Psychotherapy week 1- chapter
1 and 3 (Cooper) & chapter 1
(Wedding & Corsini)
Lecture
- Emotion focused therapy – focus on empathic attunement to the client and
emotional awareness and transformation. Integrates humanistic experiential
therapies and neuroscience.
- Psychoanalytic therapy – emphasises the unconscious source of emotional suffering.
Relationships with therapist and client is the vehicle of change. Focus on how past
gets re-enacted in the present.
- Cognitive therapy – focus on automatic maladaptive thoughts, how that makes
people feel and what behaviour results from it.
Chapter 1- Introduction: The challenge of research
The value of research:
- Research is a systematic process of inquiry that leads to the development of new
knowledge. It is empirical when it is based on concrete experiences/observation, as
opposed to purely theoretical conjecture.
- Research helps:
Give counsellors/psychotherapists an idea of a starting point when there is an
absence of other information.
Practitioners understand therapy from the client’s perspective.
- Empirical research findings are valuable since they can challenge therapists to
reconsider their implicit assumptions and expectations.
- Limitations of research findings:
They talk in generalities rather than specifics.
They are influenced by the researchers’ own assumptions and agendas.
The use of different tools, measures or procedures will influence the findings.
Chapter 3- Does orientation matter? The great
psychotherapy debate
Differential effectiveness:
- Empirically supported treatments (EST) refers to therapeutic practices that have been
shown to be efficacious with a particular group of clients, with its roots being in the
concept of ‘evidence-based medicine’. Empirical support depends on if it has better
effects than no treatment. CBT has been found to be efficacious for many difficulties,
psychodynamic therapy for a few and existential therapy for none.
Depression – mild/moderate difficulties. CBT most efficacious.
Bipolar disorder – multimodal treatment progress with CBT, family-oriented
and psycho-education.
Specific phobias, social phobia, panic disorder, GAD, OCD, PTSD, obesity – CBT
most effective with high clinically significant gains.
, Anorexia and bulimia nervosa – cognitive-analytic therapy, interpersonal
therapy and psychodynamic therapies. CBT not as effective for anorexia.
Substance dependence – motivational interviewing/therapy to reduce
severity of dependence, twelve-step programs and CBT.
Schizophrenia – family based interventions, CBT where its more effective in
the long-term and stronger for positive, persisting psychotic symptoms.
Relational distress – behavioural marital therapy, systematic therapies and
emotion-focused couples therapies.
Deliberate self-harm – CBT where evidence is very limited.
Anger, pathological gambling and complicated grief – CBT.
Challenges to the differential effectiveness position:
- Clustering symptoms together to form diagnostic criteria is controversial since there
are high rates of comorbidity between illnesses.
- The generalisability of empirically supported treatments are argued since they are
researched using biased samples.
- Research allegiance effect is the tendency for researchers to find results that support
their own beliefs and expectations. It has been shown that the experimenter’s
allegiance predicts their findings massively.
File drawer problem is the tendency for researchers to not put into print
findings that disconfirm their hypotheses.
Measures used to asses therapeutic outcomes may be more sensitive to
certain outcomes.
- The assertion that different bona fide therapies are about as equivalent in their
efficacy and effectiveness is known as the dodo bird verdict. Some primary
determinants of therapeutic change include the quality of the therapeutic
relationship. The main arguments against this approach are –
It ignores that different clients benefit from different kinds of therapy.
Many meta-analyses show meaningful differences between therapies where
CBT is the best.
- Non-specific factors (client factors, relationship variables and expectancy/hope)
account for 85% of the variance in therapeutic outcomes, and 15% of it is attributed
to the therapist’s specific techniques. Represented through the Lambert’s pie.
However, it assumes that the proportions are similar across different forms of
psychological distress.
The APA identified the key principles of change for clients with particular
forms of distress, which can be client, therapist, relationship and technique
factors associated with positive therapeutic outcomes.
- Patient uniformity myth is the notion that clients with similar diagnosis benefit from
similar treatments. Aptitude-treatment interactions (ATIs) starts from the premise
that patients with certain characteristics will do better in a certain treatment.
Chapter 1- Introduction to 21st century psychotherapies
Evolution of this science and profession:
- Historical cures for mental disorders include the shamanistic societies’ healing
rituals, asklepia (religio-philosophical lectures and meditation), Hippocrates’s
humour-based four-factor theory of personality (illness due to natural means) and
Hellenist physicians (brain as the source of depression and madness).
, - The first one to scientifically study the unconscious was Leibniz, including subliminal
perceptions (visual stimuli that can be discriminated while they don’t report
consciously seeing these stimuli) and dynamic forces (operate in the unconscious).
- Mesmer was the pioneer of hypnotherapy and highlighted the importance of the
rapport between therapist and patients. He also stressed the influence of the
unconscious, including common factors such as spontaneous remission and the
influence of unconscious memories.
- 3 streams of study that built the foundation of psychotherapies in the 19th century
include systematic, lab-bench empiricists, philosophers of nature and clinician
researchers.
Psychotherapy-related science in the 19th century:
The natural science empiricists:
- Gustav Fechner – investigates the distinction between waking and sleeping states.
Conducted psychophysical experiment to investigate how much psychic stimulation is
need for ideas to cross from the unconscious to full awareness, also called working
memory.
- Herman von Helmholtz – discovered unconscious inference, which is our
unconscious reconstruction of what our past taught us about the object.
- Emil Kraepelin – created the basis for DSM by classifying and describing the course of
diseases.
The psychologist philosophers:
- Arthur Schopenhauer – focused on human sexuality and the unconscious, and that
our behaviour is largely driven by irrational forces along with a pansexual view on
human sexuality.
- Carl Gustav Carus – proposed several levels of unconscious and therapist
transference, the ideas that the conscious and unconscious of the therapist and
patient continuously communicate through a simultaneous, nonverbal process.
- Friedrich Nietzsche – wrote about tacit cognitions, which is knowledge that we are
unable to articulate and is acquired through experience. He proposed defence
mechanisms including sublimation (social unacceptable impulses transformed into
acceptable ones) and repression (exclusion of distressing memories from the
conscious mind).
The impact of the biological sciences on psychotherapy:
- Past-oriented psychotherapies can encourage clients to ruminate about their past
and reinterpret past traumas, however it can strengthen dysfunctional neural
circuits. Future-oriented psychotherapies are modern and focus on teaching people
to avoid dysfunctional rumination.
- Much of the plasticity in our neural systems, called neoteny, is achieved through
epigenetic changes (genes turning on/off by proteins that connect to the genome).
Effective psychotherapies use 2 neural strategies – exposure to nurturing
social events for positive epigenetic changes and neural circuit-altering
placebo-laden talk.
Cultural factors and psychotherapy:
- Some issues include the race/culture of the therapist, biracial/bicultural couples in
counselling and the interaction of gender and culture. Therapies should be
developed in a way that they reflect the cultures philosophy and values.
Negotiating fault lines in the EBT terrain:
, - As per the APA, clinical decisions should be made in collaboration with the patient,
along with consideration for the probable costs and benefits.
- Often the therapist’s unscripted ‘throw-ins’, their own intuitive ideas and notes,
make the biggest difference for the patient.
- Manualization of therapy refers to a creation of sequential, algorithmized steps for
proceeding through phases of therapy.
- In therapies such as CBT and DBT, it is easier to adopt manualization. There is,
however, still room for spirituality and spontaneity for self-discovery.
- Integrated health-care teams (consisting of varieties of psychologists) helps provide
readily accessible perspectives.
- The main faces of the 21st century positive psychology are Martin Seligman and
Mihaly Csikszentmihalyi. Historically Alfred Adler came up with self-actualisation.
Maslow, Carl Rogers and Erickson insisted that the potential for personal well-being
and solution to personal problems resided in every human.
1 and 3 (Cooper) & chapter 1
(Wedding & Corsini)
Lecture
- Emotion focused therapy – focus on empathic attunement to the client and
emotional awareness and transformation. Integrates humanistic experiential
therapies and neuroscience.
- Psychoanalytic therapy – emphasises the unconscious source of emotional suffering.
Relationships with therapist and client is the vehicle of change. Focus on how past
gets re-enacted in the present.
- Cognitive therapy – focus on automatic maladaptive thoughts, how that makes
people feel and what behaviour results from it.
Chapter 1- Introduction: The challenge of research
The value of research:
- Research is a systematic process of inquiry that leads to the development of new
knowledge. It is empirical when it is based on concrete experiences/observation, as
opposed to purely theoretical conjecture.
- Research helps:
Give counsellors/psychotherapists an idea of a starting point when there is an
absence of other information.
Practitioners understand therapy from the client’s perspective.
- Empirical research findings are valuable since they can challenge therapists to
reconsider their implicit assumptions and expectations.
- Limitations of research findings:
They talk in generalities rather than specifics.
They are influenced by the researchers’ own assumptions and agendas.
The use of different tools, measures or procedures will influence the findings.
Chapter 3- Does orientation matter? The great
psychotherapy debate
Differential effectiveness:
- Empirically supported treatments (EST) refers to therapeutic practices that have been
shown to be efficacious with a particular group of clients, with its roots being in the
concept of ‘evidence-based medicine’. Empirical support depends on if it has better
effects than no treatment. CBT has been found to be efficacious for many difficulties,
psychodynamic therapy for a few and existential therapy for none.
Depression – mild/moderate difficulties. CBT most efficacious.
Bipolar disorder – multimodal treatment progress with CBT, family-oriented
and psycho-education.
Specific phobias, social phobia, panic disorder, GAD, OCD, PTSD, obesity – CBT
most effective with high clinically significant gains.
, Anorexia and bulimia nervosa – cognitive-analytic therapy, interpersonal
therapy and psychodynamic therapies. CBT not as effective for anorexia.
Substance dependence – motivational interviewing/therapy to reduce
severity of dependence, twelve-step programs and CBT.
Schizophrenia – family based interventions, CBT where its more effective in
the long-term and stronger for positive, persisting psychotic symptoms.
Relational distress – behavioural marital therapy, systematic therapies and
emotion-focused couples therapies.
Deliberate self-harm – CBT where evidence is very limited.
Anger, pathological gambling and complicated grief – CBT.
Challenges to the differential effectiveness position:
- Clustering symptoms together to form diagnostic criteria is controversial since there
are high rates of comorbidity between illnesses.
- The generalisability of empirically supported treatments are argued since they are
researched using biased samples.
- Research allegiance effect is the tendency for researchers to find results that support
their own beliefs and expectations. It has been shown that the experimenter’s
allegiance predicts their findings massively.
File drawer problem is the tendency for researchers to not put into print
findings that disconfirm their hypotheses.
Measures used to asses therapeutic outcomes may be more sensitive to
certain outcomes.
- The assertion that different bona fide therapies are about as equivalent in their
efficacy and effectiveness is known as the dodo bird verdict. Some primary
determinants of therapeutic change include the quality of the therapeutic
relationship. The main arguments against this approach are –
It ignores that different clients benefit from different kinds of therapy.
Many meta-analyses show meaningful differences between therapies where
CBT is the best.
- Non-specific factors (client factors, relationship variables and expectancy/hope)
account for 85% of the variance in therapeutic outcomes, and 15% of it is attributed
to the therapist’s specific techniques. Represented through the Lambert’s pie.
However, it assumes that the proportions are similar across different forms of
psychological distress.
The APA identified the key principles of change for clients with particular
forms of distress, which can be client, therapist, relationship and technique
factors associated with positive therapeutic outcomes.
- Patient uniformity myth is the notion that clients with similar diagnosis benefit from
similar treatments. Aptitude-treatment interactions (ATIs) starts from the premise
that patients with certain characteristics will do better in a certain treatment.
Chapter 1- Introduction to 21st century psychotherapies
Evolution of this science and profession:
- Historical cures for mental disorders include the shamanistic societies’ healing
rituals, asklepia (religio-philosophical lectures and meditation), Hippocrates’s
humour-based four-factor theory of personality (illness due to natural means) and
Hellenist physicians (brain as the source of depression and madness).
, - The first one to scientifically study the unconscious was Leibniz, including subliminal
perceptions (visual stimuli that can be discriminated while they don’t report
consciously seeing these stimuli) and dynamic forces (operate in the unconscious).
- Mesmer was the pioneer of hypnotherapy and highlighted the importance of the
rapport between therapist and patients. He also stressed the influence of the
unconscious, including common factors such as spontaneous remission and the
influence of unconscious memories.
- 3 streams of study that built the foundation of psychotherapies in the 19th century
include systematic, lab-bench empiricists, philosophers of nature and clinician
researchers.
Psychotherapy-related science in the 19th century:
The natural science empiricists:
- Gustav Fechner – investigates the distinction between waking and sleeping states.
Conducted psychophysical experiment to investigate how much psychic stimulation is
need for ideas to cross from the unconscious to full awareness, also called working
memory.
- Herman von Helmholtz – discovered unconscious inference, which is our
unconscious reconstruction of what our past taught us about the object.
- Emil Kraepelin – created the basis for DSM by classifying and describing the course of
diseases.
The psychologist philosophers:
- Arthur Schopenhauer – focused on human sexuality and the unconscious, and that
our behaviour is largely driven by irrational forces along with a pansexual view on
human sexuality.
- Carl Gustav Carus – proposed several levels of unconscious and therapist
transference, the ideas that the conscious and unconscious of the therapist and
patient continuously communicate through a simultaneous, nonverbal process.
- Friedrich Nietzsche – wrote about tacit cognitions, which is knowledge that we are
unable to articulate and is acquired through experience. He proposed defence
mechanisms including sublimation (social unacceptable impulses transformed into
acceptable ones) and repression (exclusion of distressing memories from the
conscious mind).
The impact of the biological sciences on psychotherapy:
- Past-oriented psychotherapies can encourage clients to ruminate about their past
and reinterpret past traumas, however it can strengthen dysfunctional neural
circuits. Future-oriented psychotherapies are modern and focus on teaching people
to avoid dysfunctional rumination.
- Much of the plasticity in our neural systems, called neoteny, is achieved through
epigenetic changes (genes turning on/off by proteins that connect to the genome).
Effective psychotherapies use 2 neural strategies – exposure to nurturing
social events for positive epigenetic changes and neural circuit-altering
placebo-laden talk.
Cultural factors and psychotherapy:
- Some issues include the race/culture of the therapist, biracial/bicultural couples in
counselling and the interaction of gender and culture. Therapies should be
developed in a way that they reflect the cultures philosophy and values.
Negotiating fault lines in the EBT terrain:
, - As per the APA, clinical decisions should be made in collaboration with the patient,
along with consideration for the probable costs and benefits.
- Often the therapist’s unscripted ‘throw-ins’, their own intuitive ideas and notes,
make the biggest difference for the patient.
- Manualization of therapy refers to a creation of sequential, algorithmized steps for
proceeding through phases of therapy.
- In therapies such as CBT and DBT, it is easier to adopt manualization. There is,
however, still room for spirituality and spontaneity for self-discovery.
- Integrated health-care teams (consisting of varieties of psychologists) helps provide
readily accessible perspectives.
- The main faces of the 21st century positive psychology are Martin Seligman and
Mihaly Csikszentmihalyi. Historically Alfred Adler came up with self-actualisation.
Maslow, Carl Rogers and Erickson insisted that the potential for personal well-being
and solution to personal problems resided in every human.
