature on CBT Rector.....................................................................................................20
Literature CBT Driessen and Hollon....................................................................................21
Literature CBT by Kaczkurkin and Foa...............................................................................23
Lecture 4 ACT..........................................................................................................................25
Literature ACT by Hayes.....................................................................................................28
Literature ACT by Harris.....................................................................................................29
Lecture 5 self-esteem and autonomy........................................................................................29
Article Korrelboom et al (2009) on COMET for eating disorders.......................................32
Lecture 6 EMDR......................................................................................................................34
Literature EMDR van den Hout and Engelhard...................................................................39
Lecture 7 Schema Therapy.......................................................................................................39
Lecture 8 Psychodynamic therapies.........................................................................................46
Literature on MBT by Bateman and Fonagy........................................................................49
Lecture 1 common factors
The dodo bird verdict: there are many different types of treatments that are deemed effective
(although they might be differently effective for different disorders), so then, which one is the
best? Nobody wins and nobody loses (big ongoing debate since the 1930s) > then, we can ask
ourselves whether the different types of psychotherapy matter or are the changes acquired
through general common factors which are present in all psychotherapies
,What makes a common factor ‘common’? Although treatment methods differ in their
approach to treatment, there is also a general belief that there are mechanisms at work that
contribute towards helping people change > these are common mechanisms that are present
in most people and are part of our socio-biological heritage. It is not clear what percentage of
common factors specifically, contribute towards the effectiveness of the therapy
3 common factors: therapeutic relationship, expectations and motivational factors
The therapeutic relationship > 5 factors
- Defining a relationship: although a therapeutic relationship starts like a regular social
encounter (first impressions etc), it becomes notably different from any other social
encounter > every developed treatment method has defined the way the relationship
should look like > common factors that develop the relationship well:
o Different roles each person plays (patient and therapist) > video Alex: patient
expects a certain thing from the therapist while the therapist tries to adjust his
expectations of what type of therapist he has to be
o Trustworthiness (safety and confidentiality)
o Reliability (will you be there for me?)
o Verbal and non-verbal communication
o Level of cooperation towards forming a working alliance
o Empathy or closeness and warmth
o Holding: the capacity of the therapist to manage all these factors and
maintaining a secure therapeutic relationship
- Managing emotions and anxiety
o Managing stress
- The role of attachment (esp. important in personality disorders and other persisting
psychopathology)
o People have social needs and we can use social interaction for healing:
Understanding
Mentalisation
Perspective taking
Empathy
Sense of togetherness
Attachment
o Types of attachment
Secure attachment
Easily formed treatment alliance: willing to connect with the
therapist, not too many difficulties
Treatment pretty straightforward; wont take extremely long, not
too many hiccups > follow the treatment plan and will most
likely be successful
Anxious-preoccupied
Easily formed treatment alliance
But, difficulties in terminating treatment > patients don’t want
to end the relationship (got attached); like feeling attached to
someone (dependency issues) > may also seem like they have
improved until you want to terminate treatment and then these
problems emerge again and it’s like you have to start from the
beginning
, Therapist needs to have a lot of patience
Fearful-avoidant
Forming a secure alliance takes a lot of time
Patient might seem less motivated but this is often not the case
They are at risk of being rejected by the therapist
More focused on skill and problem-solving, less on the
relationship
o Epistemic trust = the capacity to learn through a relationship and attachment
> insecure attachment styles interfere with the presence of epistemic trust so
they have more trouble with learning through the relationship (e.g.
complimenting your patient on their homework. If there is insufficient
epistemic trust, they will hear something else. ‘you’re just saying that because
you feel bad for me’)
- Transference = the interaction between a patient and a therapist > this is a very
complicated relationship
o 3 factors that influence transference
Patient (mood; how are you doing?)
Past (e.g. past failed therapy)
Present (e.g. problems at home)
o However, transference is not only about the
patient but also about the therapist themselves.
The therapist is not only a therapist but also be a
parent, have a bad day, have trauma in their own
past, have feelings towards a patient etc. These
can form dangers to the therapeutic relationship
o Managing transference: Leary’s rose = method to manage transference (note:
this method on its own is insufficient and different treatment methods have
additional techniques)
o Boundaries: needed in every treatment in every method > they identify what
the relationship should look like and help the therapist identify when there is a
healthy working alliance and when there are troubles > it provides clarify and
with clarity comes security and safety for the patient
Therapy expectations: both the patient and the therapist bring expectations to therapy
- Important factors
, o Timing (e.g. come see a therapist after big financial problems > the
expectations of the therapist are that the patient does not need therapy at the
moment but first need to fix their financial problems because it is very normal
to experience distress after such a stressful event)
o Previous experiences
o Beliefs about the complaints of the patient
o Beliefs about the solutions for the complaints which most of the time lead to
demoralisation and motivation problems (are their expectations realistic? The
idea that ‘I can be like I was before’ = not true)
- How to alter expectations
o Providing the patient with a framework / working model that showcases the
therapy method or conceptualisation of the problem
o Psycho-education about their problem and the treatment > re-establish hope
and motivate the patient
o Promoting self-efficacy, sense of control and autonomy, sense of self-esteem
and the ability to change their own behaviour and the situation
o Discussing and chancing response expectancies (the idea that ‘things always
end up the same’)
o Therapist and patient should be in agreement about the above described
factors before continuing > it can be seen as a type of treatment contract
Note: although the common factors are important, they are proven to be insufficient on their
own for a successful therapy outcome. So, the choice and fit of treatment method also has a
major effect on the treatment outcome
Literature Lecture 1 Common Factors
Contextual model of common factors = there are 3 different pathways through which
psychotherapy produces benefits (psychotherapy does not have 1 influence on patients but
works through various mechanisms)
- The real (therapeutic) relationship
o Initial meeting based on first impressions (are they trustworthy or not?)
o Different from any other social relationship in:
The interactions are confidential
Disclosure of difficult material (e.g. shameful things, infidelity of
spouse)
o Evidence:
The therapeutic bond is the most researched common factor
(correlation alliance and outcome 0.37 and Cohen’s d of 0.57 =
medium to large)
Effect of empathy on outcome also large (Cohen’s d = 0.63)
o Criticisms
Contents
Lecture 1 common factors..........................................................................................................1
Literature Lecture 1 Common Factors...................................................................................4
Lecture 2 Client-Centered and Emotion-focused therapy..........................................................5
Client-Centred Therapy..........................................................................................................6
Literature Marjorie C. Witty on Client-Centred Therapy (35-48).........................................8
Emotion-Focused Therapy (EFT)..........................................................................................8
Literature Alberta E.Pos and Lrslie S. Greenberg on Emotion Focused Therapy (25-31). .11
Literature R. Elliot and L.S. Greenberg on EFT..................................................................12
Lecture 3 CBT..........................................................................................................................13
Literature CBT Beck............................................................................................................19
Literature on CBT Rector.....................................................................................................20
Literature CBT Driessen and Hollon....................................................................................21
Literature CBT by Kaczkurkin and Foa...............................................................................23
Lecture 4 ACT..........................................................................................................................25
Literature ACT by Hayes.....................................................................................................28
Literature ACT by Harris.....................................................................................................29
Lecture 5 self-esteem and autonomy........................................................................................29
Article Korrelboom et al (2009) on COMET for eating disorders.......................................32
Lecture 6 EMDR......................................................................................................................34
Literature EMDR van den Hout and Engelhard...................................................................39
Lecture 7 Schema Therapy.......................................................................................................39
Lecture 8 Psychodynamic therapies.........................................................................................46
Literature on MBT by Bateman and Fonagy........................................................................49
Lecture 1 common factors
The dodo bird verdict: there are many different types of treatments that are deemed effective
(although they might be differently effective for different disorders), so then, which one is the
best? Nobody wins and nobody loses (big ongoing debate since the 1930s) > then, we can ask
ourselves whether the different types of psychotherapy matter or are the changes acquired
through general common factors which are present in all psychotherapies
,What makes a common factor ‘common’? Although treatment methods differ in their
approach to treatment, there is also a general belief that there are mechanisms at work that
contribute towards helping people change > these are common mechanisms that are present
in most people and are part of our socio-biological heritage. It is not clear what percentage of
common factors specifically, contribute towards the effectiveness of the therapy
3 common factors: therapeutic relationship, expectations and motivational factors
The therapeutic relationship > 5 factors
- Defining a relationship: although a therapeutic relationship starts like a regular social
encounter (first impressions etc), it becomes notably different from any other social
encounter > every developed treatment method has defined the way the relationship
should look like > common factors that develop the relationship well:
o Different roles each person plays (patient and therapist) > video Alex: patient
expects a certain thing from the therapist while the therapist tries to adjust his
expectations of what type of therapist he has to be
o Trustworthiness (safety and confidentiality)
o Reliability (will you be there for me?)
o Verbal and non-verbal communication
o Level of cooperation towards forming a working alliance
o Empathy or closeness and warmth
o Holding: the capacity of the therapist to manage all these factors and
maintaining a secure therapeutic relationship
- Managing emotions and anxiety
o Managing stress
- The role of attachment (esp. important in personality disorders and other persisting
psychopathology)
o People have social needs and we can use social interaction for healing:
Understanding
Mentalisation
Perspective taking
Empathy
Sense of togetherness
Attachment
o Types of attachment
Secure attachment
Easily formed treatment alliance: willing to connect with the
therapist, not too many difficulties
Treatment pretty straightforward; wont take extremely long, not
too many hiccups > follow the treatment plan and will most
likely be successful
Anxious-preoccupied
Easily formed treatment alliance
But, difficulties in terminating treatment > patients don’t want
to end the relationship (got attached); like feeling attached to
someone (dependency issues) > may also seem like they have
improved until you want to terminate treatment and then these
problems emerge again and it’s like you have to start from the
beginning
, Therapist needs to have a lot of patience
Fearful-avoidant
Forming a secure alliance takes a lot of time
Patient might seem less motivated but this is often not the case
They are at risk of being rejected by the therapist
More focused on skill and problem-solving, less on the
relationship
o Epistemic trust = the capacity to learn through a relationship and attachment
> insecure attachment styles interfere with the presence of epistemic trust so
they have more trouble with learning through the relationship (e.g.
complimenting your patient on their homework. If there is insufficient
epistemic trust, they will hear something else. ‘you’re just saying that because
you feel bad for me’)
- Transference = the interaction between a patient and a therapist > this is a very
complicated relationship
o 3 factors that influence transference
Patient (mood; how are you doing?)
Past (e.g. past failed therapy)
Present (e.g. problems at home)
o However, transference is not only about the
patient but also about the therapist themselves.
The therapist is not only a therapist but also be a
parent, have a bad day, have trauma in their own
past, have feelings towards a patient etc. These
can form dangers to the therapeutic relationship
o Managing transference: Leary’s rose = method to manage transference (note:
this method on its own is insufficient and different treatment methods have
additional techniques)
o Boundaries: needed in every treatment in every method > they identify what
the relationship should look like and help the therapist identify when there is a
healthy working alliance and when there are troubles > it provides clarify and
with clarity comes security and safety for the patient
Therapy expectations: both the patient and the therapist bring expectations to therapy
- Important factors
, o Timing (e.g. come see a therapist after big financial problems > the
expectations of the therapist are that the patient does not need therapy at the
moment but first need to fix their financial problems because it is very normal
to experience distress after such a stressful event)
o Previous experiences
o Beliefs about the complaints of the patient
o Beliefs about the solutions for the complaints which most of the time lead to
demoralisation and motivation problems (are their expectations realistic? The
idea that ‘I can be like I was before’ = not true)
- How to alter expectations
o Providing the patient with a framework / working model that showcases the
therapy method or conceptualisation of the problem
o Psycho-education about their problem and the treatment > re-establish hope
and motivate the patient
o Promoting self-efficacy, sense of control and autonomy, sense of self-esteem
and the ability to change their own behaviour and the situation
o Discussing and chancing response expectancies (the idea that ‘things always
end up the same’)
o Therapist and patient should be in agreement about the above described
factors before continuing > it can be seen as a type of treatment contract
Note: although the common factors are important, they are proven to be insufficient on their
own for a successful therapy outcome. So, the choice and fit of treatment method also has a
major effect on the treatment outcome
Literature Lecture 1 Common Factors
Contextual model of common factors = there are 3 different pathways through which
psychotherapy produces benefits (psychotherapy does not have 1 influence on patients but
works through various mechanisms)
- The real (therapeutic) relationship
o Initial meeting based on first impressions (are they trustworthy or not?)
o Different from any other social relationship in:
The interactions are confidential
Disclosure of difficult material (e.g. shameful things, infidelity of
spouse)
o Evidence:
The therapeutic bond is the most researched common factor
(correlation alliance and outcome 0.37 and Cohen’s d of 0.57 =
medium to large)
Effect of empathy on outcome also large (Cohen’s d = 0.63)
o Criticisms
