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Lecture 1:Introduction to psychotherapy
Exam material:
Cooper, M. (2008)
Reader psychotherapy (PSBFH50E), code 184.54.011
Mental disorders:
- Experience of feelings, thought, behavior tendencies, bodily sensations
- These experiences are unwanted, intolerable, abnormal, uncontrollable, absurd
- Fragmented sense of ‘self’ is in charge
Goal:
- Psychotherapy aims to change subjective experiences of which one is not feeling in charge of
- Viewed from medical model – reduce agreed upon symptoms, disorders, etc.
Means of psychotherapy:
1. Changing propositional representations: language based pieces of information
➔ By language-based, symbolic, deductive reasoning
➔ Change is easy: provide information; reason, persuade: psycho-education, cognitive therapy
➔ Problems: 1) therapist is authoritarian; 2) patient is likely to be passive; 3) persuasion often
ineffective or transient because disorder is experience based mostly (words does not really work)
2. Discover who you are
- Self-knowledge; classical philosophical proposition
- Care of psychoanalysis and client-centered theory
- Problems:
➔ Classical psychoanalysis (interpretations, ‘archaeology’) inefficient; client-centered therapy
assumptions untenable
➔ Unsupported by academic psychology: mental processes hardly accessible, fragmented sense of self;
instead ‘English butlers’
- English butlers: Brain sub-programs,
➔ implicit processes that we have no control of
➔
- How can we change automatic or implicit processes (English butlers)
, ➔ Synaptogenesis: connections between neurons; experiences help to make these connections,
emotions as well, and repeated encounters (associative representations -> neural networks)
➔ A schema representation might be changed with another representation that could interact
- Possibilities:
➔ Change schematic representations by simultaneously activating multiple neural networks; like
induce emotions; connect past present future, images, and previous experiences. Experiential
techniques: chair technique, imagery rescripting; but only within sessions
➔ Corrective emotional experience (Multidimensional evaluation)
➔ Changing narrative (propositional representations)
3. Systematic exercise
- Change associative representations
- Core business in cognitive therapy, behavior therapy, systems therapy
- In and between sessions
- It included exposure, systematically challenging negative automatic thoughts, behavioral rehearsals,
assertiveness training, role playing, communication skills
- A lot of evidence for effectiveness
- Problem: patients have to practice
4. Patient activation and involvement
- Without involvement no change in the way we experience things
- Preferably in and between sessions
- Disclosure (patient), emotional experiences (optimal), training, etc.
5. High quality therapeutic alliance (good relationship with a patient)
- Core ingredient in client-centered therapy and psychoanalysis
- Used for motivation and involvement in behavior therapy and cognitive therapy
- Consistent but not strong relation to psychotherapy results
- Problem: fuzzy and untested theories in clinical psychology
- But: sound theories from social psychology and communications science about (resistance to) social
influence
6. Reorganizing environment & social interactions
- Spouse and family support; enhance/increase social or daily activities; reduce stress; job-related
interventions
- Also, (family) care plan (multiple professionals), alert plan, relapse prevention plan
- Strong (and last resort) treatment packages for severe psychiatric disorders
Summary:
- Psychotherapy: undertaking aimed at changing unwanted patterns of experience: ‘that things are
otherwise’ has to be made available
- Psychotherapy is means for:
➔ Patients involvement
➔ High quality therapeutic relationship
➔ Providing information (propositional)
➔ Systematic exercise (associative)
, ➔ Simultaneous activation of meanings (schema)
➔ Rearranging environment-> for severe psychiatric disorders
Lecture 2
Behavior therapy
Behavior therapy characteristics:
- Psychopathology 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
Behavior therapy process:
- Problem inventory
➔ What is the problem, how often, how severe
➔ How did it start, course, why treatment now
➔ What elicits or exacerbates the problem
➔ What prevents or reduces the problem
➔ Positive consequences, short-term, long-term
➔ Negative consequences, short-term, long-term
➔ What means or solutions have already tried
➔ What is the treatment goal
Paper:
Inventory of problems and symptoms
Global understanding of the problems without going into details
Understandable picture of symptoms and its consequences
Inform about the therapy, division of roles, beginning of the therapeutical relationship
- Position in holistic theory
➔ Individualized
➔ Whether this problem makes sense and if one should treat this problem or some other
Paper:
Seek and check connections between the current problems and between problems in the past
Specific personality characteristics as well as specific events may contribute to several of the present problems
or to a history of related problems throughout the years.
, From these connections that are investigated during the first treatment sessions, the therapist forms a holistic
theory in which connections are formulated between the various difficulties and problems. Additionally,
possible core issues are proposed.
- Problem selection, measurement and functional analysis
➔ Deciding to address this particular problem
➔ Whether this problem is measurable, home assignments for the patient
➔ Measurement helps understand if one is on the right tract of treating a problem
➔ Classical conditioning theory (UCS/UCR)
Sequential conditioning means that the person, on the base of the association between CS and CR fells that the
CS predicts or signals the occurrence of the CR
Referential conditioning means that the CS stimulates or triggers a cognitive representation with emotions,
thoughts and behaviors (CRs) → PTSD
➔ Operant conditioning (FA)
Srs can be pleasant (S+) or unpleasant (S-)
R may lead to:
R present: a pleasant consequence (S+) or a negative consequence (S-) → (+S)
R absent: a disappearing or not taking place of (S+) or (S-) although expected (~S or -s)
Paper:
The problem should be important and rather central in the holistic theory
Therapist should be confident that the identified problem can be successfully treated with BT and within an
acceptable amount of time.
After selecting a problem, this needs to be further specified
This is done through monitoring and measurement assignments at home → when do the problems occur,
further relevant information
Find out why certain problems continue to resurface again and again. → UCS/UCR analysis (relevant for
classical conditioning, FA (relevant for operant conditioning)
A FA or UCS/UCR analysis can be formulated for every emotion, thought etc. which results in the generation
of a hypothesis about the sort of or the content of the relearning that has to be achieved in treatment in order to
reduce the patients problems.
- Treatment plan and treatment execution
Paper:
Discussing the treatment goals
Goals are expressed in explicit terms
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