Introduction to Treatment Methods - Notes
Lecture 1: Common Factors in Psychotherapy
The Therapeutic Relationship
● Defining the relationship
○ Different roles the therapist has in contrast to patient
○ Trustworthiness
○ Reliability
○ Verbal and non-verbal communication
○ Level of cooperation towards forming a working alliance
○ Empathy or closeness and ‘warmth’
○ Holding: the capacity of the therapist to manage all of these factors and
maintaining a secure therapeutic relationship
● Healing Relationship
○ Understanding / Mentalisation
○ Perspective taking
○ Empathy
○ Sense of togetherness
○ Attachment
● Attachment and Epistemic trust
○ Epistemic trust is the capacity to learn through a relationship and attachment
, ○ Insecure attachment styles interfere with the process of epistemic trust
● Expectations
○ Both the therapist and the patient bring expectations to therapy
○ Important factors are:
■ Timing
■ Previous experiences
■ Beliefs about the complaints of the patient
■ Beliefs about the solutions for the complaints, which most of the time
lead to → demoralization (the process of making someone lose
confidence, enthusiasm and hope) → motivational problems
○ How do we 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
(remoralization 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 the above
described factors before continuation, consider it a contract for the
treatment
Transference as a Threat for the Therapeutic Relationship
● Transference in treatment
○ The therapist might be a parent or
have a bad day
○ The therapist might have trauma from
the past and might have certain
feelings towards the patient
, ○ Setting boundaries provides an opportunity to talk about transferences
● Managing transference
○ A common method for managing transference is using Leary’s Rose:
○ Furthermore: intervision and supervision are important in recognizing
therapist transference and own limitations
Take Home Messages
● Common factors are found across all therapy methods
● The most important common factors are the therapeutic relationship and managing it
● Secondly, expectations and motivational factors are important
● Transference is an important threat to be considered → managing transference could
be considered a common factor
Article
- The contextual model posits that there are three pathways through which
psychotherapy produces benefits. That is, psychotherapy does not have a unitary
influence on patients, but rather works through various mechanisms. The
mechanisms underlying the three pathways entail evolved characteristics of humans
as the ultimate social species; as such, psychotherapy is a special case of a social
healing practice.
- The three pathways of the contextual model involve: a) the real relationship, b) the
creation of expectations through explanation of disorder and the treatment involved,
and c) the enactment of health promoting actions. Before these pathways can be
activated, an initial therapeutic relationship must be established.
, - Although the common factors have been discussed for almost a century, the focus of
psychotherapy is typically on the development and dissemination of treatment
models. If not discounted, then the common factors are thought of as perhaps
necessary, but clearly not sufficient. The evidence, however, strongly suggests that
the common factors must be considered therapeutic and attention must be given to
them, in terms of theory, research and practice.
- One of the criticisms of the common factors is that they are an atheoretical collection
of commonalities. In this paper, the contextual model was presented to convey a
theoretical basis for these factors.
Lecture 2: Client-Centered Psychotherapy and Emotion-Focused Therapy
Carl Rogers
● Humanist
● The first to record his therapy sessions → demonstrating his ideas theories and beliefs
Humanistic Psychology
● Response to Psychoanalysis and Behaviorism
● Positive: people are always able to understand and solve their own problems
● Every human being has a potential for growth if the environmental conditions are
favorable
● It is more important how someone experiences something than what is the reality
● Non-directive → following instead of leading
● No focus on abnormal behavior but on being human
● Against institutionalization
● Rogers agreed with Maslow, but added that for a person to grow, they need an
environment that provides them with:
○ 1. Genuineness (transparency and self-disclosure)
○ 2. Acceptance (unconditional positive regard)
○ 3. Empathy (being listened to and understood)
● Then → self-actualization will occur and one can become a ‘fully functioning person’
Lecture 1: Common Factors in Psychotherapy
The Therapeutic Relationship
● Defining the relationship
○ Different roles the therapist has in contrast to patient
○ Trustworthiness
○ Reliability
○ Verbal and non-verbal communication
○ Level of cooperation towards forming a working alliance
○ Empathy or closeness and ‘warmth’
○ Holding: the capacity of the therapist to manage all of these factors and
maintaining a secure therapeutic relationship
● Healing Relationship
○ Understanding / Mentalisation
○ Perspective taking
○ Empathy
○ Sense of togetherness
○ Attachment
● Attachment and Epistemic trust
○ Epistemic trust is the capacity to learn through a relationship and attachment
, ○ Insecure attachment styles interfere with the process of epistemic trust
● Expectations
○ Both the therapist and the patient bring expectations to therapy
○ Important factors are:
■ Timing
■ Previous experiences
■ Beliefs about the complaints of the patient
■ Beliefs about the solutions for the complaints, which most of the time
lead to → demoralization (the process of making someone lose
confidence, enthusiasm and hope) → motivational problems
○ How do we 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
(remoralization 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 the above
described factors before continuation, consider it a contract for the
treatment
Transference as a Threat for the Therapeutic Relationship
● Transference in treatment
○ The therapist might be a parent or
have a bad day
○ The therapist might have trauma from
the past and might have certain
feelings towards the patient
, ○ Setting boundaries provides an opportunity to talk about transferences
● Managing transference
○ A common method for managing transference is using Leary’s Rose:
○ Furthermore: intervision and supervision are important in recognizing
therapist transference and own limitations
Take Home Messages
● Common factors are found across all therapy methods
● The most important common factors are the therapeutic relationship and managing it
● Secondly, expectations and motivational factors are important
● Transference is an important threat to be considered → managing transference could
be considered a common factor
Article
- The contextual model posits that there are three pathways through which
psychotherapy produces benefits. That is, psychotherapy does not have a unitary
influence on patients, but rather works through various mechanisms. The
mechanisms underlying the three pathways entail evolved characteristics of humans
as the ultimate social species; as such, psychotherapy is a special case of a social
healing practice.
- The three pathways of the contextual model involve: a) the real relationship, b) the
creation of expectations through explanation of disorder and the treatment involved,
and c) the enactment of health promoting actions. Before these pathways can be
activated, an initial therapeutic relationship must be established.
, - Although the common factors have been discussed for almost a century, the focus of
psychotherapy is typically on the development and dissemination of treatment
models. If not discounted, then the common factors are thought of as perhaps
necessary, but clearly not sufficient. The evidence, however, strongly suggests that
the common factors must be considered therapeutic and attention must be given to
them, in terms of theory, research and practice.
- One of the criticisms of the common factors is that they are an atheoretical collection
of commonalities. In this paper, the contextual model was presented to convey a
theoretical basis for these factors.
Lecture 2: Client-Centered Psychotherapy and Emotion-Focused Therapy
Carl Rogers
● Humanist
● The first to record his therapy sessions → demonstrating his ideas theories and beliefs
Humanistic Psychology
● Response to Psychoanalysis and Behaviorism
● Positive: people are always able to understand and solve their own problems
● Every human being has a potential for growth if the environmental conditions are
favorable
● It is more important how someone experiences something than what is the reality
● Non-directive → following instead of leading
● No focus on abnormal behavior but on being human
● Against institutionalization
● Rogers agreed with Maslow, but added that for a person to grow, they need an
environment that provides them with:
○ 1. Genuineness (transparency and self-disclosure)
○ 2. Acceptance (unconditional positive regard)
○ 3. Empathy (being listened to and understood)
● Then → self-actualization will occur and one can become a ‘fully functioning person’
