Lecture 1 Psychotherapeutic change
Aims of the course (ψϴ = psychotherapy)
- Acquire knowledge of major ψϴ-schools and several contemporary common ψϴ methods
- Acquire insight in ψϴ applications in daily practice
- Promote a scientific and critical attitude towards ψϴ and its effects
- Additionally: reflect on (own) professional actions
To put things in perspective: some data
Of adults in the Netherlands (18-75 years) in 2023:
- 48% lifetime prevalence of a mental disorder of which 29% anxiety disorders, 25%
depression, 17% substance abuse
- 26% (3.3 million) had a mental disorder in the previous 12 months
- 9% (1.5 million) seek help in mental health care, the others consult GP, social work, local or
online support or do nothing at all
- Typically between 5 and 16 sessions but > 50 is possible
A few concerns and a few praises
- Gap: academic psychology and clinical practice: small impact of research findings
- Strong effects for disorder-specific treatments
- Little theoretical integration across ψϴ schools
Mental disorders
- Experience of…
Feelings, thoughts, behaviour tendencies, bodily sensations
As a problem: unwanted, intolerable, abnormal, uncontrollable, absurd
“Who is in charge?”
Fragmented sense of “self”
Feeling like you don’t have control over your own life
ψϴ schools
- Psychoanalysis: brief psychodynamic ψϴ
Struggles are about things that are unconscious
- Client-centered ψϴ = Rogerian-, person-oriented – or humanistic ψϴ
You can’t change these automatic things because you are not differentiated from
oneself
- Directive treatments: cognitive / behaviour therapy (CBT); hypnosis; ACT
Fears are about learned behaviour, so you have to unlearn these
, - Family and systems therapy
Disorders exist because of patterns within families, symptoms are part of the roles;
roles of the family have to be changed in order for the therapy to be successful
Schema: a dominant holistic, self-describing neural network
What is the goal of psychotherapy?
- Correct: change unwanted patterns of subjective experiences
- Correct: viewed from medical model – reduce agreed upon symptoms, disorders, etc.
- Wrong: make patients happy (again)
- Wrong: help patients understand reality
1. Mechanisms of change in psychotherapy: change by reasoning arguments, and
explanations?
- Conceptual, symbolic, logical, semantical use of language (propositional representations)
- Change is rather easy: provide information, reason, persuade f.i. psycho-education
- Problems: (1) patient is too passive; (2) persuasion has transient or no effect: it taps too little
in experience level
2. Mechanisms of change in psychotherapy: Discover who you are?
- Self-knowledge; classical philosophical proposition
- Classical assumption of psychotherapy, talking-cure, still layman’s-view
- Of course you learn a bit about ‘yourself’ but in so far ‘identity’ is concerned: two problems
- Problem 1: Too proposition (again), too intellectual & philosophical; pub talk. although …,
changing one’s “narrative” may be moderately helpful
- Problem 2: Unsupported by academic psychology: Mental processes hardly accessible,
fragmented sense of self. Instead “English butlers” (automated processes)
3. Mechanisms of change in psychotherapy: Change dominant schemas (holistic
representations)?
- Step 1: distancing the dominant schematic representation (autobiographical memories) from
oneself
- Step 2: build up new (or reuse) salient experiences
- E.g. induce emotions; connect past, present, future, images, and previous experiences
- Experiential techniques: chair technique, imagery rescripting
- Problem: typically within sessions
- Example: Dominant belief: “I have to fit in with the needs of others. I have to restrain myself. I
am no one”
Laura, 37 years – married & depressed
Six sessions: (1) Talked about mother/father and atmosphere at home: uneasiness.
(2) Anger and sadness increased – distancing: “I am a prisoner”. (3) I crave freedom:
go for it
, 4. Mechanisms of change in psychotherapy: Systematic exercise?
- Change associative (procedural memory) representations
- Core business in cognitive therapy, behaviour therapy, systems therapy
- In and between (homework assignments) sessions
- E.g. exposure, systematically challenging negative automatic thoughts, behavioural rehearsal,
assertiveness training, role playing, communication skills
- A lot of evidence for effectiveness
- Problem: patients have to participate
5. Mechanisms of change in psychotherapy: Patient activation and involvement?
- Without involvement no change in the way we experience things
- Preferably in and between sessions
- E.g. disclosure (patient), emotional experiences (optimal), training, etc.
6. Mechanisms of change in psychotherapy: high quality therapeutic alliance?
- Core ingredient in client-centred therapy and psychoanalysis
- Used for motivation and involvement in behaviour therapy and cognitive therapy
- Consistently (but moderately strong) related to ψϴ results
- Problem: fuzzy and untested theories in clinical psychology
- But: sound theories from social psychology and communication science about (resistance to)
social influence
7. Mechanisms of change in psychotherapy: Reorganizing environment & social interactions
- E.g. spouse and family support; enhance / increase social or daily activities; reduce stress
(e.g. moving); 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: undertaking aimed at changing unwanted patterns of experience: “That
things are otherwise” has to be made available
- Means
1. Patient’s involvement
2. High quality therapeutic relationship
3. Providing information (propositional)
4. Systematic exercise (associative)
5. Induce new (or reuse) salient experiences
For severe psychiatric disorders
6. Rearranging environment
Lastly
“That it can be otherwise” implies that the power of new insights or behaviours consists of letting to
the older ones.
, Lecture 2 Behaviour therapy
BT characteristics
BT: huge impact despite relatively simple learning principle
BT: correct characteristics
- Psychopathology (psychological problems) based on S-R associations, that is, an interaction
between person and environment
- Rather symptom- than person-oriented
- Observation and self-monitoring are part of treatment and treatment planning/evaluations
BT: incorrect characteristics
- BT involves behaviour only
- BT is cold and mechanical
- BT is fully evidence-based
BT process
1. Problem inventory
2. Position in holistic theory
3. Problem selection, measurement and functional analysis
4. Treatment plan and treatment execution
5. Treatment evaluation
Problem inventory
1. What is the problem? How often? How severe?
2. How did it start? Course? Why treatment now?
3. What elicits or exacerbates the problem?
4. What prevents or reduces the problem?
5. Positive consequences? Short-term? Long-term?
6. Negative consequences? Short-term? Long-term?
7. What means or solutions have already been tried?
8. What is the treatment goal?
Aims of the course (ψϴ = psychotherapy)
- Acquire knowledge of major ψϴ-schools and several contemporary common ψϴ methods
- Acquire insight in ψϴ applications in daily practice
- Promote a scientific and critical attitude towards ψϴ and its effects
- Additionally: reflect on (own) professional actions
To put things in perspective: some data
Of adults in the Netherlands (18-75 years) in 2023:
- 48% lifetime prevalence of a mental disorder of which 29% anxiety disorders, 25%
depression, 17% substance abuse
- 26% (3.3 million) had a mental disorder in the previous 12 months
- 9% (1.5 million) seek help in mental health care, the others consult GP, social work, local or
online support or do nothing at all
- Typically between 5 and 16 sessions but > 50 is possible
A few concerns and a few praises
- Gap: academic psychology and clinical practice: small impact of research findings
- Strong effects for disorder-specific treatments
- Little theoretical integration across ψϴ schools
Mental disorders
- Experience of…
Feelings, thoughts, behaviour tendencies, bodily sensations
As a problem: unwanted, intolerable, abnormal, uncontrollable, absurd
“Who is in charge?”
Fragmented sense of “self”
Feeling like you don’t have control over your own life
ψϴ schools
- Psychoanalysis: brief psychodynamic ψϴ
Struggles are about things that are unconscious
- Client-centered ψϴ = Rogerian-, person-oriented – or humanistic ψϴ
You can’t change these automatic things because you are not differentiated from
oneself
- Directive treatments: cognitive / behaviour therapy (CBT); hypnosis; ACT
Fears are about learned behaviour, so you have to unlearn these
, - Family and systems therapy
Disorders exist because of patterns within families, symptoms are part of the roles;
roles of the family have to be changed in order for the therapy to be successful
Schema: a dominant holistic, self-describing neural network
What is the goal of psychotherapy?
- Correct: change unwanted patterns of subjective experiences
- Correct: viewed from medical model – reduce agreed upon symptoms, disorders, etc.
- Wrong: make patients happy (again)
- Wrong: help patients understand reality
1. Mechanisms of change in psychotherapy: change by reasoning arguments, and
explanations?
- Conceptual, symbolic, logical, semantical use of language (propositional representations)
- Change is rather easy: provide information, reason, persuade f.i. psycho-education
- Problems: (1) patient is too passive; (2) persuasion has transient or no effect: it taps too little
in experience level
2. Mechanisms of change in psychotherapy: Discover who you are?
- Self-knowledge; classical philosophical proposition
- Classical assumption of psychotherapy, talking-cure, still layman’s-view
- Of course you learn a bit about ‘yourself’ but in so far ‘identity’ is concerned: two problems
- Problem 1: Too proposition (again), too intellectual & philosophical; pub talk. although …,
changing one’s “narrative” may be moderately helpful
- Problem 2: Unsupported by academic psychology: Mental processes hardly accessible,
fragmented sense of self. Instead “English butlers” (automated processes)
3. Mechanisms of change in psychotherapy: Change dominant schemas (holistic
representations)?
- Step 1: distancing the dominant schematic representation (autobiographical memories) from
oneself
- Step 2: build up new (or reuse) salient experiences
- E.g. induce emotions; connect past, present, future, images, and previous experiences
- Experiential techniques: chair technique, imagery rescripting
- Problem: typically within sessions
- Example: Dominant belief: “I have to fit in with the needs of others. I have to restrain myself. I
am no one”
Laura, 37 years – married & depressed
Six sessions: (1) Talked about mother/father and atmosphere at home: uneasiness.
(2) Anger and sadness increased – distancing: “I am a prisoner”. (3) I crave freedom:
go for it
, 4. Mechanisms of change in psychotherapy: Systematic exercise?
- Change associative (procedural memory) representations
- Core business in cognitive therapy, behaviour therapy, systems therapy
- In and between (homework assignments) sessions
- E.g. exposure, systematically challenging negative automatic thoughts, behavioural rehearsal,
assertiveness training, role playing, communication skills
- A lot of evidence for effectiveness
- Problem: patients have to participate
5. Mechanisms of change in psychotherapy: Patient activation and involvement?
- Without involvement no change in the way we experience things
- Preferably in and between sessions
- E.g. disclosure (patient), emotional experiences (optimal), training, etc.
6. Mechanisms of change in psychotherapy: high quality therapeutic alliance?
- Core ingredient in client-centred therapy and psychoanalysis
- Used for motivation and involvement in behaviour therapy and cognitive therapy
- Consistently (but moderately strong) related to ψϴ results
- Problem: fuzzy and untested theories in clinical psychology
- But: sound theories from social psychology and communication science about (resistance to)
social influence
7. Mechanisms of change in psychotherapy: Reorganizing environment & social interactions
- E.g. spouse and family support; enhance / increase social or daily activities; reduce stress
(e.g. moving); 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: undertaking aimed at changing unwanted patterns of experience: “That
things are otherwise” has to be made available
- Means
1. Patient’s involvement
2. High quality therapeutic relationship
3. Providing information (propositional)
4. Systematic exercise (associative)
5. Induce new (or reuse) salient experiences
For severe psychiatric disorders
6. Rearranging environment
Lastly
“That it can be otherwise” implies that the power of new insights or behaviours consists of letting to
the older ones.
, Lecture 2 Behaviour therapy
BT characteristics
BT: huge impact despite relatively simple learning principle
BT: correct characteristics
- Psychopathology (psychological problems) based on S-R associations, that is, an interaction
between person and environment
- Rather symptom- than person-oriented
- Observation and self-monitoring are part of treatment and treatment planning/evaluations
BT: incorrect characteristics
- BT involves behaviour only
- BT is cold and mechanical
- BT is fully evidence-based
BT process
1. Problem inventory
2. Position in holistic theory
3. Problem selection, measurement and functional analysis
4. Treatment plan and treatment execution
5. Treatment evaluation
Problem inventory
1. What is the problem? How often? How severe?
2. How did it start? Course? Why treatment now?
3. What elicits or exacerbates the problem?
4. What prevents or reduces the problem?
5. Positive consequences? Short-term? Long-term?
6. Negative consequences? Short-term? Long-term?
7. What means or solutions have already been tried?
8. What is the treatment goal?
