Psyc 360 Midterm Lecture Notes

PSYC 360 MIDTERM NOTES

Module 1: History and Modern Psychotherapy

1A. Historical Foundations of Psychotherapy
Foundations of Psychotherapy
 Early psychotherapy was practiced by Pre-Christian retreats centers, tribal ceremonies,
and religious healing.
 The birth of modern psychotherapy began with the birth of modern medicine
o Hellenist physicians
 Hippocrates was the father of modern medicine
 When he came along with other Hellenist physicians, they emphasized the
organic roots of disease.
 i.e. specifically, they believed that the brain was the seat of
knowledge. And if the brain is the seat of knowledge, then the
brain is the seat of depression, delirium, and madness.
 Psychological illness is not the result of spiritual changes or the gods, but
the result of organic processes.
 Hippocrates gave us the concept of “first do not harm”
Early Interest in the Unconscious
 Gottfried Wilhelm Leibniz (17th-18th century)
o He was a German philosopher and mathematician and the father of modern
calculus
o He was really interested in understanding how the brain works and in particular
how we can bring in perceptions from the outside world in ways that we aren’t
even aware of
o He focused on “subliminal perceptions”
 Perceptions we aren’t consciously aware of
 Subliminal (below the threshold)
 “dynamic” was the term he coined to describe these unconscious forces at
play.
 Franz Anton Mesmer (18th-19th century)
o He was interested in the unconscious brain and hypnotic therapy.
o Hypnotherapy is still practiced by some therapists today.
o Mesmer gave us multiple concepts that we still do today regardless of the type of
therapy we implement:
 (1) the importance of patient-therapist rapport
 The relationship between the client and the therapist will make a
difference in how the patient responds to treatment
 (2) how the personal qualities of the therapist influence a client/patient
 A treatment delivered by two different people with two completely
different personalities could end up having a treatment look very
different, and a certain patient may have a preference of one over
the other.
 (3) spontaneous remission of disorder

,  It is really important for us to understand that if we see a patient
getting better, we should not jump to conclusions that it was the
result of the treatment. Sometimes, spontaneous remission occurs
—some people will suddenly just get better.
 (4) importance of the client’s confidence in therapeutic procedures
 If the patient believes that the treatment will work and is confident
in the procedure, then it will work better
 On the other hand, if the patient has an attitude that the therapy is
not going to work, it creates a self-fulfilling prophecy, and may not
work as well.
th
19 Century Psychology: Natural Science Empiricists
 Based on empiricism. Knowledge is based on the experiences through the senses.
 Gustav T. Fechner and Herman Von Helmholtz
o We can conduct experiments, tests in the lab, and observations that will help us
generate knowledge of the human mind.
o Bench scientists
 They studied and theorized about the unconscious (bringing the
unconscious to the conscious), but they did so using the scientific method
in a lab and informed later psychodynamic models.
o Fechner made the distinction between waking and sleeping states.
 Attempted to measure the intensity of psychic stimulation (i.e. working
memory)
o Helmholtz discovered the phenomenon of unconscious inference which he
perceived “as a kind of instantaneous and unconscious reconstruction of what our
past taught us about the object”
o The spirit and approach of these lab-based scientist resounded through Europe
and in large part constituted what became known there as organicist tradition—an
approach that contrasts with the psychic mentalist tradition
 Emil Kraepelin (19th-20th century)
o He was concerned how bench science isn’t transferring enough with practice
 How do we get the information out of the lab and use it in the clinic?
 So Kraepelin takes a different approach…
o He becomes interested in using the scientific inquiry and method to classify
disease and identifies the prognosis of the disease.
 He thinks this is the way in which to bridge the gap between what’s
happening in the lab and what’s happening in the clinic
o He forms the framework for the DSM which is what we use to classify mental
diseases today.
Psychologist-Philosophers
 The philosopher of nature had a much greater long-term influence on the development of
the psychotherapies described than did lab-based scientists
o They had embraced nonbiological methods of curing the fashionable disorder of
the day—even those that today would be classified as major mental disorders
 Arthur Schopenhauer
o The World as Will and Representation (1819)

,  We know things we don’t even realize we know. We are inherently driven
by blind irrational forces.
 Carl Gustav Carus
o Role of the unconscious in communication
 We have different levels of the unconscious and they can speak to one
another across people
 Transference and countertransference
 So central to the psychodynamic theory
 In the clinic, as patient and therapist are at work, the conscious of
each speaks to the others unconscious and conscious
o Further, the unconscious of each speaks to the conscious as
well as the unconscious of the dyadic other.
 Nietzsche
o We lie to ourselves more than we lie to others
 Our conscious is a vessel for holding self-deception, repression, or
neurotic guilts, which is known as a defense mechanism and important for
psychoanalysis.
Clinician Researchers
 The emergence of analytic psychotherapy
 Modern-day scientist practitioner or clinical scientist
o The idea that someone who practices psychotherapy should also be trained in the
scientific method and should understand how to consume scientific research to
contribute to that scientific research and vice versa
o Someone who considers themself a scientist should still have some training in
what happens in the clinic
 This is what Kraepelin was trying to bridge
Impacts of Biological Scientists
 People often ask nature vs. nurture.
o Its both! We know that humans are incredibly plastic.
 We can change and be molded. We have a level of plasticity to us that
changes based on the environment around us.
o Psychotherapy actually makes changes at the neural level
 Psychotherapy takes advantage of this neural plasticity to help change how
our brains function.
 Epigenetics: external events can turn genes on or off enabling the
synthesis of proteins that act in the moment on the genome in cell
nuclei.
o Introducing even minor opportunities and novelties into a
client’s life can have an enormous impact on the way they
perceive and experience themselves.
o In brief, it is the complex biocultural matrix of the organic
and environmental that co-construct our way of being in the
world and our potential for growth.
o The field is interested in understanding how those
environmental influences and changes can further influence
our gene expression

,  Life events change us and our neurons. Only neuronal decay/lesions undo memory.
o Grawe: “psychotherapy achieves it effect through changes in gene expression at
the neuronal level.”
o Psychotropic medications should require clear, preset clinical objectives.
Cultural Factors
 Cultural factors
o Demographics, culture, language shape experience
o Stigma
 Psychotherapy still needs to undergo some shifts
 Evidence-based treatment
o What works, why it works and for whom it works.
1B. Evaluating the Evidence-Base
Psychotherapy Research
 What works? For whom? In what context? And why?
o Questions that are necessary to answer to determine whether a treatment works
for a particular patient.
Efficacy vs. Effectiveness
 Efficacy
o The efficacy of a treatment can be determined by well-controlled studies that hold
many variables constant, while trying to manipulate as few variables as possible.
 When we want to determine the cause-and-effect, it is important for us to
design these well-controlled experiments that only hold one variable.
(what efficacy studies try to do)
o You often see patient populations in efficacy studies that are very “cookie-cutter”
or “textbook”
 These patients usually don’t have multiple disorders, and well-defined
criteria is what they need.
 These folks work very well for these controlled types of studies because it
helps us hold so many other variables about them constant, but this
necessarily doesn’t translate into the real world.
 Which is why it is important for us to look at the effectiveness of a
treatment.
o This is because it is very uncommon to find “cookie-cutter”
or “textbook” representations for patients.
 Effectiveness
o The effectiveness of a treatment focuses on how well the treatment works in the
real world with people who are not predetermined to meet a narrow set of criteria.
 Asks the question: “how well does this treatment work in the real-world
with people who are just walking around and not pre-screened or
predetermined to meet a very narrow set of criteria.”
Empirically Supported Treatments
 Treatments that have undergone research, typically randomized controlled trials, that
have found to be efficacious.
o This means that the researchers have used very limited subject pools where many
of the variables were held constant.