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PsychotherapySamenvatting artikelen
Article 1. Psychotherapy and implicit mental processes
The first point is that mental problems involve undesired experiences against the patients’ will
and cause them discomfort. Sometimes, certain experiences are annoyingly absent, even though the
patient wishes that they would take place.
The second point is that these psychological problems are seen as insoluble. Patients are not able to
solve the problems they are experiencing on their own.
The third point, and quite a burdensome one, is that mental problems are very often perceived as
absurd. The perception is the personal experience of reality. Even if the perception is absurd, it is
impossible to simply ‘step out’ of the confines of that perception. After all, it is impossible for them
to perceive the problem differently, let alone to solve it with a little extra will power.
A dominant concept in the literature of is that mental disorders are caused when people become
alienated from themselves. This alienation is the consequence of such things as far-reaching
experiences in youth, restrictive learning experiences or the inability to permit oneself certain
feelings or attitudes.
The assumption here is that the psychopathology persists because of certain motives from a portion
of their personality or ego (meaning ‘I’ and ‘me’), to which the patient has insufficient access. The
most important therapeutic remedy is the understanding of how to reintegrate the ‘inaccessible
components of the ego into the personality.
Modern psychopathology also holds the view that a mental disorder points to disturbances in
patients’ experiences which are considered as alienating and involuntary
Biological, genetic, neurocognitive research
Modern research offers little proof of a central and autonomous ego (meaning ‘I’ or ‘me’)
with accessible or inaccessible motives
Conversely, research shows that human experience consists of a large number of complex mental
operations that constantly proceed in an automatic and parallel manner, but independently of each
other. Our conscious experiences are only a limited reflection of these mental operations. The ego
does not organise or motivate these mental operations; it is only a component of them
The fact that the majority of our information processing takes place automatically does not mean
that the mental operations, emotional reactions, and selection of locomotor plans are fixed. On the
contrary, it is important that these automatic processes be attuned to the environment and can be
flexibly employed in order to take advantage of changes in the environment.
- On the one hand, this takes place by means of conscious learning. Conscious learning allows
us to acquire skills
- On the other hand, for interaction with the surroundings, implicit learning is of special
importance. In implicit learning, associations are mutually formed between stimulus
characteristics (characteristics of situations) as well as between stimulus characteristics and
our own behaviour, without any conscious action on our part
o Implicit learning can be quick and very powerful in emotional, biologically, relevant
situations
,Experiments in psychopathology investigate more and more whether mental disorders involve
disturbances in attention and information processing, when assessing emotional situations
Propositional representations are by nature linguistic, symbolic and factual enable us to reason
logically and to use deductions to arrive at a particular opinion
Schematic representations are holistic by nature and consist of the integration of linguistic, visual,
auditory, tactile and somatosensory information that we have acquired through experiences with a
particular subject or situation. This knowledge is not so easily expressed in words, but is nonetheless
often strikingly precise also contain emotional information
In contrast, what psychotherapy must try to achieve is to undermine the entire higher order
networks with its interrelated associations. The therapist must be able to get patients to re-evaluate
their holistic views of themselves, others and the future
Additionally, propositional representations can be effectively altered with logical reflection and
arguments, but schematic representations cannot
In anxiety disorders and possibly addiction as well, there is evidence that normal attention processes
have been disturbed.
Discoveries of this type from experimental psychopathology are making it ever clearer that
malfunctions or adaptations in automatic cognitive processes play a significant role in the
origin and persistence of mental disorders. It is extremely important to realise that these
disturbances can be influenced only to a limited extent by talking during psychotherapy.
What is needed instead is specific and systematic training.
Systematic exposure for example is a form of controlled alteration of perception
Similar systematic alterations of perception take place when changing persistent automatic
cognition and in skills training, such as communications skills, assertiveness training,
relaxation exercises, behaviour shaping and gradual activation. Practice brings about change.
Psychotherapeutic change implies that patients are enabled to perceive their difficulties in a different
way practice is needed
It’s not the treatments that make the patients better, but the patients themselves therefore good
therapeutic base attitude and relationship is important.
The greater the patient’s commitment is, the better the possibility of achieving change in
problematic perceptions and the greater the chance of permanent change.
If evidence-based treatments are lacking, it is also extremely important to focus the treatment well.
From the variety of symptoms and impasses, one or several small problems should be selected,
crystallised and focused on during treatment. No more is asked of the patient than what is strictly
necessary. The same is true of the treatment objectives. It is not possible to change someone’s
essence, nor should this be the goal.
- Synaptogenesis is enabled when a large quantity of relevant associations, emotions,
semantic information, goals and experiences are simultaneously activated. Such experiences
often occur during therapy sessions brings about therapeutic change.
- Also, as earlier discussed, systematic practice is a suitable way of acquiring new or altered
experiences.
In both cases, the brain learns by means of experience, not through language, deduction,
logic or analysis
,Article 2. Psychotherapy: a brief note on schools of psychotherapy
In 1994 400 different schools of psychotherapy were counted
Non-directive forms of therapy
The therapist exerts no direct influence, gives no advice, homework or assignments. The effects of
non-directive forms of therapy arise or take shape during the consultation. Insight and improved self-
knowledge are generally the principal aims
- Principal school 1
o Psychoanalysis: Usually, this is now taken to mean classical analysis with free
association and interpretation as the main therapeutic procedures. The theoretical
background is derived from Freud and other psychoanalysts.
o Psychodynamic psychotherapy: Based partially on the working method of Malan.
Uses forms of psychoanalysis that are much compacter, of shorter duration and
more focussed on a clear goal. The therapist is more active than in classical
psychoanalysis.
- Principal school 2
o Psychotherapy (Roger)
o Contact between therapist and patient is central (empathy, acceptance, respect)
o Client-centered / person-centered / Rogerian therapy / humanistic psychotherapy
o Existential psychotherapy helps patients to investigate the core themes of
existence and discuss themes such as dealing with finiteness and the
meaninglessness of existence, loneliness
Directive forms of therapy
The hallmark of these forms of therapy is that their emphasis lies less on the therapeutic relationship
as the main vehicle for therapeutic change, and more on treatment procedures in which certain
things are tested out or practised. This practice takes place during the sessions, but for the most part
outside the sessions as part of daily life. The therapist gives more direction and has a relationship
with the patient which is generally defined as a collaborative one, with the therapist in the role of the
expert.
- Principal school 3
o Behaviour therapy is a therapeutic school in which learning processes occupy an
important position. Based on theories of how behaviour patterns are learned and,
especially, how they are maintained, methods of systematic practice have been
developed to change undesired feelings, behaviour and views. Behaviour therapy is
generally more aimed at changing complaints/symptoms/disorders than at matters
such as balance, personal growth or self-insight.
o Cognitive therapy is a therapeutic school which holds that many complaints /
symptoms / disorders persist because of automatic assumptions and views on the
patient’s part. We are often scarcely aware of those assumptions and views. With
the help of exercises, these assumptions and views are brought into consciousness
and the patient practises replacing them with more realistic or useful assumptions
and views. Cognitive therapy is also generally more aimed at changing
complaints/symptoms/disorders than at matters such as personal growth or self-
insight
o Cognitive behavioural therapy: old variants include hypnotherapy and various forms
of training like assertiveness training, relaxation exercises and breathing exercises.
New variants are solution-focused therapy and acceptance and commitment therapy
(ACT).
o In hypnotherapy, the possibilities of hypnosis are used to achieve effects such as
relaxation, pain reduction or the achievement of specific moods. Generally speaking,
, patients are trained in hypnosis to be able to bring about the desired effects on their
own, once learned with the help of their therapists
o Solution-focused therapy is a form of therapy that encourages people to look less at
the problems and more at possible solutions. Instead of the problem, patients
conceptualise the condition or goal they want to achieve. Appropriate methods for
this purpose are sought. These methods sometimes originate from behaviour
therapy
o ACT teaches people that control over many internal perceptions is impossible and
that the experience of problems often becomes even greater precisely because of
the desire to control our own perception. ACT uses exercises, stories and metaphors
to help people admit to their perception problems and accept them. If that seems to
go better, ACT then directs attention to relevant goals that are attainable.
Article 3. Behaviour therapy: an overview
Typically for behaviour therapists is the use and formulation of treatment goals in terms of
observable or reportable behaviour . Ideas, beliefs and so on are also considered behaviour,
although, covert, meaning, not visible from the outside.
The goal of behaviour therapy is to increase, reduce, or change overt or covert behaviour in
accordance with mutually agreed upon goals and treatment plan made from the onset of the
treatment
Learning theories concern rules that govern behaviour patterns (presence, absence, reoccurrence,
increase, or decrease of behaviour) and the ways these behaviour patterns have established
themselves over the course of a learning process of individuals interacting with their surroundings
Quite a number of these treatment techniques, such as exposure, self-control procedures,
contingency management, and behaviour activation, belong to the most effective psychological
treatment techniques ever developed in clinical psychology.
Behaviour therapists are interested in analysing factors which presently play a role in maintaining the
unwanted behaviour, the symptoms, or the mental disorder present-oriented
More than in other treatment schools, behaviour therapists have always adopted a scientific view on
treatment application. They start to specify the problem at hand, develop or apply a theory to
understand the maintenance of the problem, start measuring the problem and investigate whether a
certain manipulation (a treatment technique) results in hypothesised reductions in the problem
measured. Hence, successful treatment, in a way, proves that a proper theory had been adopted
change has to be brought about not so much by conversation, insight or personal growth, but by
systematic ‘relearning’ strategies.
Homework assignments are used to ‘relearn’ overt or covert behaviour with the consequence that
patients are involved in change processes at home, at work and in daily interactions with their
children, parents, or spouses.
Change is essentially a learning process which needs rehearsal, practice within the proper
context, and repetition
Behaviour therapy process
- 5 intertwined phases and certain phases might have to be repeated or skipped for the
moment during the process. Nevertheless, it’s a structured treatment method with a clear
starting phase, several middles phases, and a clear end point. And is personalized.
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