Psychotherapy ASPECTS OF THERAPY A Free Choice Client

Psychotherapy ASPECTS OF THERAPY A. Free Choice - Client must want therapy for change

B. Hopes & Expectations 1. Expectations about the future affect the present => Belief that therapy will work = powerful treatment itself Placebo effects Hormones & immune system

2. Different expectations of therapy by client & therapist => increase similarity in expectancies

C. Therapist-Client Interaction 1. Therapist Qualities “Nonspecific Factors” - Empathy - Warmth - Genuineness

Experience Client-therapist matching

2. Therapeutic Alliance - Joint goals & how to achieve them - Therapist’s cooperative spirit - Client’s ability to trust => Stronger alliance = better outcome

Insight-Oriented Therapies Psychoanalysis & Psychoanalytic Psychotherapy 1. Assumptions a) Disorder = childhood problems & unconscious conflicts

b)Purpose of Symptoms = express conflict & protect from conscious awareness of conflict c)Goal of therapy = uncover conflict to free person from symptoms

Methods a)Therapist behavior Anonymous Abstinent Ambivalent

b) Free association & dream interpretation - analyst interprets

c)Transference - patient comes to regard therapist as parent & enacts old relationship d)Countertransference - therapist develops personal feelings for client

Psychoanalysis vs. Psychoanalytic Psychotherapy a)Time & Expense - 5 times/week for 5+ years vs. 1 -2 times/week for 1 -2 years

b)Interaction: - little vs. much therapist input - couch vs. chair - focus = child sexuality & aggression vs. other issues

Humanistic Therapy Assumptions a)Optimistic: People are good & seek selfactualization b)Disorder = incongruence - parents don’t provide unconditional positive regard - person conforms to them

c) Goal of therapy = client accepts self - restructure self-concept to match reality - strive toward self-actualization

Methods a) Therapist behavior = nonjudgmental, warm, genuine b) Relationship: Therapist & client are equals - “client” vs. “patient” - therapist is nondirective - client knows what is best - needs facilitator to discover c) Method - therapist mirrors/reflects client

Gestalt Therapy Assumptions a)Disorder = out of touch with true self - not accepting gestalt (whole) b)Goal of therapy - improve awareness of self-aspects - take responsibility for them

Methods a)Therapist behavior = confrontational & directive b)Nonverbal cues c)Role-playing - act out relationships - “empty chair” - letter writing d)Dream interpretation

Cognitive-Behavioral • WHY of behavior is unimportant • Change current thoughts/behaviors (sx focus)

Ellis’ Rational Emotive Therapy (RET) 1. Assumptions a) Disorders = irrational beliefs - perfectionism b) Goal of Therapy = substitute rational for irrational thoughts

Methods • Therapist Behavior: dispute beliefs - Therapist as Educator - Therapist & client are active - Homework

Beck’s Cognitive Therapy 1. Assumptions a) Disorders = irrational beliefs - irrational beliefs differ by disorder - Affect, Behavior, & Cognition b) Goal of Therapy = change irrational beliefs

Methods a)Therapist: warm, but disputes b)Guided Imagery: move from unrealistic fantasies toward realistic gratification c)Homework - test out irrational beliefs - situational analysis

Behavior Therapy 1. Assumptions a) Disorders = learned responses that can be unlearned - Behavior is situationally specific so treatment must be specific

b) c) Accept client’s report as valid Goal of Therapy = change maladaptive behavior - substitute adaptive behavior

Methods a) Therapist Behavior - directive, gives advice - also warm - Client controls focus of therapy - Therapist = how to change

b) Functional Analysis reinforcements & contingencies Problem - What Antecedents - When - Where Consequence - How (is problem rewarded) - Change cues/contingencies to change behavior

c)Flooding - expose to worst fears until person can tolerate without anxiety - imaginal or in vivo

d)Systematic Desensitization - gradually expose to fear - start with least fearful - in vivo or imaginal - with or without relaxation

e)Aversive Conditioning - pair negative behavior with aversive stimulus - in vivo or imaginal - last resort

Family & Couples Therapy Assumptions a)Disorder occurs in context of family & marital relationships - Communication = biggest problem - Relationship issues

b) Goal of Therapy = change interactions so that “patient” no longer needs the problem behavior

Methods a)Problem-Solving: State problem *Restate in other’s words Suggest solutions Evaluate solutions Agree on solution & try it

b)Structural Family Therapy - problems in family structure - change by “unbalancing” current system c)Family Systems Tx - reduce over-involvement - promote healthy individuation

Group Therapy Assumptions a)Advantages - Not alone in problem - Additional support of group members - Some problems = relevant for groups - Cheaper

b)Disadvantages - self-disclosure to many - confidentiality - less therapist attention

Methods: General - 8 -10 people in circle - All provide feedback & support - Therapist is less directive - Therapist may self-disclose

Methods: Specific a)Psychodrama - each person’s problems enacted as a play b)Assertiveness Training passive — assertive — aggressive c)Social Skills Training

Eclecticism Technical Eclecticism • Use techniques of different orientations • Theory: either one or none • Many therapists

Theoretical Eclecticism • Integrate different theories • Based on common principles of behavior and on nonspecific factors • Problem = basic assumptions of theories conflict

• Challenge = rigid adherence to one theory vs. superficial knowledge of several **Must have a plan, conceptualization of each case that drives therapy

Effectiveness of Psychotherapy • Outcome studies • Meta-analysis - statistical combination of many studies

Smith & Glass (1977) • 375 controlled studies • Average client better than 75% of controls Smith, Glass, & Miller (1980) • 475 controlled studies • Average client better than 80% of controls

• Some research: Effectiveness generalizes to real therapy (external validity) • Other research: research therapy vs. clinic therapy

• • Effects seen in 3 -4 months for 50% Effects seen in 6 months for 75% But, many clients terminate early Few differences among therapy types

Issues • Match therapy to problem • Match therapy to client

Ethical & Legal Issues Clients’ Rights 1. To treatment - cannot just be confined

2. To efficacious treatment - statistical vs. clinical significance - 70% spontaneous remission - but therapy is better - continued improvement - right to not be abused

Must terminate therapy (refer to someone else) if - not efficacious - problem between therapist & client

3. To confidentiality - increases trust & disclosure - exceptions: suicide/homicide child abuse subpoenas

4. To informed consent - explanation of treatment, purpose, & projected outcome 5. To refuse treatment - a limited right

Forensic Psychology Determining mental competency 1. For involuntary commitment 2. At the time of committing a crime Criteria - result of a mental disease or defect - can’t appreciate wrongfulness - can’t conform behavior to the law

Frequency - almost never used - rarely effective when used - when used and person NGRI, more time in hospital than in jail

3. At time of trial - participate in own defense 4. At time of execution - retribution