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College aantekeningen Psychotherapy (SOW-PSB3DH50E) Essential Psychotherapies, Fourth Edition, ISBN: 9781462540846
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Psychotherapy samenvattingboekhoofdstukken
Chapter 4 – behavioural therapy
Behaviour therapists differ with respect to the importance placed on environmental
contingencies; the role of cognitions in understanding behaviour; and the need to develop a unique,
individualized, evidence-informed treatmentplan for each client versus relying on standardized,
session-by-session treatment protocols
RCT’s
Behaviour therapy
- Directive, modelling alternative behaviours, teaching new skills
- Didactic (instruction, education, homework)
- Brief (about 16 sessions)
- Strongly rooted in empirical research
History
- Assumed that fundamental principles of learning occurred universally across humans &
animals therefore, cultural factors were not viewed as an important consideration in the
development of behaviour therapy now increasingly recognized
Racial/ethnic groups in Western countries show lower effects
- Due to values that underly behaviour therapy are incongruent
- Therapists may not routinely attend to cultural and systematic stressors
- Therapists may overlook cultural strengths
Concept of personality
- Individuals have characteristic patterns of feeling, thinking and acting
- Behavioural therapists emphasize the role of context or situational factors in determining
an individual’s behaviour
- Operant conditioning seems to play a larger role in the development of personality than
classical conditioning
Radical behaviourism behaviours are determined by patterns of reinforcement and punishment
from the environment
Behaviours are discussed as adaptive or maladaptive in a particular context
- Not ‘healthy’ or ‘unhealthy’
- Whether a behaviour is called pathological depends on the consequences and sociocultural
context
Understanding the problem functional analysis
- Traditional: SORC (stimulus, organism, response, consequence)
- Nowadays: more symptom-focused assessment measuring presence, absence, severity
DSM-V
Behaviour therapy big value of measuring outcome
,Assessment strategies in behavioural therapy
- Direct behavioural observation
- Monitoring forms and behavioural diaries
- Clinical interviews
- Self-report measures
Multimodal approach often used (more than 1)
Transdiagnostic treatment manuals parsimonious
- Provide broad interventions that can be applied to an array of clinical presentations
- Empirically supported and allow comorbidity
Common strategies in behaviour therapy
- Goal setting
- Psychoeducation
- Exposure based strategies
o In vivo exposure
o Imaginal exposure
o Interoceptive exposure (feared sensations)
o Virtual reality exposure
- Extinction/inhibitory learning
General principles
- Focus, intensity and duration under client’s control & enhanced by introducing
unpredictability over time
- Sufficient duration to really unlearn
- Intense enough, but not too overwhelming
- Practices should be spaced close together
- Stimulus varied across sessions
- Conducted in multiple contexts
- Focus on feared stimulus (no distraction)
- Response prevention
- Operant strategies
o Contingency management arranging for different consequences to follow a given
response natural reinforcement, self-management/self-control
o Shaping
o Extinction response-cost procedures, response-contingent-aversive stimulation
o Target cues stimulus control
- Behaviour activation (BA) aimed at helping depressed patients increase their contact with
positive reinforcers and decrease patterns of avoidance and inactivity
- Social and communication skills training
- Modelling
- Problem-solving training
o Modifying problem orientation
o Teaching problem solving skills
Problem definition and formulation
Generation of possible solutions
Selection of best solutions
Implementation of selected solutions and evaluation outcome
- Relaxation-based strategies
, o Progressive muscle relaxation
Early detection anxiety cues
Progressive muscle relaxation
Learning to apply relaxation skills when anxiety cues are first detected
- Emotion-regulation skills training
Exposure hierarchy list of things that are feared, rank-ordered from most to least difficult
bottom-up therapy
Cultural considerations
- Incorporating specific cultural values
- Working with resources within one’s community
- Making therapy accessible within the local context
Functional analytic psychotherapy (FAP) idea that in-session reinforcement and contingent
responding to client behaviours can yield therapeutic benefit
Helps clients identify clinically relevant behaviours in-session and real life relevant
Motivational interviewing collaborative conversation style used to help clients explore and resolve
ambivalence about making change
Behaviour therapy helps clients to decentre from their thoughts learn to recognize them as
mental events rather than indicators of truth or nature of self
Learning in interventions for certain problems may generalize to other, related problems
Ethics
- Therapists should attend to the power differential inherent in therapy and be sure that
mutually agreed upon goals are in place
- Also be aware of outside practice and exposure changes in context challenge traditional
conceptualizations of the boundaries that surround therapy
- Also take culture into account
Effectiveness research: studying the use of behavioural interventions in frontline clinical settings
Efficacy research: in highly controlled research settings more exclusion criteria, less representative
examples, not in context
Medication + CBT = effective
Medication to influence the brain and learn easier
Internet & app CBT more in primary care settings now very effective
, Chapter 7 – person-centred and emotion-focused psychotherapies
Person-centered psychotherapy
Emotion-focused psychotherapy
Focusing-oriented psychotherapy
All share the idea that psychotherapy is a process that’s based in human’s potential for
growth and creative actualization of their potential
The main impetus for therapeutic change arises from clients themselves, mobilized in a
warm, accepting, empathic relationship with a therapist
Person-centered Rogers
- First called client-centered practice expanded to other realms of human interaction
education & international conflict resolution
Carl Rogers
- Facilitating growth and testing hypothesis attitude in life
- Saw the client as the central figure in the therapeutic process, emphasizing that clients have
an innate sense of what they need to develop
- Role of therapist is to support this by focusing on clients’ present experience in therapy
- Non-directive therapy fundamental emphasis on the therapist’s non-directiveness
create a permissive, open atmosphere, designed to facilitate clients’ self-disclosure and
openness to their own experience
Eugene Gendlin
- Also important in development person-centered experiential psychotherapies (PCEP)
- Developed a method whereby he could communicate with people on both sides of various
issues
- Accept their entire system, try to formulate whatever point was being made within that
system
- The symbolization of experience
Laura Rice & Leslie Greenberg
- Established a research paradigm called “task analysis” to help illuminate different client
processes in therapy
- Then developed the process-experiential approach to psychotherapy
- Each developed models of specific in-session change processes
- Basis of PE-EFT = process-experiential/emotion-focused therapy
Person-centered concept of personality
- Humans are growing, changing organisms (living systems)
- Dynamic organisations that are constantly configuring and reconfiguring themselves as they
interact with their environments
- Traits and cognitive schemas evolve during life
- PCP focus on how the organism organizes itself, navigates through the world and
confronts problems
- Focus on growth, the nature of the self, the idea of multiple realities, open internal and
external communication, the process of experiencing, emotion, and dialectical constructivism
- Rogers capacity for growth as actualizing tendency expanded to formative tendency
tendency for things to move toward greater order, complexity and interrelatedness
- Built-in potential for resilience
- People’s capacity for self-righting is the primary force that makes psychotherapy work
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