Lecture 0: Introduction
Psychotherapy schools:
Long: 1 year or more
Classic psychoanalysis: getting insight and resolving unconscious psychological conflicts,
client laying on couch, therapist writes and analyses, very long, clear hierarchy
- Free association, dream analysis, interpretation
Humanistic client-centered therapy: flat hierarchy, self-acceptance and personal growth,
nondirective, client takes the lead, therapist as an empathic listener, solution is in the client
themself
- Use of reflection, creation of warm, accepting therapeutic relationship
Emotion-focused therapy: flat hierarchy, focus on accepting ans supporting the client, solution
is in the client themself
Modern psychodynamic approaches: shorter than classic psychoanalysis, working with own
feelings and thought, more focused and specific
- Direct analysis of client’s defenses and transference relationships
Integrative therapies: combines several therapies together, mix of psychodynamic,
emotion-focused and cognitive-behavioral approaches
Short: 10-15 sessions
ACT: focus on well-being and values and what is important to you in life, not on complaints, not
changing the negative but experiencing it, CBT has embraced ACT nowadays
EMDR: eye movement desensitization and reprocessing, separate from the rest, developed as
he was walking in a park and saw leaves falling and noticed how her eyes were moving,
typically applied to trauma patients, following finger or light from left to right, helps reduce
traumatic symptoms (not included in all guidelines - argue that effective component is actually
just exposure)
Behavioral therapy: directive, targets maladaptive behavior, if you do something many times it
becomes habituated (putting yourself in anxiety-evoking situations), reward and punishment,
learning-based techniques
- Systematic desensitization, gradual exposure, modeling, reinforcement techniques
1
,Cognitive therapy: challenging conscious maladaptive thoughts and beliefs
- Identifying and correcting distorted thoughts, behavioral homework, including reality
testing
Rational emotive behavioral therapy (Ellis): replacing irrational beliefs with rational alternative
beliefs, making adaptive behavioral changes (similar to CBT), direct, sometimes confrontational
- Identifying and challenging irrational beliefs, behavioral homework
2
,Lecture 1: Common Factors
The dodo bird verdict:
- A debate that has been going on since 1963 and is still going on
- Research over time (using RCTs) focussed on which therapy is better
- Main question: do different types of psychotherapy matter, or are changes acquired
through general or common factors which are present in all psychotherapy in general?
- Yet results indicate that all methods are effective, but how and why?
- So instead of focusing on differences, there is an increasing focus on studying common
factors in addition to specific factors (as related to treatment methods) on the other
Although treatment methods differ in their approach, the general belief is that there are also
measurable, yet not so perceivable mechanisms at work that contribute towards change in
people
They are common mechanisms in most people and it is expected to be part of our
socio-biological heritage, so in psychotherapy we have patient factors and therapist factors
The verdict is unclear what % of common factors contributes towards effectiveness of therapy
(but what we do know is that specific treatment methods rarely surpass 50% response rate to a
certain treatment)
Why are differences important?
It helps us to understand why different therapy models are more or less similarly effective and
that all methods probably have blind spots
- It is alright to have a preference for different models as a therapist (as do patients)
- It stimulates us to think about universal working models for the human psyche
- It provides a universal language to communicate about phenomenon across
psychotherapy methods
The contextual model for common factors:
1. The real or therapeutic relationships:
Starts with a first impression, but every developed treatment method thinks therapy should be
different from other social encounters, and they have defined the way the relationships should
look like
Defining the relationship:
- Different roles each plays (patient and therapist)
- Trustworthiness (safety and confidentiality)
- Reliability (will you be there for me?)
- Verbal and non-verbal communication (and so called undercurrent)
- Level of cooperation towards forming a working alliance
- Empathy or closeness and warmth
- Holding: or thee capacity of the therapist to manage all these factors and maintaining a
secure therapeutic relationship
Healing relationships: people have social needs
- Social interactions can be healing through: understanding, mentalization, perspective
taking, empathy, sense of togetherness, attachment
3
, Attachment: especially an important factor in persisting psychopathology like personality
disorders, but not exclusively
- More and more evidence available of attachment as a predictor for other
psychopathology like: mood disorders, eating disorders, PTSS, anxiety disorders,
aggression and other regulatory pathology
Attachment also predicts treatment outcome
Treatment outcome and attachment:
- Secure attachment: easy forming of treatment alliance, should go pretty much straight
forward
- Anxious-preoccupied attachment: easy forming of treatment alliance, difficulties in
terminating treatment, therapist needs to have abundant patience
- Fearful-avoidant attachment: forming of secure alliance takes time, might seen less
motivated, but it is not the case, at risk of rejection by the therapist, more focused on skill
and problem-solving and less on the relationship
- Disorganized attachment: therapist needs to have abundant patience
Attachment and epistemic trust: epistemic trust is the capability to learn thought a relationship
and attachment, insecure attachment styles interfere its presence
2. Expectations and how to manage them: both the therapist and the patient will bring
expectations to therapy
- Important factors: timing, previous experiences, beliefs about the complaints of the
patient, beliefs about the solutions for the complaints problem which most of the time
leads to demoralization and motivational problems
How to alter expectations?
- Providing the patient a working model (framework) with a therapy method or
conceptualization of the problem (from a rigid to an adaptive explanation model)
- Psycho-education about their problem and the treatment (remolarization and
establishing hope)
- Promoting self-efficacy, sense of control, sense of mastery and autonomy, improving the
sense of self-esteem and capacity to change their behavior and situation
- Discussing and changing response expectancies (“things always end up the same”)
- Therapist and patient should be in agreement about these factors before continuation
(about should be discussed over and over if needed), like a contract
3. Therapist factors
Transference as a threat for the therapeutic relationship
Transference is the interaction between a patient and a therapist and is complicated
Factors influencing the transference:
- Patient: How are you doing? (mood)
- Past: past (failed) therapy
- Present: problems at home
Not exclusively for the patient
4
Psychotherapy schools:
Long: 1 year or more
Classic psychoanalysis: getting insight and resolving unconscious psychological conflicts,
client laying on couch, therapist writes and analyses, very long, clear hierarchy
- Free association, dream analysis, interpretation
Humanistic client-centered therapy: flat hierarchy, self-acceptance and personal growth,
nondirective, client takes the lead, therapist as an empathic listener, solution is in the client
themself
- Use of reflection, creation of warm, accepting therapeutic relationship
Emotion-focused therapy: flat hierarchy, focus on accepting ans supporting the client, solution
is in the client themself
Modern psychodynamic approaches: shorter than classic psychoanalysis, working with own
feelings and thought, more focused and specific
- Direct analysis of client’s defenses and transference relationships
Integrative therapies: combines several therapies together, mix of psychodynamic,
emotion-focused and cognitive-behavioral approaches
Short: 10-15 sessions
ACT: focus on well-being and values and what is important to you in life, not on complaints, not
changing the negative but experiencing it, CBT has embraced ACT nowadays
EMDR: eye movement desensitization and reprocessing, separate from the rest, developed as
he was walking in a park and saw leaves falling and noticed how her eyes were moving,
typically applied to trauma patients, following finger or light from left to right, helps reduce
traumatic symptoms (not included in all guidelines - argue that effective component is actually
just exposure)
Behavioral therapy: directive, targets maladaptive behavior, if you do something many times it
becomes habituated (putting yourself in anxiety-evoking situations), reward and punishment,
learning-based techniques
- Systematic desensitization, gradual exposure, modeling, reinforcement techniques
1
,Cognitive therapy: challenging conscious maladaptive thoughts and beliefs
- Identifying and correcting distorted thoughts, behavioral homework, including reality
testing
Rational emotive behavioral therapy (Ellis): replacing irrational beliefs with rational alternative
beliefs, making adaptive behavioral changes (similar to CBT), direct, sometimes confrontational
- Identifying and challenging irrational beliefs, behavioral homework
2
,Lecture 1: Common Factors
The dodo bird verdict:
- A debate that has been going on since 1963 and is still going on
- Research over time (using RCTs) focussed on which therapy is better
- Main question: do different types of psychotherapy matter, or are changes acquired
through general or common factors which are present in all psychotherapy in general?
- Yet results indicate that all methods are effective, but how and why?
- So instead of focusing on differences, there is an increasing focus on studying common
factors in addition to specific factors (as related to treatment methods) on the other
Although treatment methods differ in their approach, the general belief is that there are also
measurable, yet not so perceivable mechanisms at work that contribute towards change in
people
They are common mechanisms in most people and it is expected to be part of our
socio-biological heritage, so in psychotherapy we have patient factors and therapist factors
The verdict is unclear what % of common factors contributes towards effectiveness of therapy
(but what we do know is that specific treatment methods rarely surpass 50% response rate to a
certain treatment)
Why are differences important?
It helps us to understand why different therapy models are more or less similarly effective and
that all methods probably have blind spots
- It is alright to have a preference for different models as a therapist (as do patients)
- It stimulates us to think about universal working models for the human psyche
- It provides a universal language to communicate about phenomenon across
psychotherapy methods
The contextual model for common factors:
1. The real or therapeutic relationships:
Starts with a first impression, but every developed treatment method thinks therapy should be
different from other social encounters, and they have defined the way the relationships should
look like
Defining the relationship:
- Different roles each plays (patient and therapist)
- Trustworthiness (safety and confidentiality)
- Reliability (will you be there for me?)
- Verbal and non-verbal communication (and so called undercurrent)
- Level of cooperation towards forming a working alliance
- Empathy or closeness and warmth
- Holding: or thee capacity of the therapist to manage all these factors and maintaining a
secure therapeutic relationship
Healing relationships: people have social needs
- Social interactions can be healing through: understanding, mentalization, perspective
taking, empathy, sense of togetherness, attachment
3
, Attachment: especially an important factor in persisting psychopathology like personality
disorders, but not exclusively
- More and more evidence available of attachment as a predictor for other
psychopathology like: mood disorders, eating disorders, PTSS, anxiety disorders,
aggression and other regulatory pathology
Attachment also predicts treatment outcome
Treatment outcome and attachment:
- Secure attachment: easy forming of treatment alliance, should go pretty much straight
forward
- Anxious-preoccupied attachment: easy forming of treatment alliance, difficulties in
terminating treatment, therapist needs to have abundant patience
- Fearful-avoidant attachment: forming of secure alliance takes time, might seen less
motivated, but it is not the case, at risk of rejection by the therapist, more focused on skill
and problem-solving and less on the relationship
- Disorganized attachment: therapist needs to have abundant patience
Attachment and epistemic trust: epistemic trust is the capability to learn thought a relationship
and attachment, insecure attachment styles interfere its presence
2. Expectations and how to manage them: both the therapist and the patient will bring
expectations to therapy
- Important factors: timing, previous experiences, beliefs about the complaints of the
patient, beliefs about the solutions for the complaints problem which most of the time
leads to demoralization and motivational problems
How to alter expectations?
- Providing the patient a working model (framework) with a therapy method or
conceptualization of the problem (from a rigid to an adaptive explanation model)
- Psycho-education about their problem and the treatment (remolarization and
establishing hope)
- Promoting self-efficacy, sense of control, sense of mastery and autonomy, improving the
sense of self-esteem and capacity to change their behavior and situation
- Discussing and changing response expectancies (“things always end up the same”)
- Therapist and patient should be in agreement about these factors before continuation
(about should be discussed over and over if needed), like a contract
3. Therapist factors
Transference as a threat for the therapeutic relationship
Transference is the interaction between a patient and a therapist and is complicated
Factors influencing the transference:
- Patient: How are you doing? (mood)
- Past: past (failed) therapy
- Present: problems at home
Not exclusively for the patient
4
