Psychotherapy/Psychotherapies
Overview
• • • • • What is psychotherapy? Who does psychotherapy? Approaches to psychotherapy. Classification of psychotherapies. Three examples of psychotherapy:
– psychoanalysis – cognitive therapy – interpersonal therapy.
Psychotherapy
• “Psychotherapy…is a fiendish and expensive way of tampering with the lives of patients weak enough or foolish enough to seek outside help with personal problems for which, in fact, only will power is any solution.”
• Quentin Crisp
Definitions
• Somatic therapies
– – – – Medicines Electroconvulsive Therapy Surgery Historical
• • • • Insulin coma treatment Hydrotherapy Removal of teeth Hysterectomy
• Social Treatments
– Environmental therapy – Work therapy – Moral therapy
• Psychological treatments
– – – – Talk-therapy Hypnosis Psychodrama Behavioral therapy
• “Despite their diversity…all psychotherapies attempt to relieve suffering and psychological disability by inducing changes in patients‟ attitudes and behavior.”
– Jerome Frank 1991
Psychotherapies
• • • • • • • Psychoanalysis (Freudian, Jungian) Cognitive Therapy Dialectical Behavioral Therapy Existential Psychotherapy Interpersonal Psychotherapy Gestalt Psychotherapy Motivational interviewing
Who practices psychotherapy?
• Prescribing
– – – – Psychiatrists Psychoanalysts Nurse Practitioners Psychologists (some)
• Non-Prescribing
– – – – Psychoanalysts Clinical Psychologists Social Workers Counsellors (MA, Religious counsellors) – Co-counsellors, peer therapy
Modes of Psychotherapy
• Dyadic/Individual
– Adult – Child
• Non-dyadic
– Couples therapy – Family therapy – Group therapy
Classification Schemes
• Exploratory (insight oriented, expressive, uncovering)
– insight into unconscious psychic conflict – Goal: structural change in personality
• Supportive (suppressive)
– support adaptive ego defenses – Goal: strengthen adaptation
• Evocative Psychotherapies
– Seeks to improve total psychological functioning by providing a supportive, accepting therapeutic relationship in which unconscious experiences can emerge into awareness leading to change.
• Psychoanalysis • Existential Psychotherapy • Self-actualizing therapies (Rogers, Maslow)
• Directive Psychotherapies
– Symptom- or problem-focused. – Cognitive
• Cognitive Therapy (Beck) • Rational Emotive Therapy (Ellis) • Social Learning Therapy (Bandura)
–
Behavioral
• Reinforcement • Counter-conditioning
–
Abreactive
• Primal therapy • EMDR
• Schools and Practitioners
– – – – Eclecticism Cross-trained Self-selection General (e.g., psychoanalysis, client-centered therapy) vs. Condition-specific (e.g., Dialectical Behavioral Treatment for Borderline Personality Disorder, CBT for Panic Disorder)
Psychoanalysis
• Freud • Office-based psychiatry • Drive theory
– Structural model of the mind (ego, id, superego)
• Derivations: Ego psychology, Object Relations Theory, Self Theory • Unconscious • Psychic determinism: past as prologue
Psychoanalysis: Basic premise
• By making the implicit explicit, the uncontrollable becomes controllable.
• Psychoanalysis in practice
– Free association – Transference – Resistance
Cognitive Therapy
• Aaron Beck • “Common sense psychology” • Psychological problems result from faulty learning, making incorrect inferences on the basis of inadequate or incorrect information, and not distinguishing between imagination and reality. • Patients systematically misconstrue specific kinds of experiences
Cognitive Distortions
• All-or-nothing thinking (black-white, polarized, dichotomous thinking) • Catastrophizing („fortune telling‟) • Emotional reasoning • Mind reading • Over-generalization • „Should‟ and „Must‟ statements • Etc.
Core Beliefs
Intermediate Beliefs Event
AT
Behavior
Emotion
• Cognitive Therapy techniques to modify intermediate and core beliefs:
– – – – – – – Socratic questioning Behavioral experiments Cognitive continuum Rational-emotional role playing Acting „as if‟ Using others as reference points Self-disclosure
Interpersonal Psychotherapy
• Psychotherapy should focus on what happens between people, not on the brain, mind, unconscious, etc. • Social attachments are protective against stress and depression. • Depression is related to interpersonal relationships--as cause and consequence.
Interpersonal functioning and Depression
• • • • Grief Role Transition Interpersonal Disputes Interpersonal Deficits
Interpersonal Therapy in Practice
• Focus on the here-and-now • Personality restructuring is not attempted • Assessment:
– – – – inventory of relationships quality and pattern of interactions cognitions regarding self, others, roles associated emotions.
Why Does Psychotherapy Work?
• Re-moralization • Supportive, non-judgmental attitude of therapist • Expression of emotions • Unanalyzed positive transference • Unanalyzed negative transference • Identification with the therapist • Strengthening ego functions
Further Reading
• “Freud and Beyond” by Stephen Mitchell and Margaret Black • “Approaches to the Mind. Movement of the Psychiatric Schools from Sects toward Science” by Leston Havens • “Persuasion and Healing” by Jerome Frank