Psychotherapy exam notes
Lecture 1: introduction lecture
A few concerns and a few praises
Gap: academic psychology and clinical practice: small impact of research findings
Strong effects for disorder-specific treatments
Little theoretical integration across psychology schools
Gap between clinical psychologists and the scientists. Psychologists need to have a more scientific view
and the scientists need to know more about what is happening in the clinical field.
Psychotherapy have better effect in psychological problems than in medicines. Medicines work for
common problems but the psychological problems are often very heterogeneity.
There are findings in research that should be implemented in the clinical field. In clinical field much
freedom.
Talk about theories
What are mental disorders?
Experiences of:
Feelings, thoughts, behavior tendencies, bodily sensations (that reoccur)
problems / you do not want them: unwanted, intolerable, abnormal, uncontrollable absurd
Who is in charge? People have the feeling that they are not in charge of their feelings and/or
behaviour. Fragmented (versnipperd) sense of ‘self’. (urge to pull hair while not wanting it)
In DSM there should be suffering, without suffering no disorder. Scared of heights but never have
problems with it because you do not live in high apartment, then no disorder according to DSM.
What is the goal of psychotherapy?
Correct: change unwanted patterns of subjective experiences
o Or viewed from medical model: reduce agreed upon symptoms, disorders etc
Wrong: make patients happy (again), not about the 100% but people change as side effect also
happy. Wrong: help patients understand reality, It is not about the meaning of life
Psychotherapy = psychological treatment
Why does it work? Does psychotherapy work because of …
1. Changing propositional representations (= linguistic knowledge and knowledge gained from logical
reasoning)?
o Language-based, symbolic, deductive, arguments
o Change is easy: provide information; reason, persuade, psycho-education, cognitive therapy.
o The therapist gives reasoning to the patient.
o Problems:
, Therapist is authoritarian
Patient is likely to be passive
Persuasion is often ineffective of transient
o Can work when the patients have wrong concepts or ideas, factual information
o But when saying: the dog doesn’t bite don’t be afraid, that does not research the fearful
experiences.
2. Discover who you are?
o Self-knowledge: classical philosophical proposition
o Core of psychoanalysis and client-centered therapy
o Problems:
Classical psychoanalysis (interpretations ‘archaeology’) inefficient; client-centered therapy
assumptions untenable (onhoudbaar)
Unsupported by academic psychology; mental processes hardly accessible, fragmented
sense of self;
instead ‘English butlers’ = automatic processes. We do not direct those butlers. If you hear
a man yelling, you process this via visual and emotional brain areas etc, these are already
there while you are not aware of it already. ‘’consciousness is the last to know.’’
Adaptation of English butlers: lecture 2
o It is more about how to find a way to change these
automatic processes like being scared of a dog.
o Discovering who you are? Not important in
psychotherapy according to lecturer. Not a real part of
treatment. Exceptions, maybe it is not about discovering
who you are but about:
Possibility 1: change dominant schematic representations by simultaneously activating
multiple neural networks.
E.g. you have the idea that you are a worthless person. Building up other ideas to
change these.
E.g. induce emotions; connect past present future, images and previous
experiences. Example: anorexia nervosa à following mother / cannont do
it herself was the dominant view, new idea: craving freedom.
Experimental techniques: chair technique, imagery rescripting
Problem: typically within sessions
Possibility 2: changing narrative (propositional representations = linguistic knowledge and
knowledge gained from logical reasoning) may be helpful. Talking about who you are may
lead to positive ideas of yourself, that is helpful. Not always realistic though.
Happy and unhappy people don’t exist à Healthy people have more good stories about themselves than
unhealthy people
Adaptation of English butlers
Emotions
Experience based (Exposure effect: change the association between stimulus and response, that fear
drops when hours with a dog.)
, Repeated encounters: ‘cells that fire together wire together’-> associative representations (when you
eat spoiled food and you get sick, you immediately associate negative things with that type of food.
These changes in associative automatic processes is called associative representation).
These need to be changed in order for psychotherapy to work:
1. Systematic exercise?
o The patient has to do exercises.
o Change associative representations
o Core business in cognitive therapy, behavior therapy, systems therapy.
o In and between (homework assignments) sessions
o E.g. exposure, systematically challenging negative automatic thoughts, behavioral rehearsal,
assertiveness training, role playing, communication skills
o A lot of evidence for effectiveness
o Problem: patients have to participate
2. Patient activation and involvement?
o Without involvement no change in the why we experience things
o Preferability in and between sessions
o E.g. disclosure (patient), emotional experiences (optimal), training, etc.
3. High quality therapeutic alliance?
o Core ingredient in client-centered therapy and psychoanalysis
o Used for motivation and involvement in behavior therapy and cognitive therapy
o Consistently (but moderately strong) related to psychology results
o Problem: fuzzy and untested theories about the importance of the alliance in clinical psychology
o But: sound theories from social psychology and communication science about (resistance to)
social influence.
4. Reorganizing environment & social interactions?
o E.g spouse and family support, enhance/increase social or daily activities, reduce stress (e.g.
moving), job-related interventions
o Also, (family) care plan (multiple professionals), alert plan, relapse prevention plan
o Strong (and last resort) treatment packages for severe psychiatric disorders
Conclusions
Psychotherapy = undertaking aimed at changing unwanted patterns of experience: ‘that things are
otherwise’ (= the power of new insights or behaviors consists of letting go the older ones) has to be
made available. The picture will never be neutral anymore once you see the other face.
Means
1. Patients’ involvement
2. High quality therapeutic relationship
3. Providing information (propositional)
4. Systematic exercise (associative) à change needed when not changing possible via self-control
5. Simultaneous activation of meanings (schema) à changing the not helpful ideas
6. For severe psychiatric disorders: rearranging environment
, Lecture 2: behavior therapy
Cognitive behavior therapy (CBT) is the dominant form of treatment in the Netherlands (world 3th). The
most used is an eclectic form, second most used is psychodynamic therapy. 90% of disorders have CBT
available. Cat video that ring a bell and getting food: operant learning. You can learn via yourself that
dogs are scary or via modelling = your dad is scared of the dog.
BT characteristics
Psychopathology (psychological problems) are based on Stimulus-Response associations, that is, an
interaction between person and environment.
o Treatment techniques are based on learning theories that concern rules that arrange behavior
patterns and how they established through learning of interaction with environment. Learning
theories are used to devise a treatment plan.
Rather symptom- than person-oriented
Observation and self-monitoring (writing down when depressed/anxiety) are part of treatment and
treatment planning / evaluations. Bc these should change over time when in treatment.
The goal of behavior therapy is to increase, reduce or change overt or covert (visible on outside or
not) behavior in accordance with mutually agreed upon goals and a treatment plan.
Behavior school have always adopted a scientific view on treatment application.
Incorrect characteristics are: BT involves behavior only (are techniques to change emotions rather
than cognitions, emotions also important next to behavior) BT is cold and mechanical (a friend or
adviser) BT is fully evidence-based à all wrong.
BT process
Five intertwined phases where certain are skipped or repeated. This also makes clear that BT is
structured treatment method but it is not rigid: each case is considered unique.
1. Problem inventory
2. Position in holistic theory
3. Problem selection, measurement and functional analysis
4. Treatment plan and treatment execution
5. Treatment evaluation
1. Problem inventory = have a clear idea about the problem
o What is the problem? How often? How severe?
o How did it start? Course? Why treatment now?
o What elicits or exacerbates the problem?
o What prevents or reduces the problem?
o Positive consequences? Short-term? Long-term?
o Negative consequences? Short-term? Long-term?
o What means or solutions have already been tried?
o What is the treatment goal?
o This can be 1-2 sessions. Often information offered on BT. In the first 3 session
relationship between patient and therapist is vulnerable, then more
stabilized. Issues have negative effects on treatment.
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