Psychotherapy
Lecture 1 – 08/04/2021
Psychotherapeutic change
Few concerns in psychotherapy in the Western world;
- Gap between the academic psychology and clinical psychology, in the field there are still a
lot of questions patients have that have not been researched.
Learn from other patients, experience and colleagues
- Psychotherapists are not bound to the academic world; not obliged to follow those
treatments which have been proven to be the best treatments.
- Little theoretical integration across psychotherapy schools, each school has its own way of
for example communicating with patients.
- There are strong positive effects for disorder-specific treatments; however, at many
universities theories for psychopathology are formed, but this does not only mean reducing
symptoms but is also about for example the relationship with the patient.
Whenever a patient comes into therapy, he/she experiences feelings, thoughts, behaviour
tendencies or bodily sensations as a problem.
- These issues are often unwanted, intolerable, abnormal, uncontrollable or absurd.
- People with these issues often feel like they aren’t in charge, they experience a fragmented
sense of self and psychotherapists have to change this feeling.
- Psychotherapy has to change subjective experiences
So, the goal of psychotherapy is to change unwanted subjective experiences.
Means
- Changing propositional representations; language-based, symbolic, deductive, reasoning
The change component is pretty easy; change experiences through information,
reason and persuasion -> psycho-education or cognitive therapy
Problems with this mean is that the therapist is authoritarian, the patients is passive,
and persuasion often is an ineffective or transient form of treatment.
- Discover who you are; self-knowledge in a classical philosophical proposition.
Core of psychoanalysis and client-centred therapy; patients trying to discover
themselves
Problem; form of therapy is completely unsupported by research and classical
psychoanalysis still is inefficient for treatment.
- Systematic exercise; change associative representations -> core in cognitive therapy,
behaviour therapy, systems therapy
Change associations through exposure, systematically challenging negative
automatic thoughts, behavioural rehearsal, assertiveness training, role playing and
communications skills
Has a lot of effectiveness but patients do have to participate, which they don’t
always want to.
- Patient activation and involvement; without involvement there is no change in the way a
client experiences things.
- High quality therapeutic alliance; used for motivation and involvement -> client-centered
therapy, psychoanalysis and CBT.
No clear scientific evidence in psychology, but there is evidence in social psychology
and communication science.
- Reorganizing environment & social interaction; strong treatment packages for severe
psychiatric disorders, often last resort.
, Change through spouse and family support, enhance/increase social or daily
activities, reduce stress, set up a family care plan, alert plan and relapse prevention
plan.
, Lecture 2 – 12/04/2021
Psychotherapeutic change pt. II
Means
- Two possibilities in discovering who we are;
1. Change schematic representations
2. Changing narrative about yourself -> positive narratives/ideas about ourselves (don’t
have to be correct!) makes people happier in general
- Systematic exercise; change associative representations about something, often in cognitive
(behaviour) therapy and systems therapy
Improvement often through exposure, challenging negative automatic thoughts,
behavioural rehearsal, assertiveness training, role playing and communication skills
This form of therapy has a lot of evidence for effectiveness
Only problem is that patients have to participate, so less effective when the patients
only watches and stays on the outside.
- Patient activation and involvement; therapeutic relationship -> therapy only works when
patient is activated and is part of the experience.
There is activation within a session and between sessions
In order to get patients involved, it is important that the patient discloses
him/herself and that there are emotional experiences.
- High quality therapeutic alliance; large differences in the way different psychology/therapy
school, but all research tells that the relationship between therapist and client is consistently
related to psychotherapy.
Core ingredient in client-centred therapy and psychoanalysis
Used for motivation and involvement in behaviour and cognitive therapy
These are however untested theories in clinical psychology, but social psychology
and communications science does have good theories about social influence.
- Reorganizing environment and social interactions; reorganizing around the problems of the
patient -> you don’t change the patient, but adapt the environment in order to make the
person function better.
Especially used in severe psychopathology; family support, enhancing social
environment, reduce stress or job-related interventions, alert plan or relapse
prevention plan
Research – especially in regard to severe psychiatric disorders – that reorganizing
the environment is powerful in helping people reduce the effects of their disorders.
