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Lecture Notes - Psychotherapy

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This document contains my lecture notes of all lectures of the course Psychotherapy. The notes include the pictures used in the slides. I completed this course with a 7.5 :)

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  • 26 de abril de 2023
  • 40
  • 2021/2022
  • Notas de lectura
  • G. keijsers
  • Todas las clases
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College 1 – Course framework: Psychotherapeutic change
A few concerns and a few praises

 Gap: between academic psychology and clinical practice: in de clinical practice we are not
bound by the answers of research findings
 Little theoretical integrations across psychotherapy schools
 Strong effects for disorder-specific treatments

Mental disorders

Experience of:

 Feelings, thoughts, behaviour tendencies, bodily sensations (fatigue, pain)
o As a problem: unwanted, intolerable, abnormal, uncontrollable, absurd
 Who is in charge? Fragmented sense of ‘self’

Goal of psychotherapy

Correct:

 Change unwanted patterns of subjective experiences
 Or – viewed from medical model reduce agreed upon symptoms, disorders, etc.

Wrong:

 Make patients happy (again)
 Help patients understand reality

Means by which we can change internal experiences

Mean 1: Changing propositional representations?

 Language-based, symbolic, deductive, reasoning
 Change is easy: provide information; reason, persuade: psychoeducation, cognitive
therapy
 Problems:
o Therapist is authoritarian
o Patient is likely to be passive
o Persuasion if often ineffective or transient

Mean 2: Discover who you are?

 Self knowledge; classical philosophical proposition
 Core of psychoanalysis and client-centred therapy
 Problems:
o Classical psychoanalysis (interpretations, ‘archaeology’) inefficient; client-
centred therapy assumptions untenable
o Unsupported by academic psychology: mental processes hardly accessible,
fragmented sense of self, instead ‘English butlers’




1

,Brain sub-programmes (English butlers)

Subprocesses which happen automatically




Adaptations of English butlers

Synaptogenesis: making connections between neurons

 Improved by motions
 Experience-based
 Repeated encounters: ‘cells that fire wire together’
Associative representations (e.g., urge to drink alcohol when seeing beer)

Mean 2: Discover who you are? (continued)

 Possibility 1: change schematic representations by simultaneously activating multiple
neural networks
o E.g., induce emotions, connect past present future, image, and previous
experience
 Experiential techniques: chair technique, imagery rescripting
 Problem: typically within sessions
 Possibility 2: changing narrative (propositional representations) may be helpful

Mean 3: Systematic exercise?

 Change associative representations
 Core business in cognitive therapy, behaviour therapy, systems therapy
 In and between (homework assignments) sessions
o E.g., exposure, systematically challenging negative automatic thoughts,
behavioural rehearsal, assertiveness training, role playing, communication skills
o Repetition of new learning in order to learn the new associations
 A lot of evidence for effectiveness
 Problem: patients have to participate  otherwise no effectiveness

Mean 4: Patient activation and involvement?

 Without involvement no change in the way we experience things
 Preferably in and between sessions
o E.g., disclosure (patient), emotional experiences (optimal), training, etc.

Mean 5: High quality therapeutic alliance?

 Core ingredient in client-centred therapy and psychoanalysis
 Used for motivation and involvement in behaviour therapy and cognitive therapy
 Consistently (but moderately strong) related to results
 Problem: fuzzy and untested theories in clinical psychology. No proof that the patient
will change due to a relationship


2

,  But: sound theories from social psychology and communication science about (resistance
to) social influence

Mean 6: Reorganizing environment & social interactions?

 E.g., spouse and family support; enhance/increase social or daily activities; reduce stress
(e.g., moving); job-related interventions
 Also (family) care plan (multiple professionals), alert plan, relapse prevention plan
 Strong (and last resort) treatment packages for severe psychiatric disorders

Conclusions

Psychotherapy: undertaking aimed at changing unwanted patterns of experience: ‘That things are
otherwise’ had to be made available

Means

 Patients’ involvement
 High quality therapeutic relationship
 Providing information (propositional)
 Systematic exercise (associative)
 Simultaneous activation of meanings (schema)
For severe psychiatric disorders:
 Rearranging environment

College 2– Behaviour Therapy
Characteristics

Behaviour therapy: correct characteristics

 Psychopathology (psychological problems) based on S-R associations: an interaction
between person and environment
o Behaviour therapists are interested in the situation and the behaviour in that
situation
 Rather symptom- than person-oriented
 Observation and self-monitoring are part of treatment and treatment
planning/evaluations

Behaviour therapy: incorrect characteristics

 BT involves behaviour only
 BT is cold and mechanical
 BT is fully evidence-based

BT process

1. 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?

3

,  Negative consequences? Short-term? Long-Term
 What means or solutions have already tried?
 What is the treatment goal?
2. Holistic theory - example



Therapist makes a sort of check/schema of the information
he/she has and check whether this is right or wrong




3. Problem selection, measurement, and functional analysis

Functional analysis: way of understanding what sort of conditioning processes are here at
hand

Classical and operant conditioning

Classical conditioning

 Unconditioned stimulus (UCS = food) elicits unconditioned response (UCR = saliva)




After repeated trials
 Conditioned stimulus (CS = bell) elicits conditioned response (CR = saliva) Dog attached
‘meaning’ to the CS

Classical conditioning – Patient’s description

Trichotillomania (urge to pull out hair)

CS ‘…in the evening when I am tired…’
‘…TV on…’, ‘…while studying…’, ‘…when I feel down…’ ‘…while talking on the phone…’
CR ‘…I feel the urge to…’, ‘…select one hair and start pulling…’
Dog phobia

CS ‘…especially in parks…’, ‘…when the dog is not leashed…’, ‘…small dogs also…’
CR ‘…then I panic…’, ‘…haven’t visited my aunt since then…’

Operant conditioning

Sd: R-S

Given a discriminative stimulus (Sd), certain behaviour (R), results in a situation (S) becoming
(more) positive or negative

S+ or S- = pleasant or unpleasant

4

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