Psychotherapy

Psychotherapy




Docentgegevens
Coördinator: Ger Keijsers ()
Assistent: Monica Wagner ()
Examination (17 juni, 18.00 – 20.00)
MPC vragen: 40 vragen – 3 antwoordopties
Herkansing: 2 juli 8.30 – 10.30




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,Book

Literatur
e
Textbook Essential psychotherapies, all chapters except for 3, 6, 8 and 13
Reader 118 pages


Content Lectures
Lecture Content Page
Lecture 1 Introduction 3
Lecture 2 Behavior therapy 5
Lecture 3 Psychodynamic psychotherapy 8
Lecture 4 Cognitive therapy and supervision (interactive lecture) 12
Lecture 5 Client-centered therapy 16
Lecture 6 Family, spouse, and system therapy 19
Lecture 7 Group therapy 24
Lecture 8 How to motivate people to change
Lecture 9 Treating personality disorders
Lecture 10 Empirically supported treatments and psychotherapy research
Lecture 11 Me, a therapist? Applications (interactive lecture)




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,Week 1
Lecture 1: Introduction
Psychotherapy is more effective than medicine.
Having a mental disorder is:
 The experience of feelings, thoughts, behavioral tendencies and bodily sensations
 The experience of as a problem: unwanted, intolerable, abnormal, controllable, absurd
 The experience of a fragmented sense of self  ‘Who’s in charge?’

Types of psychotherapy schools
Psychoanalysis; brief psychodynamic (Freud)
Symptoms you have are based on unconscious struggles between ego, id and superego. You do not
know the cause of these symptoms.
Client-centered (Rogers, person-oriented):
Humanistic therapy: you cannot change the symptoms because you are alienated from yourself
(parentification)  you feel responsible for everything around you  therapy about finding yourself.
Directive treatments (Skinner(CBT), hypnosis; Acceptance and Commitment Therapy (ACT)
Unlearn what you have learned
Family and systems therapy (Minutschen)
Disorders exist due to rules within the family you grow up in.

Goal of psychotherapy (Aims)
Right goals Wrong goals
Change unwanted patterns of subjective Making people happy
experiences
Reduce agreed upon symptoms, disorders, etc. Understand reality


Aim 1: Changing propositional (semantic (factual) memory) representations?
(this aim is incomplete)
 Language-based, symbolic, deductive, arguments
 Change is easy: provide information; reason, persuade; psycho-
education, cognitive therapy
Good aims
 Problems:
1. Therapist is authoritarian Bad aims:
2. Patient is likely to be passive
3. Persuasion often ineffective or transient 1&2

Aim 2: Discover who you are?
 Self-knowledge; classical philosophical proposition
 Original assumption of psychotherapy, talking-cure, still layman’s view
 Problems:
1. Too propositional, pub-talk, although changing one’s narrative may be moderately
helpful
2. Unsupported by academic psychology: mental processes hardly accessible,
fragmented sense of self. Instead ‘English butlers (automated processes).’
Discovering who you are is not a real treatment


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, Aim 2: Discover who you are (continued)? Insight?
 1. Distancing oneself from a dominant schematic representation (autobiographical memory)
2. Build up new (or reuse) salient experiences
 For example: induce emotions; connect past, present and future, images and previous
experiences.
 Experiential techniques: chair technique, imagery rescripting
 Problem: typically within sessions.

Aim 3: Systematic exercise?
 Change associative (procedural memory) representations
 Core business in cognitive therapy, behavior cognitive therapy and systems therapy
 In and between sessions
 For example: exposure, systematically challenging negative automatic thoughts, behavioral
rehearsal, assertiveness training, role playing and communication skills.
 There is a lot of evidence for effectiveness
 Problem: patients have to participate

Aim 4: Patient activation and involvement?
 Without involvement no change in the way we experience things
 Preferably in and between sessions
 For example: disclosure (patient), emotional experiences (optimal), training, etc.

Aim 5: High quality therapeutic alliance?
 Core ingredient in client-centered therapy and psychoanalysis
 Used for motivation and involvement in behavior therapy and cognitive therapy
 Consistently (but moderately strong) related to psychotherapy results
 Problem: fuzzy and untested theories in clinical psychology
 But sound theories from social psychology and communication science about (resistance to)
social influence.

Aim 6: Reorganizing environment & social interactions?
 For example: spouse and family support; enhance/increase social or daily activities; reduce
stress; job-related interventions
 Also (family) care plan (multiple professionals), alert plan, relapse prevention plan.
 Strong (and last resort) treatment packages for severe psychiatric disorders.

Conclusions
Psychotherapy is aimed at changing unwanted patterns of experience: ‘that things are otherwise’ has to
be made available. (de gedachte dat: “dingen anders kunnen zijn”, moet worden vrijgespeeld). This
means that the power of new insights or behaviors consists of letting go of older ones.
Aim 1: Patient’s involvement
Aim 2: High quality therapeutic relationship
Aim 3: Providing information (propositional)
Aim 4: Systematic exercise (associative)
Aim 5: Induce new (or reuse) salient experiences
Aim 6 (for severe psychiatric disorders): rearranging environment




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